The Chicago Psychoanalytic society was founded in 1931; its charter members were Franz Alexander, Lionel Blitzsten, Thomas French, Karl Menninger, Helen McLean, and seven others. The society's current membership now approaches 225; the society has adjusted to this eighteenfold increase by developing new programs and recognizing its responsibilities to the psychoanalytic community and to the community at large.
In 1990, an ad hoc committee on marketing was formed at the urging of one of our members, who had been invited by the medical director of Illinois Blue Cross to discuss how psychoanalysis would respond to the changes in psychiatric and medical economics brought by managed care. In April 1991, the ad hoc committee became the society's official Practice and Marketing Committee.
Its first decision was to recommend retaining an outside consultant to study practice problems of the membership and whether the structure of the society could provide any solutions. This led to a contract with the University of Chicago Business School's marketing class; the school provided this consultation at a reduced fee. The consultants met regularly with the Practice and Marketing Committee, interviewed forty members of the society in depth, conducted six focus groups, and surveyed members' practices with a detailed questionnaire. The consultants' report was disturbing. Their findings included a lack of a clear organizational identity, a limited organizational structure, lack of communication among members, and low involvement.
One immediate result was that the society organized a weekend retreat, which led to the development of an idea to establish an independent entity that would provide clinical services along with public relations and marketing efforts. The idea was presented by the Practice and Marketing Committee to the society in the fall of 1994. The following spring 1995 saw the formation of the Center for Psychoanalytic Services. Fifty-nine members of the society joined the center. Each contributed $1,000 to provide the capital needed to retain a public relations firm and to cover administrative costs. Teams were developed to market to specialized sectors of the community, such as business, law, dentistry, medicine, arts, and education. The results were dispiriting to the fifty-nine members: Only a handful of referrals were generated out of the hundreds of man-hours given to team meetings and contact with the specialized sectors.
A significant hurdle was the psychoanalysts' discomfort with an active marketing initiative; their tendency was to make one or two efforts and conclude that it was unlikely to produce results. Toward the end of this period, the Center was advertised on one of the local classical radio stations, WFMT, for three weeks, but the advertisements produced no responses. (However, the special-interest group for educators flourished, has continued to function, and has approached the institute about becoming an affiliate of the institute's clinic. This group has established consultations at various preschools and private schools.) The handwriting was on the wall. Membership dropped to only twenty, and activity dwindled. In the fall of 1998, the center dissolved.
In hindsight, several problems undermined the effort. The project was probably too ambitious and required a more realistic understanding both of the length of time needed to achieve its goals and of the financial investment needed from its members. Greater administrative help in the form of at least a quarter-time person was needed, and more help in finding venues where analysts could be speakers.
Nonetheless, benefits can be identified from this project. The society was invigorated, and members became more familiar with the importance of an active outreach effort. The society has established an incentive for its members to give talks in the community and gives the members $200 per talk, with a limit of one honorarium per year. The most tangible result has been the establishment of a joint Public Relations Committee by the institute and the society (the Chicago Institute and Chicago Society are autonomous organizations); each provides half of an annual retainer to Dottie Jeffries for marketing (the same Dottie Jeffries who has become the media relations consultant for the APsaA).
Five years ago, the president of the Chicago Society, Harvey Strauss, recognized the need for a process to aid medically or psychologically impaired psychoanalysts. He had encountered instances in which an analyst continued to see patients when he/she was unable to perform professional duties competently. Typically, the patients and the community suffered from the haphazard manner in which such situations were resolved.
A committee was formed to develop a set of guidelines and procedures for an impaired analyst committee, which came to be called the Psychoanalyst's Assistance Committee (PAC). While the exploratory committee had to consider the society's legal requirements to report an impaired analyst to the Illinois Department of Registration and Education, the committee also wanted to create guidelines that reflected the society's wish to help an impaired colleague at a difficult time. Defensiveness and suspiciousness are regularly encountered in someone whose functioning is being questioned; the threat to his/her livelihood and career is real. Efforts on the part of family and friends to protect the analyst whose competence is questioned are also natural. Guidelines to cope with these responses in a way that minimized confrontation were a priority for the committee. The guidelines were to include ways of safeguarding the patients under the care of the impaired analyst.
The exploratory committee consulted with physicians experienced in dealing with impaired colleagues in hospital settings. It also obtained extensive legal consultation to be certain that the society's guidelines would comply with state laws for all the disciplines represented by its members. The legal counsel assisted in constructing guidelines that would protect the identity of the analyst being evaluated for impairment and would also protect the society and the committee members from lawsuits.
The committee learned that an assessment would have to be initiated by complaints from any source about the possible impairment of a colleague. The assessment it would proceed through a series of careful steps: (1) meeting with the analyst to explain the PAC's position, (2) requesting that the analyst seek appropriate evaluations to determine whether such a condition of impaired functioning existed, and (3) determining what the next appropriate step would be.
Phil S. Lebovitz, M.D., is president of the Chicago Psychoanalytic Society.
The committee realized that the procedures would also require that the PAC remain involved until the impairing condition was relieved or the analyst decided to retire from practice when no beneficial treatment existed. The work of the exploratory committee extended over many months and numerous drafts of the guidelines. A final document was approved by the membership in April 1998. The PAC has since dealt with a situation of the type for which it was created. The society believes the outcome proved that the procedures were sound, effective, and as fair as could be hoped.
Because the society and the institute have different responsibilities, we realized that situations could arise when efforts to assess a colleague's impairment would result in duplicate processes; this would be wasteful of both time and financial resources. We also realized that both organizations might be proceeding without the knowledge of the other. The society and the institute are now developing a joint committee to function as the PAC. The need for such an entity and such procedures becomes more imperative as time passes; the legal requirements impose it on us. Perhaps more importantly, concerns for our patients' welfare and our profession's integrity, and our compassion for our colleagues, demand that we respond with procedures that are just and fair.
Finally, a quick note about our recent biennial conference, which was held on March 17–18, 2000. The theme of the conference was “Clinical Issues in the Lives of Lesbians and Gay Men.” The aim of the conference was to facilitate our learning about gays and lesbians and their learning about us as contemporary psychoanalysts.
The prepared addresses were given by Ralph Roughton, Elisabeth Young-Bruehl, and Martha Nussbaum. Roughton presented clinical material about a patient he treated years ago for a conflict on whether to remain straight or to come out as a gay man. Young-Bruehl presented material about the complexities of lesbian parenting. Nussbaum, a faculty member of the philosophy department at the University of Chicago, presented an engaging lunchtime address on the cultural context of homosexuality in ancient Greece; 205 people attended.
A lengthy article about the conference appeared on the front page of the “Tempo” section of the Chicago Tribune the day after the conference, and a videotaped replay of Nussbaum's speech was aired on a Chicago cable-access station. The conference explored new ground for us because, for the first time, we asked non-analysts to co-chair the discussion groups along with a member of our society. This conference, we hope, represented a substantial step toward re-establishing psychoanalysis' relevance to contemporary issues in people's sexual lives.