In an extemporaneous talk last December to an overflow meeting of the Committee on Psychoanalytic Practice, Marvin Margolis, chair of BOPS, described the efforts of the Michigan Psychoanalytic Society to educate the general and professional public about psychoanalysis and psychoanalytic treatment. As a result of these efforts, he believes, recent graduates of the Michigan Institute have significantly greater numbers of patients in analysis than have their counterparts elsewhere in the country, and members generally have psychoanalytic practices larger (mean numbers of patients in analysis = 5.7) than the mean determined for the nation (3.94) in the 1990 Survey of Psychoanalytic Practice. This was accomplished, rather surprisingly, in an atmosphere of prolonged and severe economic recession in the Detroit area.
For the group to engage in its outreach program it had first to deal with low morale and feelings of alienation among many of its members, feelings that contributed to a meager analytic productivity. To improve this situation it was necessary for the group to understand the reasons for such widespread disaffection. The alienation was found to be linked to feelings of exclusion from what Dr. Margolis described as the “loop” of activities in the Society and Institute that lead from membership to faculty appointment and eventually to training analyst status. This perception of exclusionary practices seemed connected to the dissatisfaction that motivated the recent move to delinkage.
The inclusion of greater numbers of members and candidates in the circuit of Institute and Society activities required extensive organizational change. for example, members and faculty were invited to teach Institute courses in greater numbers, in some instances replacing training analysts and in others working with them in teams. Often outreach efforts worked synergistically with efforts to promote the membership's participation and development. When it became apparent that psychiatric residents were using the Society's extension division to augment training programs that emphasized brain function to the relative neglect of psychological factors, the Institute's response was to assign its better teachers, often training analysts, to extension courses, thus opening slots for other faculty in the Institute. In addition, a vigorous faculty development program was established that stressed faculty study groups. Other changes included the appointment of nontraining analysts to the education committee, and indeed to all committees of the Institute, and a major expansion in candidate participation in the educational process. These administrative adjustments have led to less mystery, less anxiety, and greater clarity, and that facilitated individual progress.
Dr. Margolis observed that psychoanalysts, out of a concern for education, have tolerated a certain degree of autocracy. He suggested that the accompanying penchant for exclusionary behavior might be more appropriate to the Berlin, Vienna, or Budapest psychoanalytic societies, but is hardly in keeping with the atmosphere in the United States. He noted that there was still too much elitism in the Michigan group, and too much control exercised by the educational committee, despite the creation of a faculty organization that meets three to four times a year to discuss major issues. Analysts too often feel that the training analyst possesses superior wisdom, and this is simply not true; in so believing, he argued, we deprive analytic organizations of the talents of others and thereby “deplete ourselves.”
Once organizational restructuring was accomplished, and members and candidates began to feel included and aided in the achievement of professional goals, outreach could be addressed and the pool of potential patients expanded. Dr. Margolis felt that many constituent societies and institutes of The American may be in need of similar democratic reforms. He wondered whether the current situation might also reflect an insensitivity of the analytic community to the dynamics of group process.
Outreach programs should be as comprehensive and inclusive as possible. Not only medical schools, universities, and mental health professionals but the general public should be targeted. To that end the Michigan Society has formed what Dr. Margolis characterized as a family of psychoanalytic organizations. Besides the usual institute, society, and candidate groupings, there is an Association for the Advancement of Psychoanalysis (AAP) with over 300 members—drawn largely from the mental health professions but also including lawyers, academics, etc.—and an organization called the Michigan Psychoanalytic Foundation.
Recently the foundation cosponsored with the University of Michigan the Freud antiquities exhibit, which was attended by 6000 people (250 of whom attended a half-day symposium). In addition to arranging activities of this sort, the foundation has a fund-raising arm that enlists the efforts of 30 to 40 volunteer solicitors. In 1991-92 over $100,000 was raised from over 400 contributors; 575 people attended last year's benefit dinner. (It hardly needs saying that patients are not solicited by their analysts, and confidentiality is never compromised, even after treatment.) The foundation also maintains a liaison to the Black community, through educational activities which as often as possible include Black psychoanalysts. The foundation maintains outreach activities to universities, medical specialties, and various religious and ethnic groups as well. Each month finds several outreach activities sponsored by either the foundation or by AAP.
Residents and other mental health students are of course target groups for psychoanalytic education. As a result of these stepped-up efforts at outreach, increasing numbers in the Michigan area are seeking training. The past four years have seen a doubling in new candidates, for whom viable psychoanalytic practice upon graduation is now a very real prospect.
Isaiah Share, M.D. is a member of The Psychoanalytic Association of Philadelphia