the FALL/WINTER 2003 AMERICAN Volume 37, No. 4 PSYCHOANALYST Quarterly Newsletter of The American Psychoanalytic Association

Capturing Time and Space INSIDE TAP... in the Analyst’s Office Winter Meeting . . . . . 5–6 An Interview with Photographer Shellburne Thurber Organizational Michael Slevin Consulting ...... 12 In a program at the Boston meeting titled “In-Depth: Art, Culture and Politics: Memory and Material Space:Analytic and Other Interi- Special Section on ors in Photographs,” noted photographer Psychotherapy Shellburne Thurber presented work from two Training...... 13–17 of her series.Thurber has exhibited widely in the United States and Europe, including three Practice one-person shows in New York City.The Fogg Museum, Harvard University, the Museum of Guidelines...... 19–21 Fine Arts, Boston, and the Polaroid Corpora- tion are among the public collections holding APsaA Fellows . . . . 27–29 her work. Her awards include the Maud Morgan Prize from the Museum of Fine Arts, Boston, and a Bunting Fellowship from the Photo: Shellburne print ©2000 Thurber chromogenic Radcliffe Institute for Advanced Study at Har- Newtonville, MA: vard University. She was artist-in-residence at Blue couch with multiple portrait of Freud. the Boston Athenaeum from 1999 to 2002. Morris L. Peltz, founder of the “In-Depth:Art, Michael Slevin conducted and Culture and Politics” presentations, introduced edited the following email inter- the program. Daniel H. Jacobs chaired the morn- view with Shellburne Thurber. ing panel. Discussants were Michael Belldoch, faculty member at the Payne Whitney Clinic in Q. When did you begin taking New York City, and Lia Gangitano, founder and photographs? director of Participant, Inc., an alternative, non- A. I started to photograph seri- profit art space in Manhattan.The two black- ously around the time that my and-white photographs on this page, originally mother died. I was 19 and had in color, were among those shown. dropped out of college. I was liv- ing in Saratoga Springs in a San- Michael Slevin, M.A., is a Ph.D. candidate ford White-designed Victorian in British literature at George Washington mansion that had been converted Photo: Shellburne print ©1998 Thurber chromogenic University and an academic associate into a boarding house. I was living Gholson Homeplace: at the Baltimore-Washington Institute with an eclectic mix of people. Upstairs hallway with window and torn curtain, view #2. for Psychoanalysis. Continued on page 4

THE AMERICAN PSYCHOANALYST • Volume 37, No. 4 • Fall/Winter 2003 1 CONTENTS: Fall/Winter 2003 THE AMERICAN PSYCHOANALYTIC ASSOCIATION President: Newell Fischer 3 The Crisis on Our Threshold Newell Fischer President-Elect: Jon Meyer Secretary: K. Lynne Moritz 5 A Three-Ring Circus of Exciting Choices at the January Meeting Treasurer: Warren Procci Sharon Zalusky Executive Director: Dean K. Stein Administrative Director: Ellen Fertig 9 Chair of Psychoanalysis, Uncommon or Not? Harriet Basseches 11 American Imago: Past and Present Vera J. Camden THE AMERICAN PSYCHOANALYST Newsletter of the 12 Opportunities and Obstacles in Organizational Consultation: American Psychoanalytic Association Joint APsaA and ISPSO Panel Mark F. Poster Editor Prudence Gourguechon Member, Council of Editors SPECIAL SECTION of Psychoanalytic Journals Spotlight on Psychotherapy Training Programs: National Editor 13 K. Lynne Moritz Dilemmas and Accomplishments Robert S. White and Caryle Perlman Editorial Board New Life for Cleveland’s Psychotherapy Program Richard Lightbody Harriet Basseches, Abbot Bronstein, 14 Randi Finger, Sheri Hunt, Lee Jaffe, The Role of Psychoanalytic Institutes in Training Psychotherapists Janice Lieberman, Jack Miller, 15 Caryle Perlman, Marie Rudden, José A. Saporta and Alan Pollack Hinda Simon, Michael Slevin, Gittelle Sones, Julie Tepper, Robert S. White, 16 The Child and Adolescent Psychotherapy Training Program Harriet Wolfe, Sharon Zalusky, at the Chicago Institute Erika Schmidt Ellen Fertig and Dean K. Stein, ex officio APsaA Practice Guidelines Address Common Problems William D. Jeffrey, Consultant 19 Paul Mosher, Consultant of Members Robert R. Cummings Michael and Helene Wolff, Technology Management Communications, ShrinkWatch: Therapy Room Stars in Award-Winning Manuscript and Production Editors 22 Mervin Stewart, Photo Editor Commercials Dottie Jeffries The American Psychoanalyst is published quar- Politics and Public Policy: Illegal Privacy Notices Fail to Protect terly. Subscriptions are provided automatically 23 to members of The American Psychoanalytic Medical Privacy Deborah C. Peel Association. For non-members, domestic and Canadian subscription rates are $32.50 for indi- 24 Everything You Wanted to Know about HIPAA and Were Afraid viduals and $75 for institutions. Outside the U.S. to Ask Robert S. White and Canada, rates are $52.50 for individuals and $95 for institutions. To subscribe to The American TechNotes: Protecting Your Computer Paul W. Mosher Psychoanalyst, visit http://store.yahoo.com/ 26 americanpsych/subscriptions.html, or write TAP Subscriptions, The American Psychoanalytic 26 Membership: Finding a Voice for Mid-Career Analysts at APsaA Association, 309 East 49th Street, New York, Zoe Grusky New York 10017; call 212-752-0450 x18 or email [email protected]. 27 APsaA’s Stunning New Fellows for 2003-2004 Copyright © 2003 The American Psychoanalytic Association. All rights reserved. No part of this 30 Strategic Marketing publication may be reproduced, stored in a retrieval system, or transmitted in any form or by Curriculum: Beginning with Freud Lee Jaffe and Ellen Rees any means without the written permission of The 32 American Psychoanalytic Association, 309 East 33 New Committee to Promote Psychoanalysis through the Arts 49th Street, New York, New York 10017. Laurie Wilson ISSN 1052-7958 An APsaA Fable for Our Times Ronald M. Benson The American Psychoanalytic Association does 34 not hold itself responsible for statements made in Dean Stein Arrives to Take Administrative Helm The American Psychoanalyst by contributors or 35 advertisers. Unless otherwise stated, material in as Executive Director The American Psychoanalyst does not reflect the endorsement, official attitude, or position of The American Psychoanalytic Association or The SPECIAL INSERT: Practice Guidelines 1, Revised—Committee on Peer Review American Psychoanalyst.

2 THE AMERICAN PSYCHOANALYST • Volume 37, No. 4 • Fall/Winter 2003 PRESIDENT’S MESSAGE

that many of the issues on the table for The Crisis on Our Threshold discussion are invested with consider- Newell Fischer able passion. Old hurts, the sense of enti- tlement, the inequities of a hierarchical Efforts to more clearly define our organi- Association and system, the privileges/benefits of the zational priorities and a mandate to reduce the International abused are just a few of the hot spots the internal tensions in our governance are Psychoanalytical that can become the foci of personal action items on the Association’s agenda.The Association (IPA) agendas, which may obscure and derail need to address these all too familiar issues is over the issue of the larger organizational mission. It is made more pressing by the fact that APsaA, lay analysis. This imperative that we keep in focus that as a not-for-profit corporation, is not in com- debate began as this is a time-limited process to achieve pliance with New York statutes. Expert legal early as 1910 and certain objectives and that we not con- consultation has advised us and we have reached critical fuse an absorbing process with the mis- actively begun the process of studying our proportions prior sion itself. Newell Fischer current organizational structures and func- to World War II. As the challenges in our surround become tioning.We must come into compliance with In addition to the historical roots of these more complex and more intense, there may State laws. Even more important to our Asso- internal struggles, the nature of our clinical be a temptation and some transient comfort ciation’s well-being, we must reduce the orga- work might fuel these organizational conflicts. in turning further inward and becoming nizational tensions that drain our energies As psychoanalysts, we work with intense totally immersed in studying the internal and distract us from addressing the challenges intrapsychic and interpersonal affective pres- dynamics of the Association. Such a preoc- to our profession. sures in relative isolation. We might specu- cupation might well serve to protect and Reviewing the history of the psychoana- late: Do the conflicts and tensions experienced blind us to these daunting challenges. Intro- lytic movement and the establishment of the in the privacy of our consultation rooms find spection, so highly prized in our profession, American Psychoanalytic Association, it appears expression and an arena for enactment in the can also be mobilized in the service of that from the earliest years, ambiguities, con- more public domain of Association politics? defense and to avoid confronting threatening flicts, and debates about internal governance Though these speculations may be of impor- external realities. have been intrinsic to our Association. tance in our ongoing discussions, at the The IPA devoted several years, and a great deal of money, to reorganizing its complex international corporate configuration as well as its internal governance structure.This restruc- Introspection, so highly prized in our profession, turing process was certainly necessary and is can also be mobilized in the service of defense and still ongoing. But, while immersed in these complexities, no one seemed to notice the to avoid confronting threatening external realities. need to develop a strategy to deal with the worldwide crisis unfolding in psychoanalytic practice. It was only in recent months that an official position paper was put forward by Freud set the stage for internal organiza- moment we have a mandated task before us Professor Daniel Widlocher, president of IPA, tional conflict. His intense battle to establish and to examine and modify our governance with that the priority for 2003-05 will be to address define psychoanalysis in a hostile environment “due diligence.” I feel confident that this self- the crisis in clinical practice. Unfortunately, found expression in his delineating an inner cir- examination and the ensuing deliberations will the crisis has been with us for quite some cle of confidants and then extruding dissidents result in a less conflicted Association and a time but we seemed to have been transfixed and detractors. Bob Wallerstein in his thought- more effective organization. by organizational blueprints. ful book, The APsaA, the IPA and the Certifica- However, I also have some concerns about tion/Training Analyst Linkage developed the how we proceed, concerns that I believe REASONABLE INERTIA thesis that many of the contentious structural require our attention: My second concern about our current and governance issues that have been with us 1. Will this study and debate about gover- process to study and reorganize governance for nearly a hundred years find root in the nance become an end unto itself, pre- structures is worrisome because on the surface struggle between the American Psychoanalytic occupying and interminable? it seems so “reasonable” and suggests a work- 2. Will the “reasonable” caution about ing premise that may be accepted without Newell Fischer, M.D., is president of the keeping the process insulated lead to further reflection.This reasonable voice says, American Psychoanalytic Association. organizational inertia? My first concern is Continued on page 33

