Robert Pyles, presiding over his first Executive Council meeting as president of the American, said at the December 17, 1998, meeting in New York that a transformation is occurring. The American is becoming an increasingly effective group, with a strong internal organizational structure. He noted that recent campaigning for national office in the American indicated a healthy and vigorous organization. Candidates for office disseminated their visions and platforms, which in turn stimulated intelligent discussion of serious issues facing psychoanalysis.
The meeting's full agenda included approval of a new eligibility/membership by-law proposal (which will be sent for a vote to the certified members) and approval of an affiliated (non-member) category for psychotherapy associates. There was extensive discussion of federal legislation, including issues of patient-therapist confidentiality. The deliberations proceeded under the knowledge that the American is budgetarily challenged.
Treasurer Newell Fischer presented a report on the fiscal situation that looked back at 1998, looked forward to 1999, and addressed concerns about the future. He thought the Association would come close to a balanced budget for 1998. Because some funds for research were restored, there was a planned deficit of $11,000–12,000, with hopes to make it up in 1999. On the positive side, dues collection has been excellent, and income from JAPA subscriptions has increased. For 1999, income and expenses are expected to be $2 million, with no leeway. Assets are growing slowly but are not what they should be for an organization the size of the American. Income is relatively fixed, while expenditures rise. Some expenses are essential for survival, such as for government relations and public information, and of course there are fixed expenses such as salaries, overhead, etc. Budget cuts, as painful as they are, may become a greater reality in the future.
Phyllis Tyson presented a new, improved version of the eligibility/membership by-law amendment developed by the Committee on Preparedness and Progress (COPAP). Over the past several years, the Board on Professional Standards (BOPS) felt it could gradually relinquish its oversight function with regard to selection of certain candidates for analytic training. The by-law proposal allows each constituent institute the option of accepting most applicants for training without obtaining a waiver from the American. Within the guidelines and standards of BOPS, the amendment would allow institutes to select physicians, doctoral-level mental health professionals, and mental health professionals with clinical masters degrees (which are generally recognized as the highest degrees within that profession) and who have at least two post-degree years of didactic and clinical training. This by-law proposal was passed by the Council and is to be voted upon by the certified membership. Two-thirds of the certified membership must favor the amendment for it to be enacted.
Photo by mervin S. Stewart
Gail Trivedi presented a proposal to create an affiliate (non-membership) category of psychotherapy associates. Associations for Psychoanalytic Thought (APTs) and other forms of affiliation with psychotherapists have developed in Cincinnati, Cleveland, Wisconsin, and southern California. Chicago, Boston, Pittsburgh, Atlanta, Virginia, and Ontario are all interested in having affiliations. Already some 700 people nationwide have expressed interest in this affiliation. The category of psychotherapy associate was approved by Council.
Warren Procci, representing the Committee on Government Relations and Insurance, reported that the CGRI/CPR fundraising effort brought in $41,000. CGRI is actively engaged in a dialogue with the Health Care Financing Administration to get an outline of its auditing procedures of 90845, the psychoanalytic code. Protecting confidentiality will be the most important task in the next federal legislative session. A major opportunity to influence legislation on privacy and confidentiality is coming up in the spring: CGRI will hold its second Washington meeting in March, and the Annual Meeting of the American will take place in Washington in May. The agenda for the May meeting will include several programs relating to political activism. [See box on page 5.]
James C. Pyles of Powers, Pyles, Sutter & Verville gave an update on legislative matters. He advised that members of the American must be ready to act quickly with regard to possible legislation on privacy and confidentiality. Congress will address the HMO Patient Protection Act, which has attracted much public support. The public wants privacy for psychotherapy communications.
Glen Gabbard reported for the Committee on Confidentiality. He said that this committee believed the American should not open its doors to third-party reviews because there would be no protection of confidentiality once information reached a third party. The committee's position is that the Association should endorse only genuine peer review, in which a consultant psychoanalyst would review the treatment within the confines of strict confidentiality and no report of the content of the analysis would be made. Robert Cummings, speaking for the Committee on Peer Review, thought there may be some, perhaps rare, occasions when confidentiality could be protected with reporting and with patient and analyst in agreement about the matter. It could be restricted to pre-authorization of treatment, not for ongoing review. Paul Mosher thought that confidentiality could not be protected when subjected to third party review. Jon Meyer indicated that there are some enlightened insurance companies that do cover psychoanalysis, and he is the medical director of one. At six-month intervals, there are progress reports, and at times an independent consultant is called in. The Council voted to support the report of the Committee on Confidentiality.
Leon Hoffman, co-chair of the Committee on External Credentialing, stated that Division 39 has thought the American had an unfair competitive advantage by virtue of its internal structure. [See BOPS article on page 6.] The Council voted a year ago to join in the Consortium's accreditation efforts and to push for inclusion of the Independent Psychoanalytic Societies (IPS). The IPS is still not a member of the Consortium.
Two guests from the IPS, James Gooch and Barbara Stimmel, also commented. Gooch spoke of the IPS's desire to go forward with external accreditation within the Consortium. Stimmel said the IPS represents a significant membership and has visibility and determination to be recognized. The IPS wants to move forward with the American because of shared values and interests.
Drew Clemens reported for Jonah Schein on the Ad Hoc Task Force on Certification and Membership. The Committee will examine two questions: (1) Should certification be linked to membership privileges in the American? and (2) Should the American maintain different levels of membership privileges for its organization, and if so, how should those levels be structured? Currently, one must be certified to be eligible to hold office, to sit on the Executive Council, and to vote on by-law changes. Those are the three functions at issue. A report is planned for May 1999.
