Intense. Enlightening. Controversial. These are the adjectives that best sum up the rather mixed reactions to last summers gathering of analysts in Santa Fe.
Conceived in the fall of 1992, the conference was intended originally to bring together a critical mass of the most active members of The American, who could come to know each other in a setting less formal than the usual meetings. Eventually the notion of a free agenda gave way to a decision to consider the future of psychoanalysis in terms of education, practice, research, and organization. The idea of an informal conference was first suggested by Helen Fischer to President Bernard Pacella, who asked Owen Renik and Sander Abend to develop ideas for such a meeting and to suggest participants. The Executive Committee then fleshed out their proposal, modifying it somewhat, and extended the list of invitees. Finally, on June 10–13, a group of eighty convened at the El Dorado Hotel in Santa Fe, New Mexico, to acquaint themselves better and to consider the prospects for psychoanalysis.
The format of the meeting was less unusual than its season and setting. Morning and afternoon sessions were held Friday and Saturday, with small discussion groups concluding each session. Sunday breakfast was followed by fifteen-minute reports from the discussion groups. What was different is that participants used the sessions as think tanks. Old but unresolved issues resurfaced and were reviewed with vigor, while newer visions were brought in and elicited considerable interest. In general, the meeting seemed to accomplish at least one of its goals—to provide a forum in which ideas could be freely discussed, without the tensions associated with voting.
Some of those present circulated statements of their impressions, and a number of participants specified that no report of the meeting should neglect to mention their feelings, mostly negative, about the gathering.
The Friday morning presenters—Sam Rubin, Marianne Coldberger, and Arnold Goldberg—opened the meeting with papers arguing for educating, rather than simply training, future analysts. They urged that attention be paid to personalizing training procedures, that curricula be developed that include both current and classical literature, and that the role of supervisors as educators be examined. Goldberg expressed a concern that insufficient attention is paid to changes occurring in the world of psychoanalysis beyond The American, especially in the academy and in the psychotherapies. In the discussion groups the focus was on whether to characterize The American's institutes as training schools or as educational facilities on the university model. Some emphasized the need to become more expert as teachers over the need to reach more people. Others expressed a desire to teach psychoanalysis at the undergraduate level, to those aiming for general education or academic careers, as well as to those who intend to become social workers, psychologists, or physicians.
David Sachs and others floated the idea that at least some training and supervising analysts should be nationally accredited, which would facilitate their movement around the country as needed.
The gratifications and incentives of teachers were also discussed. Owen Renik pointed to work and career satisfactions, rather than income, as the main motivators. Next the issue surfaced of the arbitrariness of training requirements and educational rules in the absence of outcome studies that could substantiate their value.
Friday afternoon the focus shifted to the future of psychoanalytic practice and research. The subject was timely enough, but discussion was hampered by the uncertain future of health care delivery, which was being formulated at the White House even as the group met. Bold predictions, tentatively held, were quite in order. Judith Schachter wondered if analysts would be going back to the future, to a time when patients would come from among those who could afford treatment, as in the pre-insurance world of the past, or whether they would come from managed care groups, or be largely low-fee, through group and clinic organizations. She speculated that societies might in fact draw together to form local IPOs or PPOs, or to contract as groups with HMOs. Analysts might also move, she argued, into fields peripheral to psychoanalysis, such as medical schools, administration, teaching, and research. Consultative roles in law, the arts, and the humanities were other possibilities she envisioned, as well as general medical practice with a sideline in psychoanalysis.
David Hurst argued that the overcareful selection of candidates for training ill serves the profession, which could easily, as a result, become a small coterie of “fossils of the highest quality.” He reviewed some of his successful training cases, making the point that these were highly disturbed people; psychoanalysis, he insisted, must be advanced as a viable alternative to the quick-fix, self-help-only mentality. Following this presentation, Jorge Schneider made the point that in Chicago researchers in psychopharmacology consult regularly with analysts to study the interaction between prescribers and patients in order to learn about noncompliance and other issues.
In the discussions following these presentations, the focus was on practice rather than research. Some paid particular attention to the kind of individuals who become psychoanalysts, on the ground that understanding them will afford the best insight into issues surrounding practice. Some spotlighted other issues, such as training trends and the future of health care delivery, as factors affecting practice. That less attention was paid to research may indicate that analysts as a group maintain an ambivalent stance on the subject.
Different visions of the psychoanalytic organizations of the future highlighted the Saturday morning session. Robert Michels began with a rousing call for a focus on growth and development, rather than preoccupation with the status quo. Reminding those present that the concept of development implies a future different from what exists today, he expressed the belief that The American's institutes may be focused on growth, a quantitative category, rather than on development. He advocated a healthy skepticism toward previously held beliefs, despite the discomfort it might occasion, and a search for different populations that might benefit from psychoanalysis, different kinds of people to deliver that care, and different ways of exercising quality control for the sake of the public. He predicted a reduction in The American's microinvolvement in local groups, and a more forward-looking focus in the institutes. The profession, he declared wryly, is endangered more by boredom than by assassination.