THE AMERICAN PSYCHOANALYST • Volume 37, No. 4 • Fall/Winter 2003 3 PSYCHOANALYSIS AND THE ARTS

Thurber Interview Before I knew it, she had lined up several Continued from page 1 offices for me to visit and I was off and running. I got a Bunting Fellowship from the Radcliffe The bikers lived on the first floor; the jockeys Institute for Advanced Study at Harvard the from the track nearby lived on the second, the following year and decided to spend that time witches on the third, and the artists on the top photographing analytic offices in the Boston floor. I lived in a turret surrounded by stained area.There are so many aspects to this project glass.With this move to Saratoga, I had finally that fascinate me.These offices clearly belong found a group of people that I felt comfortable to the analysts.The analysts choose them, dec- with and I began photographing them. I’m orate them, spend their working lives in them, sure that this need to record was given an surround themselves with objects that are extra edge by my mother’s death. I suppose I often significant and meaningful. Yet, for the had this sense that by photographing my life, hour that the analysand is there, the space the people and places that meant something to becomes his or hers. me, I could insure against their disappearance. Michael Slevin The interior work began when I started Q. There are no people in your analysts’ offices making pilgrimages out to southern Indiana distracted almost immediately. As I looked or your abandoned houses, but they have such a to visit my mother’s mother. I never knew my around, I started to think about all the history palpable psychological presence. mother well and our relationship had always it had witnessed—Gela’s, her patients’, and A. I agree, but I think that the sense of been difficult. I was hoping that by visiting the difficult and sad history of the country presence plays out in the two types of spaces my grandmother and the place where my itself. Every object seemed charged to me, in different ways. When I decided to photo- mother grew up, I would come to a better every object felt like it was there for a reason. graph abandoned domestic dwellings, I was understanding of who she was. My grand- I asked Gela if I could photograph it. She very much interested in how human energy mother lived alone in a Hopper-like Victorian said, yes, and then asked me if I’d be interested plays out in spaces where the inhabitants are farmhouse on the top of a small rise in the in photographing some of her friends’ offices. Continued on page 31 middle of a cornfield.At night, when she went to bed, I would skulk around looking for any- thing that could give me some sense of who TH TO E E S D my mother was, but my grandmother had R I E T O T cleared anything of any meaning out of the R T 2003

E house.What I was left with was the house itself L and I began to photograph it at night.When I got home and processed this work, I was MENNINGER CLINIC staff to Houston,Texas at the end of May stunned by how accurately these empty inte- STAYED ALIVE AND WELL 2003. In Houston, the Clinic is continuing its riors spoke about my mother and her family In the article about new appointments at nearly eight-decadeletters tradition of providing and their life in this place. the Anna Freud Centre in the most recent psychodynamically informed assessment, issue of TAP, Dr. Tyson incorrectly notes treatment, education, and research in col- Q. What prompted you to photograph the closure of the Menninger Clinic as an laboration with the Baylor College of Med- analysts’ offices? example of the outcome of financial trou- icine and the Methodist Hospital. Some A. I was visiting Buenos Aires with a close bles in many organizations.While it is true of its research, in fact, will be done in con- friend. We stayed with a friend of his who that the Topeka Institute for Psychoanalysis junction with the Anna Freud Centre and lives with his mother, who is an analyst. We closed, the Menninger Clinic remained open the Child Study Center at Yale University. happened to be down there during soccer and moved with over 100 patients and In addition, the department at Baylor season and there were two TV’s in the house was renamed the Menninger Department going almost constantly. When I got home of Psychiatry. Psychoanalysts from the from walking around, I would want to read but TAP welcomes letters to the editor. Topeka Institute relocated to Kansas City, could never find a place quiet enough. Finally Letters must be less than 350 words St. Louis, Portland, Cincinnati and Houston, Gela suggested that I take my stack of books long. Letters will be printed as space and many remained in Topeka. into her office. I was a little shy about it at first. allows and at the discretion of the Richard L. Munich, M.D. It was as if there were some kind of force field editorial board. Vice President and Chief of Staff, over the entrance.Anyway, I went in, stretched The Menninger Clinic out on the couch and started to read, but I got

4 THE AMERICAN PSYCHOANALYST • Volume 37, No. 4 • Fall/Winter 2003 WINTER MEETING

A Three-Ring Circus of Exciting Terrorism Choices at the January Meeting Symposium: Sharon Zalusky Towards Peaceful

When Marvin Margolis was president of Later that day,Anton Kris will challenge us with Resolution this organization some years ago, he envi- his plenary entitled,“The Lure of Hypocrisy.” On Friday morning, January 23, sioned that one day our program would be as Saturday morning, we again have to choose 2004 at APsaA’s Winter Meeting, vibrant as a three-ring circus. Each ring would from two equally inviting offerings: ” Revenge” attendees will have the opportunity house something exciting, informative, provoca- and “How Psychoanalysts Think about Children: tive, even foreign, to contemplate.After look- The Analysis of an Adopted Child.” In the to be in conversation with one of ing at the upcoming program, no one can afternoon, we have a panel on shame and the world’s foremost experts on doubt that we have accomplished his goal. If humiliation which meets opposite a psycho- bringing peace to situations involving anything, our program is an embarrassment of analytic dialogue,“The Love Debate,” featuring terrorism. In a symposium entitled riches that forces us to make choices among Ethel Person and Otto Kernberg. “Terrorism: Looking Toward Conflict many stimulating experiences.The richness of The concept of revenge will be dramatized Resolution:A Conversation with our current program is due in large measure during a two-day film workshop featuring Lord John Alderdice,” participants will to the efforts of Glen Gabbard, chair, and the Carrie and In the Bedroom. engage in discussion with Alderdice rest of the hardworking program committee. If you take a look at our program, you will regarding one of the most challenging On Wednesday and Thursday, in addition to see an increasing commitment to psycho- sociopolitical problems of the 21st our many ongoing discussion groups, we are analysis in the community. century.Alderdice, who is speaker fortunate to begin the meetings with two dif- Here are some symposia and other pro- of the Northern Ireland Assembly ferent two-day clinical workshops in process grams that might interest you: ”Terrorism: Look- and a psychoanalytically oriented and technique, featuring Peter Fonagy from ing Toward Conflict Resolution: A Conversation psychiatrist, was instrumental in London and Jorge Canestri from Rome.The with Lord John Alderdice, Speaker of the establishing the landmark 1998 presence on the program of two major child Northern Ireland Assembly,” “Psychoanalysis Good Friday Agreement.This sessions, the two-day workshops led by Ruth and Spirituality,” “Expanding Our Psychoanalytic agreement, the unique outcome of Karush from New York and Cal Narcisi from Identity: 111 Lessons from Case Studies of the ongoing Ireland peace process, Denver, represent a new effort to include Community Psychoanalysis,” “Bridging Worlds: offered new ways of transacting old programs on child and adolescent analysis. In Contributions of Attachment and Reflective disputes after thirty years of violence addition, Fred Pine will chair what appears to Functioning to our Understanding of Psycho- and bloodshed. be an extremely interesting course on multiple analytic Psychotherapy,” “Promoting Emotional Not only does Lord Alderdice models as unified theory. Competence and Academic Achievement: Psy- have substantial experience regarding A Friday afternoon highlight, not to be choanalysts and Educators Working Together.” political conflict and terrorism, missed, is the Third Annual Poster Session And more:“Capturing the Friedmans: A Con- subjects on which he has published a showcasing research relevant to theory and versation with Director Andrew Jarecki,” “Psy- number of critically important papers, practice of psychoanalysis. choanalysis without Walls: Interventions in he is also immersed in international On Friday, the panels begin placing the audi- Violent Communities,” “Psychoanalysis and affairs. He is vice-president of the ence right in the middle of the current clinical the Opera: A Conversation with Soprano European Liberal Democrat Party debate with “Do Analysts Do What They Say Shirley Verrett,” and ” In-Depth: Art, Culture, (a key voting block in the European They Do?” There will be many of us wishing we and Politics—The Legacy of Bloomsbury.” Parliament) and deputy president could be in two places at once, because at the We finish our meeting on Sunday with a of Liberal International, a worldwide same time, we could listen to another timely timely panel entitled “Have Non-Psychoanalytic federation of over eighty political presentation, the “Meet the Author” series, Sciences Affected Your Practice?” In another featuring Gilbert Cole, who has written Infecting room at the same time, an interdisciplinary parties. For all of us interested in the the Treatment: Being an HIV-Positive Analyst. colloquium on “Psychoanalysis and Literary application of psychoanalytic thinking Criticism” will be occurring. In the afternoon, a to social problems, this symposium Sharon Zalusky, Ph.D., is faculty, Southern second interdisciplinary seminar,“The Clinical provides a unique occasion for California Psychoanalytic Institute, a member Applications of Self-Psychology—the Neuro- learning and discussion. of the APsaA Program Committee, and a sciences,” will finish our official program. —Nadia Ramzy member of the TAP board. Continued on page 6

THE AMERICAN PSYCHOANALYST • Volume 37, No. 4 • Fall/Winter 2003 5 WINTER MEETING

January Meeting Continued from page 5

Throughout the meeting, there will be spe- cial programs for psychiatric residents and psy- chology and social work students.They include: 1) “Working Within and With the Patient Metaphor,” 2) “Whose Trauma is it?: Counter- transference with the Traumatized Patient,” 3) “Intensifying Psychotherapy,” and 4) “Contem- porary Kleinian vs. Attachment Theory: Two Perspectives on a Case Presentation.” Special programs will also be presented during the week for candidates and affiliate members. And though it may be difficult to believe, there will be additional papers, a course on ethics, meetings, and discussions going on all around you. Come. Enjoy. Partake. Photo: NYC & Company See you in New York. The Metropolitan Opera House at Lincoln Center.

