The American has essential concerns in two worlds: the world of ideas (including theory, research, and training in principles of caregiving), and the world of real events (practice, acceptance in the marketplace, alliances, politics, and community interactions). The Council's December 18 meeting reflected the tensions between these worlds and was characterized by detailed and intense discussions.
The Council heard and debated external credentialing, budgeting, governmental issues (especially Medicare legislation and administration), practice guidelines, ethics, and practice issues. It also continued the debate over new membership categories (carried over from the San Diego meeting). Toward the end of the meeting, at the end of a significant discussion over governmental issues, President Margolis characterized the discussion as “the Council at our best.”
There is now general agreement within The American on the plan for external credentialing. The American will work within the Psychoanalytic Consortium, provided the International Psychoanalytic Societies (IPS) are included. Co-chair Calvern Narcisi presented the report of the Joint Ad Hoc Committee on External Credentialing; the other co-chair, Leon Hoffman, contributed explanatory information to the ensuing discussion.
This item had been extensively discussed within BOPS the day before (see page 6). The plan is close to the position presented by the past external credentialing committee chaired by Allan Rosenblatt. The Council now appears to be more unified on this direction than before.
The budget of The American is now publicly presented and discussed in detail — a significant change. Treasurer Newell Fischer delivered a slide presentation illustrating the demographic and financial changes in The American. This opened the way to an extended discussion of priorities and the philosophy behind budgeting, which in turn enabled the Council to debate and vote on a number of specific budget items. The major change from the presented budget was a vote to restore cuts in the research budget.
Fischer presented ideas and plans for new income sources that could reduce The American's inordinate reliance on the membership dues base, which renders it financially vulnerable. Investment strategies are under study, and funds are now in the hands of a new advisor, John Schott, publisher of the Schott Report. He is both a graduate psychoanalyst and a successful investment advisor.
The PEP CD-ROM project, JAPA, and other publishing projects are potential sources of more income. Also under consideration are higher fees for non-member registration at meetings, CME/CE credits, financial returns for facilitating subscriptions to other psychoanalytic journals, and possible contributions from commercial sources including pharmaceutical companies.
The Task Force on Communication and Information requested an investment of $120,000 for upgrading and maintaining the central office computer systems. In addition, capital funds of up to $70,000 were approved to reconfigure the current central office space to accommodate staff expansion.
All committees of The American were asked to pare their budgets, and then all were asked to reduce their figures by an additional 6 percent. The ensuing discussion led Joseph Schachter to propose that budgets be prepared six weeks before the Executive Council meets and that budget requests from committees be detailed. This requirement may mean that the Steering Committees will need to meet earlier in the fall. The motion passed without objection, with one abstention. Elise Snyder noted that the Fellowship Committee was already committed to expenditures a year in advance and thus could not make the reductions. This discussion led President Margolis to announce that a handbook of committee mandates is being prepared and will soon be distributed.
Requests for reconsideration of budget allocations were voiced by Lee Brauer, chair of the Practice Committee, and Robert Galatzer-Levy, co-director of the Fund for Research. Galatzer-Levy mentioned the vast sums spent by drug manufacturers for single-drug clinical trials, contrasting this with the much smaller sums allocated by The American for research. This creates a serious handicap in the marketplace to demonstrate the value of psychoanalysis. When the issue was finally brought to a vote, about $13,000 was restored to the research budget, with only six “nays.”
Contributions designated for research, requested as a check-off on the dues notice, will not decrease the official funding. The Budget and Finance and Executive Committees will decide the source of the reinstated research money. JAPA will become a benefit of membership and will be included, at a reduced price, with the 1999 dues.
Ralph Roughton, The American's representative to the IPA House of Delegates, noted that it takes study to understand the governance structure of the IPA. He briefly reviewed the history of the very recent development of the House of Delegates, whose rules of operation are under study. Roughton reported that study of the psychoanalytic educational system is also under way. He noted that psychoanalysis is still taught under the “Eitingen model,” developed in 1926, and that the IPA leadership's announcement of support for research on psychoanalytic education brought in an avalanche of requests. The requests were evaluated into three categories: very high, poor, and needing further study. The next meeting of the IPA is scheduled for July 1999 in Santiago, Chile.
Otto Kernberg, President of the IPA, addressed the Council. He outlined problems being addressed by his administration and the House of Delegates, such as reducing administrative costs and expanding relationships with significant people and institutions in the non-analytic world. The German and Dutch health plans, until now active supporters of psychoanalytic treatment, no longer offer such support. Ominously, psychoanalytic treatment could conceivably be outlawed in these countries, perhaps unintentionally, as a result of the requirement that all treatment, for any medical condition, must be provided only under the auspices of the governmental plan. If a treatment is not supported, it may become illegal.
The IPA is contemplating a new journal, but it wishes to exercise care so as not to take subscribers away from the current International Journal of Psychoanalysis, which is actually a publication of the British Psycho-Analytical Society.
Kernberg thanked President Margolis for encouraging the interest of members of The American in the goals and activities of the IPA.
Roughton also reported for the Joint Committee on Issues of Homosexuality, of which he is chair. It is now a standing committee, and membership is on a rotating basis. John Boswell, Judy Kantrowitz, and Jon Meyer have left the committee, replaced by Michael Gundle, Christopher Wallis, and Kathryn Zerbe; Ralph Roughton, Judith Schachter, and Edwin Wood will complete their six-year terms in May of this year. Susan Vaughan has been selected to succeed Roughton as chair.
