“I guess analysts are seen as irrelevant, ridiculed by some. Analysis is a thing of the past. I don't know anyone who is thinking about becoming an analyst.”
Although saddened, I wasn't surprised to hear these words from a sensitive psychiatric resident, the sort of person who in years past might have sought psychoanalytic training. I believe that the attitude she described characterizes the current ambiance in all but a few exceptional psychiatry, psychology, and social work training programs. The young people joining us as colleagues in the various mental health disciplines are increasingly unfamiliar with psychodynamic orientations and are increasingly dismissive of psychoanalysis. The leaders in our universities and professional organizations are increasingly without understanding, connection, sympathy, or respect for psychoanalytic perspectives, research, or practice.
Under these circumstances psychoanalytic educators have debated whether the problems that institutes are facing result in part from unrealistic standards of education and practice. It is our view that the survival of psychoanalysis as we know it will depend on two factors. First, we need to adhere to the standards of education and practice that we have found to be most consistent with the optimal analytic training conducted in institutes of The American. Second, we need to respond actively and directly to the issues that are at the source of what amounts to a most serious contemporary crisis in psychoanalysis.
Several systemic issues are involved in this crisis. One of them is the dismissive marginalization of psychoanalysis by the mainstream. Another is the financial pressures that beset the practice of psychoanalysis. Quite apart from the critical issue of whether restrictions on the right to privately contract would effectively end psychoanalytic practice, potential candidates are concerned about whether they will be able to achieve a reasonable practice and income from a psychoanalytic career. When we ask candidates to learn and practice psychoanalysis in accordance with the standards we have determined to be optimal, we are also asking them to undergo an expensive and rigorous training, to set themselves apart from the values both of earlier mentors and of the nonpsychoanalytic colleagues with whom they will spend their professional lives, and to provide a treatment for which they will receive substantially lower fees than for other treatments they are qualified to offer.
The American has a critical role to play in finding the solutions to the systemic problems facing psychoanalysis. The American should dedicate itself to developing and implementing a broad, effective, and coherent action plan that would direct it in doing the following.
Actively advocate for psychoanalysis in the print and broadcast media. We need to use our talents and resources to develop materials and media contacts, and to develop a cadre of professionals and consumers who can represent us effectively in a variety of public forums. We cannot wait for magazines to come to us or just respond to attacks on psychoanalysis with letters of defense. We need to take the offensive.
Actively advocate for psychoanalysis within training programs in a variety of disciplines. We have made an excellent start in this area with our Fellowship Program. This model is a small piece of the overall solution.
Oppose managed care. It is time to acknowledge that managed care is antithetical to ethical psychoanalytic practice. We need to assist members in their ethical objections to managed care and to explore ways of maintaining analytic practices outside of third-party systems. It is time to be courageous on this issue.
Support research necessary to demonstrate the value of psychoanalytic treatment—not to reimbursing agencies but to future patients and analysts.
Our institutes need the help of The American. We have discussed this potential initiative with the Coordinating Committee of the Board, which has responded with great enthusiasm and approval, and with fresh ideas. The American needs to rethink many of its current initiatives as we search within the organization for talent and finances for this major undertaking. History sometimes goes in cycles, but institutions and intellectual movements have been known to disappear. The survival of our institutes as we know them, the survival of our standards of education and practice, and—most important of all—our ability to offer a treatment that can save lives and relieve profound suffering depend on our ability to respond quickly and creatively to the current challenges.