Theater Lights in Manhattan And Other January Joys

Broadway shows are a warm and natural destination Some of New York’s most exciting theatrical experiences are for our January meeting attendees.Tickets are more easily those off-Broadway and off-off-Broadway—this is a sample. available than at our old pre-Christmas meeting time. Opera is another unique cultural opportunity available in APsaA member and theater aficionado Fred Sander the city during our visit. Playing at the Met during our meeting recommends that visitors pick up the weekly publications, are no fewer than five different operas—Boris Godunov, TimeOut New York, and the waiting room standby, The New Yorker. Madama Butterfly, Rigoletto,Werther, and Tosca.Go to Both have comprehensive listings and useful reviews. Sander metopera.org for more information. recommends “Avenue Q,” a musical (for adults) improbably For restaurants, you might want to pick up a copy based on Sesame Street. He describes it as “not an intellectual of TimeOut New York’s 2004 Eating and Drinking Guide. heavy hitter, but an unforgettable entertaining evening.” It’s available on New York City newsstands, and can also Catch up on your Pulitzers. Don’t miss Anna in the Tropics, be ordered from the Web at store.yahoo/com/shoptony in performance at the Royale Theatre.Tolstoy’s Anna Karenina for those who like to plan ahead. features prominently in Nilo Cruz’s 2003 Pulitzer-winning Newsstands also have a special edition of New York drama, set in a Cuban-American cigar factory. Jimmy Smits Magazine, a guide to New York shopping.The New York stars.And sometimes, you know—“a cigar is not just a cigar.” Magazine Website, newyorkmetro.com, also is a good A stellar off-Broadway play not to be missed is The source for store information. In addition, this Website Exonerated, directed by Bob Balaban, the noted New York features enticing “best of New York lists” reprinted actor and writer of Gosford Park acclaim. On stage in Greenwich from the magazine. Village’s Bleecker Street Theatre, the play is based on interviews You can also check out The New York Times online general with innocent men and women freed from death row and guide to New York City—Times.http://www.nytimes.com/ has proven to be a compelling experience for theater goers, top/features/travel/destinations/unitedstates/newyork/ regardless of what they may think of the death penalty. newyorkcity/index.html.

6 THE AMERICAN PSYCHOANALYST • Volume 37, No. 4 • Fall/Winter 2003 WINTER MEETING

Support Group for Analysts with Cancer

On Friday, Jan.23, 2004, the third Support Group for Analysts We have had very interesting discussions about how the impact with Cancer will be held at an offsite restaurant from 12:00 PM of the illness may have brought out certain transference issues to 2:00 PM.The idea for the group evolved as a number of earlier than might be expected or how the analysis may have our members who attended the Discussion Group on the taken another course. Psychoanalytic Treatment for Cancer Patients were themselves The members of this group appreciate this opportunity to cancer patients and came looking for support.Actually, some meet together.They have found a great sense of relief in having of the presenters chose to present their cases because of a forum that is safe, and supportive without risk of possibly countertransference issues created in part by their also having damaging their referrals.The camaraderie and the strong bonds cancer. Jerry Winer encouraged the establishment of this created by having a fellow traveler cannot be underestimated. support group under the auspices of the Committee on the The co-leaders of the group are Norm Straker and Miriam Impaired Faculty Analyst (CIFA).The members of the group Winicoff. Each has had a long-standing experience with cancer have expressed satisfaction and enthusiasm about the first patients. Straker is consultant at Sloan-Kettering Cancer few meetings. Center, clinical professor of Psychiatry at Weill Cornell College As you might expect, we have discussed mutual problems of Medicine, and faculty at New York Psychoanalytic Institute. connected with carrying this diagnosis and the impact on our Winicoff is a nurse who cared for cancer patients prior to her families, our work, and ourselves. Participants have revealed as training and graduation from the Pittsburgh Psychoanalytic much information as they wish about their illness experiences. Society and Institute. She has a private practice that includes However, the majority of the time has been spent discussing cancer patients. the practical and theoretical issues that relate to working We know there are large numbers of our membership with analysands in general and in particular from the time who have cancer and are coping alone with the serious issues of diagnosis of cancer.We have observed that the content of of how to handle their analytic or psychotherapy practices. the sessions, especially when issues that involve the illness or We urge you to join us for an informal and supportive meeting absence of the analyst are raised, is largely dependent on the over lunch. If you are interested, you can be in touch with me psychological comfort of the analyst.We have asked one another at [email protected] or contact the registration desk to find about the considerations given for disclosing or not disclosing out where the lunch is to take place. illness information and the outcomes of those decisions. Norm Straker

NY Meeting Free for Students

Thanks to generous grants from the American Psychoanalytic Foundation and three New York area psychoanalytic organizations, all residents in psychiatry, post-docs in psychology, graduate and undergraduate students, and student associates can attend the New York meetings in January 2004 free of charge. The New York groups are the Association for Psychoanalytic Medicine and Columbia University Center for Psychoanalytic Training and Research; the New York Psychoanalytic Society and Institute; and the NYU Psychoanalytic Institute and its affiliated society, the Psychoanalytic Association of New York, Inc. Additionally, the Psychoanalytic Center of Philadelphia will be underwriting the registration fees of students from the Philadelphia area who attend. The practice of underwriting attendance for students began just this year with the Boston meeting, where a grant from the institutes and societies of PINE and BPSI covered student fees.The inaugural project was a great success, with more than 200 students attending. The initiative of the Philadelphia Center institutes another valuable angle to this outreach approach. Societies and Institutes in the host cities of meetings are often burdened by the tasks of hosting a meeting, both financially (paying for receptions and special events) and in terms of manpower. If regional societies can pitch in by also supporting student attendance, the load is lighter for the host community, and the other local communities in the region can benefit from the exposure of their students to a national psychoanalytic meeting. To quote president Newell Fischer,“The more students who come to our superb scientific meetings, the more we will all gain.” For registration information, including free fees for students, go to apsa.org and click on meeting registration.

THE AMERICAN PSYCHOANALYST • Volume 37, No. 4 • Fall/Winter 2003 7 WINTER MEETING

Book It Through APsaA!!

When you book your hotel room for our meeting in New York in January, or San Francisco in June, or any future meetings, PLEASE use the official APsaA reservations line. For the Waldorf in January, call 1-800-WALDORF and use code APA. Debra L. Eder,APsaA’s Scientific Program and Meetings director, negotiated a rate of $199 for a queen room, a price that couldn’t be beaten by either Orbitz or Expedia at the time this article was written.And obviously, these business related hotel expenses are tax deductible Are there cheaper hotel rooms available in the area if you search hard? Yes.Is it possible you could book a room at the Waldorf via your computer at an even lower rate than the terrific $199 bargain? Maybe. But don’t do it. If you enjoy the hunt for huge travel bargains on the computer, save that for your vacation trips. Like every other company or association hosting a meeting, when our organization negotiates with a hotel we must guarantee that a certain large number of rooms will be used in order to obtain meeting rooms at no cost.Without this tradeoff, we wouldn’t be able to afford meetings.The cost of renting meeting space would be enormous, and would lead to drastic increases in our registration fees, which remain modest. In August, the Wall Street Journal reported that conference attendees booking hotel rooms at other hotels or at the conference hotel through discount computer sites is the number one problem in the meeting and convention industry.At some conventions, attendees staying at another hotel are charged more for their registration fees.Associations are losing tens of thousands of dollars. Hotel contracts contain fines they can levy against the association if the block of rooms is not full. One organization emailed its members:“I implore you to STOP doing this.” The Journal article notes that off-site conventioneers have to find transportation to the meeting site, and also miss out on networking opportunities in the lobby. For our group,“Meet me at the clock,” is a familiar refrain, and running into friends in the lobby and nearby lounges is a pleasant habit. Personally, I’ve gotten very attached to the Waldorf.When I was a candidate, I thought it was such a stuffy place for APsaA to meet. But over the years, meeting after meeting, it’s become, in its old fussy elegance, and perfect location—quiet but near everything—a home for a treasured interval in my year.There are very cheap eats nearby for breakfast and lunch and a good inexpensive wine store (go out the Lexington Avenue door, take a right, and look for where local workers eat); nice moderate restaurants, dry cleaners, and drug stores over on Second and Third Avenues.You know about the rest of the glories of midtown Manhattan—but that’s our home neighborhood at the Waldorf. I like pretending I live at Lexington and 49th for the better part of a week each year. —Prudy Gourguechon

Accreditation Council on Continuing Medical Education Recredentials APsaA

The Accreditation Council on Continuing Medical Education on Continuing Education; Debra Eder, Scientific Program and (ACCME) has reaccredited APsaA for four years. In its letter Meetings director; and Ellen Fertig,APsaA administrative director, of notification,ACCME cited “Exemplary Compliance” in with support from the assistants to Edgar and Janicki. one particular area, Needs Assessment, which was the most Accreditation by ACCME for both the Association and for jointly problematic to those involved in the preparation of the sponsored programs by societies/institutes should by no means be reaccreditation materials.The application requirements had taken for granted.ACCME requires that the Association concretely changed significantly from previous years, becoming even demonstrate and extensively document compliance with its lengthier and more complicated. In addition to the submission of Essential Area Elements and Policies.The reaccreditation process extensive documentation, this Review required an interview via with ACCME takes place as often as every four years.Accreditation videoconference with an ACCME appointed team of surveyors. to offer CEUs for psychologists is a less onerous process, but does The preparations and interview were a collaborative effort involve its own application procedures. Because each state has its by the following: James Edgar, the then chair of the Committee own social work licensing guidelines, avenues are being explored for on Continuing Education; Glen Gabbard, chair of the Program social work accreditation. Continuing education credit is a valuable Committee;Anna Janicki, who is now chair of the Committee member benefit and APsaA is pleased to be able to offer it.

