I have had a disorienting experience repeatedly in recent years. It occurs when a colleague who has the general reputation of being either “liberal” or “conservative” espouses an attitude contrary to what is expected. I believe that the behavior of these colleagues is explained by the fact that there is no single philosophy that helps us decide our positions about all the various issues before us.
As I grapple with the questions that confront The American and the Board of Professional Standards, I have clarified a triad of orienting viewpoints that guide my own thinking. Because I have recognized this cluster of positions in a number of our colleagues, I will dignify these positions with a moniker: the progressive middle ground. Those who stand on the progressive middle ground support achieving egalitarian goals, maximizing relationships between our organization and other organizations and publics, and preserving our best understandings of how to teach psychoanalysis and practice the psychoanalytic method with integrity.
The progressive middle grounder attempts to coordinate the egalitarian, relationship-building, and preservationist goals but recognizes that the coordination of these aims is sometimes impossible. When goals are incompatible, the progressive middle grounder will generally choose to preserve the basic integrity of our educational processes and the psychoanalytic method.
The progressive middle grounder is deeply committed to egalitarian reforms. This commitment leads to support for changes including the increased sharing of responsibility for our educational programs by our full faculty and the increased involvement of candidates within institutes, societies, and the APsaA. This commitment also involves support for equal opportunity in admissions and progression both within institutes and after graduation for all, free from any discrimination on the basis of sex, race, religion, sexual orientation, or any other discriminatory factor.
The progressive middle grounder is also deeply committed to the building of relationships between our organization and other psychoanalytic or psychodynamic organizations and various publics. He or she supports the Psychoanalytic Consortium on the basis of its potential to assist The Americans wish to address various public dimensions of psychoanalysis, such as lobbying and public education. He or she supports external credentialing with other groups to the extent that it fulfills its potential to represent a sufficiently high standard of training in psychoanalysis and to inform and protect the public accordingly. The progressive middle grounder's support of building relationships includes advocacy for the application and teaching of psychoanalysis in such settings as the academy and psychotherapy training programs.
Finally, the progressive middle grounder is deeply committed to preserving the integrity of our psychoanalytic educational processes and the psychoanalytic method. Such a principled preservation is open to continued evolution, based on valid scientific evidence and clinical and educational experience. Preservation does not mean stasis; it allows even for radical paradigm shifts. From this perspective, the progressive middle grounder can be passionate in his or her effort to insulate considerations of education and of the psychoanalytic method from political considerations. The preservationist agenda involves protecting the conditions that govern decisions about education and psychoanalytic methodology.
My preservationist orientation informs many of my views about issues that confront the Board on Professional Standards. For example, I believe that it is not possible to conduct an appropriate (ethical and efficacious) psychoanalysis — the most private and intimate of treatments and, in a certain sense, of human relationships—in an intrusive, non-confidential environment. I also believe that the psychoanalytic attitude is compromised when the analyst has to work within an insurance system to advocate for the treatment and his or her own continued fee, particularly if that activity on the part of the analyst takes place during the course of the analysis.
I am concerned about impediments to learning appropriate technique, as well as to offering appropriate treatment, when the analyst has to override careful imparting of comments to the patient in favor of reviewing detailed information and formulations that are being reported to external reviewers. I am also concerned that our organization has not sufficiently emphasized its own practice standards as described in “Charting Psychoanalysis,” which details the incompatibility of conducting psychoanalysis and participating in an intrusive review process. Literature cited in “Charting Psychoanalysis” suggests that it is not reasonable to expect that an analysis subjected to ongoing claims review can be satisfactorily completed through the standard termination phase.
I worry that the Board on Professional Standards and some of our institutes are occasionally neglecting the special responsibility to our candidates to provide an optimal analytic environment in which the patient feels safe to reveal unconscious contents so that candidates can learn the technique of psychoanalysis and create a true analytic identity.
My preservationist orientation is also the philosophical basis for my belief that psychoanalytic identity cannot be coordinated with a contemporary psychiatric identity, as currently epitomized by the DSM IV perspective through which patients are viewed. I do not believe that it is possible to coordinate a closed system, based on phenomenology, with the psychoanalytic open system, in which there is unencumbered exploration and discovery.
It may not always be possible to coordinate the preservationist aim with the egalitarian and relationship-building aims of our organization. In these instances of incompatibility, the progressive middle grounder will generally consider the preservationist aim to be the super-ordinate one.
One issue that exemplifies the difficulty in coordinating the egalitarian, relationship-building, and preservationist goals is the idea of “unifying” psychoanalytic groups under one organizational roof. We should be open and encouraging to any institute that wishes to explore the possibility of affiliation, and the Board on Professional Standards should work with any such group in the hopes that such an affiliation can be accomplished. The progressive middle grounder is aware, however, that the
political and economic aims that are part of the argument for unification should not override the principled preservationist orientation. In this context, I believe that we must be precise about the meaning and implications of psychoanalytic pluralism; otherwise, we might lose sight of an essential issue.
Pluralism within the APsaA occurs within the context of a shared core of psychoanalytic attitudes and perspectives; it enables us to maintain a valuable shared identity. Sometimes, what may be psychoanalytic to one person or group is quite different from what is psychoanalytic to another. When is it mutally valuable to coordinate different traditions, and when it might lead to a babel of voices and identity diffusion? This issue of whether different psychoanalytic traditions have a sufficiently common psychoanalytic core to be able to come together in a mutually productive way is a subtle determination that is insufficiently elucidated when discussed in limited and concrete ways, such as in terms of frequency of sessions. It is even more important that our attempts to understand these critical educational and methodological issues not be confounded by other other considerations, such as our organizational political agenda.
Thus the preservationist orientation may, from time to time, conflict with the egalitarian and relationship-building orientations. When this coordination is difficult or impossible to achieve, the progressive middle grounder will insist on the priority that he or she assigns to preserving autonomy for education and for psychoanalytic methodology.
Unfortunately, such a position is occasionally misunderstood within our organization, and even reviled. When this occurs, progressive middle grounders are labeled as elitist or arrogant. Or they may be dismissed in sound bites, as being in favor of the “studying for 20 years approach” or of “playing the fiddle while Rome burns.” These attributions generally tend to be unhelpful.
I hope that we can find the collective wisdom to keep the long view in mind. We must retain our integrity and our conviction that adherence to our core educational values, to our core educational principles, to our core human commitments, progressively understood and adapted, is our best strategy for survival. Guided by this organizing philosophy, the committees of the Board and the Fellows of the Board are hard at work examining new strategies and new solutions with which to assist our institutes in these difficult times.