the FALL 2010 AMERICAN Volume 44, No. 3 PSYCHOANALYST Quarterly Magazine of The American Psychoanalytic Association

The Life and Work of Edgar A. Poe INSIDE TAP… R. Curtis Bristol APsaA Elections . . .6 –13 Edgar Allan Poe once described his litera- the darling of the American literati. He died ture as: “The ludicrous heightened into the destitute and alone in Baltimore at age 39. grotesque; the fearful colored into the horri- D.C. Meeting ble; the witty exaggerated into the burlesque; MYSTERY AND THE UNCONSCIOUS Highlights. . . .15–23 the singular wrought out into the strange and I believe a unifying theme common in mystical.” His life was burdened by loss, death, many of Poe’s works is evident when explor- and desperation so that his tales of terror, ing his literature using the common denomi- Cancer, Candidacy, mystery, and the bizarre appear as if a repeti- nator, “mystery,” that to Poe was what the and the Couch. . . .28 tion of his own experience. Edgar was born “unconscious” was to Sigmund Freud: a tool in 1809 to transient thespian parents who to examine the mind. were dead before he was three. He was pro- “William Wilson” marks the transition of Finding Cases vided a good home and education by his Poe’s literature to inner mindedness. The for Candidates. . . .29 childless guardians, John and Frances Allan. story’s protagonist, William Wilson, has a sul- But after his first year at the University of Vir- lied past traced to his unscrupulous choices ginia he aroused the wrath of John Allan as a school boy. There he encountered because of a “slothful, drunken, and indebted another of his own likeness by name, birth student life.” He was 17 when John Allan date, and physical characteristics. Although stopped supporting him. Edgar wandered, there is affection between them, his performing various jobs, joined the Army, behavior sets him apart from the attended West Point, and at 27 married his other William Wilson. At school and 13-year-old first cousin. afterwards he is deceitful and In contrast to his chaotic life, he was a pro- malevolent. His “double” appears at ductive and focused writer and became critical moments in his life as a increasingly well known as a brilliant short “whisper” in his ear to monitor story writer and essayist, but he was unable him. Enraged when his double to keep editing jobs or launch his own maga- places his “hand on his shoulder” zine. He was often drunk and always poor. during a masked ball at Carnival in He achieved international acclaim for “The Rome where he plans the seduc- Raven,” published when he was 35, and was tion of an older nobleman’s younger wife, the first William Wilson draws his R. Curtis Bristol, M.D., is a member sword intending to murder the second of the Baltimore Washington Society for William Wilson, only to recognize in the Psychoanalysis, APsaA, IPA, founding mirrored room of their fatal duel that the member of the Institute for Contemporary other person is himself. This is a brilliant Psychotherapy and Psychoanalysis and clinical demonstration of conscience by projection professor of psychiatry and adjunct professor of the opposite of a pair—good and bad. of liberal studies at Georgetown University. Continued on page 36

THE AMERICAN PSYCHOANALYST • Volume 44, No. 3 • Fall 2010 1 CONTENTS: Fall 2010 THE AMERICAN PSYCHOANALYTIC ASSOCIATION President: Warren R. Procci 3 Reflections on the June Meeting: Organizational Challenges President-Elect: Robert L. Pyles and Innovative Change Warren R. Procci Secretary: Robert M. Galatzer-Levy Treasurer: Judith S. Schachter Executive Director: Dean K. Stein 4 Direct Pathway to Membership Bylaw Amendment Approved, Eight Years in the Making THE AMERICAN PSYCHOANALYST Conflict Resolution and Growth Colleen L. Carney and Lee Ascherman Magazine of the 5 American Psychoanalytic Association Editor 6 APsaA Elections: Campaign Statements Janis Chester Editorial Board The Proposed Bylaw Amendments Jane Walvoord Brenda Bauer, Vera J. Camden, 14 Leslie Cummins, Phillip S. Freeman, Maxine Fenton Gann, Noreen Honeycutt, 15 99th Annual Meeting Highlights Sheri Butler Hunt, Laura Jensen, Navah Kaplan, Nadine Levinson, A. Michele Morgan, Julie Jaffee Nagel, 24 COPE: Classroom Teaching Workshop Gerald A. Melchiode Marie Rudden, Hinda Simon, Vaia Tsolas, Dean K. Stein, ex officio Science and Psychoanalysis: Studying Unconscious Senior Correspondent 25 Jane Walvoord Motivation Andrew J. Gerber Photographer Mervin Stewart Projections: What We Talk About When We Talk About Reality: 26 Manuscript and Production Editors Michael Haneke’s Cache Lissa Weinstein Michael and Helene Wolff, Technology Management Communications

SPECIAL SECTION The American Psychoanalyst is published quar- Candidates terly. Subscriptions are provided automatically to members of The American Psychoanalytic Asso- ciation. For non-members, domestic and Cana- Cancer, Candidacy, and the Couch Patricia Plopa dian subscription rates are $36 for individuals 28 and $80 for institutions. Outside the U.S. and Canada, rates are $56 for individuals and $100 The Affiliate Council: Widening Scope and Practice at the for institutions. To subscribe to The American Psy- 29 choanalyst, visit http://www.apsa.org/TAPSUB, or New York Psychoanalytic Institute Navah C. Kaplan write TAP Subscriptions, The American Psycho- analytic Association, 309 East 49th Street, New York, New York 10017; call 212-752-0450 x18 or 30 Affiliate Council Practice Network e-mail [email protected].

Copyright © 2010 The American Psychoanalytic 32 Neurotic Attitudes Toward Money John W. Schott Association. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by 33 Politics and Public Policy: Health Reform Legislation any means without the written permission of The and Psychoanalysis Graham L. Spruiell and Fredric T. Perlman American Psychoanalytic Association, 309 East 49th Street, New York, New York 10017.

34 Poetry: From the Unconscious Sheri Butler Hunt ISSN 1052-7958 The American Psychoanalytic Association does Certification 2010 not hold itself responsible for statements made 35 in The American Psychoanalyst by contributors or advertisers. Unless otherwise stated, material in The American Psychoanalyst does not reflect the endorsement, official attitude, or position of Correspondence and letters to the editor should be sent to TAP editor, The American Psychoanalytic Association or Janis Chester, at [email protected]. The American Psychoanalyst.

2 THE AMERICAN PSYCHOANALYST • Volume 44, No. 3 • Fall 2010 FROM THE PRESIDENT

work and for contributing their creative ener- Reflections on the June Meeting: gies to the organization. We are also seeing a decline in the number of candidates who have Organizational Challenges and chosen to become members of the organiza- tion as well as in the total number of candi- Innovative Change dates. The only group increasing is the senior Warren R. Procci members. While we are delighted to have these members continuing to contribute to We recently Newell Fischer. This amendment will allow the Association in many ways, it is absolutely concluded the well qualified analysts not trained in APsaA essential that the organization replenish itself spring meeting or IPA institutes to become members of our with adequate numbers of newer members of the American Association. It is an example, similar to pas- and unfortunately we are not accomplishing Psychoanalytic sage of the standards document, of how this. I will be discussing these trends with you Association. A APsaA members with very different view- in greater detail in subsequent postings. number of points were able to work together in sup- important things port of innovative change. In this case it was BUOYANCY AND HOPE occurred, some to expand membership, however modestly, There is an unavoidable message here much with historic sig- while also maintaining the quality of our stan- as we do not want to hear it. We are in a Warren R. Procci nificance for us, dards. The language of the MRRC amend- decline. I intend to devote my presidency to and I would like to tell you about a few of ment makes clear that only individuals with establishing as the major priority for APsaA them. I would also like to acknowledge my training that is “substantially equivalent” to the stabilization of our resources, including our sense of honor at becoming the 64th presi- that obtained in an APsaA or an IPA institute membership, and the development of long- dent of the American Psychoanalytic Associa- will be acceptable for our membership. term strategies that will help us confront and tion at the conclusion of that meeting.

NEW SET OF EDUCATIONAL I am confident that our organization can work together STANDARDS The first issue of importance is that we to make our second century a glorious one. now have a new standards document from BOPS. This has occurred in response to a strong need, expressed by a number of local Both of these innovations vividly demon- manage these problems. In order to do this, institutes, for a set of standards that takes into strate that our members can work well we will be engaged in the formulation of an account certain pressing realities facing together and that we are able to overcome organizational plan, which will ultimately lead potential candidates in today’s environment. the tensions that have existed within the orga- to specific strategies, strategies that will help us The document that was assembled repre- nization over the past several years due to the deal with these problems. It is our responsibil- sents the first change in our standards in over very serious external challenges and threats ity to do this and we must not avoid it. 70 years. BOPS is to be congratulated on that we face. In many respects my predecessor, When I spoke to the Association for the being responsive to the needs of a number of Prudy Gourguechon, did a great deal to help first time at the business meeting in Washing- our local institutes, and in a very timely fash- advance both of these initiatives and bring ton, I invoked words that Churchill used in ion, something unusual for APsaA. We made them to fruition. We thank her. We can work 1940 when facing the dire situation in Europe. these important changes without eroding the constructively and effectively when the focus He concluded that famous “blood, toil, tears quality of our standards. is on progressive change and the need for and sweat” speech by saying that he was our organization to take a forward position. approaching his task with “buoyancy and EXPANDING MEMBERSHIP, hope.” I bring this to your attention in the MAINTAINING STANDARDS ADDRESSING OUR DEMOGRAPHICS same spirit. I am confident that our organiza- The second item of importance is the My final note is unfortunately a less salutary tion can work together to make our second passage of the MRRC bylaw amendments. one. The membership data presented at the century a glorious one. This has been incubating in the organization meeting show without doubt that there con- for over six years, since the presidency of tinues to be a decline in our membership and Editor’s Note: This column appeared on the indeed it may even be accelerating a bit. Espe- Association listserv on July 24, 2010, with Warren R. Procci, M.D., is president of the cially affected are our active members, those permission from The American Psychoanalyst. American Psychoanalytic Association. who are in their peak years for doing analytic

THE AMERICAN PSYCHOANALYST • Volume 44, No. 3 • Fall 2010 3

Direct Pathway to Membership Bylaw Amendment Approved, Eight Years in the Making

By the largest majority seen for such a vote in recent membership at large are all involved at various stages of years, APsaA’s members approved a bylaw amendment the implementation process. To read the complete lan- at the Annual Meeting in June. The bylaw amendment guage of the bylaw amendment, go to the bylaws section completes an eight-year-long effort to provide a mecha- of the APsaA Web site which is under Association Docu- nism for qualified analysts who did not graduate from an ments in the Members Section—Article II Section 1. APsaA or IPA approved institute to join the Association. As prescribed by the new bylaw, the Membership “This is an historic vote,” said past president Prudy Requirements and Review Committee formulated new Gourguechon. “With this amendment, APsaA is trans- procedures for implementing direct membership, and in formed from an alumni association to an association of late August, President Warren Procci announced that committed, like-minded psychoanalysts.” these were available to all members and components of The approved amendment spells out a mechanism for the organization for a 90-day review and comment period. creating and implementing a pathway to direct member- To access the recommended procedures and provide ship including criteria and procedures based on the con- your input go to www.apsa.org/ExpandedMembership. cept of “substantially equivalent training.” The Executive Eighty-three percent of the members voting voted to Council, the Membership Requirements and Review approve the bylaw amendment. Sixteen percent voted Committee, the Board on Professional Standards, and the against and one percent abstained.

Statements from electionsthe candidates in the Fall 2010 elections begin on page 6. CANDIDATES David Falk and Beth Seelig will be running for secretary. The winner will begin a two-year term in June 2011. Arthur Farley, Peter Kotcher, and William Myerson are running for treasurer. The winner will begin a three-year term in June 2011. Candidates for councilor-at-large include Will Braun, Laura Jensen, Carmela Pérez, Mark Smaller, and Graham Spruiell. The two winners will begin four-year terms in June 2011.

BYLAWS Four proposed bylaw amendments will be submitted to the membership. The first three proposed bylaw amendments focus on “housekeeping” issues: • An amendment to remove the phrase “As to Form” in regard to proposed changes in bylaws—Article VIV (Amendments), Section 2 • Changing “revocable proxies” • Appointment of BOPS committees Article XII (Board on Professional Standards), Section 1(j) The fourth proposed bylaw amendment proposes to add four new voting members to the Executive Committee. The full text of the proposed changes can be viewed on the APsaA Web site at www.apsa.org/bylawamendments. Ballots will be mailed during the first week of December. Completed ballots must be received in the National Office no later than Friday, January 7, 2011.

4 THE AMERICAN PSYCHOANALYST • Volume 44, No. 3 • Fall 2010 FROM BOPS

and Special Training, which will address Conflict Resolution and Growth the specific tasks of these committees in Colleen L. Carney and Lee Ascherman this time of transition. • Finally, with the help of the National As of July 1, 2010, we began the complex 1940s. One might wonder, if this original Office, we will have a system for internal task of implementing our newly adopted emphasis on research had not been lost, communication in place to facilitate dia- Standards for Education and Training in Psy- would we now carry a different internal logue between and among institutes as choanalysis. This document is the most com- image of our training model, one that looks we implement these new standards, prehensive revision of our training standards more like a chair than a three-legged stool: step by step. since 1938. Born out of decades of intense personal analysis, didactic teaching, super- internal conflict, it now represents the collec- vised clinical work, and a research orientation DEVELOPMENTAL PATHWAYS tive synthetic work of countless individuals, to all that we do? All institutes are encouraged to incorpo- committees, and administrations. Those of us rate pre-graduation colloquia into their cur- who had the privilege of hearing Vamik Vol- FOUR-PART IMPLEMENTATION ricula and progressions process. Institutes kan’s plenary address at the recent APsaA In this regard, the focus adopted in these choosing the developmental pathway are Meeting, will recall that there truly is an art to new Standards for Education and Training in required to incorporate two colloquia, one conflict resolution. If we may loosely para- Psychoanalysis represents a historic mile- to be conducted after the candidate’s third phrase his key points: Learn to talk to one stone. The process of implementing these year of training, or prior to taking a third con- another, do not force artificial agreements, new standards is complex and will be coordi- trol case, and a second, pre-graduation col- and learn to live with and respect differences. nated through a number of ad hoc advisory loquium. We believe that this scholarly This new document stands as a hopeful sym- committees and sub-committees. practice will elevate the quality of psychoana- bol of such healthy conflict resolution; but at • First, a BOPS Planning Committee will lytic education throughout all of our 31 insti- the moment it is only a symbol, something be asked to develop a strategic plan, to tutes. In addition, this revision offers two like a sketch, or a promissory note. It is up to identify long and short-term goals, and other important opportunities: to facilitate us, individually and together, to grow into it recommend manageable ways to mea- collaboration between and among institutes, and make it real. sure them. Our hope is that the Planning and to provide a uniform point of evaluation Committee will give us a road map for which will allow us, over time, to establish RE-EMERGENCE OF RESEARCH reaching our ultimate objectives: more some educational benchmarks for our candi- It would be misleading, however, to charac- and better educated candidates, meth- dates. We anticipate that most institutes will terize these changes as merely a resolution of ods for collecting meaningful data, and need particular assistance in incorporating our conflicts, as important as that may be. the means to organize the knowledge colloquia into their training programs. Infor- The real intent of the Revisions Task Force needed to arm ourselves and our future mation and guidance about how to develop was to shift the focus of our attention to the analysts with a stronger voice in the these colloquia will be provided on the BOPS quality of education and training in our insti- larger mental health and scientific section of the APsaA Web site. We also plan tutes. The new document is an intelligent bal- communities. to offer BOPS workshops pertaining to col- ance between reckless non-regulation and • Second, an advisory sub-committee of loquia and the developmental pathway of stifling over control, between individual cre- the Committee on Institutes will develop education at the national meetings. ativity and responsible oversight. It firmly a policy and procedure for processing As difficult as the mechanics of implement- anchors all of our institutes in the history we waivers from institutes which choose to ing these changes will be, our greater chal- share, the tripartite training model. But this apply for a waiver of a training analysis lenge will be effecting a fundamental shift in document also recaptures a part of our his- for a candidate who is already in an the way we think about psychoanalytic edu- tory that had been lost, the importance of established personal analysis. cation and the role that BOPS can play in research in our training programs and to our • Third, an advisory sub-committee of the helping each institute develop its unique profession. The original Eitington-Freud Certification Examination Committee features. The spirit of these revised standards model in Berlin was built on the triad of will develop a procedure to operational- is two-fold: to preserve our national commit- teaching, treatment, and research. These new ize the developmental pathway to certifi- ment to a shared philosophy of psychoana- standards reach back and pick up that loop cation and training analyst appointments lytic education and professional standards, which was dropped sometime during the for those institutes choosing to adopt while encouraging the creativity and unique the developmental pathway. Similarly, culture of each institute. BOPS and APsaA Colleen L. Carney, Ph.D., is the chair there will be an advisory sub-committee institutes have entered a new era of psy­ of BOPS; Lee Ascherman, M.D., serves to the Committee on New Training Facil- choanalytic education. Success depends upon as secretary. ities and the Committee on Research all of us.

