“Can We Survive?” That is the question posed by the BOPS leader ship in their previous TAP column [TAP 48/1, page 5]. It is indeed a critical question. A hostile media, a tight economy, the cost-cutting policies of the insurance industry, and new governmental sponsored health plans are all squeezing the life out of practices and our profession. The Committee on Institutes has estimated that at least 13 of our institutes are in trouble and may very well go out of existence in the near future.
When I ran for president the first time in 1995, I had the specific intent of mobilizing our Association to address these environmental challenges with the same vigor and focus that have long characterized our emphasis on education and science. Now, more than a decade later, we are engaged in the most extensive and energetic programs of public information and advocacy in our organizational history. We can and must persist in these efforts to ensure our survival.
However, these efforts are not enough.
When I ran for a second term as president four years ago, I was once again concerned about our survival, not because the external environment was tougher—though it was—but because I felt that our organization had become too rigidly fixed in its ways to adapt successfully to the changing world in which we live. To be clear: Our Association has been plagued by internal organizational problems since our bylaws were written in 1949.
These problems are nothing new. What is different today is not our organization, it is the environment. An environment of mounting challenges demands thoughtfulness and suppleness of adaptation, not a blind attachment to past policies and practices. A rigid adherence to institutional habits may offer solace and the illusion of safety, but it will cripple our capacity to adapt to the world we live in now.
One enduring feature of our Association has been an artificial separation between education and membership. This separation is a legacy of the original psychoanalytic institute in Berlin, in which all authority and power were vested in those named to be training analysts. This organizational design was institutionalized when our first four institutes (New York, Chicago, Baltimore Washington and Boston) were established in this country.
Our structure as a national Association was formed in the context of an early and very intense conflict between the American Psychoanalytic Association and the International Psychoanalytical Association (IPA) over the training of non-physicians. The resolution of this conflict, which occurred in 1938, included the establishment of our Association as a “regional association” within the IPA. According to this agreement between APsaA and the IPA, the IPA granted us an “exclusive franchise” over the development and regulation of psychoanalysis in the United States. We were authorized to accredit our own institutes, regulate our own training programs, and control access to membership in the IPA, all subject, of course, to our adherence to the minimum IPA training standards.
We are now suffering from the consequences of the ideas and attitudes that prevailed among our members at that time. Training was privileged above all other professional functions, and the position of the training analyst was exalted above all other organizational posts and functions. Accordingly, the Board on Professional Standards (BOPS) was formed as the preeminent administrative body of organizational elites, with unparalleled power and authority within our Association. For many years, the Executive Council was no more than an appendage of minimal importance. In fact the Executive Council was assigned the title of a Board of Directors only because BOPS could not legally serve as its own Board of Directors.
Over the last 25 years, our Association has been undergoing a difficult but necessary transition, as the Executive Council slowly has assumed its proper role as a Board of Directors, responsible first and foremost to the members it represents. In recent years, this chief responsibility has brought the Executive Council into painful conflict with the Board on Professional Standards.
To address the question posed by the leadership of BOPS, “Can We Survive?”, my answer is that it will be very difficult for our Association to survive, if BOPS continues to operate in the manner it has for the last 60 years. The evidence is clear. Our recruitment is dwindling. Our membership is declining. Our members are divided. And more than a third of our institutes are on a course to fail.
In my view, a core factor in the genesis of our internal problems is the training analyst (TA) system. When, as a candidate, I first became familiar with the training analyst system, it seemed contrary to every principle I was being taught. It seemed profoundly anti-analytic and anti-educational and very close to being unethical.
In addition to analytic and educational considerations, the TA system and the general conservatism and “splendid isolation” that it breeds, has made it increasingly difficult to recruit candidates. It is an undeniable fact that the independent analytic groups with standards comparable to ours, but no TA system, do far better in recruitment than most of our institutes, many of which are seen as hopelessly conservative.
In 1985 I wrote a paper on the TA system, which I distributed privately among colleagues at the Psychoanalytic Institute of New England (PINE). In it, I questioned the TA system and predicted that we at PINE would find it hard to survive as an institute,
Bob Pyles, M.D., is president of the American Psychoanalytic Association.
if the TA system remained in place. If this were true of other institutes, as I imagined it must be, the entire edifice of our Association was surely in a state of long-term progressive jeopardy. Unfortunately, events have proven that both predictions were accurate.
It was with these concerns in mind that Rick Perlman, Warren Procci, and I introduced the PPP Proposal in September 2011, calling for a reconsideration of the training analyst system. We were joined by Mark Smaller. We had intended that the proposal would be a starting point for discussion.
We had expected that BOPS would establish a task force to consider and discuss the TA system, with input from the Board of Directors and membership, to decide upon a course of action that would remedy the problems that the current system entails.
