When asked by a passing lady at the Constitutional Convention in 1787, “What have we got, Mr. Franklin, a Republic or a Monarchy?” Franklin uttered those now famous words, “A Republic, Madam, if you can keep it.”
I am honored to address my friends and colleagues in my first column as your president. It comes at a particularly crucial moment in our Association. It seems that we are at a major crossroads.
The recent meetings of our Association in Chicago produced vigorous debate and controversy in both the Executive Council (our board of directors) and the Board on Professional Standards (BOPS). At the heart of the debate was a proposal that has come to be known as the PPP Proposal. This is a series of suggestions put forth by Rick Perlman, president of the Institute for Psychoanalytic Training and Research (IPTAR), Warren Procci, our immediate past-president, and me. The crux of the proposal was aimed at reorganizing the way we select training analysts and the way we carry out our certification.
These two issues, training analyst selection and certification, have been the two perennial flashpoints for internecine conflict in our Association for some 30 years. This seemingly endless argument has preoccupied us enormously and drained our individual and organizational energies, hindering us from considering those matters that are actual threats to our patients and our profession.
It has been difficult for us to focus on the external threats to psychoanalysis, such as government and third-party intrusion, the declining numbers of analytic candidates and patients, and our aging membership.
The primary purpose behind the PPP Proposal was to get the training analyst issue and certification squarely on the table in a way that they could no longer be avoided. In the entire history of our Association, to my knowledge, there has never been a serious attempt to consider the training analyst issue in such a way as to examine its advantages and disadvantages, and perhaps to consider alternatives.
It is certainly true that from time to time BOPS has discussed the TA issue (e.g., the Project for Innovation in Psychoanalytic Education [PIPE]) and has made improvements, such as separating the training analyst function from the supervising analyst function. Most significantly, reinforcing the essentially clinical nature of training analyses some years ago, education and analysis were separated by creating a non-reporting “firewall” between the two. However, a discussion that goes to the basic premise of the system itself, to my knowledge, has never occurred. Our intention was to remedy this oversight.
When the PPP Proposal was introduced online in September 2011, some reacted to it as though the Apocalypse had arrived, while others felt that a new dawn had come. We attempted to make it clear that it was put forth as a work in progress and a matter for discussion and consideration, yet some viewed it as a threat to life as we know it. It is striking that this subject has been so taboo that startlingly few papers have been written by any of our educators or members since the foundation of this organization (although Sylvan Kaiser in 1984, did refer to the TA system as the primary “pathogen” in our educational system).
By the same token, certification, which is required to become a training analyst, has been a subject for considerable struggle. Although it is no longer the case, certification was once required to be a member of this organization. While it is true that certification has undergone a considerable number of humanizing changes, nonetheless it remains an internal examination by the same body that is doing the educating, a clear conflict of interest. Our proposal called for certification to be automatically awarded at the time of training analyst appointment. Subsequent discussion has made it clear that a more acceptable solution would be to move certification to an external body, similar to the Accreditation Council for Psychoanalytic Education (ACPE), which credentials institutes.
As with any good neurosis or character disorder, the point of origin of all of this difficulty goes back to issues from our organizational childhood. The first institute, the Berlin Institute founded in 1920, was organized along the lines of the German educational system with a heavy emphasis on the “Herr Professor” hierarchical pattern. This model for the formation of institutes and societies was imported almost unchanged by the founders of our four original societies, New York, Boston, Baltimore Washington, and Chicago.
From the founding of the American Psychoanalytic Association in 1911, and for many years thereafter, only physicians could receive psychoanalytic training. This was in stark contrast to Europe where, from the beginning, candidates from a variety of disciplines received training. This is also in contradistinction to Freud's suspicion of physicians as being rather poorly equipped to become psychoanalysts. Nonetheless, our Association clung to this position until the settlement of a lawsuit in 1988 compelled us to open up training to non-physicians. As with so many aspects of our training, change is resisted. The suggestion of any alteration in our familiar pattern raises the fear that the sky will fall if we admit “less qualified people.” Thankfully, the sky remained firmly in place when we began to admit psychologists, then social workers and others, and this move has greatly enriched our Association.
