Lee Zacharias, APsaA's marketing consultant, presented a challenging address separately to Council, BOPS, and the Meeting of Members in Philadelphia in May. A summary of Zacharias' report can be found on page 5 of this TAP.
“Don't shortchange yourselves as you address these issues,” Zacharias cautioned, “and be brutally honest about the resources that must be spent.” Most who commented on Zacharias's presentation stressed the need to change our culture and our behavior. “We don't listen well when we go out, but also we don't tend to go out,” said Jon Meyer.
The Council spent most of its time in an open discussion on empowerment, a topic suggested by Committee on Council chair Mike Gundle. He decried a “malignant form of parallel play [within the organization] — various groups don't talk and listen to each other, but they're carried away with fantasies about each other.” He observed, “There's a finite amount of power in any organization.”
In response, Bob Galatzer-Levy argued that a “conceptualization of a discrete amount of power is incorrect. In fact there is so little power, that's the problem. Except for the power to make individuals very unhappy, we have very little power.”
Paul Mosher complained that training analysts occupy five of the seven slots in the Committee on By-Laws Revision. He also questioned where a procedure code would fit into organizational structure.
Closing out the open discussion, Gundle put forward a motion “to clarify our options for bringing APsaA into compliance with our bylaws concerning the Meeting of Members, the procedure for amending our by-laws, and the role and composition of Council committees.” The motion was immediately tabled.
The Committee on Gay and Lesbian Issues presented the final version of its position statement on gay and lesbian parenting. The position statement, which had been approved the previous day by the Board, won unanimous approval from Council. See page 1 for full text of the position statement.
Photo by Mervin Stewart
Three committees from the section on practice (the Committee on Peer Review, the Committee on Government Relations and Insurance, and the Joint Committee on Confidentiality) worked together to produce a “Minimum Necessary Position Statement for Disclosure of Information to Third Party Payers for Psychoanalytic Treatment.” The Health Insurance Portability and Accountability Act (HIPAA) medical privacy rule intends that the professional organizations of covered clinicians establish standards for disclosing information to third-party payers for the processing of routine or typical claims. The standards aim to appropriately limit access to personal health information without sacrificing the quality of health care. They are not meant to override professional judgment and standards. (Readers wishing to see the full text of the Minimum Necessary Position Statement should contact Bob Cummings at .)
Howard Levine addressed state-level licensing problems. The Committee on Local Health Care Initiatives has been gathering local information and distributing it. Members need to watch what's happening locally. The committee can play a consultative role in helping local groups address state-level problems and welcomes requests for consultation.
Vivian Pender described the current struggle in New York. A “scope of practice” bill has been in the legislature since 1996. [Editor's note: As of July 2002, the bill had passed both the assembly and the senate but had not yet been sent to the governor for signature.] The bill covers the licensing of mental health counselors, creative arts therapists, psychoanalysts, and others. It allows people who have met very low training standards to be licensed as “psychoanalysts.” The New York licensing bill has attracted attention in the international psychoanalytic community. Daniel Widlöcher, president of the IPA, and APsaA's Fischer and Benson have written a letter to Governor George E. Pataki stating that their organizations support a higher level of qualifications.
Jim Pyles, APsaA's political lobbyist in Washington, D.C., reported on the status of our lobbying efforts. On March 27, the Bush Administration proposed rules that would reduce the privacy rights and protections that were introduced in the original HIPAA privacy rules. APsaA officially “entered comments.” To date, the rule has not been amended, but there are rumors that amendments will come out in October that will eliminate a patient's right to consent.
The U.S. Department of Health and Human Services offered the justification that this is another benefit to the people and will improve access to good-quality health care. HHS claimed it was taking a patient-oriented approach and was certain that patients would want this barrier to health care removed. Consent would be replaced by “optional consent.”
Prudy Gourguechon is editor of TAP.
Photo by Mervin Stewart
What is weakening the commitment to privacy? Pyles suggested that (1) some of our colleagues in other professions are becoming less committed, (2) it is difficult to alert the public to the threat to its right of consent, (3) insurers are trying harder to obtain mental health and other health information, and finally (4) there may be a post-9/11 syndrome — people are willing to give up privacy if they think it is being traded for more safety.