To our astonishment, none of this happened. I will not burden the reader with an accounting of the many attempts we made to engage the leadership of BOPS, both individually and through committees. Suffice it to say that all were unsuccessful. The sole opportunity that was given to consider the substance of the PPP Proposal was limited to 15 minutes at the June 2012 meeting.
The resulting sense of frustration led the Executive Council the next day to enact an interim resolution calling on BOPS to develop “objective and verifiable” criteria for the selection of training analysts.
In January 2013, seven members of BOPS responded to the enactment of the objective and verifiable proposal by filing a lawsuit against our Association—without warning and without discussion. The reasons for filing the lawsuit were never clear to me. I was told by one of the petitioners that the BOPS group felt they had exhausted all other means of redress. However, from my point of view, they hadn't tried any other means, and the filing of the lawsuit seemed arbitrary and unnecessary.
To the surprise of many, Judge Schlesinger (who ruled in the lawsuit) found for the BOPS side and indicated if we wanted things to be different we should change our bylaws. Accordingly, Mark Smaller and I took two actions. Working with the newly formed Litigation Committee (consisting of the nationally elected officers), we filed an appeal. Secondly, we formed a Bylaws Task Force to do exactly what Judge Schlesinger had suggested. The news of the appeal was met with indignation by the original filers of the suit, which once again seemed odd to me, for while they had felt free to file the suit, they were angered by our decision to appeal. Currently, we await the results of the Court decision.
However, certain things are clear. This organization will never be the same, regardless of the outcome of the lawsuit. The genie has been let out of the bottle and can never be put back in.
To return once more to the question posed by the BOPS leadership, can we survive? It will be difficult, perhaps impossible, unless our organizational structure is altered to match our educational and membership missions. The crux of the problem is not, as BOPS leaders proclaim, that there has not been enough separation between membership and education. It is that there has been too much.
In reviewing the BOPS minutes over the past several years, I was struck by the fact that BOPS in many ways seems to have gone out of the education business and into the rules business. We have heard there are some institutes planning to split off from APsaA in order to form their own association. This, of course, is completely unnecessary, since any institute can continue to do exactly as it has been doing, even if the PPP Proposal were adopted.
An alternative some have suggested would involve the externalization of BOPS and the credentialing function. To me, an externalized BOPS would be the worst possible solution, since it would enshrine permanently the maladaptive methods of the last 60 years. It would also enable BOPS to continue as is, only now permanently without “checks and balances,” and without having to be responsible to the membership and the Board of Directors.
To justify such a separation, some have imagined a kind of nightmare scenario, with some groups (including the officers) pushing to eliminate any standards at all, and moving to become a psychotherapy organization. Happily, these all seem to be scare tactics that have never been suggested by anyone, as far as I know.
Whatever the fate of the PPP Proposal, we have the opportunity and responsibility to create a very different kind of organization, one that deals with education, with the needs of our members, with the environment—and is not thwarted and constrained by an organizational elite that values rules over reason and privilege over progress.
We have a critical and historic opportunity to form a different kind of Board on Professional Standards. I hope we can do it without any groups splitting off. However if some choose to go their own way, we wish them well. Either way, we will have the opportunity to create a BOPS that embodies a modern educational philosophy, adapting to the needs of the students and adapting to the conditions we encounter now and will in the future. I visualize an educational body that embraces innovation, inclusiveness, and openness and an organization that would welcome new members and new groups with respect, interest, and open arms.
It is embarrassing that after BOPS and the Executive Council agreed to invite the William Alanson White to join our Association, it took nearly a year to extend a formal invitation to this important and vibrant psychoanalytic community. There are other independent groups we could immediately invite into our Association. When I was president previously, Don Rosenblitt was chair of BOPS. We estimated that we could bring in 1100 new members to our group. We failed to bring in any. But now we have a new and golden opportunity.
In considering change, we have been hampered by the deep belief among some that the training analyst system is synonymous with the survival of psychoanalysis, and that the TA system represents a higher standard.
At the very least, we should be capable of a thorough and serious reevaluation of what one of our Association leaders in the '50s, called “the central pathogen” of psychoanalytic education.
It is interesting to note that elsewhere in the world of psychoanalysis, there is no separation between membership and education. All educational functions are subsets of committees of the society, which is the main organizational body. It is also worthy of note that among the three recognized educational models approved by the International Psychoanalytical Association, two of the three do not feature any training analyst system at all.
I believe it is time for us to take a lesson from the rest of the analytic world. We can also learn from our own mistakes. We can transform our Association into a living, breathing organization again, eager to innovate, emboldened to experiment, and equipped to adapt intelligently. If we can seize the future by combining a capacity for flexible responsiveness to the needs of students and members with our ever-more vigorous efforts at public information and advocacy, we can not only survive—we can thrive.