At the end of the May 2003 meeting of the American Psychiatric Association, APsaA member Marcia Goin will become president of the APA, its fourth female president in 160 years. Despite worry about the diminution of psychoanalytic influence in psychiatry, three of the last five APA presidents have been psychoanalysts: Goin, Daniel Borenstein, and Allan Tasman.
TAP interviewed Goin following a speech she gave last fall on mentoring to woman residents and early career psychiatrists.
Goin ran for president on a platform that included her fight to preserve psychotherapy within psychiatry,
She said the single most important thing analysts can do to preserve an analytic presence in psychiatry is to supervise in psychiatry training programs and help residents see the dynamics in even the sickest patients. However, she cautioned repeatedly that supervisor analysts working in psychiatry residencies must be extremely careful to work with the patients the resident presents, typically very sick patients, not those usually considered for psychoanalytic psychotherapy or psychoanalysis. Use the clinical material presented. Be sure to speak a language the residents can understand. Residents will present patients who are angry, impulsive, and demanding. When analysts help residents understand that there are dynamic elements, developmental issues, conflicts, and unconscious motivations in these very sick patients, analysts can have an enormous positive impact on the residents. On the other hand, analysts who say something like “Residents have terrible patients” or “Bring me another patient, this one isn't good for supervision” can have a terrible negative impact, Goin cautioned.
Asked about her area of emphasis for her one-year presidential term, Goin explained that she and her two predecessors all focused on access to care. Paul Appelbaum, during his term, began a business initiative to show employers how good mental health benefits made good business sense. Dan Borenstein focused on public-sector psychiatry—issues of poverty and homelessness. Goin is focusing on mental health care in jails and prisons. She and others hope to pull together a blueprint for prison mental health care that will make a business case to state legislatures that it is in their best interests to invest in prisoners' psychiatric care.
The APA will continue to be very involved in lobbying and legislative activities at the national level and encourage state lobbying through its district branches.
Goin is concerned that so few psychiatrists are now pursuing psychoanalytic training. She is concerned about the aging of those psychoanalysts who do supervise in psychiatry programs and are not being replaced by younger colleagues.
She hopes that psychiatrist analysts will stay involved with the American Psychiatric Association. She cited Drew Clemens as an example of one analyst who has made a great contribution to the work of the APA. “We need a unified voice on [Capitol Hill] for lobbying” for mental health, she said. “Thirty-eight thousand [APA's current membership] does not have the same clout as fifty thousand.”
I asked if she felt her identity as an analyst had been a liability or an asset during her presidential campaign, and whether she had emphasized it. Goin replied that she had neither hidden it nor loudly proclaimed it. She thinks it may be an advantage among some older APA members and a slight disadvantage among younger members.
Goin's recommendation to APsaA and psychoanalysts for improving their standing in the psychiatric community is for psychoanalysts to use any opportunity to serve as a good role model for young psychiatrists.
Prudy Gourguechon is editor of TAP.