Nadine Levinson praised Paul Mosher for the PEP CD-ROM idea. An update, to include both a PC and a MAC format, is on the way. It will include journal articles through 1996 or 1997. To date, 1,700 disks have been sold. The project is now in a position to generate a profit.
Fred Busch gave the report of the Task Force on Self-Publication. This committee was formed because the number of publishing houses interested in publishing quality psychoanalytic books has decreased. It was thought that the American might take a leadership role in the dissemination of creative psychoanalytic thinking. The committee also investigated whether such an effort might be profitable. It was decided to move toward publishing a book series in collaboration with JAPA. This project would incur minimal financial risk and might possibly generate revenue.
Betsy Comstock reported for the Committee on Honorary Membership and Awards. Paul Mosher was the first person to be nominated for an award for distinguished service to the American. Carol Hymowitz, a senior editor at the Wall Street Journal, was nominated for a distinguished service award in journalism. Wilma Bucci, a psychoanalytic researcher, was nominated for honorary membership. The nominations of Mosher, Hymowitz, and Bucci received overwhelming approval by the Council [see page 2].
In the afternoon session, Otto Kernberg, President of the International Psychoanalytical Association, spoke. The IPA Congress will take place at the end of July in Santiago, Chile. Its program, “Affect Theory,” is one of the best yet. The IPA is now investing about $200,000 per year in research, which is very important for the survival of psychoanalysis. The administrative structure of the IPA has become too big and expensive, leading to internal conflict and stress. A task force has been appointed to simplify radically the administrative structure of the IPA.
Harvey Rich, speaking about the American Psychoanalytic Foundation, noted that he had served as both chair and president of the foundation. He has held both roles since the early days of the APF's existence. He proposed Carol Lindemann Abend for chair of the board, with responsibilities to increase the board's development, bring new members onto the board, and oversee board activities. Rich's duties, as he continued to the end of his term as foundation president, would then be day-to-day operation of the foundation, as well as fundraising. He proposed Maurice Beznos as a member of the foundation's board. His nominations were approved.
Judy Chertoff reported on the Committee on Council. A briefing book is being put together for members of Council. It will introduce new councilors to the activities of Council, fiduciary responsibilities of Council, and channels of communication within the American. It will include an organizational chart, a summary of a day in Council, and CVs of its members.
Robert Galatzer-Levy, speaking for the Committee on Scientific Activities (CSA), said that a background paper developed by the CSA Subcommittee on Homosexuality indicates that there is no essential condition that could be referred to as homosexuality. There is no evidence for any uniform cause or group of causes, psychological or biological, for same-gender interest. Also, there is no increase in anything that could be labeled as psychopathology that is associated with same-gender sexual interest except for the consequences of stigma. And there is no evidence that people who are predominantly homosexual in their sexual orientation can change that orientation through any form of therapy whatsoever, including psychoanalysis. It is a misrepresentation to indicate that such can be done. There is considerable evidence that attempts to change sexual orientation in people can be damaging, even extremely so. The committee is working on a statement to be presented to Council. Bertram Cohler and Galatzer-Levy are completing a book based on the report which will soon be published.
Erik Gann and Lee Brauer spoke for the Committee on Psychoanalytic Practice. The 1996 survey indicates a continuation of the slow decline in analytic cases (declining 1 percent per year since 1976). The average member has four cases in analysis, and 13 percent of members have no analytic cases. Currently 30 percent of cases in analysis are seen three times a week. Now 50 percent of members have at least one case in analysis three times a week. Three years earlier, that figure was 35 percent. Members who do this tend to have smaller practices, are less satisfied with their practices, and are somewhat less affiliated. Most members have assiduously avoided managed care. Only one-third of members participate in any managed care, but 50 percent of affiliate members do.
Prudy Leib, chair of the Fellowship Subcommittee, proposed making it into a freestanding committee. It has been a subcommittee of the Committee of University and Medical Education. The measure was approved, making it a joint committee of Board and Council.
Gerald Melchiode reported on the Student Associates Committee. He proposed that the American establish a teaching award for members and candidates who teach non-candidates. The objective is to recognize at the local level those who are excellent at teaching and to encourage members to do this kind of teaching. The award would be named after Edith Sabshin, who strongly advocated and epitomized such teaching. This was approved.
Arnold Richards was reappointed to a second five-year term as editor of JAPA.
DeWitt Montgomery reported for the Committee on Council Structure and Function. It recommended using existing committees to perform new tasks rather than creating new and costly committees.
Ralph Engle reported that many institutes contributed to refining the new ethics principles and standards proposals. The proposals will probably be voted on in May 1999. A suggestion was made to have the Ethics Committee meet with the committees on Confidentiality and Peer Review. What is ethical and what is lawful may differ.
Leon Hoffman, chair of the Committee on Public Information, indicated that there was considerable interest by the press in the public conference on homophobia. Hoffman praised the work of Dottie Jeffries, who has helped the American make many important contacts.
Allan Rosenblatt, co-chair of the Committee on Societies, stated that working liaisons have been established with almost every society. His committee has found that societies are rather leery of site visits, feeling them as judgmental. He pointed out that the committee is available to help, not to evaluate or judge.
Lee Jaffe, representing the Affiliate Council, reported that there are 675 candidates in the twenty-nine institutes of the American. Existing since 1994, the Council meets twice yearly at the Association's meetings. Each institute has a delegate and an alternate. The delegates are liaisons with candidate organizations at each institute. The incoming president of the Affiliate Council is Nancy Brehm.