Today we live and practice in the midst of a major restructuring of our society's health care systems. Many of the basic values traditionally associated with quality treatment in this century are being called into question — freedom of choice of therapist, freedom from destructive intrusion into the trustworthiness and confidentiality of the therapeutic relationship, and freedom in the choice of treatment approach. As these freedoms are being eroded, the American public's expectations about quality health care are being transformed.
In this context it is necessary that psychoanalysts join together to preserve the integrity of the treatment process and to meet rather than succumb to the challenges posed by the current environment. This must be done if we are to protect the welfare and interests of patients as they seek optimal health care. Negative publicity, the inroads of biological approaches and managed care, and the general national trend toward the “quick cure” have all contributed either to a negative valuation of psychoanalysis by the general public or, worse, to ignorance of its value as the treatment of choice in many clinical situations. An example of these developments is the recent decision by the Library of Congress to cancel its Freud exhibit in response to attacks made on the way Freud's contributions were to be presented. (Paradoxically, this controversy demonstrates the continuing vitality of his pioneering methodology for the treatment of emotional illness.)
An effort to address the negative public image of psychoanalysis in a vigorous and concerted manner, through a thoroughgoing education of the public, remains the most urgent need of our association. We must reach beyond the issue of our ability to maintain a psychoanalytic career, and the clinical immersion so necessary for our professional and clinical advancement, to address the survival of our profession and of the psychoanalytic process and method itself as a necessary and vital treatment modality for our patients.
In this regard the most important actions The American has taken in recent months have been (1) the hiring of a media relations consultant to prepare an action plan for such a concerted and long-range media and public relations effort, (2) the selection of a Washington lobbyist of great skill and repute and with known achievements in the area of health care legislation, and (3) the membership's decisive election of a presidentelect known for his successes in both legislative and public education matters. Our membership has spoken clearly about where its anxieties and concerns are and where it wishes our leadership to place its energies. Division among us does not exist as regards this crisis for our patients and our profession.
The path we must take is clear, and we are united in pursuing it. I am confident that the current consensus will sustain a growing momentum, and in order to sustain this positive direction, it is especially important that we do not fall back into internal squabbles. It is therefore regrettable that a recent column by our president in these pages (TAP 29/4) might possibly revive controversies and attacks on the Board, its officers, and its committees. Such disputes have occupied our energies in the past and are divisive and counterproductive in the present. Because Dr. Schachter's views of our organizational structure have been published in TAP, I would like to present my own views, despite a reluctance to engage in diversionary issues.
In her column Dr. Schachter suggested a revision of our organizational structure that would place the Board as a committee of Council and that would give the latter the final decision on actions taken by the Board in carrying out its essential functions. There is the strong implication in this scenario that only a few aspects of Board functioning — relatively superficial ones — would survive such a restructuring. In her words, “BOPS surrenders none of its prerogatives but only grows when it dedicates itself to exploring the usefulness and validity of innovations in psychoanalytic education. These include the creative use of E-mail, small group on-line activities, the sharing of curricula and bibliographies, and video conferencing to enhance satellite institutes.”
According to our bylaws, the purposes of the association are (1) to study and advance psychoanalysis; (2) to advocate and maintain standards for the training of psychoanalysts and for the practice of psychoanalysis; and (3) to foster the integration of psychoanalysis with other branches of science and to encourage research in all fields having to do with the scientific knowledge and welfare of human beings.
It is primarily in relation to the second purpose that the bylaws, in a separate major section, spell out the autonomous functions of the Board: the accreditation of institutes; setting and maintaining standards for the training of candidates and for the accreditation of institutes; and setting standards of eligibility to apply for training, professional standards for membership, and professional qualifications for certification. The bylaws give BOPS the authority to set up Board committees to perform these duties. It should also be noted that while the officers of the association are ex officio members of the Board, the Board elects its own chair and secretary according to procedures that it alone determines.
Thus, the Board has been given, by the association and its members, the serious responsibility of maintaining clarity about our educational requirements, procedures, and goals as we work toward an optimal understanding of psychoanalysis and its many areas of application. As a body of representatives of our institutes and their members, the Board functions collectively and collaboratively to develop and articulate the values of the association and its members. While the Board's autonomy gives it the freedom to reflect in an objective way on these important educational values, clearly the best interests of our members are served when Board, Council, and the full membership work in concert. That is how we can maintain our identity in the eyes of the public as an organization devoted to quality and excellence in education, practice, and patient care.
Ongoing efforts of the Board in relation to education and practice express central values of The American and its members, and will remain central to any attempted solution to our problems. These efforts are a vital part of our association's assurance of quality treatment. The presence of the officers of the association on the Board assures the general membership a strong voice.
During stressful times like these, it is not unusual for an organization to direct its anxieties and energies toward internal conflicts, where change seems easier, rather than toward the more dangerous and difficult external realities. The perspective Dr. Schachter has represented has been thoroughly debated over several decades, with clarification and resolution having been reached. It does us little good and potentially much harm to reimmerse ourselves in the details of the rationale for the Board-Council relationship. It is my hope that, taking respectful notice of Dr. Schachter's views, we can continue along the progressive path that we are embarked on.