Division 39 President Shares His Thoughts

I would like to begin with a brief description of the American Psychological Association. Over a hundred years old, the APA is one of the largest scientific associations in the world, with nearly 125,000 members. It comprises fifty distinct interest groups, referred to as divisions, one of which is the Division of Psychoanalysis. Known more commonly as Division 39, it is, with 4,100 members, one of the larger groupings within the APA, though by no means the largest.

Despite the presence of psychologist analysts within the APA, however, some within the organization view psychoanalysts with disdain at worst, suspicion at best. They attack psychoanalysis as being archaic and unscientific, and urge the APA to distance or even dissociate itself from psychoanalytic theory, teaching, and practice. A situation similar to that in medical schools has unfortunately resulted, with ever fewer graduate programs in clinical psychology offering substantive training in psychoanalytic or psychodynamic approaches.

These organizational tensions are similar to those faced by The American in relation to the American Psychiatric Association. But there are important differences as well. The politics and economics of the psychiatric organization drive it primarily to support inpatient care and biological approaches. By contrast, the internal dynamics of the APA, despite the existence of antianalytic sentiment, drive it to support outpatient psychotherapies, including intensive psychoanalytic approaches.

There is also an important structural difference. The APA is Division 39's parent organization, a relationship that of course does not obtain between the American Psychiatric Association and The American. In many ways, in fact, The American shares more in common with Division 39 than it does with the other APA.

Health Care Reform, Accreditation

The most pressing concerns of Division 39 and The American are the revolutionary restructuring of the nation's health care system and the corrosive effects of managed care.

It is unfortunate that a single payer system, never considered by Congress or the Clintons

as a serious option, has virtually disappeared from the political radar screen. Instead we are left with the administration's proposed Health Security Act (HSA) and a variety of Congressional counterproposals. I support the two fundamental goals of the HSA, comprehensiveness of benefits and universality of coverage. But, as the saying goes, the devil is in the details. And those details can create an environment that becomes increasingly hostile to the practice of psychoanalytic/psychodynamic therapies.

I am in agreement with the goals articulated by Drew Clemens, Marvin Margolis, Alice Medine King, and others within the Psychoanalytic Consortium. We need to advocate for nondiscriminatory mental health coverage that is fully on a par with the coverage provided for medical illnesses. We need to develop innovative approaches to utilization review that will ensure delivery of clinically appropriate care while protecting the privacy and confidentiality of the treatment relationship, minimizing harassment of patients and therapists, and eliminating conflicts of interest whereby reviewers or their employers benefit from denial of coverage. We need to defend the rights of patient and therapist to contract directly on a self-paying basis, if they so choose, apart from any third-party payer system. We need to fight for open provider panels that allow all qualified professionals to join and that prevent arbitrary exclusion or ejection.

Both Division 39 and The American have been carrying on their own advocacy efforts. In addition, through joint participation in the Psychoanalytic Consortium, along with the National Membership Committee on Psychoanalysis in Clinical Social Work and the American Academy of Psychoanalysis, the groups are attempting to identify policy areas where we can speak with a united voice, perhaps with greater impact than any one organization would have on its own.

Division 39, The American, and other members of the consortium have already successfully collaborated to oppose the National Association for the Advancement of Psychoanalysis (NAAP) in its attempt to become the officially recognized accreditor of psychoanalytic training programs in this country. But the political landscape is changing. Whereas the Council on Postsecondary Accreditation (COPA) had previously indicated that it would approve only one national accrediting body for psychoanalytic training programs, its successor body, the Committee on Recognition of Postsecondary Accreditation (CORPA), has apparently shifted from this stance and is prepared to approve more than one. This change of policy may prove divisive. If any of the constituent organizations of the consortium applies individually, either to CORPA or to the U.S. Department of Education, the accreditation process will become fragmented and confusing. In my view, we would serve the public better by maintaining standards, working out our differences, and applying together within the consortium to establish a united accrediting body.

Division 39 and The American

Not surprisingly, the relationship between Division 39 and The American is complex and ambivalent. Each organization, while subject to its internal conflicts and struggles, is proud of its identity and autonomy.

At the personal level there are many warm relationships between members of the two organizations. A number of people, in fact, belong to both. At the organizational level, it can be said, there is considerable mutual respect. Nevertheless, mistrust lingers on both sides. A long history of exclusionary practices, by both The American and the IPA, necessitated the famous lawsuit and remains part of the organizational consciousness of Division 39. To this may be added the ongoing competition among institutes for candidates and among practitioners for patients. It is important that these organizational differences not be minimized or denied. But it is equally important that we identify areas of common interest and that we work to strengthen the growing relationship between Division 39 and The American.

Both organizations value psychoanalytic/psychodynamic theories and treatments and are fighting to preserve them despite an increasingly hostile practice environment. Less tangibly, but perhaps even more fundamentally, the ego ideals of both organizations include profound respect for the historicity and uniqueness of the individual in these ahistorical, narrowly symptom-focused times.