The Council was asked to support the Lambda Legal Defense and Education Fund, a civil rights advocacy group for gays and lesbians, in its efforts to promote passage of a “marriage resolution.” This was presented as a simple “no interference” resolution and is intended to combat the backlash of state laws aimed at outlawing same-sex marriages. Paula Bernstein noted that in Colorado the group was instrumental in writing an amicus brief leading to the overthrow of a state proposition that had created such a backlash. The Executive Council approved the resolution (see box on page 2).
The Elections Oversight Committee, which comprises the councilors-at-large, is chaired by Allan Compton. He and President Margolis congratulated the candidates in the recent elections on the high level of their campaigns. For the first time, an election was overseen by the EOC, which was organized to maintain a level playing field and regulate elections, but not to control candidates or what they may say. President Margolis congratulated our past president, Judith Schachter, for the idea of appointing the councilors-at-large to constitute this committee.
Nadine Levinson advised the Council that PEP sales were 36 percent ahead of original projections. The PEP directors have paid back $150,000 of seed money to The American, but the project owes an additional $40,000, plus interest. Producing a MAC version, and technical problems unearthed via feedback from users of the beta version, have delayed a final version. A new version, incorporating many modifications, is expected in 1999.
Chair Warren Procci reported for the Committee on Government Relations and Insurance (CGRI). Sam Rubin is now co-chair of this committee. The main focus of CGRI is the Kyl Amendment, a complicated issue whose outcome will influence the decision on whether it will be possible to treat a Medicare recipient outside the Medicare system and the conditions under which this may become possible. The American's government relations firm in Washington has obtained a statement from the Health Care Financing Administration affirming the right of providers not to have to file claims for treating Medicare patients. Paul Mosher, who elaborated the issue for the Council, urged members to check the APsaA Web site for ongoing news.
Robert Cummings reported for the Executive Committee on his concern about the treatment guidelines that have been issued by the American Psychiatric Association. He also urged The American to immediately attempt a total withdrawal of psychoanalytic treatment from any government-supported system in order to protect confidentiality in psychoanalytic practice (see TAP 31/4, page 24). He feels that time is of the essence, because it may become too late to take this route if we linger.
Procci advised the Council that the CGRI had debated this issue at length and unanimously rejected what it referred to as a “doomsday scenario” (see page 10). Drew Clemens, who is hard at work within the American Psychiatric Association on these issues, supported Procci's views. Allan Rosenblatt spoke for what he called the “patient's interests,” reporting that he had been successful in obtaining payment while conducting an analysis under Medicare auspices. Rubin joined in, saying that if we The American withdrew from the system, it would never be able to return. Lee Brauer supported this position.
Sheila Hafter Gray, who heads The American's efforts on practice guidelines, reported that she has been getting no feedback from our membership. Responses are vital to carrying on her work, and she wondered whether she was being given careful inattention or if denial is at work. She made a plea for responses.
Ralph Engle, Chair of the Ethics Committee, has distributed new proposed ethics guidelines. His committee is developing a casebook, which has been under way for three years and will require at least another year. The Ethics Committee proposes that each society of The American develop its own ethics committee that will to interact with the Ethics Committee of The American. A number of smaller societies objected on the grounds of excessive cost. The parliamentarian noted that the Council's approval does not constitute a command to local societies but is a strong message of urging. Local societies are urged to consider this item and be prepared for a final vote at the Toronto meetings. The Council approved this report, with three opposed and one abstaining.
Lee Brauer presented the latest interpretation of his committee's review of practice trends. The decline in numbers of patients being analyzed per member continues, although it is slowing.
Jon Meyer presented a report on the process of bringing membership criteria into line with Board standards of training, particularly as it pertains to the training and membership of masters-level clinicians (see “BOPS Approves Process Toward External Credentialing,” page 6). The issue came at the end of the Council meeting. It requires more study, and it will be discussed further at the Toronto meeting.
Mel Mandel has been a valued member of TAP, serving as associate editor for the past six years. His beat was the Executive Council. With conviction and ardor, he reported on the historical changes that occured within the Council. In addition, we have appreciated and used many of his ideas to improve the newsletter, and we thank him. He will continue to serve TAP as a consultant.
Editor
In executive session, the following members were elected to the Committee on Council: Judith Chertoff, Gregory Graham, Michael Gundle, Muriel Laskin, and Victor Monke. Alice Brand Bartlett was elected to the PEP board to replace Judith Schachter, who will retire after the May meeting. The Committee on By-Laws, which is considering the matter of changing membership categories (see above) and other inconsistencies within the by-laws, will be chaired by Jorge Schneider.
Dorothy Holmes reported on honorary memberships: Hans Strupp of Vanderbilt University was honored for his efforts over many years to legitimize psychoanalytic thought. It was noted that his efforts to gain acceptance into one of The American's institutes for training was rebuffed in the 1960s because of The American's exclusionary policies in effect then. Martin Bergmann, who was also rebuffed when he sought training decades ago, was awarded honorary membership in light of a number of his books that have been strong contributors to psychoanalysis over the years.
Holmes also reported that in San Diego her committee was urged to develop a new set of awards for such honors as distinguished research, application of analysis, teaching, service, child analysis, policymaking, and applied analysis. The committee recommended that no officer be eligible for any such awards for a three-year period after leaving office.