THE AMERICAN PSYCHOANALYST • Volume 44, No. 3 • Fall 2010 5 APsaA ELECTIONS: SECRETARY

CAMPAIGN STATEMENTS

orthodoxy to allow the organization to David I. Falk change and are met by obstructive and rigid We are the guardians the Association. Changes in the economy resistance. of what I like to think of along with threats to privacy and hostile These myths were conflated with the as the last free place on insurance strategies all make psychoanalytic struggle for power within the unusual gover- earth. This is, of course, practice difficult. These problems require nance structure of APsaA. Now we find a bit of hyperbole but it persistence and a clear focus for action, and ourselves at a moment where there is real allows me to share my we have as an Association addressed some of opportunity to change the usual ways we love of psychoanalysis these problems. However, the last free place relate to one another. The Training Stan- David I. Falk and the special role we on earth is also threatened by difficulties we dards Document has been revised and the have in maintaining an have struggled to resolve within our own threat of rupture averted. The governance accepting and safe place for our patients to be profession. I am more hopeful at this writing struggles that have dominated past meetings themselves and come to understand and work than at any other point in my membership seem to have calmed down as the Council through their difficulties. The safety and free- in APsaA; the acceptance of revisions to the moves to fulfill its role as the Association’s dom come from the care we take in maintain- Training Standards Document that will allow board of directors. ing the analytic frame, listening with great care our organization to come together with to the conscious and unconscious aspects of greater mutual trust and harmony. Many of DISMANTLING DESTRUCTIVE MYTHS our patients’ thinking and providing interpreta- BOPS members worked long and hard to We all want psychoanalysis to survive and tions with tact. We tolerate much as the treat- achieve this remarkable compromise. The thrive but we can only achieve this as an ment deepens and all of this depends on the way they worked offers some lessons to us organization when we end the destructive ability of the analyst to listen with acceptance as we move forward. myths and associated attitudes that persist and concern for the patient’s struggle to in spite of changed circumstances. We need become him or her self. This free place is VOLKANIAN SOLUTIONS to apply the kind of process that worked for unique to our analytic treatment and it has It was a great meeting in Washington. I was the Task Force on Educational Standards been a place of enormous value to me. particularly impressed with the wonderful Revision and the Task Force on Externaliza- The secretary’s tasks are mainly adminis- plenary by Vamik Volkan. As I listened to Vol- tion. Each featured a sincere commitment to trative and require diligence to complete. You kan talk about his work in the Balkans and working in small diverse groups to attempt a can be sure that I have worked on many proj- the Middle East, I could not help but think his synthesis to prevent a crisis in the organiza- ects for APsaA and I get things done. I am ideas about group psychology could readily tion. The groups came to accept and under- currently a board member and treasurer for apply to our own organization. One of his stand the positions of the other, allowing a the Cleveland Psychoanalytic Center and a ideas was that projection, polarization, and creative solution to develop. Just as the small board member for a for-profit health-care hatred inevitably lead to intense conflict. I groups came to propose changes to the organization. I have found in doing this work think we all remember and feel uneasy about training standards, we can work to appreci- that I needed more expertise in finance, things that were said or done over the years ate the value and importance of the views of management, and organizational processes by those arguing for or against change. His each of our members. We are a small orga- to fully and responsibly carry out my fidu- solution to group conflict is to have small nization of highly trained professionals com- ciary responsibility to these organizations. I groups come together and talk and thus to mitted to a difficult task with our patients. have, therefore, enrolled in a health-care humanize their experience of each other. We need to foster a shift of attitude to wel- MBA program. Perhaps we can work toward that goal by come our members and candidates and ending our two destructive myths: There are value and respect their interests and ideas. THREATS TO THE LAST FREE PLACE those who must protect the goodness and I would hope to be an important part of this ON EARTH: INTERNAL AND EXTERNAL purity of psychoanalysis from others who are needed shift in attitude. It will make our The Practice Survey has long suggested a out to destroy it; conversely there are those meetings more pleasant and our Association slow decline in psychoanalytic practice within who seek to throw off the burden of more welcoming.

6 THE AMERICAN PSYCHOANALYST • Volume 44, No. 3 • Fall 2010 APsaA ELECTIONS: SECRETARY

of psychoanalysis in the community. Research Beth J. Seelig will also increase our excitement about what Almost 100 years challenges faced by institutes and societies we do everyday in our practices, improving ago, the founders of in various parts of our country. I am on the the morale of individual analysts, institutes, our organization were faculty of a large institute, the Columbia societies, and our Association. innovators, exploring Center for Psychoanalytic Training and I teach and supervise psychiatric residents a new approach to Research, and a small one, the Emory Psy- and co-teach with graduate school educators understanding human choanalytic Institute, and have served as in the humanities. While director of the beings. Again, as we director of the Emory Institute. I am also a Emory Psychoanalytic Institute, I worked with approach the centen- member of the Committee on Affiliation Robert A. Paul, psychoanalyst and dean of Beth J. Seelig nial of our organization, with Freestanding Institutes (CAFI). In addi- Emory College, to create Emory’s Graduate it is essential for us to be innovators to ensure tion to my broad national and local organiza- School of Arts & Sciences’ widely admired that psychoanalysis will thrive and grow. We tional background, I am a North American and highly successful Psychoanalytic Studies must heal discord within our organization and representative to the IPA Board. Program (PSP). In addition to serving on the find ways to surmount obstacles to psycho- If elected secretary of APsaA: PSP Executive Committee and teaching in analytic treatments and psychoanalytic train- the PSP, I organized two international inter- I will work to maintain a produc- ing. At the recent meeting of the American disciplinary conferences: Women & Power: tive collaborative spirit within our Psychoanalytic Association in Washington Psychoanalytic Perspectives on Women in organization. D.C. a huge step was taken towards healing Relationships, Groups, and Hierarchies and divisiveness within our organization. The Utilizing my broad perspective, Interdisciplinary Responses to Trauma. These Board on Professional Standards adopted the gained from experience at local, conferences brought together psychoanalysts two-track educational model and a rewritten national, and international levels, I and other clinicians with university scholars. I “Standards for Education and Training in Psy- will participate effectively in APsaA’s am presently organizing a third interdisciplin- choanalysis.” In the same meeting, a previously governance. ary conference, Creativity through the Lifecycle, defeated bylaw amendment was adopted, April 14-16, 2011, Atlanta, Ga. This confer- I plan to increase the transpar- granting eligibility to apply for membership in ence is part of the IPA’s 100th Anniversary ency of APsaA’S governance by APsaA to individuals whose psychoanalytic Celebration and APsaA’S Education Division sending our members periodic training is “substantially equivalent” to APsaA has designated it a Special Initiative. e-mail “Notes from the Secretary.” or IPA training. Having graduated from Columbia School As I believe in the importance of of Engineering and Applied Science, I received FUTURE OF APsaA outreach and research initiatives, I my M.D. from New York Medical College, did By adopting new educational standards will support existing initiatives and my psychiatric residency at New York State and substantial equivalency, our organization encourage new ones. Psychiatric Institute/Columbia Presbyterian has begun to remake itself. The ways in which Hospital and my psychoanalytic training at these changes are implemented will deter- PAST AND PRESENT Columbia Center for Psychoanalytic Training mine our Association’s future. APsaA’s lead- My professional life has been dedicated and Research. My academic appointments ership must be responsive to our members’ to clinical work with patients, psychoanalytic are clinical professor of psychiatry and TA/SA, concerns and devoted to their best interests. education, and the education of non-psycho- Columbia Center for Psychoanalytic Training My energy, creativity, and extensive experi- analysts, for which I received APsaA’S Edith and Research and professor emerita of psy- ence in governance, combined with my ser- Sabshin Award for Excellence in the Teaching chiatry, TA/SA, and past director, Emory Psy- vice on numerous committees and task of Non-Candidate Students. choanalytic Institute. I am a member of the forces, have prepared me well to help While I was chairing APsaA’S Science Divi- Association for Psychoanalytic Medicine and APSAA grow in a productive direction. I sion and serving on both Executive and the Atlanta Psychoanalytic Society. have served on APsaA’s Executive Commit- Steering Committees, I recommended and I ask for your vote so that I can work cre- tee, the Executive Council (APsaA’s board of was successful in initiating the Scientific atively and collaboratively to foster the directors) as councilor-at-large, on the Board Poster Session that has been so successful goals of our members and to strengthen on Professional Standards, as a fellow and as in attracting researchers and the press to our our organization. If you would like to learn secretary, and on Steering and Coordinating winter meetings. Research demonstrating the more about me, my Web site is www. Committees. Chairing the Committee on effectiveness of psychoanalytic and psycho- bethseeligmd.com; to talk with me, call me New Training Facilities (CNTF) has given me analytically based treatments is a vital ingredi- at 917-639-3978; my e-mail address is knowledge about the internal workings and ent in sustaining and improving the position [email protected].

THE AMERICAN PSYCHOANALYST • Volume 44, No. 3 • Fall 2010 7 APsaA ELECTIONS: TREASURER

balanced budgets, we need to add to APsaA’s Art Farley non-dues income, as we have done with our I am honored to support those who do psychoanalytic visionary initiation and investment in the have been nominated research and who can then go on to leverage PEP enterprise. For many years we have had as a candidate for our assistance by seeking additional financing strife between those members and candi- treasurer of APsaA from other agencies. dates calling for relief from the negative and I am asking for I have been a supporter of reasonable ini- effects of the certification requirements for your vote to allow me tiatives to modernize our Association. I have TA appointment and BOPS, which is charged the privilege of serving supported institute choice and the MRRC with developing and maintaining standards Art Farley as APsaA’s next trea- bylaw amendments, and I intend to work for education within our institutes and cre- surer. I am well qualified for the position of hard to make sure that the enlightened bylaw dentialing of our individual graduates. That treasurer having had extensive experience amendment to add four voting councilors strife exposed widespread misunderstanding in business, as well as having been the elected by the Council to the Executive of the Not-for-Profit Corporation Law of founder of a successful therapeutic school, a Committee is adopted. The current arrange- New York State, where APsaA is incorpo- school which recognizes the important role ment, in which a Committee of the Council rated, and of our bylaws. With the increasing that psychoanalytic approaches can serve is empowered to act on behalf of the entire recognition and acceptance of the true state within the community. I have an extensive Council, while the Council itself has no say at of affairs, we have been able to adopt a new record of service to my institute and to all into that committee’s makeup is nonsensi- approach to our conflict, one in which two APsaA, with special experience in institu- cal. Adding four elected councilors to the inclusive task forces were appointed to tional fundraising. Executive Committee will strike the appro- enable those who disagreed to come My commitment to service within APsaA priate balance between the Council and the together for direct discussion and negotia- is long standing. I have many years of experi- four officers of APsaA, who are elected by tion. It is up to all of us to support the unity ence representing the Houston and San the entire membership. that this newly adopted process has brought Antonio/Austin Psychoanalytic Societies in My past experience provides me with an about, and to remember that we can resolve the Executive Council and have seen the historical perspective, and a recognition of our disagreements successfully and creatively Council grow into its proper role as the the need for a cautious, deliberate but grad- by direct negotiation within a democratic governing body of our organization. Within ual approach to change. New initiatives not governance structure. the Council I have been gratified to have requiring bylaw changes can strengthen the We need active leadership that trusts the been elected by the councilors to serve on Executive Council. These include the creation legitimate processes of change which can be the Committee on Council, a body tasked of additional committees within the Execu- brought about by enhanced cooperation with improving the governing functions tive Council, such as a long range Financial between our board of directors and its Exec- within our organization. Planning Committee, a Publications Commit- utive Committee, BOPS, the APsaA Bylaws I am a child, adolescent, and adult psycho- tee, and a Budget Review Committee, all Committee, and the varied and talented analyst, as well as a training and supervising elected by the Council and from the Council, APsaA membership as that membership analyst, and having served on COCAA and as is appropriate and sensible for any large gradually changes as a result of evolving COCAP, I am intimately aware that local insti- board of directors. demographics within our field and our tutes in different geographic regions have In visualizing my role as treasurer, I intend changed membership requirements. I greatly varying needs. Participation as a com- to follow in the footsteps of our current embrace all efforts to make APsaA relevant mittee member in the distribution of the treasurer, Judy Schachter, with the intention and welcoming to a wider community of small grants that the American Psychoanalytic of creating an even more involved partner- worthy psychoanalysts. If you vote for me for Foundation Committee gives to outreach ship between the Executive Council and the treasurer, in a spirit of enthusiasm, openness, efforts has made it clear to me that there are APsaA members. I will work hard to encour- and collaboration I hope to bring about the local individuals and centers of creativity that age greater participation of the Executive constructive changes that will ensure that we must fund in even greater amounts. We Council in budgetary decisions and financial APsaA is a vibrant home base for psycho- must find more funds and fund sources to planning. While we currently maintain analysis in the U.S.

