At the recent Fall Meetings of our association, both Board and Council voted overwhelmingly to accept the report of the Joint Ad Hoc External Accreditation Committee. This committee, under the chairmanship of Leon Hoffman and Calvern Narcisi, recommended that The American conduct negotiations with the Psychoanalytic Consortium exclusively to create a proposal for external accreditation of psychoanalytic institutes to be presented to the Council for Higher Education Accreditation (CHEA) and the Department of Education (DOE).
The decision of the Board and Council is predicated upon the inclusion of the Independent Psychoanalytic Societies (IPS) in the Consortium. This initiative will provide a floor for standards that will have two major effects on the chaotic U.S. psychoanalytic education scene:
Many institutes will raise their educational standards in order to achieve accreditation.
Many institutes that are unable or unwilling to reach these standards will be gradually abandoned by students seeking a higher accredited status.
We expect that this development in psychoanalytic education will have the salutary effect that the Flexner Report had on medical education at the turn of the century. If the present collegial discussion within the Consortium continues in the direction of high standards of education (and there is every indication that it will), we can look forward to a completed document within 18 months. The Joint External Accreditation Committee of The American will continue to review the developing proposal and express The American's concerns. For that reason, the co-chairs of the Joint External Accreditation Committee are members of the Consortium's External Accreditation Committee. The final proposal of the Consortium must be ratified by a vote of our membership.
One year ago, such harmony between Board and Council on this topic did not seem possible. In fact, the previous joint committee had split apart over polarized attitudes that led to separate Council and Board accreditation committees. Such an impasse could only lead to organizational gridlock and further deepening of the split in our ranks. External credentialing would be dead, since it required joint approval. The generally increasing harmony between Board and Council was threatened. A descent into organizational civil war was just around the corner.
But what happened? The Executive Committee recommended the re-establishment of a joint committee, required to report its recommendations by December 1997. Some colleagues felt this was an insincere move to thwart the wishes of the Council, which was overwhelmingly in favor of the Consortium option. However, the Executive Committee believed that despite the excellent work of the previous joint committee, some questions remained to be researched and discussed. A group of leaders of our organization were selected to study these questions. The newly selected colleagues were diligent in their work and open-minded about the data collected. As 1997 progressed, it was increasingly clear that a consensus had developed toward joining exclusively with the Consortium to seek external accreditation. This conclusion was reported to the Board and Council in December 1997.
Once again, internal difficulties had been resolved through in-depth thoughtful inquiry, attesting to the underlying common base of principles that unite our organization. Change is continually necessary in our organization, but it should proceed only after thorough discussion. Following such a process of inquiry and discussion, our votes are overwhelmingly in one direction.
Our Consortium allies were, of course, pleased and validated by our decision; the committee's report affirmed our recognition of a common devotion to high standards in psychoanalytic education and practice. During the past seven years, we have worked in the Consortium to preserve and strengthen psychoanalysis. We have been occupied with an agenda that includes ethics, external credentialing, and joint political action in Washington and at the state level. In particular, we have opposed organizations with lower standards being awarded exclusive accreditation privileges by the Committee on Recognition of Post-secondary Accreditation (CORPA, now CHEA) and by DOE. In the course of this effort, the members of the Consortium's board have come to know and respect each other. We have had a similar experience in the North American IPA Groups (NAIPAG) and have found the Canadian Association and the IPS to be devoted to the same psychoanalytic ideals as those held by The American. We have bonded within NAIPAG and usually articulated a united position within the House of Delegates of the IPA that reflected the commonality of our American psychoanalytic experience, especially as it reflected our common democratic heritage and inclinations. (I will discuss the potential and promise that an enhanced NAIPAG agenda offers for our own future in my next and final column.)
This brings us to a new, broader vision of how we might best work together to promote psychoanalysis in the United States. The Consortium probably represents a core group of no more than 6,000 U.S. psychoanalysts. The American currently is the major association, with 72 committees and task forces that serve its 41 societies and 29 institutes. As effective as we are in maintaining standards of training in our institutes and in providing support to our 41 societies in political action, outreach, and scientific programming, we are just beginning to understand, invent, and articulate the programs required to carry out our mission. We are woefully short of members, funds, and community support to adequately carry out our ambitious program. How can 3,000 members really be effective in bringing psychoanalysis to the quarter-billion inhabitants of the United States? Psychoanalytic practice, both within and outside The American, is declining. In The American it has declined 1 percent per year (as measured by number of patients per analyst) for the past 20 years! The only similar data, produced by Section 1 of Division 39, also demonstrate a serious erosion in private practice.
These dismal facts should serve as a wake-up call. There are societies in which practice has stabilized or is even on the upswing. We can learn from them. Nevertheless, our own resources are not sufficient to reverse these national trends.