8 THE AMERICAN PSYCHOANALYST • Volume 37, No. 4 • Fall/Winter 2003 PROFESSORS & CHAIRS

In Yudofsky’s view, Baylor has always been Chair of Psychoanalysis, committed to a bio-psycho-social model, including a psychodynamic/psychoanalytic Uncommon or Not? perspective. Harriet Basseches Setting up such a chair is challenging, because not only the person but the named Glen Gabbard has been appointed to a Yudofsky said chair has to be approved and funded. To chair of psychoanalysis in the Department of it was his inten- arrange for a named chair, the Faculty Coun- Psychiatry at Baylor College of Medicine. tion to make it cil, made up of all faculty—the entire basic The news triggered a question as to the possible finan- science departments ( strongly representing frequency of such an appointment at a time cially for Gabbard biological scientists) as well as the clinical when it is often claimed that psychoanalysis to devote himself faculty—must approve.This appears to have has been marginalized in our culture.The view to his many and been quite a coup. of an eclipsed role for psychoanalysis and diverse psychoan- The Brown Foundation supports the arts, psychoanalysts contrasts with the situation in alytic responsibili- museums, performance arts, and education. the 1950’s when many psychiatry department ties, for example, This was the largest gift ever given to a med- Harriet Basseches chairs in medical schools were psychoanalysts. his work as pro- ical school. Yudofsky explained why he had This article focuses on two areas: the gram chair for the APsaA meetings. He is also proposed a chair in psychoanalysis, rather notable details surrounding Dr. Gabbard’s currently joint editor-in-chief (and the first than the broader category, psychotherapy. accomplishment; and TAP’s attempt to deter- non-British editor) of the International Journal He values the psychoanalytic perspective, mine how many others might hold similar of Psychoanalysis with Paul Williams. His duties which he came to appreciate through his positions. Named chairs of psychoanalysis at Baylor include directing the Psychiatry own psychoanalytic mentors, such as Hilde give recognition not only to a particular dis- Clinic, where all the residents and psychology Bruch, Larry Kolb, Sherv Frazier, to name a tinguished psychoanalyst but equally to the interns learn dynamic therapy, and being few, and other influences, Bob Michels, Roger field itself. director of Psychotherapy Training. In those MacKinnon, Ethel Person, Michael Stone, Otto First, let’s turn to Gabbard’s appointment. capacities, he has responsibility for revamping Kernberg, Harold Searles. He strongly believes He has been at Baylor since 2001. His appoint- the residency curriculum to increase psycho- that psychoanalysis must be supported in ment as the first Brown Foundation Chair of analytic therapy courses, in addition to teach- medical schools. He mentioned Jim Lomax, Psychoanalysis has recently been approved. He ing psychodynamic psychiatry and therapy to associate chair, who is also close with the was recruited two years ago by Stuart Yud- the residents. Houston-Galveston Institute. ofsky, chair of the Department of Psychiatry at Gabbard remarked that many residents go Baylor.At that time, Gabbard was the Callaway on to psychoanalytic training at the Houston- EIGHT PSYCHOANALYSIS CHAIRS Professor of Psychoanalysis and Education at Galveston Institute. He believes this choice is Following the news of Gabbard’s appoint- the Karl Menninger School of Psychiatry, so he due to the presence of analyst/role models ment,TAP searched for other known chairs of was already in a position of influence in an among their residency teachers. psychoanalysis.The search yielded eight oth- academic setting. He was promised a similar ers so honored.These include:Thomas Bar- status at Baylor, where there has been a long A VISION FOR THE 21ST CENTURY rett, Schmule Erlich, Peter Fonagy, Ed Foulks, history of sympathetic connection with psy- In my interview with Yudofsky, he explained Steven Marans, Jon Meyer, Bill Meissner, and choanalysis and close ties to the Houston- that the creation of this appointment goes Leo Rangell. Galveston Psychoanalytic Institute. What back to a planning initiative undertaken at Detailed account of the positions of three of prompted this important naming of a chair and Baylor College of Medicine in anticipation of these distinguished colleagues follows. how it was funded were questions that Gab- the new century called,“Vision 2000.” Yudofsky, Peter Fonagy has held the position of chair bard considered more appropriately answered a neuropsychiatrist, made a proposal to the of psychoanalysis at the University College by Stuart Yudofsky. I interviewed them both for Research Committee, composed mostly of of London since 1992. It was initially a visiting this article. biologically oriented scientists, to set up a professorship, with Roy Schafer the first holder, Brain and Behavior Center that would be in 1975. The one-year model did not suffi- Harriet Basseches, Ph.D., on the editorial funded by the Brown Foundation for $25 mil- ciently meet the donor’s aim of establishing board of TAP, is a training and supervising lion.This center was to consist of the full range psychoanalysis within the university, however, analyst at the New York Freudian Society of theoretical and academic pursuits, i.e., mol- so a permanent chair was instated. Joseph and a member of the Baltimore-Washington ecules and genetics, areas in which Baylor has Sandler was appointed the first permanent Society for Psychoanalysis. She is in private always been strong, but also various perspec- chair in 1985. practice in Washington, D.C. tives of psychology, areas less strong at Baylor. Continued on page 10

THE AMERICAN PSYCHOANALYST • Volume 37, No. 4 • Fall/Winter 2003 9 PROFESSORS & CHAIRS

Chair of Psychoanalysis of his overall financial support as full-time community that gave analysts a place to voice Continued from page 9 faculty at the Medical College. Meyer ex- their changing views more freely than was plained that the original concept of his position felt possible at the institutes. He arranged for The chair was established by the late owner- was to promote coordination and collabora- analysts to give paid courses in the Counsel- editor of the Observer Newspaper, the Right tion among a teaching hospital, the medical ing Program and in the Social Work School. Honorable David Astor.The interest from that school, and the Wisconsin Psychoanalytic He offered weekend symposia to the broader large donation now funds the professorship. Foundation.This was conceptualized 20 years mental health community, including one on The psychoanalysis unit, which has three aca- ago, much ahead of its time, and has worked music and one on aggression. For the past six demic staff (Peter Fonagy, Mary Target, David out more successfully than anyone could have years, he has provided an introductory course Tuckett), an editor, a conference organizer, imagined. for the University and the Counseling Pro- and two administrators, is funded by research In an interview with William Meissner, he gram, drawing approximately 25 students grants, the Higher Education Funding Council, described the way his chair of psychoanalysis each year. course fees, and conference fees, in addition to at Boston College evolved. Dr. Meissner’s posi- Meissner is enthusiastic about a new set of the donation. tion was formalized in 1987. He had resigned courses he views as a breakthrough offered in The chair’s responsibility is to promote his post as a clinical professor at Harvard, the fall of 2003. These will make up a psy- psychoanalysis within the university. Fonagy where the combination of the increasingly choanalytic minor in the undergraduate col- explained,“We run two master’s level courses, biological direction of the department and lege for students majoring in English, history, one on theoretical studies in association with the increasingly difficult institutional changes literature, and philosophy.The introductory the British Institute and one on development had become frustrating.Already on the Boston course, mentioned above, will be used as a in association with the Anna Freud Centre, and College Board, he moved fully into that Jesuit basic course for the minor. Some other a doctorate in child psychotherapy in associa- community.The president of Boston College courses include one by Bill Richardson, a Hei- tion with the Anna Freud Centre.” Fonagy and he decided on naming him University degger scholar and primary interpreter of described both master’s programs as highly Professor of Psychoanalysis, a tenured position Lacan.Thus, psychoanalytic ideas will be inte- successful and massively oversubscribed with financed within the University budget. Boston grated into undergraduate as well as graduate excellent highly qualified candidates from U.K. College did not have a medical school; his education. and U.S. first-rank universities. Since 1992, appointment was the first non-medical post of To complete this survey, mention, albeit 23 students have received research Ph.D.’s its kind in the country. brief, needs to be made about others who through the unit. As part of his responsibilities, Meissner ran hold this special title.Thomas Barrett occupies Fonagy’s group has organized the IPA’s a lecture series open to the Boston analytic a newly endowed Chair of Child Psycho- research training program for the past 9 years, analysis in the Department of Pediatrics of and the IPA’s annual research conference for Case Western Reserve School of Medicine the past 15 years.The success of the unit as a and University Hospitals of Cleveland. Barrett center for international psychoanalysis has A Red Brocade is clinical director of the Hanna Perkins Center. increased respect for psychoanalysis within Appointment Professor Shmuel Erlich holds the Freud the university. Moreover, Fonagy thinks that Chair at Hebrew University in Jerusalem, Israel. the active participation of the Freud chair in One of the most striking academic Steven Marens holds a position at the Yale the administrative work of the Department of appointments in psychoanalysis Child Study Center of the Yale University Psychology has “legitimized” psychoanalysis belongs to Elise Snyder, who is School of Medicine as the Irving Harris Asso- for many academics. ciate Professor of Psychoanalysis. Professor of Psychoanalysis in the Edward F. Foulks, associate dean of Tulane Department of Philosophy at Sichuan COLLABORATION IN ACADEMIA University Medical Center, has held the Mary On this side of the Atlantic, Jon Meyer has University in the city of Chengdu. Peters-Polchow-Sellars Chair of Psychoanaly- just retired from a chair of psychoanalysis at Snyder told TAP,“I have the most sis at Tulane University School of Medicine the Medical College of Wisconsin in Milwau- impressive appointment document since 1986. He explained that donor Mary kee, which he has held since 1996. Based on framed in red brocade.” The university Sellars had established the chair position in that position, Meyer was also the director has just gotten permission from the order to ensure that psychoanalytic psycho- of the Division of Psychoanalysis in the therapy would continue to have a prominent national government Department Department of Psychiatry. Not a customary place in the training of medical students as well of Education to begin psychoanalytic title at the college, but recommended by the as residents in psychiatry in this era of ever- chairman of psychiatry and granted by the training, says Snyder. She is supposed expanding advances in pharmacological treat- dean, Meyer has been the only person to to teach there every other year. ments of mental disorders. be so named.This position was funded as part Continued on page 38

10 THE AMERICAN PSYCHOANALYST • Volume 37, No. 4 • Fall/Winter 2003 AMERICAN IMAGO

Under its first American Imago: Past and Present three editors, V era J. Camden the journal pub- lished classic pa- “The smartest new journal on the academic As indicated by its subtitle, the special prove- pers by, among scene may actually be the oldest,” writes Diana nance of Imago has always been what Freud, others, Siegfried Fuss of Princeton University about American in The Question of Lay Analysis,called those and Suzanne Imago under the editorship of Peter L. Rud- “branches of knowledge … which the doctor Bernfeld, nytsky and his team of co-editors, Louise J. does not come across in his practice: the his- Edmund Bergler, Kaplan and myself. tory of civilization, mythology, the psychology Mark Kanzer, Vera J. Camden Every psychoanalyst has surely heard of of religion, and the science of literature.” While Richard Sterba, American Imago. Not many, however, may real- preserving this emphasis at American Imago, Géza Róheim, Theodore Reik, A. Bronson ize that, as the successor to the original Imago: today we are eager to integrate clinical per- Feldman, George Devereux, and Martin A Journal for the Application of Psychoanalysis to spectives, in the belief that it is no longer pos- Grotjahn. During Gliserman’s tenure, it the Human Sciences,founded by Freud in 1912, sible or desirable to distinguish sharply between expanded its focus to encompass new trends with Otto Rank and Hanns Sachs as its editors, “pure” and “applied” analysis. in gender, film, and cultural studies, featuring it can claim to have the longest tradition of any psychoanalytic journal.The first American jour- nal, The Psychoanalytic Review, was founded in 1913, the same year as The International Journal of Psychoanalysis. The Psychoanalytic Quarterly, established in 1932, was second in this country. Both Sachs, who was by profession a lawyer, and Rank were among the first lay analysts. In 1932, Sachs came to the United States to be a training analyst at the Boston Psychoanalytic Society.When the Nazis occupied Vienna in 1938, Freud consented to Sachs’s request to continue Imago under the name American Imago. Freud was to have served as its hon- orary editor, but did not live to see the inau- gural issue. 1912 Cover of the first edition of Cover of most recent American Sachs declared in his preface: Imago, published by Hugo Heller, Imago, September, 2003, published Leibzig/Vienna. by Johns Hopkins University Press. The American Imago lost its editor before the publication of its first Since its inception, the journal has had only such luminaries as Jacques Derrida, Harold issue. We cannot look out for five editors. Sachs remained in the post until Bloom, Shoshana Felman, Sander L. Gilman, another one to replace him … Our 1946, the year before his death. He was fol- and Slavoj Zijek. aim can be no other than to keep lowed by George Wilbur, who served until Now, building on its illustrious history, the flame alive which he lighted and 1963.Wilbur, a Harvard-educated psychiatrist, American Imago seeks to reintroduce itself to to try, as best we can, to continue in had been analyzed by Rank.After Rank’s break members of the American Psychoanalytic his spirit the science which he has with Freud,Wilbur was forced to resign from Association as the preeminent scholarly jour- founded and developed. the Boston Society so that it could join the nal of psychoanalysis and the place where American Psychoanalytic Association, but he the academic and clinical worlds intersect. Vera J. Camden, Ph.D., is an associate was readmitted in 1936. Harry Slochower, Rudnytsky, who took over in 2001, is professor professor at Kent State University and who during the McCarthy era successfully of English at the University of Florida. He a psychoanalyst in private practice in fought before the Supreme Court his politically received the 2003 Gradiva Award for his book, Cleveland, Ohio. A member of the Committee motivated firing by Brooklyn College, presided Reading Psychoanalysis: Freud, Rank, Ferenczi, on Research and Special Training of the over the journal for a quarter-century. In 1990, Groddeck (Cornell University Press) and, in American Psychoanalytic Association, his successor, Martin J. Gliserman, brought 2004, will be the Fulbright/Freud Society Visit- she is the founding chair of the annual American Imago to The Johns Hopkins Uni- ing Scholar of Psychoanalysis in Vienna. CORST Essay Prize competition. versity Press. Continued on page 18

