It is now early July as I write this column, the “ebb” phase of our work with patients and students, but not of administrative tasks. The latter seem never to cease, and even now we are in the process of preparing for September and the rush of planning for the Fall Meetings in New York.
We are also presently in the midst of preparations for the biennial meeting of the International Psychoanalytical Association, to be held in Amsterdam the last week in July. By the time this column appears, those assembled will have considered proposed amendments to the bylaws of the IPA which, if approved by the membership at large, would significantly alter its governance. The proposal, initiated by James Innes-Smith of Belgium and Paul Israel of France, calls for representatives of each society in the International to constitute a House of Delegates to render obligatory opinions on matters that come before the IPA council, which comprises the elected officers, the secretaries of the International, and nine councilors elected by the membership (three from each regional association). It is to be noted that for the present it is not proposed that the delegates be given voting rights in the council. Any such changes in governance recommended by council must now be approved by a vote of the IPA membership.
You probably all know by now that the search committee for the new editor of JAPA, chaired originally by Ed Weinshel and somewhat later by Jack Arlow, has completed its work after three arduous years of exploration and interviews. Arnold Richards of New York has been selected to replace Ted Shapiro, whose term of office ends December 31. Under Ted's outstanding stewardship, the Journal has maintained and enhanced its reputation as the most prestigious psychoanalytic journal in the world. He also played an important role in maintaining a superb Editorial Board and harnessing their talents in a subculture of collegiality and dedication to their tasks. I am certain that Arnie Richards will walk very well in his shoes.
Arnie, as editor of TAP for several years, has likewise performed with remarkable zeal and creativity in producing the Newsletter of The American. We are grateful to him for creating a newsletter that is read from cover to cover with great interest. He has unerringly selected topics that capture the reader's attention, and has increased subscriptions to TAP by nonmembers. Arnie will be a loss to TAP but a great asset to JAPA. I wish to congratulate the Search Committee on their selection of Arnie, and to extend to them the profound appreciation of the membership of The American for a difficult task well done.
I wish to add that the committee considered many different members of the Association for editor, and interviewed quite a few. The task of selection was so difficult and time-consuming because those considered were such talented and competent persons.
The Annual Meeting in San Francisco last May was a great success. Workshops and discussion groups were well attended, and the forums received high marks. For the second consecutive year attendance was up at the business meeting. The Executive Committee is heartened by this greater show of interest, which may in part be accounted for by our attempts to avoid tedious official reports; open forum discussion of such vitally important topics as practice issues and the debate over a national plan; and, perhaps not least, a free continental breakfast.
The San Francisco gathering also saw the first meeting of the new Steering Committee, which should gradually develop as a major event, semiannually “bringing to life” the ongoing work of the organization. Another first was the meeting of the new Committee on Societies. More will be said about the activities of this committee in a later issue of TAP, as work progresses.
The Santa Fe conference generated much excitement and enthusiasm, but also depression. The latter was related to anxieties and concern over the treatment likely to be accorded clinical psychoanalysis in the new health reform proposals of the Clinton Administration. Additionally, it is feared that the rapid influx of persons from academic disciplines other than medicine into the field of psychoanalysis may cause a shift of emphasis away from classical psychoanalysis and toward psychoanalytically oriented psychotherapy. However, as an initial effort, the conference fulfilled its primary goal of setting the stage for serious thinking about the complex issues facing psychoanalysis today. I have but one profound regret—that I was prevented from attending the conference by the serious illness affecting my wife. Fortunately, she is making excellent progress on a slow but steady road to recovery.
I want particularly to thank Sander Abend and Owen Renik for their remarkable work in developing the theme of the conference, selecting the main speakers, and structuring the meeting. Sandy's elegant introductory remarks established the theme right at the start. The Executive Committee, Judith Schachter in particular, performed their roles with the usual skill and dedication. Naturally, none of this could have happened without the wise counsel and hard work of Helen Fischer. I was extremely impressed by the closing statement by Otto Kernberg, who noted his intense gratification that the so-called “liberals” and “conservatives” in The American had much more in common than he had imagined, and that they “were jointly concerned about issues that united them rather than being sharply divided along simple ideological lines.” He was “very pleased that the conference had helped to focus on what our present problems and concerns are, and to erase old stereotypes.”
In winding up, I want to praise the continuing work of the “Quad,” the group of committees—Government Relations and Insurance; Peer Review; Psychoanalytic Practice; and Public Information—headed by Norman “Drew” Clemens. Drew has effectively undertaken, with the assistance of dedicated associates, the very important task of presenting psychoanalysis and psychoanalytic psychotherapy as important treatment procedures that must be accorded parity of mental health and medical benefits, with no financial cap. It is difficult dealing with third-party payers at present; a recent study has highlighted the considerable difficulties encountered in obtaining treatment renewals under managed care.
Drew has appeared before various professional groups and governmental agencies (notably, the Intensive Psychotherapy and Psychoanalysis panel of the Mental Health Working Group, White House Task Force on Health Care Reform held last April 23) in order to present the pressing need for psychoanalysis as a treatment modality. Drew was also a very effective speaker at the meeting of the Psychoanalytic Consortium held the next day at the Waldorf in New York City. He also has spurred the effort to encourage members of The American to write to their senators and
representatives in support of acceptable mental health bills, actively mailing out fliers from the Central Office to inform the membership of new developments.
Since Drew was recently elected Speaker of the American Psychiatric Association, a very important post, he will begin sharing his responsibilities with Art Farley, who will act as co-chair of the Quad. In this regard, I am particularly pleased that our newly appointed Practice and Public Education Coordinator, Claire Coyne, has been invaluable in assisting Drew and his colleagues in preparing articles and disseminating information. In addition, Sheila Hafter Gray, chair of the Committee on Peer Review, has devoted considerable time to developing practice guidelines to be sent to societies for their information. It is important that the societies of The American distribute this material to their members, as it provides invaluable and up-to-date information related to third-party payment, peer review, and practice guidelines.
At the annual meeting in San Francisco, an interesting and informative discussion was held at the Meeting of Members concerning the rapid development of health organizations involved in managed care. Their tendency to exclude or downgrade psychoanalysis and long-term psychoanalytic psychotherapy as essential treatment modalities finds a disconcerting echo in the prospect that the national health care system currently being formulated might look upon psychoanalysis as unworthy of adequate reimbursement, or at least would force its adherence to strict guidelines and periodic peer review. In response to this situation, the Southern California Institute urged The American to demand that psychoanalysis not be included in the new plan, thereby freeing it from regulations and reporting requirements. This was strongly urged in the Cummings Report, which was supported by the Southern California Institute.
Although the report raised many legitimate and important questions, Norman Clemens spoke very strongly against the proposal, citing the following reasons:
It would prematurely remove psychoanalysis from a position of any possible influence in health care reform. This would affect our ability to protect benefits for intensive psychotherapy as well as for psychoanalysis.
It would preclude psychoanalytic treatment for people of low incomes, except for a scattering of low-fee cases.
It would take away the option of participating in the system from the considerable number of our members who want third-party payment for psychoanalysis.
It would remove psychoanalysis from the mainstream of respected medical and other health care services, and might thereby discourage potential future analysts, as psychoanalysis would be viewed as an aberrant activity and one it might prove difficult to make a living at.
These are questions I am sure we will revisit, but in the meantime I hope all of you will have had a pleasant summer and are returning to our professional interests with renewed interest and vigor.