8 THE AMERICAN PSYCHOANALYST • Volume 44, No. 3 • Fall 2010 APsaA ELECTIONS: TREASURER

It is my hope that the achievement of the Peter Kotcher Task Force for Standards Revisions lead by My interest in psy- appre­ciation of the multidisciplinary nature Eric Neutzel, Eric Gann, and Allan Compton choanalysis has deep of the provision of mental health care. Over last winter will considerably smooth the path roots going back to the five years as chief of the Mental Health forward for APsaA. I also enthusiastically sup- when I was 12 years Care Line, I participated in the formation of ported the recent resolution for an expanded old. I had just com- a well coordinated and cohesive multidisci- pathway to APsaA membership. The strategic pleted reading the col- plinary team of 240 individuals including 46 planning initiative proposed by Warren Procci lected works of Arthur social workers, 42 psychologists, and 34 psy- will provide an excellent opportunity for Peter Kotcher Conan Doyle and chiatrists dedicated to caring for our nation’s APsaA to reexamine its values and goals. As found The Introductory Lectures on Psychoanal- veterans. It has been of considerable interest we enter our second century, we can develop ysis by Sigmund Freud on my family book- to watch APsaA struggle in recent years to increasing cohesion and expanding member- shelf. As I started reading about parapraxes I achieve multidisciplinary cohesion. I know it ship in our vital enterprise. was hooked; I had previously felt that what can be done. I ask for your vote and in return promise people said to me had more meaning than steady careful attention to the financial affairs they seemed to be aware of and now I had MY COMMITMENT TO APsaA of our organization. an explanation. I have been fascinated by psy- Upon my graduation, the Cincinnati Psy- choanalysis ever since. After earning a BA at choanalytic Institute chose me to be its rep- Rice University, I enrolled in Johns Hopkins as resentative to the Executive Council of the a doctoral candidate in organic chemistry. American Psychoanalytic Association. That Certified in That pursuit was interrupted by two years at role opened the door to my growing familiar- Sheppard Pratt Hospital as a nursing assistant ity with the workings of the leading psycho- Psychoanalysis which reawakened my desire to become a analytic organization of the United States. By the Board psychoanalyst. I enrolled at Louisiana State My involvement in the financial affairs of University School of Medicine in Shreveport APsaA came through my membership in the on Professional to pursue medical training as preparation for Audit Committee. Work on the audit led me Standards a career as a psychiatrist and psychoanalyst. I to a close review of Association finances. chose the residency training program at the During my chairmanship the committee June 9, 2010 University of Cincinnati largely because of its worked with Dean Stein on having our audit psychoanalytic orientation and the availability work bid out for the first time in many years. of the Cincinnati Psychoanalytic Institute. I The periodic solicitation of bids has become Adult graduated from the Cincinnati Psychoanalytic standard practice among non-profit organi- Susan Jaffe, M.D. Institute in 2006. zations. In my candidacy for treasurer of the I have been interested in and involved in Association I do not bring an agenda for any Julia A. Matthews, M.D., Ph.D. psychiatric education since my days as a major new direction. We need to complete Kathleen Miller, Ph.D. medical student. For 13 years I operated the the review of our employee retirement plan Ann G. Smolen, Ph.D. core clerkship in psychiatry for the Depart- and our investment strategy for our reserve ment of Psychiatry at the University of Cin- funds will need ongoing monitoring and Peggy E. Warren, M.D. cinnati College of Medicine. I have long reconsideration. We are in the midst of Mitchell D. Wilson, M.D. experience in evaluating learners’ progress assessing the financial viability of holding two through participation in the College of Medi- national conventions each year. That issue is cine Promotion Board where I was a mem- expected to reach resolution during the ten- Child and Adolescent ber for 28 years and chair for 14 years. It was ure of the next treasurer. Judy Schachter is Ann G. Smolen, Ph.D. in my work at the Cincinnati Veterans Affairs leading a careful review of our financial allo- Medical Center that I grew to full cations which will be ongoing.

THE AMERICAN PSYCHOANALYST • Volume 44, No. 3 • Fall 2010 9 APsaA ELECTIONS: TREASURER

on improving the functioning of my local insti- William A. Myerson tute and society. On June 30, I completed a I am passionate We all recognize that our current organiza- three-year term as president of the HGPI. As about the value of tional structure will not allow us to thrive in a result, I am keenly aware of the struggle to psychoanalysis and our today’s challenging environment, yet finding keep psychoanalysis alive and relevant in our psychoanalytic per- an alternative model has proven difficult. communities. To be successful as an enterprise, spective. It is vital for Thankfully, we are beginning to discover col- HGPI needed to relearn the importance of our patients and our laborative solutions to our internal problems. teamwork. We needed to increase the partici- communities that we The recent process, initiated by the Task Force pation of individuals from diverse backgrounds William A. Myerson keep psychoanalysis for Standards Revisions, was an excellent who could help expand our strengths. Together, and our psychoanalytic example of a new spirit of collaboration and this inclusive group reworked significant ele- perspective alive and growing. I believe that pragmatic problem solving. I believe we can ments of our institute’s governance. Our efforts the success of psychoanalysis is dependent build on this approach in developing a com- produced dramatic positive results. Student on the growth of our local institutes and prehensive plan for increasing our resources. enrollment sharply increased. Faculty morale societies. A broad-based collaboration by For APsaA and psychoanalysis to thrive, we was transformed. Operating expenses were the membership at both the local and need vibrant local institutes and societies that decreased. Our institute had its strongest year, national level is necessary to create optimal are connected by a strong, well-functioning both educationally and administratively. We solutions. If elected treasurer, I will work to national organization. I believe APsaA can do are, for the first time in many years, optimistic engage our many constituencies in the cre- more to support innovation and growth at about our future. If elected treasurer, I will ation and implementation of a strategic plan the grass roots level, actively encouraging our maintain a commitment to open and honest focusing on the advancement and growth of societies and institutes to experiment and communication with the membership; I will psychoanalysis. evolve successful models that APsaA can work to enhance the growth of our local A core commitment the treasurer makes then help disseminate. institutes and societies; and I will work to to the membership is to provide them with Our organization would benefit from engage our many constituencies in the cre- honest and transparent communication including individuals who have management ation of a strategic plan focusing on the about APsaA’s finances. Through this com- training and experience as officers. I am a advancement and growth of psychoanalysis. mitment, the treasurer helps the members psychoanalyst who has both undergraduate Election to APsaA office imposes a seri- fully participate in shaping how APsaA carries and graduate degrees in business as well as ous obligation to serve the membership. If out its mission. I will honor this commitment. psychology. I have been a professional man- elected, I will draw on my passion for psycho- I believe that APsaA can be a more effec- ager as well as a clinician in private practice. I analysis and my managerial experience to fill tive advocate for psychoanalysis if we served as a manager for a large preventive that obligation. strengthen our financial condition. It is there- medicine center with 40 employees and an fore extremely important that we develop a operating budget of over $5,000,000 before BIOGRAPHY new strategic plan with an emphasis on leaving to focus exclusively on psychoanalysis. I am on faculty at both the HGPI, where I increasing our resources. The membership’s My recent term as president of the Houston- am a TA/SA, and at Baylor College of Medi- active involvement in the development and Galveston Psychoanalytic Institute (HGPI) cine. I have been president and treasurer of implementation of this vital project is crucial. allowed me to merge these skills with very both the HGPI and the HGPS. I am currently The new strategic plan must evolve from a productive results. By blending psychoanalytic an alternate councilor, previously councilor, process of collaboration between the organi- and business perspectives, we can more to the Executive Council and a BOPS Fellow. zation’s diverse constituencies and its elected effectively manage our organization. I have served on both the MRRC and CNTF. representatives. The purpose of this process My background in management has taught I have a Ph.D and an M.B.A. Since 2007, I have would be to develop a consensus about the me how to put psychoanalytic understandings presented papers at APsaA, IPA, and ISPSO financial decisions we need to make while of motivation into practice at the institutional on both the challenges our institutes face and simultaneously bringing us together to focus level. I have become skilled at working with potential solutions. our energies. As treasurer, I will seek your groups. Active on both the Executive Council Please contact me: support for developing and implementing and the Board of Professional Standards 713-527-9854 such a plan. (BOPS), I have also focused much of my energy [email protected]

10 THE AMERICAN PSYCHOANALYST • Volume 44, No. 3 • Fall 2010 APsaA ELECTIONS: COUNCILOR-AT-LARGE

I have had the opportunity to work with Will Braun members across the country on changing the As one of our our members while reaching out and con- public image of psychoanalysis. I am inter- “younger” and newer necting to the rest of the world. ested in how the Council can be most members, I see our These have been my goals as co-chairman responsive to the needs of our local institutes Association moving of the Committee on Public Information, as a and individuals. forward, embracing supervisor and educator of psychology doc- As councilor-at-large, I would bring energy, new ideas, and reach- toral students, as a graduate of the New York a fresh perspective and innovative ideas, ing beyond our offices Psychoanalytic Institute, and while psychoan- enthusiasm for the field, and a desire to see with innovative ways alytically working with inner-city boys at psychoanalysis flourish in a world that des- Will Braun to bring psychoanalysis George Jackson Academy. The future of psy- perately needs it. I hope to be ever mindful of to our local communities. With our approach- choanalysis is now. We must move beyond the fact that psychoanalysis is much bigger ing 100th anniversary, our organization needs internal struggles as our members wrestle than our organization—that what is at stake to be creatively and courageously looking with issues of practice and the future of our is not just the future of APsaA but the future towards the future, focusing on supporting field. Through our public information efforts, of psychoanalysis.

to working with all of our faculty members to Laura L. Jensen maintain and enrich the educational experi- I am honored to important issues have been discussed. These ence for our candidates, the future of our be nominated to run issues allowed me to serve on three impor- organization. Further, I was elected to our for councilor-at-large tant task forces—the Task Force on Expanded Board of Directors, having benefited greatly on APsaA’s board of Membership Criteria, the Task Force on Reor- from watching our director help our institute directors. I have been ganization, and the Task Force on Externaliza- develop into a true nonprofit organization involved with APsaA tion. Each consecutive experience has taught based upon Colorado nonprofit law. since I became a candi- me more about how to work with others in I would expect to work just as hard as your date in adult psycho- productive ways. Each has enriched my prob- councilor-at-large. I feel it is time to infuse the Laura L. Jensen analysis in 1998 at the lem-solving and listening skills, and each has APsaA board of directors with new and fresh Denver Institute for Psychoanalysis. I began taught me how much I still have to learn. perspectives and to respect and value all my child and adolescent training after com- In addition, my experience as president- groups within our organization. Here is my pleting my adult coursework and graduating. elect and as president of the Affiliate Council pledge based upon what I have learned from has allowed a window into each major sector you, the members of APsaA: AFFILIATE COUNCIL: A WINDOW of our Association. I have served on the I promise to listen before I speak, ON THE ASSOCIATION Association’s Steering Committee and the and then listen some more. Since 1998, I have been fortunate to have BOPS Coordinating Committee for four been involved in governance of the Associa- years. The officers of the Affiliate Council met I promise to respect the past and tion. I began this work as an alternate dele- regularly with the Executive Committee of still look to the future. gate to the Affiliate Council. I went from the Association, many national committee I promise to honor my legal, fidu- there to delegate, secretary, president-elect, chairs, and head office staff. ciary, and other responsibilities as a and president of the Affiliate Council, ending board member. in January 2009. My experience working with NOW: A VIEW OF THE FUTURE fellow candidates has enriched my views Closer to home, I have just completed my I promise to remain open to about psychoanalytic training in many ways, tenure as secretary of the Denver Institute, the views of all groups within the and I am committed to giving candidates a serving on the Executive Committee there Association. voice in the Association. for three years. I have just begun my term as The years of my involvement have not chair of our Curriculum Committee (or Edu- I sincerely hope that you will give me the been smooth for our Association, yet cation Committee). There I will look forward chance to serve. Thank you.

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to continue to work together if we are to Carmela Pérez achieve this goal. It would be an honor outside of APsaA, and I am aware of both Three areas that I am invested in, and to serve you as coun- the challenges and benefits of group mem- which I think are crucial to the forward cilor-at-large. I have bership. I think there is a lot of work to be movement of our organization are: First, a been active within the done in our Association. We live in a fast- commitment and belief in the future of psy- Association since my paced world that relies more and more on choanalysis and of APsaA, specifically focused first year of candidacy technology as a way of communicating, on how to help our organization best pro- when I served as dele- where many if not most patients expect mote and market psychoanalytic ideas and gate for my institute on speedy results, and where we now compete practice; second, support and investment in Carmela Pérez the Affiliate Council. I in a vast marketplace of mental health treat- our candidates, their education and develop- remained as delegate for four of the five years ments. These external pressures together ment as practicing analysts, and, most impor- of my candidacy, and I began and chaired the with the economic downturn have affected tantly, as the future leaders of APsaA; and Affiliate Council Committee on Race and many established psychoanalytic practices third, giving prominence to all issues of diver- Ethnic Diversity. During the last three years, I and make it extremely challenging for can- sity and culture in psychoanalysis and within have served as president-elect, and currently, I didates training across the U.S. to feel APsaA, because I strongly believe that the am finishing my term as president of the Affili- hopeful about making a living as psycho- increasing diversity within our organization is ate Council. I was also a candidate-member analysts. In addition, our organization suf- an important source of strength and growth. on the Committee on New Training Facilities, fers due to internal struggles, declining I hope that you will give me the opportunity and I am currently chair of APsaA’s Commit- membership, and fewer candidates training to continue to be involved in a leadership tee on Race and Ethnic Diversity. at our institutes. I think it is time for APsaA position within the Association. I will work Thus far in my career, I have enjoyed to reclaim the place it once had in the fore- hard on your behalf to ensure we continue to a variety of leadership positions in and front of the mental health field, and we need develop into a thriving organization.

directors, its committees, and our national Mark D. Smaller meetings are addressing concerns of ALL Next year, 2011, will utilize that kind of energy and creativity to members and especially newer and younger mark our Associa- address these problems our local groups and ones. Representation of members and their tion’s 100th anniver- members are facing. concerns must inform decisions of council. If sary year. There is I believe our Executive Council is facing the newer members are to spend time and much to celebrate challenge of finding ways to make the Asso- money to be members and attend our regarding the advance- ciation even more viable and responsive to national meetings, they must feel the council ment of psychoanalytic these serious concerns about maintaining is concerned about their daily professional practice, education, psychoanalytic practice, applying psychoana- lives. Enthusiastic and secure candidates, new Mark D. Smaller and research over the lytic ideas out in our communities, and mak- graduates and members become our most suc- last hundred years. For that we should feel ing our ideas available to people in everyday cessful recruiters of new students and patients very proud. I am running for councilor-atlarge life: in families, schools, business, government, and new interest from the public. (CaL), to contribute to the task of insuring the arts, and science. Our Association, our As many of you who know me or became that we successfully continue for the next profession, and our daily work depend on it. acquainted with me during the last presiden- hundred years. tial campaign understand, the challenges fac- I recently consulted with colleagues from FOCUS ON NEWER AND ing our field inspire rather than discourage two large institutes, and one smaller one in a YOUNGER MEMBERS me. Having served on six non-profit boards, large city. The concerns remain consistent: Younger and newer colleagues are con- I have experienced the challenges of moving too few candidates, too few patients, little cerned about their practices, having spent mission-driven and educational organizations strategic planning and little structure or huge amounts of time, energy, and money for forward through strategic planning—building commitment for fundraising and develop- training. We have not paid enough attention to on what works and letting go of what doesn’t. ment to support education and community the daily professional lives of our members. As An atmosphere of shared purpose remains programs. Now that we proved we can a councilor-at-large, I will be committed to the constant ingredient for APsaA’s success overcome differences and arrive at new and supporting decisions that insure the Execu- through the council. enhanced standards of education, we must tive Council as the Association’s board of Continued on page 14

