Our current debate regarding APsaA's governance reflects the fact that we have no simple answers to two groups of questions, one centering on issues of professional identity and the other on training. Examples of the first group are:
Who is a psychoanalyst?
Who should be eligible for APsaA membership?
Examples of the second group are:
What is essential to psychoanalytic training?
Who decides who may enter training and when they have finished?
Who may analyze and supervise trainees?
Questions like these have dogged psychoanalysis for nearly a century, yet show no sign of disappearing.
Forty years ago APsaA-approved institutes had three or four applicants for every available slot and trainees outnumbered graduated analysts by a similar ratio. Today, however, it is a rare psychiatrist who sees much professional advantage in psychoanalytic training. Mental health professionals of all sorts have turned toward more “efficient” interventions.
APsaA has responded to these changes in many ways. Training has been opened to non-medical candidates. Equally important, voting rights have been expanded. Until recently, only “certified” members were allowed to vote in the affairs of the Association. Two “delink-ages” have changed matters: The first (1992) gave non-certified graduate members a somewhat restricted vote; while the second (2001) extended an unrestricted vote to all Active and Affiliate members.
These changes have provoked the Law of Unintended Consequences. The Association's board of directors (the Executive Council), which had been limited to certified physician members, was broadened to include younger, uncertified members, some from non-medical backgrounds. The Executive Council—for years a rubber stamp for APsaA's Executive Committee—began to assert itself. Simultaneously, some local institutes began to question various training standards mandated by the Board on Professional Standards (BOPS).
The Renew the American bylaws propose to turn back the clock by:
Revamping the Association's board of directors so that, once again, most directors probably would be senior analysts.
Insulating BOPS training and certification standards from the membership.
In psychoanalysis Freud created not just a new mode of treatment, a new field of research, and a new theory, but also a peculiar kind of a franchise.
Renew attempts to defend values that some APsaA members consider truly essential. While I disagree with many of its features, I believe that Renew was born out of concern for psychoanalysis. A bit of history may provide some context.
In psychoanalysis Freud created not just a new mode of treatment, a new field of research, and a new theory, but also a peculiar kind of a franchise. Trainees came to Vienna and then returned to Berlin, Budapest, London, and New York, taking with them Freud's blessings and the exhortation to spread the word. They established psychoanalytic societies across Europe and westward to America.
In the 1920s, analysts in Berlin created a model for psychoanalytic training and other training centers followed. Soon the International Psychoanalytical Association (IPA) created an International Training Committee (ITC) with representatives from five European societies plus the New York Psychoanalytic Society.
When APsaA turned its attention toward training, it decided to keep its educational activities and standards “in house.” Although the IPA allowed the training of people from a wide range of backgrounds, APsaA sought to confine training to physicians. When the ITC collapsed due to the economic and political upheavals of the 1930s, APsaA demanded (and got) an exclusive training franchise from the IPA and then imposed a “physicians only” rule upon its affiliated institutes.
APsaA has the dubious distinction of having been the most restrictive of Freud's franchisees, the only one to insist that a medical license was required for psychoanalytic training and practice. This worked as long as there were few competitors to its training and plenty of patients for its graduates. A later innovation—certification—reinforced APsaA's medical identity by mimicking the board certification available to psychiatrists and neurologists. When certification was introduced (1977), all then-current APsaA members were declared certified for life—a decision clearly designed to protect APsaA's guild more than the public.
While APsaA was busy limiting access to psychoanalytic training and practice, the market it was trying to protect was changing dramatically. New providers took a huge chunk out of what used to be the psychoanalytic market. What is more, APsaA's ability to define psychoanalysis and psychoanalytic training was expropriated by the states of Vermont, New Jersey, and New York.
As a result, the advantages of APsaA membership, educational standards, and certification are not as clear as they once were. This brings us back to the questions with which we began—those having to do with professional identity and training.
Paul M. Brinich, Ph.D., sees children, adolescents, and adults in Chapel Hill, N.C. A past president of the Association for Child Psychoanalysis, he is representative councilor for the North Carolina Psychoanalytic Society, co-chairs APsaA's Committee on Peer Review, and chairs the Executive Council's Compliance Task Force.
The early analysts who gathered around Freud included not only physicians but people from fields as widely dispersed as musicology (Max Graf), publishing (Hubert Heller), mechanics and myth (Otto Rank), law (Hans Sachs), and education (August Aichhorn, Anna Freud, Erik Erikson, and Siegfried Bernfeld)—to say nothing of people like Melanie Klein, Lou-Andreas Salome, and Marie Bonaparte, who completely evade such pigeonholes.
In stark contrast to this open creativity, APsaA fought to limit who could claim to be a psychoanalyst by restricting:
Who could obtain psychoanalytic training.
Who could join APsaA.
Who could analyze and supervise candidates.
In doing so APsaA created a Maginot Line that, in retrospect, was vulnerable to the many alternative training programs that now attract more candidates than our own institutes.
While APsaA was busy guarding the entrance, the title of “psychoanalyst” was written into legal language we find hard to recognize. The franchise has been lost.
Renew attempts to strengthen our national organization at the cost of our local societies and institutes. Under Renew our societies lose their votes on APsaA's board. Our previously approved and autonomous institutes face periodic “re-accreditation” and “re-approval.” The criteria for re-approval are those currently used by BOPS; they can be modified only if the new Institute Council (IC) recommends changes. At every level Renew moves power away from the periphery (the local societies and institutes) and toward the center (the Board of Directors [BoD], the Institute Council, and the Board on Accreditation and Certification [BAC or LLC]).
Renew is built upon the mistaken premise that APsaA owns psychoanalysis. This attitude underlies many of our difficulties in relating to colleagues who should be our allies. In my view the future of psychoanalysis depends upon our willingness to broaden our membership, our training, and the horizons of our field.
Renew is built upon the mistaken premise that APsaA owns psychoanalysis. This attitude underlies many of our difficulties in relating to colleagues who should be our allies. In my view the future of psychoanalysis depends upon our willingness to broaden our membership, our training, and the horizons of our field.
It's not hard to see the handwriting on the wall. APsaA must change and our local societies and institutes should be at the forefront of that change. Only if they are free to develop will APsaA itself survive. Moving power toward the center will simply accelerate the aging of our membership and the declines we have seen in both trainees and patients.
If a third of APsaA members agree that Renew is a regression toward the center, it will not pass. However, this must not be the end of the story.
We must bring our bylaws into conformity with New York state law governing non-profit corporations.
We must enable and encourage young APsaA members to take on active, vital roles in our Association and our profession. We cannot leave matters to the Executive Committee and the folks in “central office.”
We must help the Executive Council to become a body that truly directs our Association, focusing our efforts to benefit our practices, our profession, and our communities.
We must clarify the relationship between our Executive Council and BOPS, perhaps using the model of a university board of trustees and its faculty senate.
Finally, we must preserve the autonomy of our local societies and institutes so they can innovate and share their diverse efforts with us all.
Further details about how Renew embodies the problems mentioned are available at .