THE AMERICAN PSYCHOANALYST • Volume 37, No. 4 • Fall/Winter 2003 11 OUTREACH

interpersonal relationships. Business leaders, on Opportunities and Obstacles the other hand, often prefer action to thinking and are thick-skinned and gregarious. in Organizational Consultation: A second is frame of reference. Psycho- analysis is conducted within an individual Joint APsaA and ISPSO Panel framework, which is not immediately trans- Mark F. Poster ferable to a group. Ethics at an organizational level are different than at an individual level. A joint panel with members of APsaA and where parties are pulled and stretched. Some- Dr. Stokes recommended reading Machiavelli’s the International Society for the Psychoanalytic times boundaries need to be crossed. “The Prince” to gain an appreciation of this Study of Organizations (ISPSO) was held in Kenneth Settel, co-chair of the Committee fact.Whereas Bion wrote about “introducing Boston in June, in conjunction with the simul- on Organizational Consulting of APsaA, the individual to himself,” Stokes likes to think taneous annual meetings of both groups. traced his personal odyssey to becoming an of his work as “introducing the organization to Kenneth Eisold, co-chair of the Committee organizational consultant, paying tribute to itself.” He tries to facilitate conversation within on Organizational Consultation of the APsaA his mentor, Dr. Harry Levinson, a founder of the organization.This does not require inter- and also President-elect of ISPSO, moderated. ISPSO, who was in the audience.Twenty-five pretation, other than to himself. He tries to In his opening remarks, Eisold noted that years ago, Levinson recruited Settel to teach get the staff in the organization to have the among the obstacles to psychoanalytically in his psychoanalytically based training pro- courage to explore deeper thoughts and feel- oriented business consultation were analysts’ gram for business leaders. Initially, Settel ings. In this regard, he referenced Christo- internal inhibitions against working in a busi- wasn’t certain that doing organizational pher Bollas’ “unthought known” and Bion’s ness environment and providing concrete help, consulting was compatible with being a psy- “thoughts waiting for a thinker”. rather than therapy. Both the panel and its choanalyst, but he credits Levinson with help- The third is maturational experience, which subject matter, he said, were “boundary events,” ing him overcome this prejudice. In his work affects how one deals with tensions and each working at the boundary, between areas with organizational problems, Settel listens for conflicts. Dr. Stokes believes that a “valency” of inquiry and organizations, respectively. unconscious processes, but does not speak for one of Bion’s basic group assumptions can Kerry Sulkowicz, chair of APsaA’s Public to primary process. be generalized according to occupational Information Committee, remarked that psy- Settel summarized what psychoanalysis field. For instance, doctors tend to have a choanalysis is in trouble from external and offers to organizational consulting into two valency toward dependency, psychologists internal threats. One of the central notions of broad areas: First is the power of the uncon- toward pairing, and social workers toward psychoanalysis is the concept of boundaries, scious, especially transference including that fright or flight. He added that the asymmet- which can be both a strength and a barrier in between the organization and the consultant. ric framework of psychoanalysis is notoriously organizational consulting. Boundaries, often Second is an understanding of developmental unhelpful in learning how to deal in an expe- discussed in intrapsychic and interpersonal needs.This can often explain seemingly irra- riential and maturational way with problems terms, can also be conceptualized in terms of tional behavior. with authority. organizations. He finds it ironic that the notion Settel emphasized that he eschews psycho- The last barrier is lacking an understanding of boundaries was itself one of the biggest analytic jargon, in favor of business language. of the client’s field of work. Only by gaining boundaries to organizational consulting. To Furthermore, he tries to help his organiza- such an understanding can the consultant be psychoanalysts, boundaries are a way to pro- tional clients by providing a clear sense of of help. Stokes has a partner who is an MBA. tect the therapeutic frame and prevent the what is going on and being direct. He believes this helps him immensely working violation of ethical principles, but this idea can Jon Stokes, director of the Tavistock Con- with business people. be taken too far and become reified, resulting sulting Service in London, England, and past- Stanley Gold, chair of the Center for Psy- in a distant and obsessional stance.This seem- president of ISPSO, outlined four major barriers chodynamic Studies in Melbourne, Australia, ing paradox can be resolved by maintaining a to doing organizational consultation: began his remarks by crediting his own men- critical attitude about when boundaries are One is values and temperament. By encom- tor, Harold Bridger of the Tavistock Clinic in being crossed, and what is going on, and why. passing an inquiry into emotional phenomena, London, for stimulating his interest in organi- Boundaries can be hiding places from emo- psychoanalysis can be useful to the organiza- zational consulting. Dr. Bridger taught him that tional engagement, but they can also be help- tional consultant. However, to do organiza- psychoanalysis does not belong solely to the ful.The best work is often done at a boundary, tional consulting, psychoanalysts may have to individual treatment setting, but also has appli- work with personality types different from cations in business, politics, and health care. themselves. Psychoanalysts, in Stokes’ view, Gold summarized Bridger’s mentoring with Mark F. Poster, M.D., is in private practice by temperament often overvalue thinking, are three phrases: in West Newton, MA. thin-skinned, easily hurt, and struggle with Continued on page 38

12 THE AMERICAN PSYCHOANALYST • Volume 37, No. 4 • Fall/Winter 2003 SPECIAL SECTION: PSYCHOTHERAPY TRAINING

There is often a competition for institute fac- Spotlight on Psychotherapy ulty between candidate training programs and psychotherapy programs. Questions arise Training Programs about which professions to accept, what level of experience to aim for, and how to integrate Dilemmas and Accomplishments a variety of students. Additionally, programs Robert S. White and Caryle Perlman experience various recruitment and market- ing problems as well as shifts in enrollment APsaA societies and institutes have been off” as analysts. In fact, none of these have over time. offering psychotherapy training since 1977, proved to be major problems. On the contrary, Another major difficulty for societies and when the first program was established in psychotherapy training programs have become institutes is the fate of graduates of programs. Boston. Even at that time, there had already a major source of new candidates. Perhaps a Graduates usually form strong identification begun a progressive decrease in long-term more fundamental barrier is confusion and with the training program and wish to retain psychotherapy training in all disciplines and an controversy about the relationship between some affiliation. How welcoming are soci- increasing emphasis on alternative therapies such psychoanalysis and psychotherapy. eties to non-analytic clinicians? Solutions vary as brief psychotherapy, cognitive-behavioral As Saporta and Pollack discuss in their around the country: inclusion in general mem- therapy, and psychopharmacology.This trend article, we are not clear if psychotherapy is a bership, formation of allied associations for has accelerated in recent years. A motivation type of watered down psychoanalysis or a dis- psychoanalytic thought, ongoing study groups, for starting the psychoanalytic psychotherapy cipline in its own right.A parallel tendency is and use of some graduates as teachers in programs was that the majority of psycholo- to see teaching psychoanalysis to candidates the training program. gists and social workers were ineligible for full psychoanalytic training, since APsaA was primarily admitting psychiatrists. By 1999, there were 19 programs for adult psychotherapy In starting psychotherapy training programs, training and 5 for child psychotherapy training associated with institutes and/or societies. typically there are fears that such programs will Today, the situation in mental health education is even more dire. Many training programs in drain off candidates for full training, exposure psychiatry, psychology, and social work offer little or no training or supervision in psycho- to litigation will increase, and graduates will dynamic psychotherapy. It may well be that psy- choanalytic societies and institutes will become “pass themselves off” as analysts. the guardians of this important art. This special TAP section will focus on prob- lems in developing psychotherapy training pro- grams.Talking with training directors around as more prestigious than teaching psy- The article by Schmidt illustrates that child the country, we found a remarkable similarity of chotherapy. Often, teaching psychotherapy training programs face many of the same concerns and developmental problems. In start- courses is viewed as a career step toward tensions as adult training programs. One can ing psychotherapy training programs, typically institute teaching, rather than valuable in its see the same thread of conflict between the there are fears that such programs will drain off own right. goals of psychoanalytic and psychotherapy candidates for full training, exposure to litigation The article by Lightbody highlights typical training. will increase, and graduates will “pass themselves problems in the evolution of training pro- To explore this topic further, an excellent grams. Beginning programs struggle with the information resource is the Psychotherapy Robert S. White, M.D., is a member of the question of whether to offer an educational Training Workshop chaired by Alan Pollack TAP editorial board. He is the president of the experience or training. Full training would and Sally Rosenberg at the annual meetings. Western New England Psychoanalytic Society include supervision, evaluation of students, As this TAP goes to press,APsaA is beginning and an assistant professor of psychiatry at and often requires personal therapy or analy- a new psychotherapy initiative with a task Yale University. Caryle Perlman, M.S., also sis in addition to courses. Programs must clar- force, to be chaired by Dick Fox, charged a member of the TAP board, is on the faculty ify if their primary purpose is to be a feeder with the task of consolidating and enhancing of the Chicago Institute for Psychoanalysis program for full training or to improve the the organization’s engagement with psycho- and the Institute for Clinical Social Work. practice of psychotherapy in the community. analytic psychotherapy.