12 THE AMERICAN PSYCHOANALYST • Volume 44, No. 3 • Fall 2010 APsaA ELECTIONS: COUNCILOR-AT-LARGE

If elected councilor-at-large, I will be Graham Spruiell pleased to represent all members on the I am running for confidentiality, while efforts to achieve parity board of directors by advocating for natural councilor-at-large, hav- between medical and psychological treat- principles that are essential to psychoanalytic ing served in this posi- ments, often achieve the opposite effect. practice. In my view those principles can be tion over the past four summarized in terms of freedom from years. Prior to that I WHAT DO ANALYSTS WANT? unwarranted intrusion by third parties into served as councilor for In addition to confusing terminology in the analyst-patient relationship, confidential- the Psychoanalytic Insti- laws and regulations, our members have dif- ity, and the right to contract privately with tute of New England, fering interests regarding anticipated changes our patients. Putting aside for a moment the Graham Spruiell East. I very much appre- in health care. Many accept insurance and turmoil of recent legislation in health care ciate what a candidate for secretary recently would like to continue accepting insurance and the din of misleading nomenclatures, I said about psychoanalysis; that it may be “the and remain a part of the new health care sys- remain singularly focused upon defending last free space on earth.” In no other place can tem. Others prefer to work out-of-network, that fragile boundary that circumscribes and a person who is in psychic pain have the while still others do not involve third parties protects the last free space in the world— opportunity to confidentially inquire about at all, preferring to contract privately with that space we have come to love and know the meanings of symptoms without being their patients without any third-party involve- so well: psychoanalysis. If you agree, I hope diagnosed with a chemical imbalance and ment or possible intrusion. that you will support my candidacy for coun- prescribed medications or be assigned to a For those who accept insurance and want cilor-at-large. Please feel free to contact me at behavioral program. I know of no other “place” to remain within the health care framework, I [email protected] or (781) 719-9415. besides psychoanalysis where the dignity of will be working with CGRI to establish a the individual patient and trust in the analyst- Web-based catalog of sentinel incidents that patient relationship is taken so seriously. occur between insurance companies and our Call for Nominations: members. If there appears to be a significant Committee on LEGISLATIVE PROTECTIONS VS. violation of the rules, such incidents will be LEGISLATIVE STRAITJACKETS forwarded for review by legal counsel for an Child & Adolescent During the past four years I have been hon- opinion and if appropriate, insurers and regu- Psychoanalysis ored to serve as chair of the Division on Psy- latory agencies will be contacted. APsaA’s Committee on Child and choanalytic Practice, chair of the Task Force For members who are working out-of- Adolescent Psychoanalysis (COCAP) on State Licensing Issues, and have been a network, we hope to closely monitor changes is calling for nominations for the member of the Committee on Governmental in insurance practices that have occurred as a Children and Family Community Relations and Insurance (CGRI), having result of parity in which insurers are requiring Service Award. The purpose of the recently been appointed as co-chair. In these more frequent reviews and attempting to award is to acknowledge community- roles I have had the opportunity to observe force out-of-network practitioners to submit based programs that utilize child changes in psychoanalytic practice. On the to the review process. Clearly, we would analytic principles. The winning program state level I have witnessed efforts to license oppose such efforts. Often such tactics are must provide direct services to children psychoanalysis by competing organizations, poorly disguised attempts to deny payment and families, utilize psychoanalytic and have reviewed proposed legislation that for mental health services, ironically, the very development principles to orient would impose mandates upon clinicians, problem that parity was intended to fix. the direct services (although other requiring them to become providers in state- For those members who accept no insur- viewpoints may be integrated), utilize run health care in order to be licensed. ance and prefer to contract directly with child psychoanalysts in a significant Nationally, I have been actively working their patients, I hope to keep members way as part of its delivery of services, with APsaA’s legislative team to improve the apprised of any changes that might endanger and have established themselves as HITECH Act (promoting the use of interop- private contracting. I would like to emphasize a substantial community resource with erable electronic medical records) by advo- that private contracting is something that we general acceptance by the community cating for confidentiality. More recently I have have always assumed implicitly in our work. It at large. addressed changes in insurance reviews that is the treatment model that best preserves Please contact Carol Austad, the have occurred as a result of parity. The vol- confidentiality and protects the analytic chair of COCAP to propose a program ume of changes that is occurring on state frame from outside intrusion and undue for the award. She can be reached and national levels is breathtaking, and often influence. Hopefully private contracting will at 734-663-3060 or by e-mail: perplexing. Efforts that purport to protect not be undermined by impending changes in [email protected]. confidentiality are often in fact assaults on health care.

THE AMERICAN PSYCHOANALYST • Volume 44, No. 3 • Fall 2010 13

The Proposed Bylaw Amendments Jane Walvoord

The first three proposed bylaw amendments would fall into OPPOSED the category of “housekeeping” items. The fourth proposed Opponents to the proposed bylaw argue against it for a bylaw deserves your careful consideration. It addresses the variety of reasons. They believe APsaA’s Executive Commit- structure and membership of APsaA’s Executive Committee. tee works well, that having a smaller body (as it currently exists) helps it to work well, and that it would create a CURRENT STATUS OF EXECUTIVE COMMITTEE problem with the balance of power to add four councilors, APsaA’s Executive Committee is currently composed of especially since there is no consistent method by which the four nationally elected officers (president, president- councilors from their local societies are elected to the Exec- elect, treasurer, and secretary). Also on the Executive Com- utive Council (some are elected, some volunteer, etc.). mittee are the chair and secretary of BOPS (the Board on Professional Standards) as non-voting members unless they FURTHER DISCUSSION are voting members of the Executive Council. It is worth noting that discussion took place during the June Executive Council meeting regarding other models to PROPOSED BYLAW consider, (which would also require a change in the bylaws). The proposed bylaw would add four new voting mem- Two possibilities included: (1) having the two BOPS repre- bers to the Executive Committee. These four new members sentatives become voting members of the Executive Com- would be elected by the Executive Council, not by the gen- mittee, and adding two voting members from the Executive eral membership. Proponents of the bylaw would like to see Council; and (2) limiting the selection of councilors added to the Executive Council further empowered, because it is the the Executive Committee to councilors-at-large, since they official board of directors. are nationally elected.

Mark D. Smaller In 2008 I was honored with APsaA’s Distin- Expectations, a satellite program of ASAP Continued from page 12 guished Service Award. in southwest Michigan at Saugatuck High School. For more information, CV, and pub- APsaA EXPERIENCE MY WORK OUTSIDE lications, please visit my Web site: www. Briefly, my APsaA experience includes: THE ASSOCIATION markdsmaller.com. director, Communication Department; chair, Outside of APsaA, in addition to my full- Let me know your views and the issues Committee on Social Issues; chair, Commit- time private practice with adults, adoles- on which you believe the Council should be tee on Public Information; former co-chair, cents, and children, I am the founding focused, and then let’s see what we might Committee on Foundations; former Com- director of the Analytic to Service to Ado- accomplish together. As councilor-at large, I mittee on Strategic Marketing; member of lescents Program (ASAP) in Chicago (see will be working for you. I wish to thank those the Committee on Racial and Ethnic Diver- The New York Times article about our pro- who nominated me and welcome the oppor- sity and the Committee on Child Analysis; gram: http://www.nytimes.com/2010/01/24/ tunity to continue to serve you, our Associa- and co-chair of the IPA Outreach Committee. education/24cncmorton.html?) and Great tion, and our profession.

14 THE AMERICAN PSYCHOANALYST • Volume 44, No. 3 • Fall 2010 99th Annual Meeting Prizes and Awards

Photos by James Guimaraes and Diana Franklin

Prizes and Awards

JAPA PRIZE Steve Levy presented the JAPA Prize to Eve Caligor, M.D., Diana Diamond, Ph.D., Frank E. Yeomans, M.D., Ph.D., and Otto F. Kernberg, M.D. for their paper “The Interpretive Process in the Psychoanalytic Psychotherapy of Borderline Personality Pathology” published in JAPA 57:2

HELEN MEYERS AWARD Joanne Callan presented the Helen Meyers Traveling Psychoanalytic Scholar Award to Gary Goldsmith and Prudy Gourguechon Susan Lazar, M.D.

DISTINGUISHED SERVICE AWARDS Erik Gann, M.D., Robert A. Glick, M.D., Eric J. Nuetzel, M.D.—for their vision, creativity, commitment, and courage in writing the first revised standards document in 71 years that preserves the values and high standards that our Association stands for while simultaneously encouraging creative change and growth. Michael H. Singer, D.O.—for the tremendous grace under pressure he exhibited as chair of the Committee on Certification and for his leadership and sacrifice in countless hours of effort as chair of PIPE. Paul C. Holinger, M.D.—for his dedication, creativity, and innovation in conceiving and bringing about major improvements in our Susan Lazar and Joanne Callan certification process through his chairmanship of the Certification Examination Committee, and thereby helping to heal one of our most contentious issues. Gary N. Goldsmith, M.D.—for his 15 years of quiet and devoted work promoting psychoanalysis in Russia and the Ukraine through educational exchanges conducted by him and other members of the Russian- American Educational Exchanges Committee. Diana Diamond

THE AMERICAN PSYCHOANALYST • Volume 44, No. 3 • Fall 2010 15 99th Annual Meeting Prizes and Awards

Prudy Gourguechon and Erik Gann

Mike Singer

Prudy Gourguechon and Warren Procci

Prudy Gourguechon

Paul Holinger and Prudy Gourguechon

16 THE AMERICAN PSYCHOANALYST • Volume 44, No. 3 • Fall 2010 99th Annual Meeting Prizes and Awards

efficacy of transfer- Acceptance Remarks ence focused psy- chotherapy (TFP) for the JAPA Award in changing symp- Diana Diamond toms of depression and anxiety, self It gives me great pleasure to accept this award on behalf destructive behav- of myself and my co-authors, Eve Caligor, Frank Yeo- iors, attachment mans, and Otto Kernberg. Otto Kernberg particularly organization (from wanted you all to know how deeply he regrets not being insecure/disorga- able to be here today, but he has two grandchildren grad- nized to secure) uating from Stanford, and I don’t think there is a person and personality in this group who would not make the same decision. organization (from Diana Diamond I want to emphasize how much this paper is a collec- borderline to neu- tive effort and in many ways the culmination of ongo- rotic structure in many cases), along with improvement ing research, theory, and clinical work with borderline in the capacity for mentalization, in patients with severe patients conducted by colleagues too numerous to personality disorders. mention at the Personality Disorders Institute (PDI) at Second, our ideas about the interpretive process the Weill Medical College of Cornell University. As derive in part from turning our “analytic eye” to the task Steven Levy acknowledged in his moving introduction, of developing a manualized form of psychoanalytic psy- we have worked together for over 20 years to develop chotherapy, transference focused psychotherapy. Manu- and refine the technique outlined. That collective effort alizing psychoanalytic treatments, though challenging, extends to the editors at JAPA who helped us to improve is, we believe, necessary to facilitate research on psycho- this paper through the review process. therapy outcomes and to insure that psychoanalytic It is always gratifying to be honored by your col- approaches survive and flourish in this brave new world leagues, but we all are particularly honored to receive of evidence based treatments. In addition to being a this award for several reasons. practicing analyst, I teach graduate students in one of First, our paper upholds the importance of transfer- the few remaining psychodynamically oriented graduate ence interpretation even for more severely disturbed programs in clinical psychology (there are currently patients. This, in many ways, is going against the grain approximately 3 out of over 235 Ph.D. programs). of trends in technique, although compatible with the With the majority of programs moving towards teach- findings of Per Høglend’s group in Norway, where ing only evidence based treatments, the support of JAPA patients with more severe pathology of object relations in publishing papers on the research and technique of had a more positive outcome in treatments that made evidence based psychoanalytically oriented treatments use of transference interpretation than in treatments that makes a crucial contribution to keeping psychoanalytic did not. Additional support for the techniques presented perspectives alive. in this paper has been provided by ongoing research at So it is with gratitude and hopes that our paper will the PDI headed by John Clarkin and in the recent help to preserve psychoanalytic approaches to theory Munich/Vienna study, both of which have shown the and treatment that we accept this award.

Diana Diamond, Ph.D., is professor in the City University of New York Doctoral Program in Clinical Psychology, adjunct assistant professor of psychiatry at Cornell University Weill Medical Center, and a graduate of the NYU Postdoctoral Program in Psychotherapy and Psychoanalysis.

THE AMERICAN PSYCHOANALYST • Volume 44, No. 3 • Fall 2010 17 99th Annual Meeting The Freud Archives

Freud Exhibit The Sigmund Freud Archives/The Library of Congress June 11, 2010

Harold P. Blum

In honor of the 100th anniversary of the American Psychoanalytic Association and of the International Psychoanalytical Association, the Sigmund Freud Archives arranged a special exhibit in collaboration with the Library of Congress. The exhibit at the Library of Congress was open on June 11, 2010, concurrent with the Annual Meeting of the American Psychoanalytic Association in Washington, D.C. The exhibit items were drawn from the vast Freud Collection of the Library of Congress, almost entirely donated by the Sigmund Freud Archives. It is important to note that this prized collection is mostly de-restricted and is available to scholars upon application to the Library of Congress. A select group of Freud photos and historical documents were displayed. These included photos of teenage Freud with his mother, Amalia (Malka), and Freud as a child with his father, Jacob. Group photographs of the Clark University convocation (1909), and the Weimar Congress (1911) of the International Psychoanalytical Association evoked the pioneer period of psychoanalysis. Freud, Ferenczi, Jones, and Jung were clearly present on both historic occasions. Original Freud manuscripts could be closely scrutinized, e.g., the preface to Totem and Taboo, the Autobiographical Study, and Freud’s only preserved process notes, those of the analysis of the Rat Man. Significant examples of Freud’s letters were shown, a token representation of perhaps the largest correspondence of any writer. The body of his letters, answering almost any inquiry as well as those to relatives, colleagues, and friends exceeds the size of the Standard Edition. The exhibit was well attended, stimulating great interest and commentary, an inspiring contribution to note the centennial psychoanalytic anniversaries.

Harold P. Blum, M.D., is executive director of the Sigmund Freud Archives.

18 THE AMERICAN PSYCHOANALYST • Volume 44, No. 3 • Fall 2010 99th Annual Meeting The Freud Archives

Photos by Bjoern Kils

Portrait of Freud by Victor W. Krausz (1936). “It is a hard task, indeed, to deny anything to an artist.”