What can APsaA do? We can educate the public by writing op-ed pieces and articles; get the issue on the election screen by talking to candidates; and consider litigation, since the federal government is waiving a fundamental right.
Eric Gann, chair of the Exploratory Subcommittee of the Nominating Committee, presented names of people recommended for nomination to Council. [Editor's note: The Nominating Committee, in this context, is the Executive Council. The members of the Exploratory Subcommittee are elected by Council and propose individuals who have agreed to have their names put forward to Council for possible nomination for office.]
K. Lynne Moritz and Arlene Richards were nominated for the office of secretary. Betsy Brett, Malkah Notman, Mary Scharold, and Beth Seelig were nominated by Council for two positions of councilor-at-large. Later in the week, petitions were presented nominating two additional candidates for councilor-at-large, David Orbison and Alexandra Rolde. In addition to the nominees for secretary and councilor-at-large, Paul Dewald and Arthur Farley were elected to the Exploratory Subcommittee of the Nominating Committee. Barbara Deutsch and Mike Gundle were elected by Council to the Committee on Council. In addition, Ralph Fishkin was elected to complete the unexpired term of Barry Landau, who has resigned.
JAPA editor Arnold Richards asked that Robert White be appointed associate editor. Richards praised White for his work as systems operator of the JAPA Netcast.
Outgoing treasurer Allan Compton gave his final report to Council. “The more we can get away from dues dependency, the better off we are. Some similar organizations are 98 percent dues dependent, and they're in trouble,” he said. Compton praised JAPA as a highly successful first entrepreneurial venture of the organization. Meetings are another potential entrepreneurial venture.
Compton presented an analysis of APsaA expenditures that vividly showed priorities in APsaA spending patterns. Among his conclusions:
Societal issues and pure educational matters receive a very small percentage of expenditures compared to member services.
Communications and governance have been given higher financial priority than regulatory functions, research, or professional outreach.
Compton characterized us as a “financially healthy, well-managed organization,” adding that “we have clearly elected to direct our resources” towards certain types of efforts.
Gundle reminded societies to tell new councilors that they are to attend a Wednesday night orientation session at their first national meeting as councilor. He presented a motion he described as a measure to “allow Council to take itself more seriously and to empower” the councilors. This motion, which requires registration of councilors ninety days before a Council meeting, was passed. Councilors who are not registered may be seated at Council but may not vote.
Harriet Wolfe, chair of the Society Presidents' Council, reported on the work of this body. The council has developed a think-tank mentality and is focusing on revitalizing practice through outreach and inreach. [See page 37.]
Nadine Levinson presented the work of the PEP CD-ROM project to Council. She reported that negotiations are under way to get the Standard Edition (of the collected works of Freud) bundled into PEP. Levinson proudly presented a check for $30,000 to APsaA, representing the Association's share of this year's profits from the PEP project, up $10,000 from last year. [See page 9.]
The Board addressed many matters in its May meeting, with the certification issue once again dominating much of the discussion. Since the December meeting, the Board has explored certification with two approaches. An ad hoc committee surveyed members who had recently gone through certification to assess satisfaction and discontent. Another ad hoc committee was appointed to study certification and present its final report in January 2003.
Bob Galatzer-Levy reported on the results of the survey of recent applicants for certification. The committee that designed and conducted the survey consisted of Galatzer-Levy as chair, Mel Bornstein, Art Nielsen, and Bert Cohler. Mark Smaller has since replaced Nielsen on the committee. Among the highlights of the survey results, as reported by Galatzer-Levy:
84 percent of the applicants took the exam because it is a prerequisite to becoming a training analyst.
83 percent took it because they thought it was the next step in their analytic career.
80 percent thought the exam was fair.
85 percent would reapply knowing what they know now.
50 percent felt that the exam did not uncover significant weaknesses in their practice.
35 percent felt the exam increased their negative attitude toward the Association.
30 percent thought the process was degrading.
One-third of respondents had predominantly positive experiences, one-third had mixed experiences, and one-third had a predominantly negative experience. Ten percent reported an extremely negative experience.
[Editor's note: The full survey results are available on the closed section of the APsaA Web site.]
