In April 1991, forty members and candidates of the Boston Psychoanalytic Society and Institute met to discuss the challenges of building a psychoanalytic practice. Organized by Drs. Joyce Root and Alexandra Harrison, it was Boston's first formal meeting to address this topic. A panel of five Society members, four of them training analysts, reviewed the building of their careers in psychoanalysis and offered suggestions as to how to foster and maintain an analytic practice. The lively panel discussion, in which the audience participated through questions and comments, covered a wide range of suggestions. Howard Corwin, one of the panelists, recommended that the Society and Institute establish a larger diagnostic evaluation and treatment clinic. Daniel Jacobs, another speaker, advised that we look more carefully at the sacrifice of time and money that a psychoanalytic career involves and study more carefully the ambivalence, conscious and unconscious, that some may have about making such sacrifices. Ralph Engle urged those present not to abandon nonanalytic activities and described in some detail his experiences as a consultant to other medical disciplines. He felt it was very important that analysts not isolate themselves from one another or from other disciplines if they hope to have referrals. Dan Buie stated that in his view analysts have not always been sufficiently clear about what analysis offers that is unique and have at times failed to stress the limitations of psychotherapy as compared to what may be achieved through analysis. Judith Huizenga spoke of an approach, in terms of both conviction and technique, which allowed her to convert a number of patients from psychotherapy to analysis. One of the most interesting comments came from Richard Tedlow, Professor of Business Administration at Harvard Business School, who was in the audience. Although psychoanalysts have a fine and brilliant tradition and what they offer is unique, he remarked, in their veneration of their heritage they had perhaps neglected to think sufficiently about the future. “Business,” he said, “is composed of three elements: manufacturing, marketing, and management. When it comes to helping very difficult patients cope with or conquer profound intrapsychic conflict—in other words, when it comes to what might be thought of as manufacturing in the context in which you work, you are the very best. Unfortunately,” he continued, “you are completely uninterested in marketing and you do no management.” He said that analysts had simply not done what is necessary to bring an understanding of their work to the world outside their consulting rooms. He mentioned that the principal source of information about psychoanalysis for his colleagues at Harvard Business were recent newspaper articles that cast psychoanalysis in an unfavorable light. He stated that marketing is “a little like gravity—it happens whether you do anything about it or not.” Not mincing words, Tedlow said that psychoanalysis had actually been “de-marketed” in Boston over recent years and that it is remarkable that we have as many patients as we do. As Stephen Bernstein, moderator for the morning's discussion, was calling the meeting to a close, many, stimulated by the panelists' remarks and Tedlow's cogent criticisms, expressed a keen interest in scheduling further workshops. A meeting is planned at which Marvin Margolis will speak on Michigan's experience in helping members and candidates develop practices.
Recognizing widespread decline this Committee on Psychoanalytic Practice, with the help of Joyce Root, one of its members, is consulting with societies around the country about sponsoring workshops like the one held in Boston.
The response so far has been enthusiastic. On January 18, the Washington Psychoanalytic Society sponsored a workshop entitled “Assessing and Developing a Psychoanalytic Practice,” at which Judith Chused, Houston MacIntosh, and Barry L. Siegel spoke. Less than a week later, the Western New England Psychoanalytic Society held a scientific meeting, “Building a Psychoanalytic Practice,” at which Rosemary Balsam, Lee Brauer, David Carlson, and Myron Hurwitz were panelists and Sidney Phillips moderated. The Los Angeles Psychoanalytic Society and Institute held a similar workshop on March 7. Other societies currently planning programs on the topic are Columbia, Pittsburgh, New York, Seattle, and San Francisco. Several other societies, including Atlanta, Baltimore-Washington, Cincinnati, and Chicago are currently considering offering such programs.
Root was also instrumental in organizing a workshop at last fall's scientific meetings in New York. George Allison (Seattle), Judith Chused (Washington, D.C.). Norman Clemens (Cleveland), Theodore Jacobs (New York), Elizabeth Mayer (San Francisco), and Vann Spruiell (New Orleans) shared their experiences in building a psychoanalytic practice and in helping younger colleagues do the same. They emphasized that younger practitioners must get as many general referrals as possible by contact with other medical specialties and mental health disciplines. They must also learn the process of converting patients from psychotherapy to analysis. The speakers stressed here the need for younger colleagues to pay careful attention to which patients are not suitable for analysis, as taking them into treatment with poor results is discouraging to patient and analyst alike. Spruiell pointed out how consulting with a senior colleague about one's entire caseload is often helpful, both in identifying problems in the practice as well as patients already in therapy who might benefit from psychoanalysis. There was discussion of the need for colleagues to make themselves visible through active teaching and participation at institute meetings and extension divisions. In addition, some felt that colleagues need to consider whether they are willing to take patients at reduced fees in order to build a practice. They wondered whether some patients paying a regular fee for psychotherapy might be suitable for analysis were the analyst willing to see them more frequently at a reduced hourly rate.
The concerns about building and maintaining a psychoanalytic practice are many. The solutions offered are complex and varied. What is clear, however, is that the American Psychoanalytic Association and its affiliate societies are fostering active discussion of the topic. The Association is committed through seminars, workshops, and personal consultations to helping its members develop and maintain their psychoanalytic careers.