Über den Traum “On dreams.” Synthesis and Sequel to “The Interpretation of Dreams”

Freud’s handwriting on an original manuscript

“Jacob (Freud’s father) and Sigmund”

Freud at the IPA Congress, Weimar, 1911

APsaA members at the Freud Archive Exhibition

THE AMERICAN PSYCHOANALYST • Volume 44, No. 3 • Fall 2010 19 99th Annual Meeting General Photo Ops

Photos by Mervin Stewart, James Guimaraes and Diana Franklin

APsaA National Office Staff Sherkima Edwards, Debbie Steinke Wardell, Chris Broughton, Carolyn Gatto and Brian Canty Missing—James Guimaraes, Nikita Turner, Diana Franklin, Dean Stein and Tina Faison

Barbara Deutsch and Harvey Brody

Bob and Aimee Nover

Linda Procci and Janis Chester Earle Baughman

20 THE AMERICAN PSYCHOANALYST • Volume 44, No. 3 • Fall 2010 99th Annual Meeting General Photo Ops

Four candidates Dean Stein

David Dietrich

Erik Gann and Robert Glick

APsaA National Office Staff— Sherkima Edwards

Gail and Howard Benensohn

Marsha Robertson and Paul Morris

THE AMERICAN PSYCHOANALYST • Volume 44, No. 3 • Fall 2010 21 99th Annual Meeting Baseball

Baseball and Psychoanalysis: A Post-Game Summary Jake Lynn

Analysts combined work and play at the recent 99th Annual Meeting in Washington, D.C. where Washington Nationals president Stan Kasten, renowned sports psychotherapist John Ratey, APsaA president-elect Bob Pyles, and APsaA child analyst Paul Holinger joined a panel developed by member Bruce Levin to explore the psychoanalysis of baseball. This unique event was capped off by on-field access and prime seats to that evening’s game against the Pittsburgh Pirates at Nationals Park. The way Levin assembled this panel dates back to his college days, when he was a roommate of Robert K. Tanenbaum, who is a principal owner of the Washington Nationals. Tanenbaum specifically asked Kasten to do this as a unique favor for the Association. Pyles has advised Major League Baseball for many years. Every winter before spring training begins Pyles provides psychoanalytic “coaching” to a select number of rookies and promising minor league players at an off-the-field retreat. At the retreat Pyles helps players prepare for the pending fame and societal pressures that will result from their stardom and newfound wealth. Lifetime APsaA member William (Bill) O’Brien preceded Pyles in this position for several years before his retirement. Each member of the panel added a special viewpoint to baseball and human development. Holinger discussed the traumatic impact that can happen to many of the minor league players who never make it to the major leagues—and hold little more than a high school diploma. Ratey stressed the importance of play for America’s adolescents, as physical education classes continue to be cut in favor of more academic curriculum. Kasten, who has a lifetime of achievement in establishing and managing professional sports teams, discussed how he and the rest of the Nationals’ management have handled the psyche of 22-year-old rookie phenom pitcher Stephen Strasburg. Kasten recalled how he guided other future all-star pitchers while he was with the Atlanta Braves, and discussed applying the same types of focus and concentration that worked so well for pitchers like Tom Glavine, John Smoltz, and Greg Maddox. The two-and-a-half hour session included many questions posed by the audience that sparked nostalgia and a true passion for baseball among the attendees. Then, over 50 members traveled by subway to Nationals Park to see batting practice from the field and watch the game (which the Nationals won) from great seats behind the Nationals’ dugout. The next day articles about the panel appeared on Newsweek.com, NPR.org, and in The Washington Post. All in all, it was truly a home run for APsaA and everyone involved.

Jake Lynn is the director of public affairs for the American Psychoanalytic Association.

22 THE AMERICAN PSYCHOANALYST • Volume 44, No. 3 • Fall 2010 99th Annual Meeting Baseball

Photos by James Guimaraes and Diana Franklin

Bob Pyles and panel Paul Holinger Analyst in uniform

Bob Pyles John Ratey (standing), Stan Kasten, From left, Geoff Miller Geoff Miller and Bruce Levin and Bruce Levin

Two fans of baseball and psychoanalysis

THE AMERICAN PSYCHOANALYST • Volume 44, No. 3 • Fall 2010 23

theory is the best model to understand clini- cal material.” The candidates divide them- COPE selves into affirmative and negative teams and go at it with energy and excitement that I have rarely seen in requiring them to write Classroom Teaching Workshop a paper. The purpose of this exercise is to Gerald A. Melchiode promote critical thinking. The second module, lasting four sessions, The continuous case, a mainstay of psy­ guidelines in is on resistance. Candidates learn how to choanalytic institutions, is often a flawed mind. I tell them observe resistances, how to help the patient educational experience, especially for early that this is not see resistances, how to categorize resistances, candidates. There are a number of potential about them; i.e., I and how to interpret resistances to the problems it presents. Sometimes the pur- do not care how patient. The companion reading for this sec- pose of the exercise is not clear to the candi- they perform as tion is Busch’s book, Rethinking Clinical Tech- dates. It may promote passivity on the part of analysts. This is nique. Following the module, we have our the candidates who are not presenting, par- not a show and second Great Debate: “Be it resolved that ticularly during long riffs of material. The for- tell, nor do they object relations theory is the best way to mat is often too focused on the presenter have to feel that understand the clinical material.” Gerald A. Melchiode and what the presenter is doing and not they will be the The third module, which lasts four ses- doing, creating a source of anxiety for the butt of criticism. I will protect them. I simply sions, focuses on the transference/coun- presenter. Presenters may deal with the fear want them to channel psychological material, tertransference relationship. Candidates of criticism by leaving out material which which consists of what the patient is saying question what the patient’s surface reveals does not show them in their best light, by plus what the presenter is saying, thinking, and about the relationship. What do the analyst’s making up material, or by trying to get as feeling. In other words, the candidate pre- thoughts, feelings, fantasies, words, and much material in as possible in order to cut senters are ideally “educational self objects,” actions reveal about the relationship? What down on time for criticism. Worst case sce- solely related to their function as vehicles for can be said to the patient in terms of the nario, the continuous case has the tendency material. I also share with the candidate relationship in order to understand the to meander, to be boring, and is seen as group the orientation to the presenters so patient’s mind? The companion readings con- something to be endured by candidates and that we are all on the same page. sist of Gill’s monograph, “On the Analysis of to be avoided as a presenter.

THE FOCUSED CONTINUOUS CASE Although psychoanalysis may be the triumph At the APsaA 2010 National Meeting, a of the unfocused mind, the same thing group of candidates and faculty from the Dallas Psychoanalytic Center described the cannot be said for education. focused continuous case, which is part of their second year curriculum. Although psy- choanalysis may be the triumph of the unfo- THREE GREAT DEBATES the Transference,” and the Betty Joseph arti- cused mind, the same thing cannot be said for The course runs through the entire year, cle, “Transference, the Total Situation.” And education. Good teaching requires learning every other week for 16 sessions, and involves finally, at the end of the year, we have the objectives, and good execution requires care- presentations by two candidates. The first third Great Debate: “ Be it resolved that self ful preparation. Before the course begins, as module, which is five sessions, focuses on psychology is the best way of understanding coordinator of the Dallas project, I orient the psychoanalytic listening. Candidates learn the clinical material.” presenters. I meet with them with several concepts of the patient’s surface, the analyst’s For the January 2010 APsaA workshop we surface, and the workable surface. This tem- attempted to demonstrate key features of plate is applied to clinical material. There is a the focused continuous case by conducting Gerald A. Melchiode, M.D., is a training list of companion readings by Bush, Levy and an abbreviated, three-dimensional continu- analyst with the Dallas Psychoanalytic Interbitzen, and Paniaqua, which describes ous case conference. After Jennifer Unter- Center and a clinical professor of psychiatry the above concepts. Companion readings are berg, a second-year Dallas candidate, at Southwestern Medical School Dallas. optional, not required readings. After these presented clinical material, we divided the He was co-chair of the COPE Study Group five sessions, we have our first Great Debate. group of attendees into three smaller groups. on Self-Disclosure. It is formatted on the resolution: “Structural Continued on page 38

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SCIENCE and unconscious” or actively kept out of aware- ness, they keep the term “unconscious” and Psychoanalysis trace the origin of the theory to Freud him- self. Interestingly, their objection to Freud’s “complex theory” is not that it was too filled Studying Unconscious Motivation with “conflict and drama” (as James Uleman Andrew J. Gerber disappointingly suggested in the 2005 book The New Unconscious), but rather that it was The concept even as they have, in the past several years, “largely unfalsifiable.” Thus the cognitive cri- of unconscious begun to include affect, social behavior, and tique of psychoanalytic theory has moved a motivation has the “cognitive unconscious.” However, this great distance from suggesting that it was long been one may be about to change. factually incorrect to one compatible with central and the conclusions of most psychodynamic unique to the UNCONSCIOUS COGNITION IN researchers, that psychoanalytic theory has psychoanalytic MAINSTREAM SCIENTIFIC LITERATURE moved far beyond what researchers have so worldview. Psy- Ruud Custers and Henk Aarts, experi- far empirically tested. choanalytic clini- mental social psychologists at Utrecht Uni- The findings of experiments on uncon- cians structure versity in Holland, published a review article scious cognition are unsurprising, and per- Andrew J. Gerber most of their in the July 2, 2010, issue of Science Magazine haps even disappointing in their scope, to theories and interventions around the notion entitled “The Unconscious Will: How the psychoanalytic clinicians, but nonetheless that behavior is jointly motivated by con- Pursuit of Goals Operates Outside of Con- important and foundational to work in social scious and unconscious impulses and that scious Awareness.” In it they argue that new psychology and cognitive neuroscience. In a awareness of these motivations by analyst evidence from experiments with normal first set of experiments, subjects were pre- and analysand are essential to the treatment individuals in their own laboratory and in the sented with two conscious but supposedly process. When hearing about non-analytic laboratory of John Bargh at Yale (an invited unrelated tasks, and the first is shown to psychological or psychiatric theories, an ana- presenter at the APsaA 2009 National Meet- unconsciously influence their behavior on lyst’s most frequent response is to inquire ing) supports the notion that humans are the second. For example, Bargh and col- about the place of unconscious motivation. regularly influenced by motivation and goals leagues demonstrated that subjects exposed If a clinical theory or technique is being cri- outside of their conscious awareness. Though to words about achievement were more tiqued, the implication is that when such a they use the word “unconscious” to mean likely to persist and perform well on a later motivation goes unnoticed or unaddressed “outside of awareness” and not in the more task than those not exposed to those words. by treater and patient, change may be fleeting typical psychoanalytic sense of “dynamically Continued on page 38 and insufficient. If a metapsychological theory is the object of evaluation, the implication is that a theory that does not take into consid- eration unconscious motivations will never Tuition Grants for Academics be able to adequately account for the com- Starting Spring 2011 plexity and nuances of elaborate human behavior, particularly when it involves social The Committee on Psychoanalysis and the Academy seeks to promote greater interactions (and the corresponding self and interaction between colleges, universities, and psychoanalysis. Grants toward the cost other representations). The theories of cog- of tuition are available for academics to attend seminars at APsaA affiliated institutes. nitive neuroscience have always been an easy Any academic interested in gaining psychoanalytic knowledge for research or clinical target in this regard as they have not taken training is encouraged to apply. into consideration unconscious motivation, Interested applicants are invited to submit a letter of request indicating the relation of their proposed studies to their professional development, a statement detailing Andrew J. Gerber, M.D., Ph.D., is assistant tuition requirements at the institute, a CV, and a letter of support from the institute professor of clinical psychiatry at the New York State Psychiatric Institute, a faculty chair or dean hosting the seminar. member at the Columbia University Center Applications should be sent to Debra Steinke Wardell ([email protected]) by for Psychoanalytic Training and Research, December 1, 2010. and chairman of the APsaA Committee For further information contact Jeffrey Prager, Ph.D. ([email protected]). on Scientific Activities.

THE AMERICAN PSYCHOANALYST • Volume 44, No. 3 • Fall 2010 25

had planned to adopt Magid, but presumably What We Talk About because George told his parents that Magid had threatened him, Magid was sent instead When We Talk About Reality: to an orphanage. The two had not seen each other since George was six years old, the Michael Haneke’s Cache incident seemingly forgotten by George and Lissa Weinstein his family, much in the same way that the drowning of 200 Algerians had disappeared Cache opens with a static shot of a house Charlie Rose of France. The tapes begin to from the French consciousness. facing a street on the Rue des Iris; superim- arrive wrapped in sketches of a small boy Magid, now a broken man living in poverty, posed on the scene are film credits moving spitting blood; these crude drawings act as a denies any complicity with, or knowledge of, interminably across the screen. The audience, spur to memory. the tapes. Soon after their meeting, a video- lulled into complacency, assumes no need to tape of their conversation, filmed by a hidden watch carefully; it’s an ordinary day on an camera, arrives at the Laurent house, much ordinary street, a bicyclist peddles by, birds to the chagrin of Anne, as George had told chirp. Two voices, those of George Laurent, a her nothing of his meeting with Magid or his popular French TV show host, and his wife, suspicions. Other suspicions emerge from Anne, discuss the image. Only when white beneath the calm exterior of the Laurent lines appear across the screen do we realize family. Lies and half truths abound. Is Anne that we are watching a surveillance video- having an affair with her boss? Is their inno- tape, enlarged to the size of the theater cent appearing Pierrot actually the one who screen. We are thrust into the perspective of is sending the videos? On Pierrot’s wall, his the screen characters, ripped from the pro- poster of Eminem warns white parents of the tection of the extra-diegetic camera, forced A long buried and seemingly forgotten danger of their children. Other lies—the lie to question: What is the real information of incident from the father’s childhood begins of the “spontaneous” discussion in George’s our senses? From what perspective should to emerge from repression, first in intrusive TV studio that gets edited, the lie of George we view the events on the screen? Who, or thoughts while George watches a videotape himself, with his veneer of civility in his role as what information, can we trust? and then in dreams. Images of an Algerian a liberal social commentator, when in reality boy, his mouth covered with blood, later, a he remains the same bully he was as a child. dream scene presumably from George’s As the climate of terror is heightened, Pier- childhood: The same boy cuts the head off a rot goes missing for an evening; George has rooster, raises his ax and advances threaten- Magid and Magid’s son arrested on the suspi- ingly toward George while the rooster flops cion that they are involved in Pierrot’s disap- headless in the barnyard. George keeps his pearance. Despite a lack of evidence, Magid is suspicions about the origins of the videos to arrested and driven to the station in the back himself, tracking down the rundown apart- of the police van, once again a second class The surveillance videotapes sent to the ment building seen in one of the tapes and citizen. Pierrot returns the next day, having couple similarly interrupt the complacent encounters Magid, the now-grown Algerian spent the night at a friend’s house. But the rhythm of their well-ordered bourgeois life. boy whose family had lived and worked on tapes have set events in motion, careening There is no actual threat in the videos, they his parent’s estate. Magid, had been left towards the single manifest violent act that are of locations—the outside of the couple’s orphaned after an infamous incident in forms the center of Cache. Magid summons house, George’s family estate, a shabby area France’s recent history when in 1961, 200 George to his home. In front of George, of Paris. Yet the threat of surveillance is Algerian citizens were drowned in the Seine Magid slashes his own throat. This act propels omnipresent and terrifying. Their source? Per- during a political protest. George’s parents the final recovery of memory that has set haps a practical joke of their adolescent son, the events of the film in motion. True to the Pierrot, or a crazed fan of George, who is the filmic traditions he has developed in Funny Games (1992) and Benny’s Video (1997/2008) Lissa Weinstein Ph.D., is an associate Haneke offers no simple solution, no salva- professor in the Doctoral Program in tion, no easy solution to the dilemmas pro- Clinical Psychology at City College of the vided. At the end of the film, we are left to City University of New York and a graduate speculate as to the origins of the tapes. of the New York Psychoanalytic Institute. Continued on page 27