The certification survey committee plans follow-up studies, including surveying a comparable sample of individuals who did not take the exam. Galatzer-Levy pointed out, “This is a study of those who bought the car, not of those who walked by the showroom and thought ‘Boy, that's ugly.‘”
The Ad Hoc Committee to Study Certification presented a detailed status report. The committee's preliminary ideas include these thoughts:
National certification in psychoanalysis is important for the profession's standing in the academic world and with other health care professionals.
We must find a way to assure reliability and validity.
External credentialing has merit but also presents problems.
We should explore the value of a national partnership between institutes and APsaA for training and supervising analyst selection.
The committee is also exploring the value of requiring certification as a prerequisite for appointment as a training and supervising analyst.
In other Board news:
The Committee on Child and Adolescent Analysis recommended and won approval of four pilot programs that would allow child analytic training with no or minimal adult training. [See pages 28 and 32 for more on these programs.]
Dick Fox noted that the future of the Consortium is in question. Participation is expensive; APsaA needs to be sure it is getting significant benefit. Fellow Consortium members have not responded to efforts to enlist them in political battles.
The Committee on Research and Special Training reminds members to encourage recruitment of people in local academic communities. Interest in psychoanalysis has never been higher in academia than it is now. Hundreds of people on campuses constitute the brightest pool of analysts in the future, said CORST chair Steve Levy. “We need to consider how we can provide affordable training for them.” Levy warned that training is very expensive, indeterminate in time, and difficult for everyone.
Mike Singer reported on the ongoing work of the Committee on Certification. At the May meeting, eleven first-time applications and six continuing applications were considered; thirteen were approved [see box on this page]. “To do its job, the committee needs to be insulated from the pressures outside,” said Singer. “We support having our process studied. It's important to determine the reliability and validity of the work that we do. … We have an instrument that we have developed that we think is well suited as a place to begin.” BOPS chair Ron Benson commended
this committee for continuing to work professionally and with dedication in the middle of a storm. “If it were possible to have the work of this committee visible to all the members, the tone of the criticism would be different.,” said Benson. Singer asked that local institutes look for people who would be interested in serving as “participant observers” with the committee.
Committee on Preparedness and Progress chair Mary Scharold handed out COPAP guidelines for mental health training for non–mental health clinicians. These include a two-year experience in clinical training prior to matriculation, a mentoring experience, four varied clinical experiences of six months each including work with severe psychopathology and diagnostic interviewing, and a recommendation to begin a personal analysis. An example of an individual for whom these guidelines would apply would be an M.D./internist who wishes to become an analyst.
The Committee on Institutes recommended and received approval of new training and supervising analysts. The COI's response to the Latin American societies' proposing the acceptance of analysis three times a week was to reaffirm the standard of four times a week. [See page 35 for the list of new training and supervising analysts and page 32 for more on the COI's standards.]
Committee on Research and Education chair Stuart Hauser gave this new committee's inaugural report. [See page 32 for more details.] CRED's plans for the next two years include promoting more of a research orientation in institutes and sponsoring a system of visiting research professors for institutes.
Both meetings closed with outgoing president Dick Fox's farewell remarks. Speaking to the Board, Fox noted how very different things look compared to ten or even two years ago. He praised former BOPS chair Ralph Engle for establishing a new relationship between Board and Council. The Task Force on Education and Membership moved the issue from “who has the power” to collaborative efforts. Fox cautioned the Board that “there will be more challenges to the Board from the membership with democratization. It is important not to be defensive.”
Fox highlighted an evolution in the identify of psychoanalysts. Analysts are no longer involved just with education. Analysts these days have many differing interests including working with the press, applied analysis, and research, not just immersion in clinical practice. These accomplishments need organizational acknowledgment.
Benson praised Fox for his great concern for the Association, “his commitment, his building of consensus, his courage. He spoke his mind, with tact and respect.” Benson also said it has been a great pleasure to work with outgoing treasurer Compton. He described Compton as a man of integrity who says what needs to be said clearly, without equivocation but with tact.
In his farewell remarks to Council, Fox said, “This is my last meeting. The Council has matured and grown into its own, and I pay tribute to the councilors. I also pay tribute to the Executive Committee who do yeoman work, a terrific amount of work. I learned I can do things I didn't know I could do.” Fox received a very long standing ovation from his colleagues.