Last November, my wife and I moved back to Baltimore, where we met, married, and started our family. After 20 years in Milwaukee, and many good friends, I miss Wisconsin. The loss is softened by the satisfaction of having helped build that society and institute, a uniting, rewarding, grass-roots experience in psychoanalysis. Because it is a rewarding experience and because we need to reach out, not look in, I hope more and more members will be psychoanalytic pioneers in underserved areas. Because we are a national association, analysts from Boston, D.C., Baltimore, Chicago, and San Francisco came to help in Wisconsin. Because we are a national association, when we moved I found a home in the Washington and Baltimore-Washington Societies and the Washington Institute. These experiences reflect my core beliefs in our national responsibilities and our shared values.
APsaA is also moving on and moving forward. Reorganization of our governance structures was needed in the interest of representation, efficiency, effectiveness, responsibility, and compliance with New York not-for-profit corporation law. In record time we have gone from introspection, to consensus about governance reorganization guidelines, to a ratified, working Reorganization Task Force.
As necessary as it is, reorganizing governance is inward looking while the real challenges come from the outside. Whatever our internal tensions, they pale by comparison with the external challenges we face as a profession. I emphasize that fact because it is easier to argue about our familiar internal tensions— self-absorbing and sometimes even reassuring in their familiarity—than to confront the unfamiliar problems outside our well known, albeit contentious, comfort zones.
To deal with external pressures, we need to plan strategically for the next decade. APsaA has to face its challenges, appraise strengths and weaknesses, and develop a strategy to guide our future. We need priorities organized within a strategic plan so that initiatives are coordinated and effective, thoughtful rationales guide allocation of financial and human resources, and vision informs fund-raising. We all need to join in the effort to map our course. In the process, we will renew the commitment to our kindred spirits and the best interests of psychoanalysis and psychotherapy.
As we approach strategic planning, keep in mind three important facts:
Industrialization of mental health care puts humanistic therapies at a disadvantage.
Interest in psychoanalysis and psychotherapy is strong but the educational marketplace is competitive.
Those who want affiliation in psychoanalysis and psychotherapy have choices.
APsaA has to face its challenges, appraise strengths and weaknesses, and develop a strategy to guide our future.
Those are the facts of life. We cannot wish them away or ignore them. However, we can think of them as challenges that will bring out our best. Our strategic plan should address these challenges and offer possible solutions.
I have put together a five-part working draft of challenges and some examples of how to address them.
Limited access to psychoanalytic and psychotherapeutic care: If we treasure psychoanalytic and psychodynamic treatment and practice, there is no choice but to advocate for privacy, confidentiality, coverage, enlightened medical necessity screening, and informed peer review. Advocacy and activism require engagement with our communities, other psychoanalytic and professional organizations, insurance companies, government regulators, patient groups, and corporate health care purchasers. In terms of direct action, imagine if we had more community-based clinics providing affordable alternatives to managed care and keeping an entire generation from being lost to psychodynamic understanding and treatment. Basically, we must examine the most effective ways to engage, serve, educate, inform, oppose, and, when all else fails, litigate.
Reaching crucial audiences: Our outreach programs need to meet the test of reaching a crucial audience, an audience individually and collectively that will become involved in and identified with psychoanalysis, psychotherapy, and APsaA. One approach to this challenge would be to proactively build on our New Psychoanalytic Centers effort that is already fostering psychoanalysis and psychotherapy in Birmingham, Missoula, the Sacramento Valley, and Memphis. We could also put respect in and muscle behind our allied programs. It goes almost without saying that we need to create the best possible home for psychodynamic psychotherapy.
We also need to strengthen our Student Associates and interest college students. Graduate and college students are Niko Canner's “10,000 best minds,” whom we must reach. We have started an outreach to college students and I suggest that we rename our current “Student Associates” as “Associates in Training,” a more respectful way to refer to medical students, residents, and masters and doctoral candidates.
Jon Meyer, M.D., is president of the American Psychoanalytic Association.
Expanding and enhancing membership criteria: There is a consensus that APsaA will extend a welcoming hand to serious colleagues whatever their pathway to psychoanalysis. A proposed bylaw amendment putting that potential into the Executive Council will soon be with you. One way or another, we will reach the goal of expanded and enhanced membership criteria, but here is one place where internal and external meet. In working toward that goal, we must be sure that we bring everyone along. We must get to a more open and welcoming APsaA in a mutually respectful way. Since our institutes are the largest single source of new members and are the training sites of our affiliate members, we need dialogue among our institutes and societies, Council and Board, and the Affiliate Council.
The challenges and vision I have outlined are just a start. They represent only my perspective. To work more broadly, I have asked the Executive and Steering Committees to join me in working on a strategic framework for APsaA's future. I have undertaken this job, however, knowing full well that no plan, goal, or strategy can succeed unless ultimately it comes from you, you endorse it, and you put your shoulder to it. As soon as possible, a survey will be on its way to you to get your views about APsaA's priorities. Once we have your views, they will be collated and organized.
I will report back during the Winter Meeting in New York on the priorities you have outlined. I will then want your feedback on my report and we will organize sessions at the meeting for you to talk over your reactions with members of the Executive and Steering Committees. After all, the Executive and Steering Committees have to reach out and engage, too. We will take the data and your feedback and do our best to turn it into a preliminary working plan. At the Annual Meeting in Seattle, I will report to you on that draft.
The point is that the president can begin a process, but the real substance of it has to come from you, not from me. Gretchen Anderson, from Niko Canner's management consulting firm, will help us be as effective as possible. The purpose of these working sessions will be to hear what you want for psychoanalysis, what you think our priorities should be for the next 10 years, and how you think we should go about reaching the goals we evolve.
Strategic planning is new for us, so we all have a lot to learn. With the environment we face, and the responsibilities we have across the country, we have our work cut out for us. We have to consider many options and they are all on the table. The only option not on the table is failure.
I will do all I can to bring us all together by encouraging an in-depth conversation on expanded membership criteria so that all views are expressed and planning can occur. If two-thirds of you pass the bylaws proposal, the goal will be implemented in the Council. In the meanwhile, we still have the goal and we still need thoughtful dialogue and input.
Educational evolution. No educational institution can stand still and neither can APsaA. The hearts and minds of the psychodynamically-inclined need cultivation and encouragement; we can't simply wait for them to come to us. Recruitment cannot be left to chance and will require all our best efforts, since we all meet potential candidates in practice, teaching, and social life. Our training programs are working hard to evolve more flexibly but, rightly or wrongly, are viewed as strong but rigid. We need to be viewed as strong, but open, innovative, and welcoming.
A possible step toward affirmation of our next generation is to realize we cannot turn away interested candidates because they don't want to change analysts or have some other reasonable variation from the standard. One size does not fit all, so we need to offer flexible, individually tailored pathways into our education system. One way we could think about this challenge is to realize that institute training is not the entirety of lifelong analytic education but just the beginning, so we have the latitude to make the starting point user-friendly.
Creating a vision for fund-raising: The problem in fund-raising has been less one of commitment than of vision. I believe we need a vision that appeals to donors and fits our national goals. If one of our goals is to reach out, imagine what it would do if we had a 30-second spot supporting psychoanalysis and psychoanalysts on the 700 National Public Radio outlets across the nation every month for a year. That would reach a marvelous target audience and show that psychoanalysis is very much alive. If we want to proactively reach underserved areas, imagine what it would accomplish if there were a “psychoanalytic pioneers” start-up package and organizational support for analysts moving to new and promising areas.