The Montreal Psychoanalytic Society (Société Psychanalytique de Montréal—SPM), the French branch of the Canadian Psychoanalytic Society, has created a psychoanalytic clinic, the primary aim of which is to make psychoanalytic services accessible to a particular patient group. The committee working on the consultation center was mandated 10 years ago by the SPM to propose a model with the social objective of addressing the mental health needs of those who have limited financial means—young adults, precariously employed workers, recent immigrants, single parents, or people living on unemployment or welfare—and who suffer from severe depression, borderline or narcissistic pathology, and certain types of psychoses.
To meet its objective, the Montreal clinic has looked to existing models such as the London Psychoanalytical Clinic and the Tavistock Clinic in England, and the Centre de Consultation Jean Favreau and the Centre Jean et Evelyne Kestenberg in France. Isabelle Lasvergnas, an analyst and sociology professor who chairs the committee of the Montreal clinic, has studied these four clinics and describes them as having the same social preoccupation, namely to treat individuals with severe pathology who have poor financial resources. The Montreal clinic will continue to have close contact with the French and British clinics and draw on their experience in modifying the classical psychoanalytic frame. Along with a one-on-one therapy or analysis, the British model emphasizes a psychoanalytically-oriented group approach; and the French clinics have evolved an analytic type of drama therapy based on free association rather than role play.
Because of decreasing financial support for mental health and long term dynamic treatments from the Quebec government, the Montreal center is following the example of the British clinics, which are privately funded by donations (in France the clinics are completely supported by the government). In Montreal, however, patients will be asked to pay a minimal fee, even if it involves only a token, to be sure that they will be implicated in their own treatment.
The Montreal center has received an IPA Developing Psychoanalytic Practice and Training (DPPT) grant to begin its fundraising campaign to publicize the benefits of the psychoanalytical approach.
The University Institute of Mental Health (IUSAM) of the Buenos Aires Psychoanalytic Association (APdeBA) celebrated its official recognition as a fully accredited university in November 2005 . According to Sara Zac de Filc, ex-president of APdeBA, the creation of IUSAM has been the result of a nine-year struggle with the Ministries of Education and Health to gain acceptance of the degree of psychoanalysis given by APdeBA. In Argentina, local universities can give graduate degrees in psychotherapy and psychoanalysis (not following IPA's standards), thereby giving their graduates a position of advantage as compared to graduates of APdeBA who receive a much more comprehensive training.
IUSAM-APdeBA will provide university education in three areas: 1) exclusive training in psychoanalysis according to IPA standards (training analysis, supervisions and seminars); 2) a psychoanalytic understanding of mental health through the lens of culture and the community, e.g., violence, alienation, migration, social trauma, inequity, etc.; and 3) a psychoanalytic and interdisciplinary training in the mental health and psychopathology of individuals, family, and group structures. Child and adolescent psychoanalysis according to IPA standards will also be a requirement.
The University Institute will also increase the services offered to the community by APdeBA, such as low-cost therapeutic assistance or analytically-based psychotherapies, cultural activities, training, and advice to state and local governments; and providing educational opportunities to professionals from other disciplines.
It is hoped that the official recognition of a university status for psychoanalytical training and education, and the integration of psychoanalysis with other academic fields, such as psychology, medicine, public health, social service, linguistics, law, and education, will provide a stronger and better presence of psychoanalysis in the community.
The health care system in the United States, once among the finest in the world, has been steadily deteriorating for the last 14 years.
The reason can be summed up in two words: “managed care,” a system in which economic control over the delivery of health care is turned over to private, for-profit companies. This system is now infiltrating other countries.
In 1993, faced with the threat of the Clinton health plan, which would have made managed care the national standard and private practice illegal, the American Psychoanalytic Association joined a vigorous and ultimately successful campaign to protect private practice. From that beginning, APsaA has become a highly visible and effective force in Congress for the protection of the rights of our patients, particularly the privacy of mental health records.
The current legislative threat is electronic medical records (EMRs).
The EMR legislation as introduced into Congress removes all control over health care information from every citizen. Current federal EMR legislation overrides state privacy laws and makes no provision for patient consent prior to the routine release of personal health information.
This legislation directly threatens all psychoanalytic and psychodynamic therapies, including private practice. If psychotherapy records are no longer private, patients will be reluctant to participate in treatment and confide in their therapists. APsaA is taking the lead in Congress to modify these bills. For instance, APsaA recruited 30 mental health organizations to send a letter to every member of Congress calling for the inclusion of patient consent in any EMR system.
Christine Ury, D.Ps., is associate editor and international editor of TAP. She is a faculty member at the Canadian Institute of Psychoanalysis and has a private practice in Montreal.