The American Psychoanalytic Association has completed the research phase of its strategic marketing initiative. The research has revealed formidable challenges for the organization, for its local institutes and societies, and for the individual analyst.
A series of focus groups was conducted in Spring 2001 to help the Strategic Marketing Committee create messages about psychoanalysis, psychoanalysts, and local and national psychoanalytic associations that would enhance their public image. Three of the groups comprised potential patients, and the remaining four comprised mental health professionals. The committee conducted a second series of focus groups with various internal constituencies during the December 2001 meeting in New York.
These focus group findings may now be familiar to many readers. Past issues of TAP have carried several articles about the research. I presented the research to a number of different groups at the May meeting in Philadelphia.
In four focus groups we listened to mental health professionals: social workers, psychologists, and psychiatrists. All were in private practice. These professionals saw psychoanalytic theory as a core component of their training, although not the only theory they drew upon in their practices. However, despite their appreciation for psychoanalytic theory, these professionals expressed significant skepticism about the efficacy of psychoanalysis as a treatment modality. “It creates a kind of dependency. … It doesn't allow people to get on with their lives.” They spoke of a “power differential” between analyst and patient. Others saw a lack of cultural and gender sensitivity in psychoanalysis.
The criticisms were even harsher for psychoanalysts themselves. “Passive, unemotional, uninvolved, detached, isolated, and elitist” were typical words used to describe psychoanalysts and what focus group members viewed as the narrow, insular world analysts live in. The psychoanalytic community was described as having a “cult-like element” to it: “You're either in the group or you're not in the group.” Some of the participants had experienced these feelings when attending meetings and presentations at local institutes or societies.
Participants saw psychoanalysts as not open to new ideas. The psychoanalytic community “doesn't take well to challenging ideas.” One psychiatrist commented, “Psychoanalysis isn't sure what it is. … Is it a science or not? … It's not a science in terms of being interested in all forms of information.” Although focus group participants were aware through local institutes and societies of some analysts reaching out to other mental health professionals, there was some cynicism as to what it was analysts were trying to accomplish in their outreach efforts. “Even in their approach to be more involved in the community, it's still this We want to bring you the truth, we have the wisdom,'” commented one focus group participant.
Photo by Mervin Stewart
What do these mental health professionals see as the future of psychoanalysis? The conclusions were mixed. For some, psychoanalysts are a dying breed. Others felt that perhaps the psychoanalytic community was becoming more open in genuinely reaching out to the rest of the mental health community. For some focus group participants, the profession of psychoanalysis has lost important opportunities. The perceived insular and elitist nature of analysts has shut them out of universities and medical schools. The mental health professionals view this as unfortunate, because those in training now often have little exposure to psychoanalytic thinking and theory.
As Dick Fox, APsaA's immediate past president, wrote in an earlier TAP article, as analysts “we have contributed to this negative representation by embracing non-responsiveness and anonymity, not only in our consulting rooms, but also by carrying this persona into the world around us.” He noted that psychoanalysts have to attempt to modify the profession's public image as it was portrayed in the focus groups.
The research findings brought about a new challenge for the strategic marketing initiative. We needed to address the question, “How are analysts and their organizations contributing to these perceptions?” It was decided to explore the research findings further by talking to members within APsaA.
At the December 2001 meeting in New York, focus groups were conducted with members of key APsaA constituencies — BOPS, Council, members, associates, and affiliates. The findings of the external focus groups were shared with these Association groups, and they were asked, Why do other mental health professionals feel this way about you as analysts? How do analysts, both individually and as a profession, contribute to or perpetuate these notions? Do members feel treated on the “inside,” amongst their analytic colleagues, as mental health professionals feel on the “outside”? What can be done to change these perceptions?
Some APsaA colleagues participating in the groups dismissed the views of the external groups. Notions that analysts are aloof, arrogant, impassive, are in their view fostered by people's own fears of the psychoanalytic process. “They are the problem, not us.” But most participants understood the nature of those mental health professionals' perceptions. They cited several factors contributing to what analysts heard about themselves.
Lee Zacharias, M.S.W., is president of the Zacharias Group, which focuses on qualitative research, primarily in health care. Before establishing the company, she held positions with several health care organizations in Washington, D.C., and positions in clinical and administrative social work.
These included the history of professional isolation, an elitism once enjoyed by analysts, a sense of dogmatism that makes analysts seem aloof. And, they said, analysts can be arrogant, insular, and not professionally involved in the community. There is a history of analysts being exclusionary and patronizing toward other mental health professionals. There is a need to acknowledge this reality, to be less caught up in defending such behavior and to move forward, they said.
Many of the people participating in these internal focus groups described how they have felt intimidated by their own superiors and sometimes by other colleagues. They too have experienced the arrogance and aloofness described by the wider mental health community. They see institutes and societies that are hierarchical and exclusive in nature and senior analysts who seem resistant to change. An emphasis on conformity, and politics within institutes, have fostered the problems that surfaced in the research, these colleagues believe.
Are these images and perceptions cast in concrete? Is change possible? Change is critical if psychoanalysis is to survive. APsaA and its local institutes and societies must begin to look at where they want to be five years from now — as a member organization, as a training center, and as a resource for other mental health professionals and the community. Do current structures, current training models, and outreach to other professionals enhance the future of the profession? Or are they barriers to keeping psychoanalysis alive and well?
While certain issues and tasks, such as certification, must be addressed at the national level, local institutes and societies and individual analysts must also move forward. Reviewing organizational structures, expanding outreach to other mental health professionals, and pursuing greater visibility in the community require no national initiatives. They are local and can be acted upon immediately.
APsaA president Newell Fisher has made dealing with these issues a top priority of his tenure in office. He has initiated a series of “town meetings” with local institutes and societies to begin a dialogue with members about the issues and perceptions found in the research. Greater communication is the right starting point for asking the tough questions: What is it about your culture, governance, and organizational structures that creates barriers and perpetuates these perceptions? Can they be changed?
If the true values and character of the profession and its organization are at odds with the perceptions in this research, the task is clear: Communicate the values and character more clearly. If the perceptions resonate, a deeper process of rediscovering those values and characteristics is in order. What you do, what you choose not to do, what you say, and how you say it — all communicate the values and characteristics of an institute, the national organization, and an individual analyst.
Photo by Prudy Gourguechon