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Cache unconscious fantasies of the explores the characters, and those engen- consequences dered by the possibility of of the destruc- omnipresent surveillance. tion of memory Haneke, acutely sensitive to and the inter- the visual media’s capacity for relationship of deception has made its effects personal and on behavior central to his societal repres- work. In Benny’s Video a boy sion. Yet the film repeatedly views a tape of Lissa Weinstein reaches beyond himself slaughtering a young an allegory of the French suppression of girl; in Funny Games the same actor as a hom- Several repetitive themes form the center of their Arab citizens or a condemnation of icidal young man rewinds the film to alter the the iconography of Cache. These include the the bourgeois family. Cache invites a tex- progression of the plot. Previous films sug- repetition of the boyhood conflict between tured, multileveled examination of the ways gest the characters’ actions result from the Magid and George, (as adults, little has in which trauma, defense, and repetition deforming of human relationships by bour- changed between them, George maintains interact, and the role of visual media, with its geois society. Cache, by providing the genetic his unassailable privilege, Magid is left only potential for creating an alternate, infinitely roots of George’s dilemma, highlights how physicality as a response) the repetition of mutable, perceptual reality, in offering a novel our technologies interact with intrapsychic the cutting of the rooster’s head, now retold mode through which emotion can be dulled conflicts. The datum of our senses is no lon- as Magid’s self-beheading, the repetition of and guilt avoided. ger trustworthy, “real and virtual,” to quote Magid as orphan and his son, orphaned by In Cache, interlaced themes spawn alter- Gilles Deleuze, can be used to defend against Magid’s suicide, the repetitive structure of the nate interpretations that admit no final clo- rewound tapes. sure on meaning. Lying on the border Augmented by its dream-like qualities and between the hyper reality of technology and density, the power of Cache lies in the way unconscious fantasy, Cache allows the evi- Haneke induces in the audience the poten- dence of the camera to be taken as “real” at tially disruptive affects generated by these the same time that its place in the overall technological changes. Through the combina- story is continually altered. These shifts in tion of the absence of a standard narrative perspective lend the film a dream-like quality, and his extraordinary use of long shots, where what appears as reality is actually the Haneke forces us to take an active role in the product of multiple condensations, displace- what is “real and actual.” One consequence is narrative’s construction, making it imperative ments, and an association driven, rather than that the structure of the ego’s mutually that fantasy enters into our interpretation of a linear, narrative. We see the video of dependent autonomies from its motivational the film, while compelling us to look at that George’s childhood home; in the next scene core as well as external reality are altered. As which would normally elude attention. By he is visiting his mother in that house. George drive representations become more isolated destabilizing our position as safe observers, receives a videotape wrapped in a picture of from potential correctives and limitations in we are unable to find a secure point of view; him in the television studio; in the next scene, reality, there is a paradoxical intensification of as our identifications continually shift, so does he is in the studio speaking to his boss. Only the power of unconscious fantasy in the cre- our perspective. Each time the outside of the capacity for secondary revision allows ation of a disavowed, yet active ongoing nar- George and Anne’s house is shown, our per- sense to be made of these juxtapositions. The rative of the self. By allowing for the editing ception is altered; the static banality of the film becomes a screen for multiple projec- and control of data that the sensory appara- long shots become infused with terror. The tions, those of the audience, those of the tus perceives as authentic, the visual media ever accruing knowledge breeds suspicion, create an image veil that fosters alien- paranoia, and dread as the polite surface falls ation from the authentic matrix of the apart—not just within the film, but induced drives and related primary affects of love in the audience, who are increasingly impli- and hate that provides a resistance to cated in the filmic event. The involvement of reality as well as fosters its creative elab- the audience transforms Cache into a pro- oration through subliminatory channels. foundly moral and ethical film, one that dem- What substitutes for transformation, onstrates how attempts to disavow our past progression, and symbolic representation are futile, leaving one, at best, empty, and at is the primitive structure of repetition. worst, forced to repeat.

THE AMERICAN PSYCHOANALYST • Volume 44, No. 3 • Fall 2010 27 SPECIAL SECTION: CANDIDATES

being in my training analysis. I had a safe space Cancer, Candidacy, and the Couch to talk about my feelings, fears, and fantasies Patricia Plopa about my cancer, my candidacy, and my future. As I was synthesizing and thinking about all I was thrilled and honored to receive the Writing will help you see more of what you that I was going through, and about how it Affiliate Council 2009 Scientific Paper Prize are preconsciously and unconsciously picking would impact my patients, it was my analyst at the American Psychoanalytic Association up. Trust it.” who encouraged me to keep good clinical 2010 National Meeting in January. When notes of my sessions with patients. My super- Carmela Pérez, president of the Affiliate MASTERY visors also expected me to keep good notes Council, asked me if I would write about how The most significant factor that inspired for supervision. However, it seemed that my I was “inspired” to write that paper, I gladly me to write my paper was that I had cancer. analyst was thinking about my future because agreed, thinking that writing would afford I believed that I had something to offer as a she knew how helpful such a record would me an even greater appreciation of the moti- result of my experience of being a candidate, be if I later chose to write about it. To me, it vations and factors influencing my writing. in supervision, undergoing an analysis and was a vote of confidence that helped seal my The title of my paper, “Cancer, Candidacy, working with patients while being treated determination to generate some perks from and the Couch,” has to do with my experi- for cancer. Writing was a form of intellectual a cancer diagnosis. ence as a candidate working analytically with patients, in LIMITED supervision and in analysis, SELF-DISCLOSURE after being diagnosed and In addition, I needed to treated for breast cancer. It write a graduation paper for addresses the impact of the my institute. It was the last disclosure of a cancer diagno- requirement I had before I sis on the analyst/candidate, could graduate from the the patient, the transference/ Michigan Psychoanalytic countertransference, the ther- Institute. I had previously apeutic alliance, and treatment started with a different process. I actually began writ- topic, but once I learned ing the paper after completion that I had cancer, I was moti- of chemotherapy and radia- vated to focus on what was tion, but the idea of writing closest to my experience, occurred much earlier. interests, emotions, and So, how was I inspired? The needs. I remember reading first and simplest motivation and agreeing with Evelyn was that I like to write. I find Schwaber who had written

the writing process useful in Photo: Bernadette Kovach in JAPA in 1998: “I have organizing my thoughts and Patricia Plopa (left), with her First Place Award, and Prudy Gourguechon found, generally, that it is revealing more to me about only when something feels what I think and know. I must thank Mel mastery, a form of action at a time where I affectively immediate that I am able to speak Bornstein, in part, for making writing an easier had earlier felt so little in control. It was a way or write in any meaningful way; my cognitive process by encouraging my candidate class to of making a contribution to the literature, of functions alone don’t allow me to express write as a way of discerning/learning more of sharing my experiences with other therapists my ideas. Though I tried to do so, I could not what we know about a patient. He would say: and analysts. My own psychoanalytic identity make myself write of issues removed from “Just write. Go with what you are thinking. became stronger as I read what other ana- where my feelings were. If I was going to You know more than you think you know. lysts had said and done at times of illness. speak, I would have to find a way to bring Long before I began to write my paper, I not head and heart together.” I found her writing Patricia Plopa, Ph.D., is a graduate of the only researched all that I could about cancer of her experience with illness as both inspir- Michigan Psychoanalytic Institute and member but also reviewed the professional literature ing and useful as I forged my own under- of the faculty. She is program chair of the on how other analysts, beginning with Freud, standing of the kind of analytic working Michigan Psychoanalytic Society, adjunct dealt with their own illnesses and cancer space that I needed to best function as an professor of psychology at the University while working with patients. Fortunately, at analyst who could be helpful to her patients. of Detroit, and maintains a private practice. the time of my diagnosis I had the benefit of Continued on page 30

28 THE AMERICAN PSYCHOANALYST • Volume 44, No. 3 • Fall 2010 SPECIAL SECTION: CANDIDATES

Widening Scope and Practice at the Navah C. Kaplan New York Psychoanalytic Institute Navah C. Kaplan

In the last issue of The Candidate Connection, I wrote on the model of the psychiatric interview. According to Dunn, this rigid topic of the widening scope of analytic practice from the per- model provoked a counter-reaction among analysts whose clini- spective of one of its greatest promoters, Arnold “Chuck” Roth- cal experience showed that many ego-healthy patients proved to stein. Here, I present the thinking at my home base, the New York be poor analysands while patients with sicker egos benefited Psychoanalytic Society and Institute (NYPSI). I was fortunate to greatly. Healthier patients often had firmer defenses and greater interview the head of our Treatment Center (TC), Peter B. Dunn, resistances to dependency and to tolerating regression in the who is responsible for conducting its monthly case disposition service of the analysis. conferences and, ultimately, making the selection of patients likely More recently, as theory has advanced with the garnering of suitable for analysis that are referred to candidates. Dunn treated experience and an accumulating number of treated patients, the me to a tour de force exposition on the history of the “widening scope is cautiously widening once again to include patients that scope” and its vicissitudes over time. Freud, in his later years, came to regard as outside the capacity of Who is suitable for this unique form of psychotherapy, that is, analysis to benefit. The changing popularity of analysis in the cul- who can benefit from the treatment and whom we as analysts ture has further contributed to a widening scope. The drastic are competent to treat are the questions before us in considering decline in demand over the past several decades has correlated the idea of widening the scope in our selection of patients. In the with the rise of alternative treatment methods such as medica- earliest days, when Freud and his followers eagerly used the new tion and short-term, symptom focused therapies. Dunn believes analytic methods, a wider scope of patients was accepted into that in light of alternatives to the intensive, highly demanding ana- treatment. Very primitive patients, including those with psychotic lytic modality, many analysts themselves have lost faith in their processes (e.g. the “Wolf Man” and “Anna O” come to mind), method and abandoned it. However, others have responded by were given analyses; their case histories constitute some of applying the theory and techniques of depth psychotherapy to Freud’s earliest expositions on analysis and continue to form the treating populations with ever greater degrees of disturbance. primary introduction given for candidates. Today, patients showing an equivalent degree of pathology would not likely be considered ADAPTING TO A BUYER’S MARKET suitable control cases for beginning candidates. In the heyday of psychoanalysis, during the ’50s and continuing into the ’70s, there were more patients than places for them in EVALUATIVE MEDICAL MODEL practice. Candidates were assured of a plentiful supply of “good” REPLACED FREUD’S TRIAL ANALYSIS patients and thus, like an exclusive college with a surplus of appli- After World War II, the influx of European analysts shifted the cants, rigid criteria for acceptance by the TC could be maintained. center of the profession to the United States. The NYPSI enjoyed Today, patients are in short supply and institutes struggle to help a particular concentration of this talent and continued the work candidates obtain suitable cases. The current model as practiced of developing psychoanalysis, now located in a new society and at the NYPSI incorporates more of the recent advances in culture. In the 1950s during the ascendant Hartmann et al. era of understanding more primitive levels of functioning and, hence, ego psychology, the past experiences were codified, more restric- permits a widening scope of patients as capable of benefiting tions were placed on the method, and the type of patients from analytic treatment. thought to be amenable to psychoanalysis was reined in; the At the NYPSI Treatment Center, a patient applicant is referred scope narrowed. In contrast to Freud’s explicit recommendation to a candidate who is trained to use the evaluative model to take that only a trial analysis could assess a patient’s ability to benefit a history and formulate a structural understanding of the patient’s from the analytic method, an evaluative model focusing on ego functioning. History is considered the best predictor of patient strengths and weaknesses was adopted, following the medical Continued on page 31

THE AMERICAN PSYCHOANALYST • Volume 44, No. 3 • Fall 2010 29 SPECIAL SECTION: CANDIDATES

The Couch Continued from page 28

I found that a limited form of self-disclosure Affiliate Council of my breast cancer diagnosis and treatment strengthened trust and the therapeutic alli- Practice Network ance. Most importantly, to name “the ele- phant in the room” gave me a sense of Last January, the Affiliate Council launched the Affiliate Council freedom and space to emotionally engage Practice Network hosted on ning.com for the purpose of sharing practice with my patients…It allowed me to listen issues that concern candidates in training at APsaA accredited institutes. more easily to their associations and inter- The ning.com network has the ability to host discussions, communicate pret more freely their reactions to my cancer diagnosis, both as a real life threat to their upcoming events, share photos of gatherings, create blogs, and allow analyses as well as a stimulus to multiple fan- chats among candidates. In short, the Network can do what Facebook tasies fashioned along transference lines. does for social networking. Lastly, what inspired me to write and pres- The site is devoted to practice issues among Affiliate members with the ent my paper was the hope that my experi- goal of helping candidates to build analytic practices. It was created by ence and reflections upon it would be a useful contribution to candidates and analysts, espe- Laura Jensen, past president of the Affiliate Council, and Carmela Pérez, cially to those clinicians facing life-threatening president of the Affiliate Council, at the suggestion of APsaA’s Web illnesses themselves. I hoped that it would fur- producer, Johannes Neuer. ther add to the literature about the types of The Affiliate Council Practice Network is set up to be private, meaning self-disclosure that support the therapeutic that members must be invited to join. Each Affiliate member will have alliance and the analyst’s ability to analyze. a “page” where he or she can give basic information about a practice Since writing the paper, I have presented at cancer workshops and given presentations address and upload a photo. Pages can be customized to some extent. locally as well as at APsaA. These presentations Three discussions have been set up: have helped open up discussions on illness, self-disclosure, and how one works clinically • Control Cases (where members are encouraged to share how under such conditions. I have had a number of control cases are obtained at their institutes), therapists and analysts consult with and reveal • Managed Care (where members are encouraged to discuss the to me their past or present struggles with seri- advantages and pitfalls of the managed care system), and ous health conditions and the impact it has • Suggestions for Other Practice Discussions (where members can had on their lives and clinical work. My experi- suggest other discussions in which they would like to participate). ence with cancer and writing about it has con- tributed to greater involvement in working The site began with a small group of participants in order to test it with women breast cancer patients. It has and determine its usefulness and will expand in the coming months. impressed upon me how valuable and helpful (emotionally and physically) it is to be in psy- At the APsaA Annual Meeting in Washington last June, a committee choanalysis or psychotherapy at the time one was formed which will be in charge of monitoring the site and will is going through cancer treatment. expand the invitations to all Affiliate members in the coming months. So, as I hope I have made clear, my “inspi- For more information, please contact Tom Franklin, chair, Affiliate ration to write” has come to me as a result Council Practice Network Committee at [email protected]. of trying to turn adversity into something more meaningful and hopeful. Inspiration also rests upon the shoulders of the many who were thoughtful and supportive of me, especially my husband, my analyst, my super- visors, and my candidate colleagues. I am grateful to these and to the Affiliate Council for recognizing my paper with its 2009 First Place Award.