THE AMERICAN PSYCHOANALYST • Volume 37, No. 4 • Fall/Winter 2003 13 SPECIAL SECTION: PSYCHOTHERAPY TRAINING

NEW ENERGY FROM APsaA New Life for Cleveland’s Simultaneously, new energy came from APsaA. By happy coincidence, a member of the Psychotherapy Program Cleveland Psychoanalytic Center was on the Richard Lightbody Committee on Preparedness and Progress (COPAP). This committee reviews waiver Cleveland’s Analysts seemed to be doing all the copying, requests from Institutes that want to provide Psychoanalytic filing, and organizational busywork themselves. full clinical training to those without so-called Psychotherapy terminal degrees (i.e., Ph.D., M.D., D.S.W.), Program (PPP) ORGANIZATIONAL ANXIETY mostly M.S.W.’s. From this, two key things got off to a great In retrospect, it appears we worked both became apparent: (1) Supervision is a vital start in 1990, but inefficiently and with some fear, among other part of a psychotherapy course, as it provides by 2000, it had things, of liability and lawsuits. Because nobody a convincing experience that over time brings run out of steam. wanted to be the target of litigation, there identification and often a wish for further Two years later, was a determined, if quiet, effort to avoid the training; (2) COPAP and its parent Board on it was restarted. prospect of training therapists who might then Professional Standards had adopted formal Richard Lightbody Why and how assert kinship. For example, some esteemed policies defining acceptable minimal immersion did all this happen? That’s what this essay by colleagues not involved with PPP had con- for master’s level applicants that precisely one participant will attempt to explain in the cerns that therapists participating in the pro- matched the two-year PPP program, provided hope that these reflections may be of interest gram would represent themselves as analysts. it included supervision. In short, there were and assistance to other communities who are Consequently, the program offered no super- national as well as local reasons to bring in a past the start-up phase. vision and no membership opportunity for supervision component. An enthusiastic group of experienced analysts graduates. Furthermore, liability worries at the We instituted three other innovations: and candidates (the Steering Committee) set up Steering Committee level led to abandonment 1. The Center’s Executive Committee the original program as a didactic seminar, two of an initial plan to refer cases from the low-fee recruited a non-analyst graduate of PPP hours of class each week for two years. Well clinic to PPP students, reducing still more the to be program coordinator, with a $1000 taught by excellent analysts, the program grad- integration of the students into our community. yearly honorarium and a full tuition waiver uated some thoughtful clinicians, a number of Despite our defensive response to organi- for a repeat of the course. Coordinator whom continued in postgraduate study groups zational anxiety, a series of solid classes began Jacqueline Goodin has proven herself with senior analysts. Another cadre figured every other year. But—PPP lost momentum to be of immense value, bringing savvy heavily in the formation of our local chapter of after only four classes.That fourth class (1999- and determination to re-inspire the PPP. the Association for Psychoanalytic Thought 2000) was small and attrition was high—only Working with an active Analyst Advisory (APT), a group of motivated professionals who three of the initial six students managed to Committee, she keeps our focus on the meet to explore psychoanalytic subjects. complete the course. After this unsatisfying students’ experience, adjusting the course In the heady climate of new outreach activities experience, the program stalled. Lack of enroll- in response to frequent feedback. in the ’90s, the program’s co-directors enjoyed the ment discouraged the two leaders from con- 2. We recruited two non-analysts as guest admiration and support of the broader Cleveland tinuing; our analyst faculty seemed worn out faculty.These experienced teachers, who Psychoanalytic community. Related developments and busy with other interests. It became evi- were members of our local APT chapter, in our group, similar to outreach efforts across dent that not a single student had gone on to volunteered to co-teach segments on the country, were a low-fee treatment clinic, a full psychoanalytic training. neurochemistry, psychopharmacology, new foundation, the formation of APT,enhanced Clearly, something was not working. Indif- and sexuality. Neither of these talented opportunity for candidates, and major leadership ference to the program’s future set in.With the people is formally trained in psycho- roles for non-analysts.Those were exciting days passing months came the realization of larger analysis, but both are highly regarded for the overarching Steering Committee, but organizational problems.As a result, the analysts and sympathetic colleagues.They collab- the prospect of change brought anxiety and a shifted their overall focus from the continuation orated with and, challenged the analysts sense of vulnerability to our hitherto sheltered of problematic programs to a new strategic to renewed effort. psychoanalytic organizations. Furthermore, the planning effort.Through this process, recogni- 3. We revised the curriculum to focus on outward expansion of programs stressed a weak, tion of our central weakness led to a merger practical matters, especially technique volunteer-driven infrastructure in the Society. of our Society and Institute into the Cleveland and adult clinical issues by shifting away Psychoanalytic Center, complete with the hir- from an emphasis on child development Richard Lightbody, M.D., chairs APsaA’s ing of an executive director with marketing and and psychoanalytic theory. Committee on Societies and Centers. management know-how. Continued on page 17

14 THE AMERICAN PSYCHOANALYST • Volume 37, No. 4 • Fall/Winter 2003 SPECIAL SECTION: PSYCHOTHERAPY TRAINING

Psychotherapy training programs may be likely The Role of Psychoanalytic Institutes to hold an inferior place in the institutional hierarchy. In most institutes, assignments to in Training Psychotherapists teach in the psychoanalytic program carry José A. Saporta and Alan Pollack greater status than teaching in the psycho- therapy program, although many teachers The Boston Psychoanalytic Society and Insti- relationship of psychotherapy to psycho- personally enjoy teaching in the psychotherapy tute founded the first psychotherapy training analysis. Psychoanalysts have struggled to program. Usually, training analysts tend not program among American psychoanalytic insti- define this relationship in theoretical discus- to teach in the psychotherapy program. tutes in the late 1970s.The Advanced Training sions over the years, but there is still no con- Program in Psychoanalytic Psychotherapy sensus. Is psychoanalytic psychotherapy a OUTREACH TO THE MENTAL (ATP) became a respected and vital psy- watered-down application of psychoanalysis, HEALTH COMMUNITY chotherapy training program in Boston. Many or is it a separate practice, based on psy- The Boston Psychoanalytic Society and Insti- ATP graduates have remained involved in the choanalytic theory but with its own set of tute have been active in reaching out to the academic life of the institute. skills, its own goals, and its own way of apply- wider mental health community by providing The ATP was founded in part because of ing psychoanalytic theories of the mind to consultation and programs of interest and the diminishing presence of psychoanalysts clinical practice? relevance.We have been offering a one-year (traditionally the main teachers for young Theoretical confusion leads to ambiva- fellowship in psychoanalytic psychotherapy as therapists in training) as well as a diminish- lence about the practice of psychotherapy. an introduction to psychoanalytic theory and ing psychoanalytic theoretical perspective in Often, psychoanalysts offer psychotherapy practice. This fellowship has been very well residency and other mental health training because either psychological or practical lim- attended.We have coordinated the curriculum programs. Yet, to this day, paradoxically, psy- itations contraindicate psychoanalysis:Thus, with the ATP curriculum so that it can be a choanalytic institutes do not play a leading a limitation becomes the basis for recom- free-standing fellowship as well as serve as role in training psychotherapists in the mental mending psychotherapy. In contrast, if the the first year of the ATP.(Trainees may apply to health community. evaluating psychoanalyst arrived at a clear the ATP after the fellowship and move into the In spite of an obvious market, psychotherapy formulation of the patient’s goals and sug- second year of the three-year ATP.) The one- training programs both in Boston and at other gested they indicate psychotherapy (even if year fellowship has provided more interested psychoanalytic institutes in the U.S. have had the patient were “healthy enough” and could applicants for both the psychotherapy and similar recruitment problems. Despite the fact afford psychoanalysis), then the recommen- psychoanalytic training programs. that many clinicians are interested in further dation would be made on positive as opposed Ideally, the quality of psychotherapy and psychotherapy training without becoming psy- to negative criteria. As a profession, our psychoanalytic training programs should be choanalysts, psychoanalytic institutes have not ambivalence and confusion are such that we equivalent. Students may select one training become the strong resource for psychotherapy do not have clear, agreed-upon, positive (as program over another because of a variety of training that one might expect. opposed to negative) criteria for recom- factors, including different professional goals, We want to consider if there are systemic mending psychotherapy. preference for a different manner of working factors within the psychoanalytic establish- Psychoanalysts understandably want to prac- with patients, or interest in different clinical ment itself that contribute to the lack of vigor tice a craft that they have worked long and problems. At the point of entrance to the of psychotherapy training programs in psy- hard to develop.Analysts sometimes evaluate educational community, there should be a choanalytic institutes. themselves on the basis of the number of conversation about the person’s personal and analytic patients versus therapy patients in professional goals and which program would AMBIVALENCE AND CONFUSION their practice. best suit his or her professional aspirations. But One such institutional factor has to do If psychotherapy is defined as a watered- as long as theoretical confusion and personal with ambivalence and lack of clarity about the down application of psychoanalysis, offered on and political ambivalence regarding the rela- the basis of negative indications, psychoanalysts tionship of psychotherapy to psychoanalysis José Saporta, M.D., is on the faculty of the may have mixed feelings about predominantly persists, psychoanalytic institutes will not be Advanced Training Program in Psychoanalytic practicing psychotherapy.When psychotherapy able to represent psychotherapy training pro- Psychotherapy at the Boston Psychoanalytic is a source of conflict and ambivalence in grams In the most positive and legitimate light. Society and Institute. He has a private practice theory and in our professional self-image, As a profession, we need to discuss the rela- in Newton, MA. Alan Pollack, M.D., is chair this can be enacted when we set out to train tionship between psychotherapy and psycho- of the Advanced Training Program and the psychotherapists.The enthusiasm with which analysis in theory and practice, and psychoanalysts Fellowship in Psychoanalytic Psychotherapy, psychotherapy training is marketed may be need to talk about their work as psychotherapists. Boston Psychoanalytic Society and Institute. muted compared to psychoanalytic training. Continued on page 17

THE AMERICAN PSYCHOANALYST • Volume 37, No. 4 • Fall/Winter 2003 15 SPECIAL SECTION: PSYCHOTHERAPY TRAINING

25 diagnostic evaluations of children and ado- The Child and Adolescent lescents with varying problems and diagnoses.

