James Pyles reported that while Congressman Edward Markey is still relying heavily on us to craft the health Internet technology (IT) bill in the House, Senators Ted Kennedy and Hillary Clinton have decided to try to move a health IT bill requiring broad Republican support. This bill calls for a nationwide electronic health information system with standards to be set by the secretary of the Department of Health and Human Services without notice or public comment. According to Pyles, the bill is set up so that organizations that would like to eliminate the right to privacy may do so with no congressional fingerprints and without public scrutiny. While Pyles recognized that it was a long shot to get an amendment into this bill, he encouraged members to call their senators because the more congressmen hear from us, the more they will listen to him in the future.
Lynne Moritz reminded the Council that BOPS has a specific mandate from the Association that is spelled out in Article XII in the bylaws. She then asked the BOPS leaders to introduce topics for discussion.
Eric Nuetzel told the Council that the first part of the Exploratory Proposal for Moving Forward (EPMF) was intended to spell out the BOPS relationship with the Council. It was for the Council's deliberation and feedback.
The second part considered the concerns of many on BOPS that the strain of APsaA politics interferes with their primary goal of taking care of the profession. Nuetzel said that there has been a minority view in BOPS for some time that the certifying and accrediting functions should be outside the membership organization. BOPS members felt it was time to consider the advisability and feasibility of this plan, recognizing this as the structure of most professional health-care organizations. He said that in light of the events of the last six months, with the threat of a lawsuit based on discrimination and the behavior of some members that resulted in a discontinuance of ongoing research, he had come to believe that this separation may be the only way to insure the long-range health of the educational functions of BOPS. He said BOPS was not asking for a timetable. They were simply trying to form a committee that would study the practicality of such a plan.
There was debate about the nature of the problem. Paul Mosher said that while he supported the intent of the proposal, he did not believe that BOPS was in disagreement with the Council. Instead, he believed the difficulty was between BOPS and the membership and that the Council's role was one of referee.
Others spoke about the basic complementarity of the educational interests of BOPS and Council. It didn't seem to make sense that BOPS was at odds with the membership since everyone is a member. It was pointed out that BOPS had worked hard, in a timely fashion, to address the dissatisfactions with BOPS standards. Members of BOPS were concerned that the problems were being politicized and they feared a legalistic approach rather than a deliberative one.
Jonathan House said he didn't take the EPMF as either adversarial or as a resolution of any issue. He said, “I take this proposal to be the creation of a mechanism to explore and [to inform the ExCouncil] about the meaning of the Mosher/Narcisi externalization plan.” He urged BOPS and Council to make this a “mundane matter.”
Prudy Gourguechon proposed a motion stating that “The Committee on Council and the leadership of BOPS meet together to make proposals for the establishment of standing mechanisms to provide and assure continued feedback and guidance from the ExCouncil to BOPS.”
After some discussion, Jonathan House proposed a substitute motion eliminating the first part of the EPMF and keeping the second part, attaching the beginning phrase, “Taking note of the BOPS statement entitled, the ‘Exploratory Proposal for Moving Forward,’ the ExCouncil decides that…”
All but one speaker supported the substitute motion, noting that it was a diplomatic suggestion. The motion was passed with seven opposed and three abstentions.
Lee Bauer reported a response rate of 43 percent in the most recent practice survey. He said that at first glance the raw data indicated the average number of cases of 910 graduated analysts was 4.57, up considerably from the 2001 survey. However, if responses by analysts with more than 10 analytic cases at one time were excluded, this figure dropped to 3.66, virtually identical to the 2001 survey. Forty-seven percent of analysts said they believed a frequency of three times a week could be called analysis. However, 30 percent of TAs and 26 percent of non-TAs said that four times a week was the appropriate standard.
The most common frequency of analysis is four times a week reported by 36 percent of non-TAs and 46 percent of TAs, while 13 percent of TAs and only 9 percent of non-TAs saw patients five times a week. These were statistically significant differences. Bauer said that many of the current efforts of APsaA members to increase awareness of psychoanalysis and outcome studies demonstrating the effectiveness of psychoanalysis would go a long way in the effort to improve practice.
Jane Walvoord, L.C.S.W., is TAP senior correspondent and a graduate of the Dallas Psychoanalytic Center.