30 THE AMERICAN PSYCHOANALYST • Volume 44, No. 3 • Fall 2010 SPECIAL SECTION: CANDIDATES

Affiliate Council and violent or self-destructive episodes, approach for making such predictions. and a history of paranoid or sadomasoch- Dunn agreed research is needed. He Continued from page 29 istic transferences, including how perva- mentioned that at the Columbia Psycho- functioning within the analytic situation. sive they are in defining the person’s analytic Institute a research project under- Dunn says that while senior analysts like typical relationships. One underlying way obtains patient agreement to be Freud and Rothstein could evaluate premise of the widening scope, and the periodically assessed for progress during patients very quickly, beginners cannot. major value Dunn attributes to Roth- the course of treatment by an objective The utility of the evaluative model for stein’s advocacy of a process model, is that interviewer. So far, NYPSI has been reluc- beginners is to force them to go point by the positive traits are more difficult to tant to conduct research that is intrusive point through the patient’s personality. assess via an evaluative approach but will into the treatment. At the present, my About 25 percent of TC patient appli- emerge through a period of therapy that experience, and from what I have infor- cants are deemed appropriate for referral develops or exposes the patient’s capacity mally deduced from my classmates, is that to a candidate, a percentage unchanged for such things as psychological minded- we candidates use the process model since 1946 when tracking such data began. ness and the motivation to endure the extensively. We are more likely to work However, characteristics of those who rigors of an analysis. in intensive psychotherapy with patients seek psychoanalysis have changed since Finally, I asked Dunn about research in the widening scope category for many the 1950s when the population was more efforts aimed at predicting who will ben- months prior to converting them into structured and the intelligentsia flocked efit from an analysis. So far, research has analyses than to receive a “good” case to be analyzed. Today’s applicants tend to tended to discredit the evaluative that can be started forthwith. be more disturbed and from a broader cultural spectrum. That the percentage of those accepted has not decreased is due to the widening scope. Furthermore, one quarter of those accepted by the TC fol- lowing the evaluative process are consid- ered to be only provisionally suitable and the candidate then engages the patient in an initial period of psychotherapy, in effect utilizing Rothstein’s process model. The aim, then, is to prepare the patient for a future analysis.

ASSESSING ANALYZABILITY— A PROCESS MODEL Assessment of analyzability rests on a consideration of two categories: the presence of positive and the absence of negative traits. Positive traits that weigh towards a “rule-in” for a recommendation of analysis include general indicators of ego strength—a capacity to tolerate affect without acting out, an interest in thinking symbolically, the capacity to accept responsibility and tolerate normal criticism, the ability to form normal, dependent relationships and profit from them, and a capacity for “regression in the service of the ego” as Kris delineated (seen in the ability to regress, to play, joke, fantasize, to tolerate being irrational and to misinter- preting the analyst). Negative traits factor- ing towards a “rule-out” include a history of behaviors present in psychosis, such as severe regressions in the face of painful affect or of acting out, substance abuse

THE AMERICAN PSYCHOANALYST • Volume 44, No. 3 • Fall 2010 31 MONEY

mother but rather as a magical response to Neurotic Attitudes Toward Money the baby’s own omnipotence. The signifi- John W. Schott cance of this with respect to investments is that money becomes a signifier of omnipo- In the now somewhat dated text Money & with anal reten- tence in the unconscious of the neurotic. The Emotional Conflicts, published in 1951, Edmund tion and expul- reality of money is that it has value to buy Bergler began with a dramatic erotization of sion for one real possessions or real services. All the other money drawn from one of his patients: reason only— notions commonly surrounding money— the wish to security, power, admiration, love—are reflec- Husband: I want you to teach my please the par- tions of neurotic attitudes. Money is a means wife the beauty of thrift. ents. While this to an end for healthy people. For the neu- is predominantly rotic, money becomes an end unto itself. Psychiatrist: Do you mean the true, other factors necessity or advisability also weigh in, e.g., INFANTILE CONFLICTS AND of thrift? John W. Schott peer pressure OMNIPOTENT FANTASIES Husband: Not at all. I mean the from a group. One result is that the neurotic will fear beauty of thrift. There To fully understand the evolution of neu- being cheated to such an extent that he/she is something nice and rotic problems regarding money, this simpli- suffers enormously in all investment scenar- sentimental about thrift. fied view of the anal period must be ios. It also makes spending money very dif- A dollar is a dollar! expanded. It is the Freudian opinion that all ficult. The classic example of this is the people are endowed with two distinct alleged story of the famed miser and inves- Psychiatrist: That is mathematically instinctual drives: one libidinal, the other tor Hetty Green who allowed her son to correct. destructive or aggressive. While in healthy lose a leg to gangrene rather than paying his Husband: There is more to it in adults libidinal drives are focused on other doctor’s bill. Such neurotic people experi- thrift. Beauty, do you people; in infants, they are entirely self- ence rage and indignation upon the simplest hear me, real beauty… focused and are described as narcissistic. An requests for money. infant’s worldview is self-centered and not Such neurotic conflicts are not confined to Since the world of securities represents in clearly defined between self and others. It is misers or other severely anal characters. They addition to its economic interests, an uncon- theoretically possible that the hungry infant’s also appear in milder forms with many peo- scious sublimation of conflictual thoughts and cry for food and the mother’s nurturing ple. A common example is the person who affects derived developmentally from atti- response with breast or bottle is perceived can buy only at sales or if he/she believes she tudes toward money, it is probable that the by the infant not as the response of a loving is getting a bargain. Another example is the majority of conflicts related to investing are comment, “I can’t afford it” (when the reality directly correlated to neurotic attitudes is otherwise) which is a reflection of psychic about money. masochism stemming from unresolved infan- tile omnipotence. AUGMENTING CLASSICAL THEORY All of these attitudes come into play in According to classical psychoanalytic the- investing in stocks and bonds. For some neu- ory, money equals feces in the unconscious. rotics, the accumulation of assets becomes Therefore, failure to successfully resolve the an end in itself rather than a means to an conflicts related to the anal period of devel- end. Inherited wealth is often so strongly opment (roughly ages two to three) leads identified with parents that utilization of the to neurotic attitudes toward bowel habits money is severely impaired by guilt. Parents and by displacement to money. Theoretically attempt to prolong infantile control over a child renounces the pleasure associated grown children. The variations on the theme are endless. John W. Schott, M.D., is a member of the The paradoxical result of psychotherapy or Boston Psychoanalytic Society. He is director analysis with these people is that the satisfac- and portfolio manager at Steinberg Global tory resolution of these infantile anal conflicts Asset Management. He also publishes a and omnipotent fantasies is that the individual monthly newsletter on investment psychology, simultaneously enhances his/her ability to The Schott Letter. make money and enjoy spending it.

32 THE AMERICAN PSYCHOANALYST • Volume 44, No. 3 • Fall 2010

POLITICS and PUBLIC POLICY Health Reform Legislation and Psychoanalysis Graham L. Spruiell and Fredric T. Perlman Graham L. Spruiell Fredric T. Perlman

On March 23, President Obama signed The Congressional Budget Office (CBO) has unsustainable as a result of adverse into law the Patient Protection and Afford- conceded that some of the planned reduc- selection by sicker higher-cost patients able Care Act (PPACA), Pub. L. 111-148 (H.R. tions in Medicare spending “might be difficult beyond 10 years. 3590). One week later, he signed the Health to sustain over a long period of time,” sug- Care and Education Reconciliation Act (H.R. gesting that physicians and other practitio- SPENDING CUTS 4872). These two bills comprise the most ners might opt out. If Congress prevails over There is a wide consensus that health- sweeping health reform legislation ever the administration in eliminating cuts, then care reform must reduce spending growth enacted in the United States. When fully $210 to $360 billion will be added to the under Medicare, Medicaid, and private insur- implemented, 34 million formerly uninsured costs of Medicare, increasing, rather than ance. Private insurance companies will be Americans will have health-care insurance. decreasing, the deficit. prohibited from denying coverage for pre- existing conditions, imposing lifetime or unreasonable annual limits on total pay- This will likely translate into the implementation of much ments, determining premium rates based on health status, and rescinding coverage for more stringent managed care reviews, reviews that are enrollees. Further, all qualified health insur- now being extended to out-of-network providers. ance plans must contain an essential bene- fits package that must include coverage of “mental health and substance use disorder services, including behavioral health treat- Naturally, this will have an impact on the The Centers for Medicare and Medicaid ment,” and under the parity law, coverage economy. In 2009, the deficit was $1.4 trillion Services (CMS) Office of the Actuary on for mental health services must be compa- and was the largest as a share of GDP since April 22 alerted the administration that rable to that for physical health services. the end of World War II. For 2010, the deficit health-care costs might rise for the follow- The net effect of these requirements will is projected to be $1.3 trillion, representing ing reasons: increase the cost of doing business for the second largest. President Obama has said 1. 34 million additional patients will insurance companies. As a consequence, that he plans to reduce record deficits by become insured under Medicare and insurance companies are predicted to reducing health-care spending by $143 billion private insurance. become far more concerned about per over the next 10 years. He hopes to do this 2. Insurance companies are required to capita health-care spending. This will likely by cutting projected payments to Medicare fund free preventive, screening, and translate into the implementation of much providers and reducing payments to Medi- wellness services. more stringent managed care reviews, care Advantage programs. 3. The increased demand for health-care reviews that are now being extended to services could drive up health-care prices. out-of-network providers. Additionally, RISING HEALTH-CARE COSTS 4. Planned reductions in payment updates insurers are likely to adopt the use of review Despite the administration’s plan to cut for Medicare providers based on companies that are paid a percentage of the spending, it is expected that Congress will increased productivity are unlikely, claims that they deny. Some insurers are not allow a scheduled 21 percent cut in phy- because they may encourage providers already experimenting with plans that per- sicians’ fees under the Medicare sustainable to opt out. mit access only to the lowest cost physi- growth rate (SGR) formula to go into effect. 5. The Community Living Assistance Ser- cians. (See “Insurers Push Plans Limiting vices and Supports (CLASS) long-term Patient Choice of Doctors,” The New York Graham L. Spruiell M.D., and Fredric T. insurance program, which is counted on Times, July 17, 2010). Regardless of method, Perlman Ph.D., are co-chairs of the Committee for $38 billion in savings over 10 years in the aim will be to reduce expenditures. on Government Relations and Insurance. the CBO estimate, will probably become Continued on page 35

THE AMERICAN PSYCHOANALYST • Volume 44, No. 3 • Fall 2010 33

From the Unconscious Sheri Butler Hunt poetry

Shelley Galasso Bonanno is a psychotherapist with The Time Machine

a private practice in Birmingham and Utica, Michigan. The Time Machine She has been practicing psychotherapy for 23 years. Transfer. Replace present for past, Bonanno is a psychotherapy associate member of the past for present. American Psychoanalytic Association, an associate member Intermingle time and step through the mirror. of the American Psychological Association/Division 39, Approach slowly. a psychotherapy member of the Michigan Psychoanalytic Step up to the ride and become engulfed. Society, and a member of the International Association for Step off the ride Relational Psychoanalysis and Psychotherapy. She attended and run excitedly to the back of the line again, and again, graduate school at Wayne State University where she and again. received a master of arts degree. Her interest in writing poetry began as an adolescent. She later returned to writing Enact, repeat, and relive. Twirl and spin until you merge. poetry as a result of feeling inspired by her own experiences Merge past to present, as a psychoanalytic psychotherapy patient. Her poem, present to past. “The Time Machine,” reflects the depth and importance Again and again. Never tiring, never stopping. of the transference experience expressed in the metaphor

of a time-altering mirror. As analysts, we see how these Time moves on. fantasies play out clinically and organize transference with or without the time machine, with or without the mirror. in a timeless way in both psychoanalytic psychotherapy Grieve the loss of the ride. and psychoanalysis. The more immersing and intense Grieve the loss of the ride that was quite simply, the experience can become, the more powerful and an illusion. permeable the mirror can be. Transfer. Step back through the mirror and return to the present. Step back through the mirror and carry the past.

—Shelley Galasso Bonanno

Sheri Butler Hunt, M.D., is a graduate analyst in the adult and child divisions at the Seattle Psychoanalytic Society and Institute. A published poet and member of TAP’s editorial board, she welcomes readers’ comments and suggestions at [email protected].

34 THE AMERICAN PSYCHOANALYST • Volume 44, No. 3 • Fall 2010

Health Reform Certification 2010 Continued from page 33 Total Applications 22 To address the arbitrary denial of claims, Certified 14 the health reform law requires private insur- Continued 8 Certification Rate 64% ers to have both an internal and external appeals process which allows an enrollee to New Applications 17 present evidence, while receiving continued Certified 9 Continued 8 coverage pending the outcome of the appeal. Certification Rate 53% The external appeal process must include Continued Applications 5 consumer protections set forth in the Uni- Certified 5 form External Review Model Act promul- Continued 0 gated by the National Association of Certification Rate 100% Insurance Commissioners. Female Applications 16 As with patients, there is also an appeal Certified 10 process for psychoanalysts, as providers. Continued 6 The Parity Act states the review process Certification Rate 63% cannot be more stringent for mental Male Applications 6 health-care claims than for other types of Certified 4 insurance claims. If members of APsaA Continued 2 become concerned that reviews have been Certification Rate 67% wrongfully conducted, or that there may Degree Ph.D. 7 have been a violation of the Parity Act, Certified 5 those members are encouraged to docu- Continued 2 Certification Rate 71% ment the incident and forward this infor- mation to [email protected]. Degree M.D. 10 CGRI will carefully review these incidents Certified 7 Continued 3 and establish a Web-based catalog that will Certification Rate 70% become a resource for members. If a viola- Degree M.D., Ph.D. 2 tion in the review process or of the Parity Act Certified 1 is strongly suspected, this information will be Continued 1 forwarded for legal advice. Recommenda- Certification Rate 50% tions might include contacting the individual Degree M.S.W. 2 insurer and/or HHS. Naturally, becoming Certified 0 familiar with the new regulations is the best Continued 2 defense in the review process. Certification Rate 0% In the many “thou shalts” in health-care Degree Other 1 reform legislation that psychoanalysts are Certified 1 expected to follow, there remains one Continued 0 exception. The secretary of HHS is Certification Rate 100% expressly prohibited from promulgating Child Applications 1 any regulation that violates the principles of Certified 1 informed consent and the ethical standards Continued 0 Certification Rate 100% of health-care professionals. In addition to the possibilities of wrongfully conducted Alternative Certification Process Applications N/A reviews and violations of parity, violations Certified N/A Continued N/A of professional ethics may also be a basis Certification Rate N/A for appeal. For more information on these topics, Editor’s Note: To facilitate the Association’s efforts toward transparency in the certification please see the CGRI newsletter. We are also process, TAP will publish statistics and demographics annually. Questions and comments can be in the process of developing a Web site, addressed to Paul Holinger at [email protected]. which will be coming out soon.

