I am very pleased to have this opportunity to begin a dialogue with colleagues and friends that will continue over eight TAP columns for the next two years.
First, I would like to express my deep appreciation and admiration to our immediate past president, Marvin Margolis. Marvin is of course legendary for his late-night phone calls and boundless energy. (For those who were unable to attend the Toronto dinner honoring Marvin, this was the theme of the “roast” perpetrated by the Executive Committee.) In his four years as chair of BOPS, two years as president-elect, and two years as president, Marvin, more than any other person I know, has changed the face of psychoanalysis in this country. Few realize the time, effort, and creativity he has poured unstintingly into our Association. Certainly we have been enriched and inspired by his leadership. I especially appreciate his kindness in sharing with me every aspect of the responsibilities of the office of president. I have learned a great deal during these years, and we have become close friends.
We are fortunate in having an effective and efficient leadership team in place. Dick Fox, our president-elect, and I have worked together closely over many years, beginning with the Task Forces on Strategic Planning. As you may recall, Dick was a central figure in achieving delinkage and is a longtime member of the Steering Committee for the Coalition for Patients' Rights.
Don Rosenblitt, chair of BOPS, is also an old friend (and a fellow Carolinian). He is launching a number of creative initiatives at the Board. Newell Fischer, our treasurer, has done an excellent job in cutting expenses and balancing our budget while finding funding for our many new projects. Jon Meyer, our secretary, has greatly enhanced the flow of information by making detailed minutes of proceedings available to Councilors and members. He has also recently arranged our first official meeting with the Mexican Psychoanalytic Society. Bob Cummings, secretary of BOPS, has similarly made detailed information regarding Board proceedings available to Fellows and members. He has also been a major contributor to our informative discussions about Medicare.
Ellen Fertig, our administrative director, functions as an integral member of our team. Her contributions are cogent and vital; in addition, she keeps the whole ship going.
It is a great honor to serve as president of The American, and I undertake this task with a deep sense of humility. It is my view that the Association exists to serve the members and the President serves both the Association and the membership. The office of the President is held in trust for each period of stewardship.
While I certainly have a vision for The American (which I have articulated elsewhere) and opinions about how to approach the issues facing us, I also have a deep and abiding faith in the democratic process. The decision making power rests, as it should, with our legislative bodies and, ultimately, our members. It is my intention to present my views, as everyone else will present theirs. I hope that with the advice and consent of all parties we can come to the best decisions. With our crowded agenda and limited time frame, the challenge is to find ways to facilitate that process.
I intend to continue to be absolutely direct with everyone about issues, my activities, and the activities of the Executive Committee, and I hope everyone will be equally direct with me. While this is my natural way of working, the reason I feel especially strongly about it in our current situation is that we simply don't have the luxury of time and energy to waste battling with each other. Too often destructive misunderstandings occur because something slips through the cracks, malevolent motives are attributed, and attack and counter-attack ensue.
If questions arise, please call me or any other officer. I do not intend to enter into members' list debates — I am not sure that discussion in that medium doesn't generate more light than heat — but I am very available by phone and will answer directly about any issue, or tell you why I can't.
During my two years, I intend to focus especially on political action, public information, alliances, outreach, scientific activities, and governance. I will expand on various aspects of those topics in future columns. For now I would like to make a few observations about the “state of our Association” and then move on to several salient issues facing us in the short term.
The key word here is “transition.” I believe that many of the internal tensions by which The American has been buffeted in recent years can be traced to the fact that we are undergoing a profound paradigm shift in the basic nature of our organization and perhaps in the very nature of what we see as psychoanalytic identity. The “transition” stage is the most painful stage of labor. I believe both Board and Council are on the verge of developing effective, responsive, and creative ways of approaching their respective tasks. For many years our primary focus has been an internal one — on the education of candidates and the development of scientific programs. Our connections with other professional organizations and our
communities have languished, but the world has changed, and we must also. We have begun to re-establish those ties.
We now see that the roles of societies and the Executive Council have become critical to our survival. You will notice that the six areas I mentioned involve primarily Council or membership functions. The Council and societies are struggling to find ways to achieve what must be done.
At Marvin's roast, Don Rosenblitt commented humorously on the organizational dilemmas of Council and Board. Imagining a basketball game between the two, Don suggested that it would end in a scoreless tie because the Board would pass the ball around all the day and never take a shot, while the Council would throw the ball straight up into the air and never aim at the basket.
The changing nature of our organization can be attested to by those who attended the last business meeting. At that meeting, our four outstanding new honorary members [see page 17] each spoke movingly and impressively about psychoanalysis as it related to their own field of interest. We intend to use both the new presentations awarded by the Honorary Membership Committee and the Presidential Awards to continue to expand on this tradition. Future awardees will include political and media figures who have been helpful to psychoanalysis.
The strength of The American rests on the twin pillars of education and membership. The roles of both Council and Board are vital to the health of our Association and are mutually supportive and interdependent. It is critical that both bodies function efficiently and effectively. Don is setting in motion a
series of initiatives aimed at examining the functions of the Board. Dick Fox and I, with all the advice we can get from the governance committees and others, are searching for ways to help our Council become more efficient. While the Board has eight committees, the Council has some 72 (counting joint committees and task forces). The Council committee structure has expanded exponentially as many important new projects have begun. The challenge now is to integrate these important initiatives.
