I always look forward to receiving The American Psychoanalyst, which is excellent in all respects. I particularly enjoyed the recent presidential letter by my old friend and colleague Warren Procci. His words regarding the need for a “longer-term organizational plan” rekindles my plea to most every president in the last many years. Namely, that both the medical members and organizational psychoanalysis were committing suicide by not joining in greater numbers, and more heavily involving themselves, with the American Psychiatric Association (APA) and more specifically the Practice Guidelines Project. My suspicion is that this is less of a problem with our psychologist and other analytic colleagues and their national organizations.
While there have been numerous presidents and distinguished psychoanalysts within the APA, an enormous percentage of our medical colleagues are not members. This contributes to a very sparse representation in the work groups and review process that produce clinical guidelines. These guidelines are rapidly becoming a very major force in psychiatric education, clinical practice, insurance, legislation, litigation, etc.
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I speak from considerable experience, having been a member of the Steering Committee and the Executive Committee of the Guidelines Project for 12 years. During that time I often heard cries of outrage by the psychoanalytic community about “inadequacy” in the representation of a psychoanalytic viewpoint in many of the clinical guidelines. The vast majority of these critics were not members of the APA, and therefore not eligible to participate in the process of producing a guideline or being an expert reviewer. The problem will be magnified many times over if currently discussed changes in the process of creating guidelines further reduce psychoanalytic input because of this representational problem.
We already have a major disadvantage in guideline production arising from a relatively small amount of “evidence-based research” in psychoanalysis, and to further isolate our field is certainly self-destructive. Change will only occur if there is a strong effort by the American Psychoanalytic Association to influence its physician members to expand their membership and efforts in the wider psychiatric community.
Sherwyn M. Woods, M.D., Ph.D.
Sherwyn M. Woods is a professor emeritus of psychiatry and behavioral science at the University of Southern California, Keck School of Medicine, and a supervising and training analyst at the New Center for Psychoanalysis in Los Angeles.