Perhaps I did not read my job description carefully. Presidents of sister organizations write upbeat and glowing editorials, though they face major threats and serious cutbacks. By contrast, I am alarmed and worried by our Association's numbers (a.k.a. demographics and statistics). Reflected in these numbers is the graying of our organization, fewer candidates in training, and the persistent decline in analytic practice. The numbers underscore challenges that we must address today. Tomorrow will not do. A few examples:
The average age for our total membership (active, senior, life, and affiliate) is 61.7 years.
The average age of our 747 training analysts is 69.6 years.
Over the past decade there has been a slow but steady decline (1 percent per year) in the number of analytic patients seen by our members.
Sixty-five candidates entered training for the 2001–02 academic year. An average of 116 entered training in the three previous years.
The average age of people accepted for analytic training in 2001 was 47.2 years, five years older than the average of those accepted in 1996.
Some may be comforted by the knowledge that compared to other professional groups, the APsaA is “holding its own” in overall membership. I hope they will put aside their complacency. The trends are glaring and alarming. The time to act is now; we cannot wait until we are awakened by a free-fall decline.
Addressing these issues will require effort from every sector of the Association. Polarization, fragmentation, and continued internal struggles (Council vs. Board, TAs vs. non-TAs, liberals vs. conservatives) can only distract us and drain our energies. Each of us, in whichever “cell” we see ourselves, will have to look beyond our noses to fully appreciate the direction we are going and wake up to the serious hazards that loom ahead.
I have heard the argument that if we first resolve our internal differences, we can address with greater vigor the issues that threaten psychoanalysis and our Association. This is certainly true, but we do not have the luxury of time. The trends in our numbers make it clear that we will not benefit from the passing of years.
One can easily hide behind generalities and abstractions. Here are some specific actions I believe we must do now.
Our image in the eyes of the public and non-analytic mental health professionals is dismal. If we did not know this before, the strategic marketing study enlightened us. Many outside our Association respect psychoanalytic ideas and thinking and find them valuable, but they experience psychoanalysts as aloof, uncaring, too intellectual, and arrogant.
Our Marketing Committee has distributed data from this study to every society with suggested approaches for changing this negative image. Between mid-September and the end of December I will have personally visited fourteen societies/institutes around the country to lead “town meetings” to discuss these findings and to stimulate local efforts to combat the bad rap. Analyzing the part of this perception that is related to the negative transference simply will not work if our couches are empty. During the next year I will continue visiting societies and institutes so we can think and talk together about ways to address these issues locally. This is a priority.
We must widen the doors for potential candidates who seek psychoanalytic training.
Our outreach efforts — teaching in graduate programs, talking to lay groups, hosting undergraduates, presenting ourselves in public forums, etc. — must be ongoing and vigorous. Several psychoanalytic groups around the country have proven this approach to be effective in candidate recruitment. Through our recently launched “Best Practices” newsletter, these successful experiences will be shared with other societies and institutes.
Career opportunities and economics have changed, and we must find ways to allow young people to afford training — while they are still young. I have appointed a task force to explore the possibilities: seeking outside funds, suggesting reduced analytic fees, providing loans, etc. We must explore all avenues to address this reality. Educational offerings without candidates make no sense.
With thoughtful screening and evaluation, we must seriously consider accepting the value of the analytic experience of those who have been in analysis with respected non-TAs. We have lost too many good candidates when we insisted, without thoughtful consideration, that analytic experiences with non-TAs must be insufficient by definition.
We must make our psychoanalytic curricula broader, richer, more relevant to practice needs, and more alive. Bright and thoughtful candidates do not want to hear recycled doctrine. Psychoanalytic research, competing models of thinking and conceptualizing, and studying the interface between our field and other sciences must balance our offerings. Creative and discriminating thinking must come to characterize our didactic work if we are to attract the best and the brightest candidates.
We must open our Association membership to new members and develop new alliances and coalitions.
Membership in the APsaA is currently only available to those who have graduated from one of our accredited institutes or an IPA-approved institute. It is time we rethink this membership policy. Surely we can develop other criteria to allow a membership admission committee to evaluate an applicant on the basis of analytic experience, respect and appreciation of the psychoanalytic perspective, and seriousness of intent. This position might well allow dedicated, experienced clinicians to enter our ranks who have trained to a different standard than have our graduates. For many years, the IPA has shown an openness in allowing two models of training to exist under its roof. I have seen no ill effects of such a policy. Surely we in the Association can consider this flexibility.
A handful of APsaA members are also members of the IPS groups. These individuals have been active on our committees and have enriched our group. A far more welcoming approach must be part of our policy, not an exceptional occurrence.
Some in our Association will experience my agenda for increased outreach and inclusion as misguided and risking lower standards.
Perhaps there is a risk, but I am convinced that unless we take such risks and “step out of the box,” we will perish. Twenty years ago, a respected colleague advised me that our psychoanalytic thinking embodies a certain basic truth, and to ensure survival of this wisdom we should accept no compromises, insulate ourselves (he used the analogy of an ultra-orthodox Jewish group), and continue to study, teach, and practice. Two decades ago I questioned this approach; now I am convinced that had the Association taken such an insular course, it would have suffered, and our contributions to the larger community would have been seriously compromised. Indeed, if we had won the lawsuit to restrict the entry of non-M.D.s into our organization in 1988, we would have been impoverished, and today our organization would be far more vulnerable.
Some will find my suggestions threatening and troubling. I urge these members to openly express their views. I suggest, however, that they first examine the numbers, extrapolate the trends five or ten years ahead, and then seriously consider our future viability.