THE AMERICAN PSYCHOANALYST • Volume 44, No. 3 • Fall 2010 35 EDGAR A. POE

Edgar A. Poe He categorizes The narrator-killer recounts a childhood Continued from page 1 the class, genus, history—actually an anamnesis connecting and species of adult actions with early life experience—of In another story, “The Man of the Crowd,” various men of “docility and humanity” and his fondness of, Poe begins with thoughts about human business, dandies, and parental indulgence for, his love of ani- secrets: military men, mals. His wife replaces his parents and sup- gamblers, clergy- ports his many pets. Pluto, a beautiful and which do not permit themselves to men, women of sagacious black cat, is his best companion and be told. Men die nightly in their the town of very affectionate until the “Fiend Intemper- beds, wringing the hands of ghostly “varying beauty ance” intervenes. He becomes moody, irrita- R. Curtis Bristol confessors and looking them pite- and inebriation,” ble and disregards the feelings of others. ously in their eyes—die with despair and exhausted laborers. Enraged with Pluto who avoids him one eve- of heart and convulsion of throat, A “decrepit old man” catches his atten- ning after excessive drinking, he cuts out an on account of the hideousness of tion and causes him to stir from his voy- eye from its socket with his penknife. mysteries which will not suffer euristic comfort to join the crowd and The next morning he feels “half of horror, themselves to be revealed. Now follow him as he conjectures the old man’s half of remorse for the crime…but it was at and then alas, the conscience of purpose. He follows him to a gin house— best a feeble and equivocal feeling and the man takes up a burthen so heavy in the “fiend gin” is his purpose! But no, the soul remained untouched.” The cat’s aversive horror that it can be thrown down old man joins the flow of the morning terror initially causes him grief, soon replaced only into the grave. And thus the crowd and the narrator follows him observ- by irritation. Poe offers an explicit character essence of all crime is undivulged. ing the same aimlessness. Poe concludes, study more than description of debauching: “[He] is the type and the genius of deep DOUBLES crime. He refuses to be alone. He is the Perverseness is one of the primitive The narrator, a convalescent, sits in a Lon- man of the crowd.” impulses of the human heart—one of don coffee house “peering through the Poe concludes that “crime” is more the indivisible primary faculties, or smoky panes into the street” with an “inquis- abstract than his ratiocination tales about sentiments, which give direction to itive interest in everything.” He observes clues of wrongdoing. In fact there are no the character of Man. Who has not, the details of likeness and differences of direct clues. The “wrong doing” is to be alone, a hundred times, found himself com- “innumerable varieties of figure, dress, air, unconnected, and without meaning to mitting a vile or silly action, for no gait, visage and expression of countenance.” another. The “crime” is the isolation and other reason than because he knows aloneness that one will bear in pain until the he should not? Have we not a per- grave, a double of what Poe projects as the petual inclination, in the teeth of our enlivened, cunning intelligence of the voy- best judgment to violate that which is euristic stalker recovering from illness. The Law, merely because we vex ourself— stalker and stalked are doubles. to offer violence to its own nature— My hypothesis for understanding Edgar to do wrong for the wrong’s sake only. A. Poe is the power of his language to con- struct a short tale that the reader identi- With this insightful preamble, he hangs fies with through the narrator as observer Pluto “in cold blood” from the yard tree limb on the scene, however terrifying and with “with bitterest remorse at [his] heart.” repugnant, forcing the reader to think about his own life. Poe intends to arouse Hung it because I knew that it had terror and pity similar to Aristotle’s expla- loved me, and because I felt it had nation of Greek tragedy, in order to teach given me no reason of offence; hung moral themes. it because I knew that in so doing I Poe’s “The Black Cat” is his best mad-man- was committing a sin—a deadly sin killer-in-denial. “Yet, mad man am I not—and that would so jeopardize my immor- surely I do not dream,” says the narrator. tal soul as to place it—if such a thing Condemned to die the next day, he writes a were possible—even beyond the “wild yet most homely narrative” not to con- reach of infinite mercy of the Most Illustration for “The Man of the Crowd” fess guilt or seek redemption but to explain Merciful and Most Terrible God. by Harry Clarke (1889-1931), first printed in 1923. his “perversity.” Continued on page 37

36 THE AMERICAN PSYCHOANALYST • Volume 44, No. 3 • Fall 2010 EDGAR A. POE

A conflagration follows and destroys his As he descends into the cellar aiming the home and wealth to which he resigns himself hatchet at the double of Pluto, he instead “rejecting cause and effect as to atrocity and buries it into the brain of his wife. He hides calamity,” only detailing a “chain of facts.” the corpse and looks about in “triumph” and Yet he wonders at the bas-relief of Pluto “supreme happiness.” “The guilt of [his] dark on the one surviving wall: deed disturbed [him] but little.” His heart beat calmly and as in innocence when con- Although I thus readily accounted ducting the police on their search that “left to my reason, if not altogether my no nook or corner unexplored.” Satisfied, conscience, for the startling [appari- they prepare to depart. He inexplicably brags tion]…it did not the less fail to of the soundness of his house, that like “The make a deep impression on my House of Usher,” is about to collapse. The fancy. For months I could not rid missing cat behind the catacomb reveals the myself of the phantom of the cat tomb upon the pounding of his walking stick. and during this period, there came back into my spirit of half-sentiment …a cry at first muffled and broken, that seemed, but was not remorse. like the sobbing of a child, and then quickly swelling into one long, loud, A substitute for Pluto is found offering the and continuous scream, utterly opportunity for repair of the past or the anomalous and inhuman—a howl, a compulsion to repeat it. The second Black Cat wailing shriek, half of horror and comes to resemble the first in appearance half of triumph, such as might have and fondness for the narrator. “Disgust and arisen only out of hell, conjointly Illustration for “The Black Cat” by Aubrey Beardsley (1894-1895). annoyance rose into the bitterness of hatred.” from the throats of the damned in He loathes the animal he hoped to love for their agony and of the demons that the one that he had loved but grown to hate. exult in the damnation. bipolar psychosis, narcissistic, or paranoid As a breath of pestilence, it became literally personality disorder. These psychopathologi- Pluto with an empty eye socket and white hair The stark terror presented in Poe’s tales cal views of Poe and his works are celebrated spot at the neck transformed into a noose. obscures a more profound allegorical mean- in R. W. Griswold’s “memoir” published with ing. Things are what they are and remain his collected works the year after his death unexplained—a mystery—until challenged and have clouded our understanding of Poe’s by another, as “The Man of the Crowd,” or genius judged from his creative works. challenged from within oneself, as “William Poe defies the warning of Seneca, the Wilson,” or challenged by the reader as in the Roman philosopher, “to be everywhere is to “Black Cat.” be nowhere.” In addition to his initial Gothic tales, Poe is celebrated as the originator of PSYCHOLOGICAL CONSTRUCTION horror-terror tales, the detective story, and ILLUMINATES DARK TALES science fiction as well as his excellent literary Poe’s dark tales are illuminated by psy­ criticism, commentary, and poetry. He turned chological construction and not the religious, the American reader away from manifest des- supernatural or oracular common to his tiny to the inner self to examine what is weird, time. This framework precedes psychoana- unwanted, and unacknowledged. lytic ideas, but explicitly includes free associa- tion, hubristic self-defeat, various defenses like displacement, undoing identification, Editor’s Note: Much of this article was denial, projection, and idealization. derived from R. Curtis Bristol’s well attended There is no shortage of Poe biography discussion group entitled “Love, Sex and the and commentary to document his life. These American Psyche: Romantic Attachment in biographies document his driving ambition the Literature of Edgar Allan Poe” presented to be accepted as person and writer against in June at the APsaA Annual Meeting in Illustration for “William Wilson” the odds of his unpredictability, his alcoholic by Byam Shaw in “Selected Tales of Mystery” Washington, D.C. (London: Sidgwick & Jackson, 1909). excesses, and posthumous diagnoses of

THE AMERICAN PSYCHOANALYST • Volume 44, No. 3 • Fall 2010 37

Unconscious Motivation which these motivations can be problematic in New Members Continued from page 25 various forms of psychopathology. Perhaps even our taxonomy of psychopathologies June 2010 Subjects were seen to respond even to sub- could be tied to a set of reliable tests of uncon- tle cues in the environment: A leather brief- scious motivations and their associated rep- case left on the desk caused subjects to resentations of self and other. Finally, we ACTIVE MEMBERS behave more competitively, a picture of a might use assessment of these motivations Carol D. Arland, Psy.D. library on the wall made subjects speak more to measure and ultimately optimize change in Margot T. Beattie, Ph.D. softly, and the vague scent of a cleaning agent response to individual psychotherapeutic tech- made subjects clean the table more. In each niques. It seems very likely that our colleagues Elizabeth Biggart, Ph.D. of these a conscious but seemingly unrelated in social psychology and cognitive neurosci- Jen-Yu Chou, M.D., Ph.D. stimulus affected behavior on a later task. ence would join us in this project. Hilli Dagony-Clark, Psy.D. John R. DiMartini, Ph.D. SUBLIMINAL STIMULI AFFECT MOTIVATION More recent work has established that Michael B. Donner, Ph.D. Teaching Workshop the subject need not even be conscious of Continued from page 24 Susan Flinders, Ph.D. a stimulus for it to influence his or her Cia Foreman, Ph.D. motivated behavior. Martin Eimer in London, The first group focused on psychoanalytic lis- Jason D. Greenberg, Ph.D. Stanislas Dehaene in Paris, and Hakwan Lau, tening, the second on resistance, and the third now at Columbia University, have each pub- on transference/countertransference. Unter- Daniel A. Kietz, M.D. lished work demonstrating that subliminal berg floated among the groups. Then we Bernadette S. Kovach, Ph.D. stimuli can change motivational patterns, as reconvened and each group summarized its Michael L. Krass, Ph.D. evidenced both by the resultant behavior discussion. We left out the three Great Debates. Clara Kwun, L.C.S.W. and corresponding brain activity. Custers and I asked Melody Moore and Jennifer Unter- Aarts took this a step further by demonstrat- berg, Dallas candidates familiar with the Richard Marcolini, M.D. ing that subliminal exposure to reward influ- Focused Case Conference, to comment on Patricia A. Marra, M.F.T. ences the nature of the priming. They asked a this educational approach. Here is their input: Rebecca Meredith, M.A. group of healthy young adults to squeeze a handgrip and exposed some of them sublimi- Rather than the traditional model Paul Morris, M.S.S.W. nally to words about physical exertion and of one presenter bearing the Mary Nielsen, M.D. others to words about physical exertion responsibility of providing clinical Lori Pellegrino, M.D. paired with positive rewards. Subjects primed material and the others acting as Lee Rather, Ph.D. with both sets of words squeezed the ball listeners, the focused continuous harder and longer than those primed with case affords each of us an opportu- Phillis I. Sheppard, Ph.D. the words about physical exertion alone. nity to actively and purposefully M. Ann Simmons, Ph.D., M.S.W. From these experiments, the authors sug- attend to the material. Presenters Ema Willingham, M.S.W. gest a simple theory for unconscious motiva- feel less anxious about being in the Susan Yamaguchi, L.C.S.W. tion: When there is “coactivation” consciously spotlight and listeners feel more an or unconsciously of a goal and some reward integral part of the experience. or positive reinforcement for that goal, moti- We find the Great Debates to AFFILIATE MEMBERS vated behavior is more likely to occur. This has be a new and creative way to col- Dina Abell, M.D. important potential implications for the study laborate with colleagues and bridge Andrew Bennett, M.D. of unconscious motivations in relation to psy- theory and technique. The teams choanalytic theory and treatment. Who better meet privately to develop their Lois W. Choi-Kain, M.D. than analysts to develop a comprehensive tax- strategy and outline the specified Nancy Gay, Ph.D. onomy of unconscious motivations and a set theory’s strengths and weaknesses. Helena Hansen, M.D., Ph.D. of testable hypotheses about how these moti- Each team has 20 minutes to make Marsha Lesley, Ph.D. vations influence behavior when activated? its argument and 10 minutes for Such a tool, if standardized, could be used first rebuttal. As a result of the Great Aimee J. Rusk, M.D. to understand the normal range of uncon- Debates, we are able to articulate Theodore Peter Wasik, M.D. scious motivations and their interactions and our case conceptualizations with then broadened to understand the ways in confidence and clarity.

38 THE AMERICAN PSYCHOANALYST • Volume 44, No. 3 • Fall 2010 Training and Supervising Analyst Appointments Announced By the Board on Professional Standards June 9, 2010 Renaissance Washington DC Downtown Hotel

Training and Supervising Analysts Joan Lentz, Ph.D. Rita Teusch, Ph.D. Minnesota Psychoanalytic Institute Boston Psychoanalytic Society Jeanne Bailey, M.D. (Provisional Institute) and Institute Minnesota Psychoanalytic Institute (Provisional Institute) Pamela Meersand, Ph.D. Child and Adolescent Columbia University Center for David L. Frank, M.D. Supervising Analysts Psychoanalytic Training and Research The Psychoanalytic Institute Affiliated Benjamin James Bennett IV, M.D. with the NYU School of Medicine Susan Rosbrow-Reich, Ph.D. Dallas Psychoanalytic Center PINE Psychoanalytic Center Fred L. Griffin, M.D. Dominic L. Mazza, M.D. Dallas Psychoanalytic Center Holly Anne Schneier, M.D. Psychoanalytic Center of Philadelphia Columbia University Center for Marcia Kaplan, M.D. Psychoanalytic Training and Research Cincinnati Psychoanalytic Institute Geographic Rule Supervising Analyst Hal Steiger, Ph.D. Cynthia Lee, J.D., Ph.D. Mary Jane Otte, Ph.D. Minnesota Psychoanalytic Institute Houston-Galveston Oregon Psychoanalytic Institute (Provisional Institute) Psychoanalytic Institute

I n M emoriam

Albert Ackerman, M.D. Ruth Powell Kane Coyne, Ruth F. Lax, Ph.D. Andrew P. Morrison, M.D. December 3, 2009 M.D. January 31, 2010 February 28, 2010 December 18, 2005 William R. Adams, M.D. Leroy P. Levitt, M.D. Jack Raher, M.D. March 21, 2010 H. Harlan Crank, M.D. February 16, 1998 May 22, 2005 June 19, 2005 Arnold Allen, M.D. Robert E. Litman, M.D. James S. Robinson, M.D. September 28, 2004 Robert Dickes, M.D. February 14, 2010 January 12, 2010 April 26, 2009 John E. Biddinger, M.D. William W. Meissner, Melvin A. Scharfman, M.D. October 29, 2009 Stanley I. Greenspan, M.D. S.J., M.D. October 18, 2008 April 27, 2010 April 16, 2010 Eugene B. Brody, M.D. Conrad S. Sommer, M.D. March 13, 2010 Eugene J. Kinder, M.D. Helen C. Meyers, M.D. May 2, 2006 November 1, 2009 April 8, 2010 Robert W. Buchanan, M.D. Samuel J. Sperling, M.D. May 21, 2010 Robert P. Knight, M.D. Donald L. Miller, M.D. April 23, 2006 September 11, 2008 June 20, 2010 Robert A. Cohen, M.D. Robert L. Stewart, M.D. October 9, 2009 March 18, 2010

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