This is my first column as president of our Association. I am honored at the privilege of being elected to serve you for the next two years. I hope to write in each issue of TAP about an area of central importance to our future.
Having considered our problems, strengths, and dreams with you in my visits to almost every society and institute in the past decade, I will describe an emerging, broadly shared vision of our future together with plans for achieving our goals. In the present column, I will speak of our members' yearnings for and concerns about further democratization of our Association.
I would like to begin by first noting that democratization has been proceeding in an evolutionary manner for many years throughout our Association. Every recent president has advocated for further inclusion and democratization. Judith Schachter, our most recent past president, strongly encouraged the ongoing empowerment of the Executive Council, thus giving our societies and their members a more decisive voice in our national discourse. Unfortunately, democratization has frequently become caught up in political infighting, often increasing Board-Council tensions. I believe that we can move forward toward a more democratic American in a consensual process accompanied by thorough consultation with all of our constituencies.
Despite the steady progress of recent years in democratization at both the local and national levels, there is much about our organization that is noninclusive and hierarchical. A great deal has been accomplished, but we are nowhere near optimal democratization. Isn't it paradoxical that The American Psychoanalytic Association—home to a radical, liberating science and clinical discipline aimed at maximal fulfillment of all individuals—is still widely regarded as rigid, authoritarian, and elitist? The psychoanalytic movement in its early days attracted talented, bright, free-thinking individuals; now many gifted students and intellectuals regard us as mired in old, worn-out ideas. They are often attracted to non-American institutes that they believe are more intellectually open and that provide more flexible pathways to psychoanalytic training. Although our institutes' curricula and scientific programs are now very open to new ideas, still there must be more than a grain of truth in the persistence of these critical voices.
Perhaps some readers think we have sufficiently dealt with this issue and that we must turn our attention to more urgent priorities: public education, government and insurance industry intrusions into our clinical work, and outreach. I believe we must attend to these important issues, but that we must also consider further democratization as another priority, one that will strengthen our efforts in these other areas. The decades-long, recently successful effort to extend full membership and to grant voting privileges to our graduates was a very important phase in this struggle, but it was only one step in an ongoing process to give all our members a voice and a vote on national initiatives.
The empowerment of our members, particularly at the local level, to thoughtfully discuss and vote on the issues that confront our societies and institutes is still very limited. For example, many institutes limit voting to their educational committees that are solely or largely composed of training analysts. Since only a minority of colleagues become training analysts, this effectively disenfranchises most colleagues. The small group of training analysts feel overburdened, overworked, and dispirited. Often decisions are made on the basis of information and experience a generation away from the front-line reality of practice today, leaving many colleagues feeling helpless and isolated. While societies are often more democratically structured, their agenda is usually limited, since institutes take on responsibilities that could well be handled by societies, e.g., outreach activities such as extension programs. Consequently, we refer to our physical plants as “The Institute,” ignoring the fact that our buildings also house our societies, candidate organizations, foundations, and psychotherapy affiliates. Is it any wonder that this has caused widespread alienation of colleagues, leading to poor attendance, lack of commitment to our agendas, and unnecessary tensions between the training analysts and other faculty members?
How did our institutions become so hierarchical in the light of a science of psychoanalysis that was aimed at liberating individuals? Certainly some could justifiably trace our institutional structure and mores to European countries with imperial political traditions, as well as to the hierarchical medical establishments of the time. Our American contribution could also be traced, in a Flexner-report era with chaotic medical educational standards, to a conviction that American analysis must emulate the then-current preoccupation in medical circles with regulation, standards, and oversight functions. Arguably our founding fathers and subsequent generations of American leadership were rightfully concerned about “wild analysis” and wished to protect patients and our young field.
However, I do not feel these were the sole reasons for the subsequent hierarchical organization of our institutions, nor for our decisions to exclude all but medical applicants for training, which prevailed until a few short years ago. How wrong we were to think that we upheld standards by excluding nonmedical applicants for training. This exclusionary decision should caution us in our tendency to be so certain about the necessity of other selection criteria that are still sacrosanct.
May I suggest another factor that might explain our penchant for restrictive rules and oligarchic governance? Perhaps the very free atmosphere of the analytic situation arouses anxiety relating to our own residual conflicts as well as our difficult task of understanding and dealing with
the complexity of our patients' clinical material? The certainty of rules may be a balm to our gnawing uncertainties when we are daily confronted with clinical situations that are often emotionally and intellectually overtaxing. At such times it is easy to turn defensively to perfectionist standards to assuage our anxieties. We may then hold applicants for training, candidates for graduation, and graduate analysts seeking training-analyst status to an impossible standard of competency and achievement. Few are good enough to meet our criteria. We become phobic about risk-taking.
We recognize today that high standards of education and practice are well established in the life of our societies and institutes. Perhaps this is another reason why we need less national and local controls built into our institutions and can allow a more flexible and democratic process to prevail? However, most of us would still agree that certain educational functions are best assigned to senior educators in an autonomous “carve out” that is not subject to democratic control of the entire faculty. Therefore we usually allocate to local educational committees the areas of candidate admission, progression, and graduation as well as faculty progression—particularly training analyst selection.