In the past few months, we have become aware of efforts on the part of groups of psychoanalysts outside The American to form at least two other national psychoanalytic associations. Would psychoanalysis be well served by such a development? Or would we all be better off if we could unite our efforts to promote psychoanalysis?
We believe we would be much more effective if we worked closely together along a wide front of activities that goes far beyond the Consortium's limited agenda. In fact, if we could find a path to unite all psychoanalytic groups with a commitment to high standards in education and practice, we could significantly enhance our effectiveness. Were it not for The American's early policy of training only medical candidates, we probably would all be in one organization today.
Could The American, an organization that once allowed only psychiatrists ready entry to psychoanalytic training, serve today as the organizational structure for bringing together all psychoanalytic groups? Could other psychoanalytic groups, still justifiably smarting from the exclusionary policies of our past that denied them access to training, perceive The American as a sufficiently welcoming framework for the unification of psychoanalytic groups?
While we have moved dramatically toward a more flexible, more open, less hierarchical organization, I am afraid that some of our colleagues still harbor condescending attitudes toward other groups. Our devotion to high standards in psychoanalytic education appeals to many, but our residual elitism and rigidity repel the very same people who respect us for our dedication to thoroughness in education. Despite these problems, many psychoanalytic groups have indicated an interest in joining The American and are prepared to accommodate their standards to ours where necessary.
However, they are justifiably wary of entering a process that might end with The American deciding not to accept these groups despite their willingness to make reasonable changes in their training standards. Given past experiences, such a humiliating outcome is not just a fantasy. They are well aware of our unpreparedness for this development; we do not even have a way for freestanding institutes and societies to join The American. We only make provision for creating a new group from scratch; this policy option made limited sense when there were only a few non-American groups. Today it interferes with our opportunity to accept the many new groups of psychoanalysts, mostly non-medical colleagues who developed and prospered while we maintained our exclusionary policies.
Many believe that we need to begin a process in which we consider welcoming all psychoanalytic societies and institutes with high standards to join our association by establishing a task force. It would represent a cross-section of our leadership and would take the necessary time to consider the pros and cons of this initiative. While we must be thorough, we should not become locked in an interminable process of study; therefore, it would be helpful to assign time limits for such efforts. The task force must have an open dialogue with the psychoanalytic groups that will similarly be considering such a possibility. The issues should be discussed in our societies and institutes. On a much larger scale, this might proceed along the path followed by the Joint External Accreditation Committee.
We must begin this process as soon as possible. We only have a small window of opportunity. If we do not act quickly, there will soon be three national psychoanalytic associations, all small, underfunded, and weak. The IPA is currently in contact with a number of groups that it will support along the same path of development (outside The American), as it did for the four societies in the IPS. Many among these existing groups would like to consider joining The American. However, our usual path of development to establish new institutes requires 15 to 30 years! The appeal of the direct IPA route is not unreasonable. The IPA has a shorter procedure using teams of senior educators who are assigned to work regularly with new groups.
In my view, the IPA's methods merit study. I am confident that we could find ways to improve on the successful IPA model that would also incorporate the best features of our present approach using the Committee on New Training Facilities (CNTF). We already have the beginnings of a plan in the work of the Committee on New Psychoanalytic Centers as well as the Committee on Societies. These latter two committees, working in close cooperation with CNTF, could forge a powerful team — both to develop new societies and institutes and to develop procedures to welcome existing societies and institutes into The American.
While our task force to study these issues might take up to two years to complete its report, perhaps we might begin now to try out new approaches? Experimenting with new strategies on a limited scale might be useful to the deliberations of our task force. Central to these efforts must be a respectful negotiating stance with other psychoanalytic groups. While some of our colleagues might find my caveat offensive, we must be aware that our past policies were often demeaning, even when they were rooted in a wish to maintain standards. Some might prefer separate Council and Board groups initially to consider these issues; I would be in favor of having a joint Board and Council task force, as we did when we considered de-linkage and external accreditation. Joint committees are desirable when membership, alliance, and educational matters are so intertwined.
The task force that is established to study this issue must take into account the new realities in our country. For example, the old method of establishing new training centers was predicated on candidates flying in to their sponsoring institutes for supervision, classes, and sometimes a personal analysis; this approach is no longer acceptable to today's potential candidates. They neither can nor wish to spend that much time away from their families with young children, nor can they afford the expense. Many are single parents; many are from professions that do not allow them to earn substantial fees. The potential faculty in the new sites are likewise often unable and/or unwilling to fly to sponsoring institutes continually to participate as teachers and committee members.