In the first definitive work on group process, Freud's Group Psychology , he pointed out that the cohesion of groups depended on either a central belief system or a charismatic leader. He described the
Bob Pyles, M.D., is president of the American Psychoanalytic Association.
entrance into such a group as requiring a certain suspension of critical judgment in order to buy into the core values of the group.
This is the point we arrived at in Chicago. Rather than being able to discuss the ideas and premises behind the issue of the training analyst system and whether there might be more suitable alternatives, the controversy devolved into demonizing and exaggerated fears. Some groups threatened to break away from the Association, fearing that a system unacceptable to them would be imposed, even though no such idea had been suggested.
Although it was stated over and over that this was an issue for discussion, and could be modified in any number of ways by discussions in BOPS and in other areas of the Association, nonetheless some saw this as an iron-fisted demand that the proposal's suggestions would have to be mindlessly adhered to. Nothing could have been further from our intention. At most, we were thinking of it as a kind of overarching philosophy within which different groups could operate as they saw fit.
Following a scheduled truncated discussion, the chair of BOPS announced the formation of a Reference Committee to determine whether the proposal was in compliance with our procedures, our bylaws and those of IPA, and New York law. In addition, BOPS voted to adopt the Revised Standards of Education, in spite of the fact that the leaders of the compromise that led to the Independent Pathway felt that that settlement had been unilaterally altered. Further, a straw vote was not allowed on the proposal by Lee Jaffe to allow some non-training analysts to serve on BOPS.
The reaction in Council the next day to what was perceived to be these “hardened” positions by BOPS was to vote to adopt “objective criteria” for the selection of training analysts as the policy of APsaA and to encourage BOPS to find a way to implement that policy.
It should be clear that this was only one portion of the PPP Proposal. Following the Council meeting, it was my decision to form a committee to oversee the Council action and to interact with the BOPS Reference Committee, with the aim of bringing about the discussion that we had originally intended.
The lines were then drawn as to whether Council has the right to intervene and to speak to an educational matter, which has traditionally been the province of BOPS. This is where we stand at the moment. It has become abundantly clear that as psychoanalysts we are trained in individual psychology and psychopathology, but we know very little about group function. We have now wound up in mutual armed camps where everyone is reaching for his lawyer. To quote Franklin again, “A countryman between two lawyers is like a fish between two cats.”
It is unfortunate that controversies among psychoanalysts, particularly about educational and theoretical issues, seem frequently to result in reaching mutually non-negotiable decisions. We cannot seem to tolerate an honest and open discussion about ideas, especially about educational and theoretical issues, without resorting to legalisms or threats of splitting.
I have confidence that the process between the Council and BOPS committees will lead us back to where I had hoped we would start, namely to a thoughtful discussion of the training analyst system and certification. To quote David Hume, a political philosopher from the 18th century Scottish Enlightenment, “Truth springs from argument amongst friends.”
I am a great admirer of James Madison, “the Father of the Constitution.” He was the author of our system of checks and balances whereby the three branches of government operate to keep each other from going off the rails, becoming too extreme. The genius of the Constitution is that it was not designed to protect an ideology. Instead, it allows for a creative process of continuous orderly change, in which all parties can be heard.
The Berlin academic model is not appropriate for our Association, which is both an educational and a membership organization. We should recall Freud's admonition that insulation and isolation of a group inevitably leads to extreme positions. A system of checks and balances would be much more appropriate for our purposes. We should move from an academic model to one in which members, Council, BOPS, educators, and clinicians can all have a voice.
I have every expectation that this discussion will lead us to a richer, more vibrant, and healthier Association, which I hope will allow us then to return to those major issues that threaten our existence.
I would like us to be able to focus on Freud's vision of the true value of psychoanalysis—that it could become a major force for the public good. Understanding that the number of patients directly treated by psychoanalysis would always be relatively few, Freud felt that psychoanalysis should make a larger contribution to society through the use of psychoanalytic knowledge in education, science, and public policy.