Psychotherapy Training Program UNIQUE LEARNING EXPERIENCE The educational philosophy embodied in at the Chicago Institute the process and requirements, carefully thought Erika Schmidt out by the program organizers, laid the ground- work for an extraordinary learning experi- The Child and Adolescent Psychotherapy in-depth teaching of child therapy, the Institute, ence. Students become immersed in their Training Program (CAPT) of the Chicago Insti- whose faculty often consulted at these agen- clinical work and develop strong professional tute for Psychoanalysis, which began in 1962, cies, seemed a natural location for this training. identities as psychoanalytically oriented child trains a small number of mental health pro- In reality, social workers in agency settings psychotherapists. fessionals from various disciplines to conduct provided most of the direct individual psy- Peter Shaft, a 1989 graduate, says,“It was a individual child and adolescent psychother- chotherapy to children, many of whom suffered privilege to participate in that exciting, scary apy.The changes in the CAPT program over its from significant emotional disturbance and environment. It was unlike anything else 40-year history reflect the shifting landscape family dysfunction. CTP was an innovative because of the opportunity to learn, to listen of the mental health delivery system, the response to the existing situation.These chil- to unfolding process, to tolerate not knowing, broadening of training opportunities for men- dren’s mental health needs, combined with and to acquire an understanding of trans- tal health professionals, and the tensions in the lack of systematic child therapy training, led ference and countertransference dynamics psychoanalytic institutions between medical the Institute to initiate CTP,with support from with a faculty who facilitated that kind of and non-medical practitioners, between adult the National Institute of Mental Health (NIMH) learning.” and child clinicians, and between psychoanalytic and community funding. CTP represented a Judith Schiffman, a 1980 graduate, echoes and psychotherapy training. compromise between those who supported a these sentiments, “The foundation in clinical When it started, the Child Therapy Pro- child analytic training program for lay analysts, work with children also taught students how to gram (CTP), as it was then called, trained like the European model, and those who think conceptually in ways that can be broadly social workers who were sponsored by the believed the child analytic domain should be applied to other forms of intervention with agencies they worked for. Agencies provided restricted to psychiatrists. children and adults.” tuition support, time off for classes, and super- vision. Since its establishment, 116 of the 148 students who entered the program have grad- The foundation in clinical work with children also taught uated. CAPT graduates work, often in super- students how to think conceptually in ways that can be broadly visory or administrative leadership positions, in applied to other forms of intervention with children and adults. mental health clinics, social service agencies, schools, and medical settings as well as in pri- vate practice. From its inception, the curriculum offered When CTP started, it attracted committed intensive, rigorous training. It purposely allowed students and earned the respect of the com- AN INNOVATIVE RESPONSE for an integrative process over time, as the munity because of the quality and depth of its The Child Therapy Program was originally material was repeated, increased in com- training.There were few viable options then for designed to meet several goals: to train child plexity, and examined in lecture, seminar, and post-graduate clinical training in either adult or therapists; to produce a new generation of supervisory formats.Admissions criteria were child psychotherapy. Doctoral programs empha- child therapy supervisors and teachers; and to stringent, suitability for learning and for treat- sized research and policy; supervision and train- develop a model educational program for ing children was carefully assessed, and a per- ing within agencies was increasingly limited. child therapists. As agencies that provided sonal analysis was required. About 10 years The Child Therapy Program quickly became the services to children sought more formal, ago, this requirement for analysis was modified standard for excellence within the Chicago to include an intensive psychotherapy alter- mental health community. Over time, some Erika Schmidt, M.S.W., is a candidate native.The courses, meeting six hours a week modifications in the program have been made; at the Chicago Institute for Psychoanalysis over a four-year period, covered psychoanalytic for example, the requirement for agency spon- and on the faculty of the CAPT program. theory, normal development, psychopathol- sorship was dropped in the early 1970s. CAPT She is also the coordinator, Child and ogy, the therapeutic process with children, remains one of the few routes available for a Adolescent Specialization, Institute for adolescents and parents, and clinical tech- comprehensive, integrated training program Clinical Social Work, and associate editor, nique.The clinical component of the program that emphasizes introspection, unconscious Child and Adolescent Social Work Journal. included supervision of 4 treatment cases and Continued on page 17

16 THE AMERICAN PSYCHOANALYST • Volume 37, No. 4 • Fall/Winter 2003 SPECIAL SECTION: PSYCHOTHERAPY TRAINING meaning, subjective experience, and respect different aims. Questions about what consti- New Life for therapeutic process. tutes excellent treatment and the boundaries Continued from page 14 between psychoanalysis and psychotherapy AMBIVALENCE WITHIN are not yet fully resolved. In sum, we introduced a series of changes for Within the Institute, however, there remains a renovated venture in 2002: a requirement for some ambivalence toward CAPT.Some have CAPT’S CHANGING ROLE weekly individual supervision; a non-analyst been skeptical, and at times openly antagonis- As psychoanalysis has lost preeminence in coordinator; a reconstructed curriculum; and tic, about the Institute educating psycho- the mental health field and training opportu- guest faculty. Additionally, we benefited from therapists.This reflects similar conflicts within nities in other environments have opened up, the Center’s revised organization and execu- American psychoanalysis in general regarding the role of CAPT for clinical training has tive director. non-medical therapists and the training of psy- changed accordingly. Some students who chotherapists versus psychoanalysts. Though would have gone into CAPT are now eligible POSITIVE BENEFITS designed for agency personnel as education in for full analytic training. Five CAPT graduates We had 20 inquiries for the current class. child psychotherapy, not child analysis, many have entered analytic training. Doctoral pro- Ultimately, we enrolled a qualified class of analysts within the Institute opposed such an grams with strong clinical components are nine, mostly experienced social workers, educational offering, because it disturbed the now available as are training programs in adult including one Ph.D., a Ph.D. student, and mental health hierarchy. psychotherapy. Many CAPT graduates, who two M.D.’s for spice. One of the psychiatrists Considerable effort has been made to dis- know what excellent clinical training consists was a visiting professor from Korea whose tinguish CAPT as a corollary modality for of, have been instrumental in developing alter- local stay was only one year.We made room teaching about different forms of interven- native training opportunities. Some examples for him because of his wish to learn how to tion for different problems and populations. are Joe Palombo, Louise Saltzman, and Woody teach psychotherapy at the postgraduate The perceived economic threat posed by Faigen at the Institute for Clinical Social Work, level. We mail the second year’s reading CAPT graduates and students competing with Judith Mishe at the New York Univerity doc- material to him in Korea. Adapting our rules analysts for a limited number of patients con- toral program, and Judith Schiffman at the to the wishes of students seemed a practi- stituted a strong undercurrent to the discussion Northwestern Genetics Counseling Program. cal ideal. of training issues. In reality, the broader ques- At the present time, CAPT classes are smaller, Looking back on the first year of the resur- tion has to do with the mission of the Institute the students are explicitly committed to the rected PPP,we feel the program is doing well. and the conflict between those who see its practice of child therapy, and they enter the pro- Two of our students were finalists in APsaA’s function as the education of psychoanalysts and gram with a more eclectic educational back- Fellowship Program, and now have senior ana- those who envision the Institute as a center for ground and less familiarity with psychoanalytic lysts as mentors. Nearly half of the students the study of psychoanalysis in many applications concepts.According to Director Colin Webber, have shown at least some interest in psycho- and a source for services to the community. “CAPT can thrive in this new training environ- analytic training. Supervision is enormously As a group, CAPT graduates and students ment because of its unique emphasis on clinical popular, as reflected in student evaluations. have been an influential, potent force for psy- child and adolescent psychotherapy training.” We have kept PPP “in front of” the Center’s chodynamic psychotherapy within the com- [Author’s note: Thanks to former and cur- membership with frequent communiqués, and munity.They are committed to a psychoanalytic rent directors, Joe Palombo, Barrie Childress, have polled students often in order to tailor mode of thinking and devoted to providing Barrie Richmond, and Colin Webber, for the program to their learning goals. Specific psychoanalytic psychotherapy to a wide range answering many questions about the history feedback is immediately relayed to the faculty of patient populations in varied settings, from and aims of CAPT.] after each teaching segment; global assess- child welfare agencies to private practice. ments of the program influence near and When the requirement for analysis was distant decisions. amended to include intensive psychotherapy as Psychoanalytic Institutes We are beginning to recruit our next class, an option, the rationale was to widen a dimin- Continued from page 15 scheduled to start in September 2004.Although ishing applicant pool. But the change also every current student came by word of mouth, addressed an underlying tension within the There also needs to be open discussion about we have developed a publicity brochure.With relationship between the analytic Institute and the value of psychotherapy training for insti- a streamlined decision tree, we are able to its psychotherapy students. Requiring a per- tutes and its place in the institutional hierarchy. get done that which had previously been sonal analysis to assist the therapist in dealing By discussing and clarifying these issues, we can complex and anxiety producing. And we are with countertransference and the stresses of be clearer about what we teach and can be already planning for succession of leadership. doing psychotherapy was sometimes per- better advocates for psychotherapy training, If we have learned anything, it is that new ceived as psychoanalysis being considered a and thereby play a more vital role in the mental appointments are essential for continuing better kind of treatment rather than one with health community. energy and ideas.

THE AMERICAN PSYCHOANALYST • Volume 37, No. 4 • Fall/Winter 2003 17 PUBLICATIONS

Electronic Communications a Natural for Psychoanalysis

Psychoanalysis, with its international help his readers feel they are not alone Internet-based press that will distribute reach and sparse population, is a as they pursue their interests. to the psychoanalytic community material natural for the application of electronic Using the Internet is economically of interest that falls outside the purview modes of communication.The last advantageous, Siegel says, obviously of traditional paper presses. It will provide TAP contained a report on the Virtual keeping publishing and mailing costs down. a venue for writing that does not fit Psychoanalytic Society.We posted the Electronic publishing allows for the special easily into paper-based distribution first complete TAP electronically to our trait of interactivity, and Siegel emphasizes channels, for multimedia and hypertext association Webpage in the spring of this as part of the plans for the Psychology productions, for audio (and soon video) this year. of the Self Online. material, for experimental work outside Recently, two new electronic publishing Siegel said he had been playing with recognized genres, and for out-of-print ventures were announced, appropriately the idea of an online journal for several material that may no longer have enough, via another electronic medium, years.The first time he proposed it to commercial potential but is still of our Open Line. psychoanalytic colleagues the response scholarly and clinical interest.” The International Council for was unenthusiastic and seemed Howard Shevrin’s novel, The Dream Psychoanalytic Self Psychology announced “computerphobic.” Interpreters, is the first book on their the launching of its new interactive Arnold Richards, JAPA editor, has also electronic booklist.The second volume will ejournal entitled Psychology of the Self been impressed by the potential of be selected unpublished papers by Jacob Online. Editor Allen Siegel described the electronic publishing in the psychoanalytic Arlow, and the third is expected to be ejournal as a “communicative tool to field. Richards told TAP that a new unpublished papers by Leo Rangell. connect the vastly dispersed global self electronic publishing project was the JAPA and Contemporary Psychoanalysis psychology community.” Siegel conceives brainchild of himself and Todd Essig, co-sponsor I-PPsa, which is billed as a of the community he serves as being founder and director of The Psychoanalytic project of The Psychoanalytic Connection. geographically disadvantaged, sometimes Connection, an online subscriber-funded For more information and to read the without access to teachers or like-minded resource for psychoanalytic information. books, go to www.psychoanalysis.net/ clinicians. He hopes that his journal can Richards describes I-PPsa as “an iPPsa. Editor-in-chief is Steve Reisner.