In the crucial area of how local history and educational philosophy impact these educational functions there is naturally considerable room for variation. Certainly the variable size of our institutes necessitates different arrangements for inclusion, participation, and representation. For example, in small institutes, all training analysts may be on their education committee. In our large institutes, training analysts are typically elected and thus a representational body is established that still serves similar educational goals. At the national level, a similar situation pertains to our Board on Professional Standards (BOPS), to which we assign autonomy in educational oversight of our institutes. BOPS today is still integral to our maintenance of high standards, although it has subordinated its gatekeeping role to that of being more consultative and facilitative. An argument can still be made for increasing the democratic role of faculty in the administrative aspects of local institute functioning, e.g., budget, personnel, housing, etc. A faculty could also discuss the reports of educational committees and even play an advisory role in regard to certain educational policies.
Further democratization of our national and local psychoanalytic institutions will help reverse the widespread alienation of our candidates and graduate analysts. At the national level this means reducing presidential and Executive Committee power and sharing this power with the Board and Council. These bodies always had power, but they were unable to fully execute this power because they were relatively uninformed and the initiatives basically came from above. In the past few years members of the Executive Committee have expressed a willingness to transfer or share our power with the Executive Council and BOPS. The enlivened and more productive debate in these bodies already reflects the greater sense of empowerment. For example, the Council now prepares the budget and knowledgeably decides how to allocate our limited financial resources. The Council decides its own agenda, will soon elect our representatives to the House of Delegates of the International Psychoanalytical Association, and through select committees has already investigated the Executive Committee's functions. In a real sense, the Executive Committee increasingly carries out the policies established by the Council, although it continues to propose initiatives for the Council's consideration.
“When ultimately an individual or the smallest unit of governance has the maximum amount of freedom without doing harm to our organizational effectiveness, then we are experiencing the full benefit of a democratic process and ambience. I think one can find analogies in our analytic work with patients.”
Today the Council no longer simply acts as a consultative body; it is becoming a truly representative assembly. I can envision further sharing and transfer of powers. The Board and Council, in turn, continue this evolutionary trend by transferring some of their prerogatives to local option, e.g., the Board is considering eliminating the need for institutes to obtain national waivers for admission to clinical training for social workers and other clinical professions. Our institutes and societies similarly could further democratization by allowing their own local committees a wider range of autonomous functioning. When ultimately an individual or the smallest unit of governance has the maximum amount of freedom without doing harm to our organizational effectiveness, then we are experiencing the full benefit of a democratic process and ambience. I think one can find analogies in our analytic work with patients.
At present our national bodies are moving rapidly toward becoming vigorous participatory democratic institutions. Our local societies and institutes have farther to go. Most issues could be discussed and voted on by all of our faculty and society members. Candidates could appropriately have their area of contribution and voting privileges broadened. Our foundation boards will also flourish with greater freedom. Democracy means including wider circles of people in discussion and decision-making. This also means that our psychotherapy students should participate in discussing our extension and educational outreach programs. Creative ways to include more people in our governance will not lead to dilution of education. Experience demonstrates that we can trust these colleagues to preserve quality in our educational offerings to the community.
This same critique applies to the International Psychoanalytical Association, of which we are a component group. The IPA is still largely a top-down hierarchical organization with little opportunity for analysts and candidates to directly participate in IPA affairs. Certainly, the election of IPA officers by mail ballot has been a major step toward involving more members in decision-making. Current IPA elected officers support the movement toward democratization that has been strongly promoted by Horatio Etchegoyen, IPA president.
The recently established House of Delegates of the IPA now provides societies a consultative voice. Hopefully this could evolve into a representative legislative
body similar to our Board and Council. Otto Kernberg, IPA presidentelect, has assured us that he will continue the process of democratization. As the IPA becomes more inclusive, we are certain the members of our Association will become less alienated from the IPA.
Democratization also means reaching out to mental health professionals in racial and ethnic groups who might become interested in analytic education. Our Association will greatly benefit from their presence, which has until now been nominal. We will have to acknowledge prejudicial attitudes, e.g., that some groups in our population are not sufficiently developed psychologically to benefit from analytic education and clinical work. These canards discourage outstanding African-Americans, homosexuals, and other minorities from seeking training in our institutes.
Democracy implies that every individual should have the opportunity to develop fully, including the right to equal professional education. At its best, it holds that each individual is unique, special, and must receive the necessary help and support required for his or her development. When all are included in our institutes and societies, we will have enormously augmented our energies to conduct our outreach activities, political efforts, scholarly pursuits, educational programs, and clinical work with analytic patients.
To further the democratic process, we promise that all national committee reports and proposals relating to our national agenda will be in your hands by October and March. Then they can be discussed at November and April meetings of societies and institute faculties. It will be up to the readers of this column to assure that these discussions then take place. Thus you may instruct your councilors and Fellows about your views so they can carry them forward to our national forums.
Furthermore, President-Elect Bob Pyles and I invite each candidate and member to contact us by phone, fax, E-mail, or mail. We pledge to read all of your ideas and to respond directly to as many of you as possible. Be assured that we will use your contributions. This is another means of influencing our national discourse. Your ideas will also be used in this column, which can become an additional interactive forum for our national dialogue.
Our organization is alive and well as we approach the twenty-first century. We need to quicken the pace of change to meet the challenge of strengthening psychoanalysis by increasing private practice, scholarship, and membership growth. We hope you will volunteer your ideas and energies at both the local and national levels to further our common goals.