Robert Pyles followed, reviewing the history of psychoanalytic organizations, from Freud and Ernest Jones on, and focusing on the proposals put forward by the task force on organization that he co-chairs.
Marvin Margolis then completed the morning's presentations by reviewing various changes recently enacted by The American, which he characterized as having moved toward a broader center. The Board on Professional Standards, he believes, is today a more democratic organization than in the past.
The tenor of the discussions that followed ranged from calm optimism to angry cynicism. Some said the whole conference was merely for show and doubted the likelihood of any effective results. Others seemed to rise to this challenge and developed a determination that changes would be effected. Still others questioned whether the elite group invited to the meeting could effectively—or legitimately—address the question of the future, given the overall absence of candidates, younger members, and minority analysts.
Michels's “clarion call” to transcend guild issues produced vigorous dialogue. Some spoke of The American's need to clarify itself and to instill a
sense of mission in the organization. The need to recognize obligations to the greater community and its aspirations was also raised. Criticism of The American focused on BOPS but spilled over to the manner in which from its very inception the entire organization has been run. There were complaints that it lacks the bare elements of efficiency and openness; for instance, the Executive Council, which has been acting as a board of directors, lacks access to a clear and current budget, so that decisions on expenditures are made by a small group acting virtually in camera. (The budget is even now being brought under control of a modern computerized program, and the Executive Committee is readying up-to-date financial statements for all future meetings.) Concern was expressed over the apparently large amounts of money spent on site visits, for example, compared to any number of neglected functions that should be at the center of The Americans attention.
Suggestions were made that The American develop a uniform procedure for selecting Executive Councilors and Fellows of the Board. At present, with qualifications for these offices, length of term, and method of election decided by each society and institute, these differences tend to create very different power centers. The recommendations of Pyles's task force on reorganization were discussed at length at this point, including the call for a board of directors to which both BOPS and the Executive Council would report. Some thought was given to external credentialing, but many participants wished to continue with in-house certification procedures, perhaps side-by-side with external certification. Finally, there was support for encouraging participation in the organization by younger analysts; it was felt that this would promote a more contemporary spirit, free of the baggage of nostalgia and old wars.
The final session, on Saturday afternoon, focused on the topic of “Future Analysts.” Phyllis Tyson began with an historical review of candidate selection. Focusing on questions of exclusivity, she questioned the worth of present procedures and offered various alternatives. Casting a wider net but specializing students was one; easier access to training combined with more stringent educational practices was another.
Richard Fox followed by noting that this meeting about the future of psychoanalysis had not one person of the future in attendance. Modern analysts, he remarked, view themselves as being more interactive with patients. He received applause for his plea that analysts be open to events in the world at large; psychoanalysis, he argued, seems to have nothing to contribute when it comes to dealing with events like the riots in Los Angeles, or with the natural catastrophes occurring all over the world.
The last speaker was Dorothy Holmes, who, being female, African-American, and a Ph.D. analyst, is a member of several minorities within The American. She spoke of the need for psychoanalysis to market itself, to speak to the public so that it can understand what analysis has to offer. She addressed herself also to the question of how to improve The American's administration.
Here again animated discussion followed, though signs of fatigue from a grueling two days were becoming evident. Some spoke to the question of how to reignite the field, how to spark again the spirit that the organization knew in the past. Ideas gushed forth, many focused on the need to train persons of diverse background and experience. After training, it was thought, those who pursue career tracks that fail to meet the requirement of “immersion” in psychoanalysis should not automatically be disqualified as psychoanalysts.
It was also felt that the status of training analyst, perhaps as differentiated from the function of being the analyst of someone in training, is in need of revision; reference had been made earlier to Arlow's having characterized the method of certifying training analysts as a pathogen in the organization's system.
In the course of the meeting fears were repeatedly expressed that nothing substantial might result. Many participants hoped that the leadership of The American and local society officers would view the gathering as a starting point for necessary change. Others requested that their pessimism be recorded in print, fearing that the organization is at a crossroads and that The American is responding inadequately to the challenges of the time. In this light, Morton and Estelle Shane, two of the founding members of the Institute for Contemporary Psychoanalysis in Los Angeles, founded some two years ago, were the center of attention in a number of the group sessions. Their description of a democratized organization—with easier attitudes about qualifications for training, fewer restrictions imposed through the training program, easier identification of analysts to train candidates, and a more thorough acceptance of candidates as members of the organization—was attractive to a number of participants. On the other hand, there were those who still feel strongly about issues of qualification and quality, who are comfortable with the idea of maintaining an elite corps of analysts as a model for others to follow, even if fewer followers are to be found.
Although the question has yet to be decided, the Santa Fe gathering was possibly the first in a series of such meetings. In response to complaints that no candidates or members other than active members were among those invited, and that siting the meeting at a luxury hotel lent a further element of discrimination, any subsequent meetings will be held in a different venue, and with a broader representation of members.