Back in the 1960's, Detroit auto manufacturers made a fateful decision. With a secure hold on the automobile market-place, they chose to continue their successful marketing by producing big, overpowered cars with built-in obsolescence. The consequences of this strategy are now history. Japanese and European manufacturers responded and created smaller, more efficient and durable automobiles. The demand for these vehicles grew and took hold; Detroit has been playing catch-up ever since. Psychoanalysts took an analogous stance toward their own enterprise, psychoanalysis. In the ‘50's and early ‘60's we had the best-regarded and most popular form of psychotherapy available. The American Psychoanalytic Association went to great lengths to differentiate psychoanalysis from newer and “lesser” forms of therapy and established criteria for training and practice. Although most practitioners came to use their psychoanalytic understanding to craft applications for a wider range of situations and patients, we continued to differentiate these applications from what we called “psychoanalysis.”
Unfortunately the earlier emphasis on the differentiation of psychoanalysis from psychotherapy has had unexpected and long-lasting effects on how psychoanalysis and psychoanalysts are perceived by others. The results of our recent strategic marketing survey reveal how both the general public and our fellow professionals have a very restricted and largely negative view of psychoanalysis and its current relevance to the treatment of emotional disorders. Psychoanalysis is a form of psychotherapy that occurs four to five times a week with a patient lying on an analyst's couch. However it is a great deal more. Our practice surveys continue to identify “clinical immersion” (defined as treating patients 4–5 times a week) as the benchmark to measure the health of our discipline. Unfortunately this standard tends to obscure the importance of many other equally important contributions of psychoanalysts and psychoanalysis.
An in-depth survey of our members would identify the myriad ways and varied settings outside the consulting room in which psychoanalysis is now applied. The diverse agendas of the APsaA's many committees and the wide range of contributions of individual psychoanalysts to the community give testimony in favor of a much wider definition of our science and profession. It is long overdue that we update our representation of “psychoanalysis” and of what a psychoanalyst does.
“In fact, the biomedicalization of psychiatry has created a psychotherapeutic vacuum that presents a golden opportunity for psychoanalysis. We ignore this state of affairs at the risk of our profession. Now is the time to publicize our special expertise in studying, teaching and practicing psychotherapy.”
Psychoanalysis initially was defined so as to differentiate it from psychotherapy. However, the majority of psychoanalysts employ their psychoanalytic understanding more frequently in the conduct of psychotherapy than in formal psychoanalysis. Psychotherapy constitutes a major component of a psychoanalyst's therapeutic repertoire and yet it continues to be treated like an unacknowledged stepchild.
In contrast to the time and energy devoted to investigation and discussion of psychoanalytic technique and process, scant attention is paid to this other important dimension of our clinical work. There is a presumption that practitioners trained in formal psychoanalysis can adapt psychoanalysis to other psychotherapeutic uses. However this remains uncharted territory. In spite of the major developments in psychoanalytic theory and technique and in our understanding of psychoanalytic process, remarkably little attention has been devoted to a serious study of what constitutes psychoanalytic psychotherapy and of the application of specific aspects of formal analytic technique and process to psychotherapeutic situations. These topics appear rarely if ever in our journals. When they appear on our scientific programs it is in sessions directed to non-analysts.
In fact, the bio-medicalization of psychiatry has created a psychotherapeutic vacuum that presents a golden opportunity for psychoanalysis. We ignore this state of affairs at the risk of our profession. Now is the time to publicize our special expertise in studying, teaching and practicing psychotherapy. We've studied psychotherapy more than anyone else, but we need to spend more effort in investigating applications of specific aspects of technique in treatments of less frequency. No other group can match our long experience or our clinical sophistication in this field.
Once upon a time psychoanalysts were the chairmen of prestigious university departments of psychiatry and analysts constituted the core of psychiatric faculties. Today outside a handful of departments, it is nearly impossible to locate a psychoanalyst who is a member of the paid faculty. While many analysts contribute freely of their time and effort on behalf of individual trainees (as volunteer faculty), they have little say in establishing the priorities or the philosophy of the programs their efforts support. This is a formula for continuing obscurity and obsolescence.
Richard P. Fox, M.D. is immediate past President of the American Psychoanalytic Association.
The situation for research and researchers is even more dismal. As a group psychoanalysts have paid scant attention to research; we privilege our “clinical experience” over attempts to objectify our work. Psychoanalytic researchers have worked in isolation and, until recently, our training programs have neglected the subject entirely. We can no longer base our reputation and credibility solely on subjective evidence. Regaining a foothold in universities will be dependent on our ability to develop a credible research presence.
In the past researchers and non-institute educators often were not considered “real analysts.” They seldom received recognition or support from organized psychoanalysis and not infrequently they had to choose between an analytic and an academic career. While we are scarcely responsible for our ostracism from institutional psychiatry this attitude towards researchers and academic educators has certainly contributed to the problem. Although I am less familiar with the situations in psychology and social work I can imagine parallel scenarios.
In recent years APsaA's members and committees have extended the range of psychoanalysis through efforts in political action, public information and other avenues of “outreach.” We have begun to rediscover the importance of reaching out and talking with the public. Shedding the cloaks of anonymity and neutrality, an analyst can become an activist and discuss issues with political leaders and members of the media.
Another dimension of “invisible psychoanalysis” is community psychoanalysis, a facet of psychoanalysis represented in the work of many APsaA members and committees. When psychoanalysts venture into the community they do not identify themselves as “psychoanalysts,” at least not initially because they fear they will be regarded as irrelevant to the situation. As in the office, an analyst in the community enters with an open mind and works to develop relationships before attempting interventions.
These are exciting times for psychoanalysis and the opportunities exist for the evolution of a new, post-Freudian revolution in many dimensions of the field. If we are to rectify the outdated stereotype of a “psychoanalyst” reflected in the results of the recent marketing survey, we will need a radical broadening of our horizons. APsaA has already made important strides in initiating some of these innovations. The challenge now is to lay claim to these other dimensions of psychoanalysis and integrate them into our changing identity.