We must find new training approaches, such as establishing classes in new areas, flying in faculty, and using teleconferencing. A modified sponsorship plan could allow more autonomy to new sites, would be less infantilizing, and could rely on more possibilities for national input, e.g., CNTF co-sponsorship or sole sponsorship using teams of senior educators from a variety of institutes. This might be modified and combined with the continued use of a sponsoring institute, exhibiting a more respectful, less infantilizing style of helpfulness. Fortunately, our Board leadership is open to new approaches while fully committed to maintaining our educational values, and the Board is already considering these new options. As a past chairman of the Board, I feel that we can maintain our standards as we move in these new directions. In fact, if we do not reverse the decline of psychoanalytic practice, we will seriously undermine our institutes and demoralize our faculties and candidates.
The issue of facilitating the entry of freestanding societies is also complex and would be a second necessary focus for the new Ad Hoc Joint Task Force. As an interim step toward unification, we could significantly step up our present policy of inviting individuals from such societies to serve on our Council committees. They have much to offer. These crossover experiences are very valuable to all of us and are mutually beneficial. In New York, Los Angeles, Michigan, Washington, Boston, and elsewhere, our societies are already jointly sponsoring programs with non-American psychoanalytic groups. For example, our two societies in the Washington area, together with the Washington branch of the New York Freudian Society, are jointly sponsoring a panel discussion prior to the opening of the Freud exhibit at the
Library of Congress. Members of the IPA North American Groups now can also join The American, and these individuals are creating a living bridge between The American and the other IPA psychoanalytic groups that already has contributed to mutual trust.
In becoming better acquainted with these free-standing, independent institutes and societies, I have been impressed with their devotion to psychoanalysis, their high standards of education, and their openness to new ideas both theoretical and institutional. Perhaps some groups may have standards of education that are incompatible with our positions. If they are unable or unwilling to change these policies, we can still retain or develop close ties and work together at the local and national levels.
My experience is that we lose by isolating ourselves institutionally and we gain by a greater degree of collaboration. For example, the William Alanson White Institute in New York City has a fellowship program for new candidates. These candidates see psychotherapy patients in their outpatient clinic under supervision and receive credits toward their tuition fees. In this way, candidates both learn and earn, making training more affordable. Such a program is desirable especially because our widening eligibility has brought us excellent candidates who often have limited financial capability to undertake analytic training. The clinic of the Karen Horney Institute has received approval by the American Psychological Association to provide internships for pre-doctoral clinical psychology students. They are provided with stipends that are largely funded from the clinic fees. Upon receiving their Ph.D.s, many return as candidates. In the Minnesota Institute for Contemporary Psychoanalytic Studies, eminent analysts are invited for weekends of teaching. The candidates thus have intensive educational exposure to prominent psychoanalytic educators. There are many other novel and valuable ideas that we could consider adopting. I have not yet become acquainted with an institute or society, within The American or outside it, that did not have a new idea or two worth considering by all of us.
“We need to begin a process in which we consider welcoming all psychoanalytic societies and institutes with high standards to join our association.”
Our alliances with the major mental health organizations, formerly quite frayed, have been strengthened during the present administration, but we need to devote even more effort to working in unity with our parent mental health organizations. It is suicidal to stand aloof as if we have the truth and do not need such alliances. They need us and we need them. It was partially our arrogance that led us to move away from psychiatry, psychology, and social work. In December we met with the American Psychiatric Association leadership and began planning a much closer collaboration along a wide front of activities both educational and political. Barbara Rosenfeld has been appointed to coordinate our increased liaison activities with the American Psychiatric Association, the American Psychological Association, and other allied organizations. Finally, I would hope that we can find ways to welcome child psychoanalysts who are graduates of The Anna Freud Center for Child Analysis and the Cleveland Center for Research in Child Development, to work more closely with them, and to find ways to enable them to become child analyst members of our organization. They can still be distinguished from those members who have undergone both child and adult analytic training.
If I have written today of alliance-building and the possibility of unification, I am not negating or diminishing our growing commitment to research; the strengthening of our societies, institutes and foundations; the development of student and psychotherapy affiliates; and our outreach efforts to the academic community. Our political mission both in Washington and at the local level needs to be enhanced. We are becoming very effective and sophisticated in achieving our objectives, both through our own efforts and in working with our allies. Our Executive Council, Board, and society presidents are increasingly playing a major role in these new developments. Our elected leadership is in harmony with these new objectives. In my regular visits to our societies, I also find strong support for these objectives.
The road ahead is a difficult one, but I am confident that together we can find creative solutions that will be in keeping with our traditions and will allow other psychoanalytic groups, with their own traditions, to work closely with us and find a path to unity in one organization. I believe that working more closely together and/or achieving organizational unification will provide us a greater opportunity to strengthen psychoanalysis in the United States. It is time to begin a discussion of these possibilities. I would be very eager to hear of your individual or group responses to these ideas. Please write, fax, call, or e-mail your reactions.