Freud's 1918 “Lines of Advance in Psycho-Analytic Therapy” comments on “the pure gold of analysis,” cautions against alloying analytic gold, and — less often noted — also calls for activism in extending the availability of psychoanalysis and psychoanalytic psychotherapy. Freud hoped that “the conscience of society will awake and remind it that the poor man should have just as much right to assistance for his mind as he now has to life-saving … surgery; and that neuroses threaten public health.”
The goal was to be an analyst when doing psychoanalysis but an activist in extending psychoanalytic benefits. Having taken both messages to heart, the American has maintained educational and practice standards while fighting for privacy and confidentiality, educating the public, and reaching out to other concerned professions. In the spirit of such activism, this special section is devoted to a next organic step in service to psychoanalysis and those who will benefit from it.
The trends in the Association show that the “New American” is more than a slogan. We have become more inclusive, more vigorous, and stronger. Evolution was not, and in the future will not be, without legitimate debate in which people of integrity disagree, but our organization can be proud of having a representative and democratic agenda. APsaA's internal development has brought changes in our professional ecology, including outreach to the press, Congress, and the regulatory agencies.
The result has been an impact out of proportion to our numbers. Who would have predicted accomplishments such as the landmark Jaffee v. Redmond Supreme Court decision on privilege, re-affirmation of that privilege in the Bierenbaum murder case, the Surgeon General's report supporting confidentiality in psychotherapy, and President Clinton's first effort at ensuring privacy and confidentiality in federal regulations?
“We are learning to deal with government, industry, and the public in the protection of the rights to privacy and confidentiality, fundamental to high-quality care. We need to build upon those rights to insure that the best care grows from them.”
A next step is to build upon what we have learned as an activist organization to reestablish psychoanalysis and psychoanalytic psychotherapy as the standards of mental health treatment. While we consider psychoanalysis the gold standard of care, the excesses of managed care have more than alloyed that gold. Access to care is generally governed by health-care plans purchased by employers or supported by government. With some important exceptions, those plans effectively exclude psychoanalysis and psychoanalytic psychotherapy. We need to work toward a consumer, employer, and regulatory climate in which plans without real access to psychoanalysis and psychoanalytic psychotherapy will be considered inadequate — in fact, unacceptable.
We are learning to deal with government, industry, and the public in the protection of the rights to privacy and confidentiality, fundamental to high-quality care. We need to build upon those rights to insure that the best care grows from them. We now need to learn how to deal with government and employers in the interest of quality care and fair, equitable access to it.
Are the foes formidable? Yes. Are the odds long? Yes. Is there corporate and governmental machinery ranged against us? Yes. But that was, and is, true of the struggle for privacy and confidentiality.
There are signs of hope, and we do have important experience. This section of TAP describes an insurance plan that fully covers psychoanalysis and psychotherapy on parity with physical illness, reports on one society's successful effort to prevent a health plan manager from deleting psychoanalysis from its benefits, and offers a vision of what the American can do to re-establish the benchmark of quality in truly available care.