This will be the first in a series of columns in the newsletter which will focus on issues in analytic practice. Dr. George Allison, the current president of the A. Psa. A., has made psychoanalytic practice a main focus of his administration. This initial column will be an overview of some of the main findings of the 1990 Survey of Psychoanalytic Practice. The analysis of the survey is yet at an early stage, and a full analysis and report will take several months to complete. However, each column will focus on one or two issues raised by the findings, and include a discussion of possible solutions. It is hoped these findings can be widely considered and that the ideas which evolve can lead to actions which will enhance the size of practices and increase the satisfaction of our members with their analytic careers.
2067 responses have been received from the approximately 3009 members of the association. All membership categories are adequately represented. However, only 42 responses were received from graduates of institutes who are not members of the American, so findings about this group must be viewed with caution. The overall response rate is excellent, and a credit to repeated effort by Mrs. Helen Fisher and her staff at Central Office, and the membership itself which supported the effort by their participation. The response rate is sufficient for the findings to be accepted as fact.
Analysts who do clinical work of any type saw a mean of 3.7 patients in analysis. This finding is broken down by membership type in Table 1.
| MEMBERSHIP TYPE | N | SIZE |
|---|---|---|
| Training Analysts | 474 | 5.5 |
| Certified Members | 523 | 3.6 |
| Extended Associate Members | 354 | 3.3 |
It is clear that most members spend a small amount of their time doing clinical analysis. Practice has declined for both training analysts and certified members since 1976. The size of this decline is shown on Graph 1, where the inner bars are the 1976 levels and the outer bars are the 1990 levels. Cases are not evenly distributed among the membership. Half of all analysts who are not training analysts have two or fewer cases in analysis, and 182 of them have no cases in analysis. These analysts are significantly less identified as analysts and less satisfied with their psychoanalytic career.
There was small geographic variation in general, with most analysts in most societies having between three and four cases on average in analysis. Only two groups for whom statistics were dependable had over 5 cases in analysis. The reasons for the increased success of one of these, the Michigan Society, will be discussed shortly.
Eighty percent of the respondents are strongly or most strongly identified with analysis. Training analysts are almost always most strongly identified, and affiliate and non-members of the association are moderately to strongly identified. Most analysts are satisfied with the profession, and there is strong satisfaction with the use of analysis in professional work. There is less satisfaction with income. The greatest degree of dissatisfaction was expressed concerning how the A. Psa. A. fosters one's analytic career. (See Graph 2.)
Twenty percent of the respondents were female, and twenty five percent were training analysts. Twenty five percent had some child analytic training, and twelve percent had completed their training. A greater proportion of women have entered the association recently. More men than women were training analysts, an effect which diminishes as one controls for age. Thirty percent of adult cases in analysis were seen three times a week, and almost half of all analysts had at least one case in analysis three times a week. This finding will be studied further.
The most salient finding is that substantial numbers of analysts who have small analytic practices have diminished identification and satisfaction with their careers. Identification and satisfaction increase with both size of practice and involvement in analytic activities such as teaching and supervising. These problems require solutions directed at the individual, local group and national level.
Under the leadership of Dr. Joyce Root, the committee is investigating how to foster an individual's career development. One model proving effective at local levels is for successful, senior clinicians to present their career stories and ideas at workshops. Individual or small group consultations with those who have been successful in the current climate may provide ideas. Discouragement may lead analysts to
fail to represent themselves as analysts and to fail to recommend analysis effectively to their patients. There is some need to study the evaluation and recommendation process, with particular emphasis on recognizing counterresistances on the part of the analyst.
Dr. Marvin Margolis from Michigan believes that the relative success of that society, which is an older and established society in an economically depressed city, is due to a complex and active program the society has had for over a decade to foster the practice of analysis. The program involves both intramural and extramural efforts. Younger members are given teaching responsibility early, and rapidly involved in the scientific and administrative structures of the institute and society. Graduation is experienced as an enhancement of career and not as an abandonment. There is a vigorous effort to engage the interest of the community at large through courses taught in the Medical School and offered to the ancillary professions and the interested public through an active extension division. Senior analysts teach throughout the program. There
is a foundation set up with a lay board to promulgate analytic activities. It seems likely these activities have been successful in influencing the local climate towards analysis, and most analysts have active analytic practices. In the next issue of TAP, we will report more extensively on Michigan, and Dr. Margolis will detail the particular activities of the Society and Institute. He will also be a guest at the workshop of the Committee on Psychoanalytic Practice in December, and all societies are invited to send a representative to discuss these ideas directly with him.
The dissatisfaction of the membership with their support by the A. Psa.A. is most striking. Our committee, other committees, and the officers of the American are trying to construct bridges to the membership to alleviate this situation. The committee is considering having consulting groups visit local societies to discuss steps both the individual and the society could undertake to foster practice. We hope to invigorate the workshops for members of the societies led by Dr. Isaiah Share held regularly at our biannual meeting and make them a conduit for sharing ideas and programs which have been successful.
Dr. Erik Gann, a member of the committee, has regularly held workshops at the national meetings aimed at small group discussion of fostering practice. The A. Psa. A. has set up a planning task force to consider how the organization might foster the growth of practice, including addressing the above issues. Issues involving fiscal intermediaries, the effects of review and managed care and the attitude of the press, the scientific community and of the public at large will also be considered.
The work on the survey is still in its very early stages. A comprehensive report is planned for distribution throughout the organization, and a regular column in the newsletter will keep you up to date on results.
| 240 |
| 3 |
| Affiliate Members | 292 | 2.5 |
| Non-Members | 37 | 2.5 |