I was born ten days before the expected due date. I am told I have continued to be impatient. So I will skip the introductory “the best of times, the worst of times.” We have much to do. Our plate is overflowing.
I sat in a darkened room, behind a one-way mirror, and watched two focus groups. I was embarrassed by what they said. Then I felt angry and defensive. I knew that what was being said was in large measure accurate, but I did not want it “in my face.” This was a group of mental health professionals — non-analysts. They were in their forties and fifties, sophisticated, thoughtful, and articulate. Most were well trained, all had been exposed to analytic thinking, and a few said they had been in analytic treatment.
Their message was loud and clear: Analytic concepts were useful in their thinking and clinical work, but psychoanalysts were cold, aloof, condescending, and unlikable. Analysts were oblivious to the pain that patients suffered. They seemed unrelated to the real world of those seeking help. Going to an “open” psychoanalytic meeting was oppressive. The papers were stale, irrelevant, and presented in a secret jargon. The non-analysts felt like intruders who did not know the secret handshake. In conferences and seminars led by psychoanalysts, questions were often met by counterquestions or dismissed with the implied message “If you were sufficiently analyzed, you would understand the material and the answers to your questions would be obvious.” Many in the group had large clinical practices; few would consider referring a patient to a cold “Freudian” analyst.
At first I thought that these mental health professionals must be bitter about some disappointing treatment experience and that they were exaggerating and expressing a variety of transference distortions. Maybe they were rejected from one of the training programs and were reflecting their hurt. Maybe they were talking about a previous generation of analysts — certainly before my time. Before I became “important” in the analytic community I was very unimportant; why then did I feel so attacked personally and embarrassed for the analytic community to which I belonged?
A reporter from a newspaper interviewed me. She was smart and experienced. Embedded in the pleasantries were barbed questions. “You mean that people actually come four or five days a week and lie on that couch?” “Are there still Freudians?” “If I'm the insurance company paying the bill, why shouldn't I know why the patient is seeing you and what's happening in the treatment?” “Should an insurance company pay the bills for someone who is not really that sick?” This reporter's queries reflected her view of what analysts do and who they are. She was sophisticated, and she had been around.
So what has happened? Mental health professionals, sophisticated reporters — are they all exaggerating and distorting? Was my sample skewed?
We can speculate on how we have arrived at this place and how we have acquired this persona. Historical and developmental perspectives might be informative and help us change the way we've been doing business, but I will leave that for another time. At the moment it is imperative that we address with vigor this negative image. We must do it today — not tomorrow! (My impatience again?)
Many in the Association would assert that this negative image of psychoanalysts reflects the unconscious forces of the public: displacement, transference phenomena, fear of exposing inner demons, etc. Yes, of course; I went to analytic school also. I would contend, however, that we psychoanalysts have been major contributors to this image through our behavior and attitudes: aloof, uncaring, and unpleasant. I would suggest that some of us take a certain pride or pleasure in this “analytic stance” even if it occurs in a totally non-analytic setting — teaching a college class or attending a social gathering. Perhaps acting “neutral” or mildly schizoidal is a way of dealing with the discomfort of being confronted by difficult “naïve” questions or a response to social anxiety.
Of course, it is far too simplistic to attribute this poor image only to our behavior and attitudes and to projections from the public. Clearly there are many societal and economic factors at play. In these difficult economic times, it may be a stretch for a struggling non-analytic mental health professional to refer a patient to an analyst for ongoing treatment.
Can we change our image, or is it too embedded in our culture and the mind of the public? I don't honestly know, but I feel certain that we have to give our best shot to changing this image. If we don't try to turn this around, we will most likely continue a downhill trend in terms of numbers of patients in analytic treatment and candidates in training.
What specifically are our next steps in thinking, planning, and acting? The national organization can help, but national efforts are too far from where the action is. The help is not sufficiently specific, and it cannot be sensitive enough to the unique local needs and issues of the communities where we work.
So I am coming to visit you; we can talk and think together about the challenges in your community. As of early June, we were planning with local assistance to set up society “town meetings” around the country. These meetings and the issues we will be discussing and brainstorming are top-priority, vital, and urgent. I will be there and I will try to bring a colleague, but you must be there. Please, no voicemail messages: “I'm too busy” or “I have a conflict in my schedule.” You are the key to change. Our professional lives are in danger and our Association is under fire. Don't let yourself down.
I look forward to talking with you.