In summary, I am pleased to report that the state of our Association is very good. As challenges have multiplied, opportunities have multiplied as well, and The American has responded with dramatic change over the last eight years. Many of the tensions we now face are inevitable concomitants of our healthy growth and transition.
We have responded to crisis by growing into a stronger, more pluralistic, and diverse association. We have made a good beginning, and I look forward to working with you to continue this important mission.
When I first began to attend the meetings of the Consortium as President-elect, I approached it with an open mind. While I certainly favored political and educational alliances, I was not at all sure about the feasibility or desirability of external credentialing. Our early meetings with the Consortium were extremely difficult because, after so many wounds in the past, trust was difficult to establish. Eventually, however, we have come to feel that we achieved a considerable degree of trust and consensus during the time we had been meeting.
I have come to feel strongly that the development of an external credentialing body is essential and vital to the survival of psychoanalysis as a respected profession. What has convinced me of this is not only the repeated attempts by other groups to achieve licensure in various states, or even the attempts by those groups to become the sole credentialing body for psychoanalysis. What has convinced me the most is dealing with state and federal legislative and regulatory agencies that have made it clear that a definition of who may be considered a psychoanalyst and what may be considered a psychoanalytic service is essential. If we cannot come together with like-minded colleagues of other organizations to achieve such a goal, we are likely to be marginalized and regulated into oblivion.
The document for standards of psychoanalytic training that we have been working on with the Consortium has been presented several times to Board and Council, and both bodies have indicated that it has promise, though concerns were certainly expressed. Prior to its last meeting, the Consortium seemed close to finalizing a proposal among the negotiators to bring back to our organizations for serious consideration. To do so would be to achieve our goal of creating minimum standards for psychoanalytic education in the United States in order to ensure that the psychoanalytic care delivered to the public will be of high quality.
Problems remained to be resolved, however. Serious concerns were raised by some participants about the training analyst system. They also questioned some of the numerical standards that had been agreed to earlier. A major factor in our negotiation has been our wish to include the Independent Psychoanalytic Socities in the Consortium, and indeed both Board and Council voted to make this a condition of our participation. We have been working on this issue and hope to create a path for this to occur.
In the meantime, a significant and unexpected bump has developed in a road that we had thought was smoothing out. This has to do with concerns of Division 39 that The American is unfairly competing in various cities. This came as a considerable shock to us and to the other members of the Consortium, particularly when the threat of legal action was implied. A letter from Lew Aron, the president of Division 39, to The American informing us of this possibility was read at Board and Council meetings. On June 12, we met at length with the Consortium Board, and later Don and I met separately with representatives from Division 39. At both this meeting and an earlier one on May 29 in Toronto, a more disturbing aspect of the problem emerged. The opinion was expressed by the Division 39 representatives that the fact that our Association has both a membership and an educational function creates, in their view, a significant source of difference and tension between us. In a respectful discussion, we discussed some possible ways to work together to overcome the current difficulties.
Due to the delicate and possible litigious nature of the negotiation, I cannot give more detail, but I did want to inform the membership about the situation.
The other major area of concern is that of the Panic Disorder Guidelines produced by the American Psychiatric Association and published in a supplement to the May issue of its journal. We had previously posted on the members' list two letters written to the APA expressing our deep concern about these guidelines.
Both Board and Council unanimously approved a statement to publicly question and oppose this particular guideline. This statement, as amended by members of Council, has been submitted for publication in the next available issue of JAPA and has also been submitted to the Psychiatric News and Psychiatric Times.
In Toronto I met with the Guidelines Steering Committee under the chairmanship of Jack McIntyre. He graciously invited me to participate in the meeting, and I discussed our concerns with the committee for a considerable time. In meeting with the steering committee I pointed out that these guidelines have grave legal, political, economic, educational, and patient-care implications. We had also discussed these concerns in a previous meeting with the APA officers, some of whom suggested a number of possibilities for solution. I believe that both the officers and the committee are impressed with the action of our Board and Council and are taking this matter very seriously.
There's an object lesson here. I believe this situation results in part from our isolation from our core professional groups. If we had been more involved with the APA, as we must be in the future, our Association and our individual members might well have had more effect on the shape on the guidelines project. I believe it is not too late. This particular guideline will be reconsidered in the next two to three years, and we must continue our effort to have our views and our data included. The next treatment guideline to be considered is that on treating the borderline personality. I am informed that there are seven people in this work party, five of whom are psychoanalysts.
We are making a major effort in re-establishing our affiliations with other professional groups, and a task force under the direction of Barbara Rosenfeld is working in that arena. We are conducting a survey to determine how many of our members belong to other professional organizations. We will use those data to encourage our members to rejoin and reconnect with the organizations of their parent disciplines. For example, we have very few ties to the American Psychological Association, the American Medical Association, and the National Association of Social Workers. In response to our active effort with the American Psychiatric Association, a number of analysts recently have been appointed to APA committees. We must continue that effort and achieve similar liaison connections with other groups. This is one of the major ways that we can magnify the effect of our organization and strengthen mutual collegial bonds. Members who would be willing to serve as liaison to other professional organizations should contact either me or Barbara Rosenfeld.