American Imago seemingly new in the study of psychoanalysis and Morris, Bennett Simon, and Frans de Waal. Continued from page 11 gender has been anticipated and advanced by There will be a special exhibition,“The Private Freud and his cohort of pioneer women analysts. Life of Sigmund Freud: Photographs of Edmund The current editors have brought new mem- Rudnytsky has also introduced a book review Engelman,” at the Harn Museum of Art. Papers bers onto the editorial board including Robert section to the journal. are invited on all aspects of psychoanalysis, S. Wallerstein, Peter Loewenberg, Arnold D. Reflecting its dual mission as a scholarly and literature, and the arts and sciences of healing. Richards, Sander L. Gilman, Rosemary H. Balsam, analytic journal, American Imago belongs to For further information, please visit the con- George J. Makari, Patrick J. Mahony, John Kerr, both the Council of Editors of Learned Journals, ference website at www.english.ufl.edu/pnm. Judith E. Vida, and Robert A. Paul. They join affiliated with the Modern Language Association Proud as we are of our past at American Maynard Solomon,Adrienne Harris, Ellen Han- of America, and the Council of Editors of Psy- Imago,we look forward with equal excitement dler Spitz, Joel Whitebook, Bennett Simon, choanalytic Journals, chaired by Joseph Reppen. and optimism to the future.We welcome sub- Alan Bass, Elisabeth Young-Bruehl, Laurie J.Wil- Together with Literature and Medicine, also missions on any topic from candidates, gradu- son, and Donald Moss, among others. published by Johns Hopkins, American Imago is ate students, or training analysts and senior Each issue has a thematic focus; the Fall issue sponsoring a conference on “Psychoanalysis and professors. Papers may be sent as e-mail attach- has been designated annually as a special issue, Narrative Medicine,” to be held February 19-22, ments to the editors at [email protected]fl.edu. with a guest editor. I served as editor of the Fall 2004, at the University of Florida.The conference Published quarterly and costing only $36.00 2003 issue on “Early Women Analysts,” which is made possible by the generosity of the Thomas per year for individuals, American Imago is not includes contributions by Madelon Sprengnether, H. Maren Foundation. The featured speakers only the most venerable but also, we believe, Mary Bergstein, Rosemary Balsam, Nellie L. are Jeffrey Berman, Rita Charon, Jody Messler the most innovative and the best bargain Thompson, and Judith Vida.The historical focus Davies, Lynn Gamwell, Sander L. Gilman, Geof- among analytic journals.We hope to find you of this issue demonstrates how much of what is frey H. Hartman, Norman Holland, David B. in its pages!

18 THE AMERICAN PSYCHOANALYST • Volume 37, No. 4 • Fall/Winter 2003 PRACTICE GUIDELINES

Often feeling APsaA Practice Guidelines Address isolated and alone, analysts Common Problems of Members have struggled to Robert R. Cummings respond to what they experienced When the topic of practice guidelines is TYPES OF PROBLEMS as a machine-like raised, many clinicians feel like turning away and PSYCHOANALYSTS REPORTED bureaucracy that tuning out.This reaction may reflect years of Over two decades, our Committee on Peer thinks in ways disappointment after encountering practice Review has assisted members individually alien to psycho- Robert R. Cummings guidelines from other organizations that appear and confidentially with their concerns about analysis.They dis- to present prescriptive, cookbook approaches interactions with third parties in the context cussed with the patient and tried to explain to to clinical work and are linked to a diagnostic of their psychoanalytic cases. Members com- the outside party why compliance with some system that ignores salient considerations at plained that many patients’ psychoanalytic third-party requests would be harmful to the the heart of psychoanalytic treatment. Such treatments were harmed when outside parties patient’s treatment. Analysts often became experiences have led some to lose hope that tried to intervene or obtain clinical information uneasy and unsure of their circumstances, guidelines could possibly help them face the for various uses. Sometimes, these were third- either because they had created little in the challenges of doing good work in the current party payers. Other times, they were attor- way of a health-care record of the patient’s health-care climate. neys, courts, or state licensing boards seeking treatment, or because the analyst had cre- I hope to show how APsaA’s six psychoan- the records for a wide variety of legal and ated extensive records mainly composed of alytic practice guidelines are different, and how investigative purposes. Sometimes patients, analytic process notes that the analyst did they can help clinicians construct a safer envi- and analysts, too, were eager to seek third- not want to share with the patient or the ronment for conducting psychoanalytic treat- party financial assistance because treatment outside party. ment. They aim to convey explanations of seemed impossible to arrange without it. In some cases, the patient contacted the psychoanalytic procedures as clearly and jar- When claims were filed, the third-party payer third party for advice about claims procedures gon-free as possible.They do not attempt to would request clinical information or charted and heard objections to the option that the link symptoms and diagnoses with procedures records in order to authorize payment for patient and analyst could establish a private and techniques.They were written to address treatment. Later, these requests re-emerged treatment arrangement outside the auspices frequently reported problems that psychoan- when the patient applied for disability, life, of third-party authorization.The third party alysts encounter when they establish a psy- health care, and other forms of insurance. claimed to be willing and able to authorize choanalytic treatment relationship about which Sometimes, the request was retroactive and any “medically necessary” treatment for the outside parties raise issues and request infor- the outside party wanted the complete patient. In some cases, they warned the mation.These guidelines also aim to give sub- health-care record copied and sent to them patient that any other arrangement should be stantial national support when a member’s for review. Sometimes, they directed the ana- considered suspicious and of dubious value. psychoanalytic work is challenged. lyst to create specifically detailed summaries There were cases in which patients shared Some of these guidelines are lengthy instead of the clinical treatment to send to the third with the analyst that the third party criti- of terse, because they are meant to serve well party for review. cized the analyst as being “unusual,” “unco- in a variety of circumstances. It is important Analysts reported situations where third operative,” “practicing outside the bounds from a legal perspective to convey throughout parties claimed that the patient had signed a of normal community standards,” or “a that the guidance being offered is neither pre- consent that made the third party a “stake- dinosaur” that was trying to “exploit” the scriptive nor restrictive and thus should not holder” in the treatment process. On this patient and the third party. In some instances, be misconstrued as restraining practice (or basis, the third party sought to become “part the third party claimed that psychoanalysis “trade”) or interfering with any analyst’s clini- of the treatment team” and conduct ongo- causes “regression” and fosters “dependency,” cal judgment. ing review of the treatment. Some patients two elements that the third party regarded as expressed concern about this involvement unhealthy approaches that produce more and about releasing private information for pathology and suffering for the patient. Some- Robert R. Cummings, M.D., Ph.D., is chair external purposes. Others were not so con- times, the third party used this objection as of the Committee on Peer Review. He is a cerned initially, and later were startled and the basis for recommending that the patient training and supervising analyst with the surprised to learn about information that had immediately transfer to another clinician who Southern California Psychoanalytic Institute been released and how it might be affecting would conduct treatment as approved by and has a private psychoanalytic practice their lives, for example, if they were denied a the third party. in Laguna Hills, California. job, a job promotion, or insurance. Continued on page 20

THE AMERICAN PSYCHOANALYST • Volume 37, No. 4 • Fall/Winter 2003 19 PRACTICE GUIDELINES

Practice Guidelines APsaA PRACTICE GUIDELINES CAN documents containing clinical informa- Continued from page 19 HELP AND SUPPORT IN SEVERAL WAYS tion for third-party review of psycho- Ideally these guidelines are used prospec- analysis and modified psychoanalytic When disputes arose in the context of ongo- tively, for example, at the time when psycho- treatment (CPT 90845). (This revised ing treatment, as for example when there was analytic treatment is first being considered, guideline is published as a centerspread a change of insurance carrier, some situations to explain policies about third-party involve- in this issue of TAP.) escalated into fraud investigations to deter- ment in treatment. In a more limited way, they 2. Charting Psychoanalysis—the founda- mine whether or not the analyst had accepted can also be helpful once a difficult situation tions for the recommendation that third-party subsidy for treatment not authorized develops. If the analyst and patient oppose psychoanalysts not create and chart by the third party. Federal entitlement pro- third-party efforts to impose ongoing review session-by-session progress notes for grams, like Medicare, and other third parties on the analytic treatment, the guidelines can psychoanalysis and modified psychoana- have expanded the definition of fraud to be used to suggest to the third party an lytic treatment (CPT 90845).This guide- include billing errors, lack of adequate docu- alternative review procedure that eliminates line clarifies the differences between mentation of treatment sessions, and any treat- any need for the psychoanalyst who is treating progress notes, process notes, working ment that is retroactively determined by the the patient clinically to release confidential notes, and research notes. (Journal of the American Psychoanalytic Association, 1997, 45/2: 656-672.) Use of the guidelines can open a dialogue that 3. External Review of Psychoanalysis—the foundations for the recommendation that reduces the probability that the patient will psychoanalysis be pre-authorized by a lose confidence in the analysis and suffer an method of review conducted by a psy- choanalytic consultant, who reports to untimely ending to the treatment. the third party only on whether or not psychoanalysis is warranted; also recom- mendation that pre-authorized psycho- third party not to meet their standard of information to the third party. Use of the analytic treatment should not be subjected “medical necessity.” Random or specific fraud guidelines can open a dialogue that reduces to ongoing review and presents reasons investigations have sought review of single or the probability that the patient will lose con- for this recommendation. (The American even many of the analyst’s charts.Third parties fidence in the analysis and suffer an untimely Psychoanalyst,Vol. 34, No. 2, 2000) have demanded return of reimbursement for ending to the treatment. Discussion of con- 4. Charting Psychoanalysis, a Clarifica- treatment they consider fraudulent under cepts presented in the guidelines provides tion—the reasons why charting of these new definitions. opportunities for the patient to gain clarity progress notes, including the creation of Members have complained that third parties about the conditions for third-party author- check lists that constitute progress notes, have encouraged licensing boards to investigate ization of treatment, the likely effects of those is not recommended for psychoanalysis analysts for alleged misconduct and practices conditions on treatment, and the actual and modified psychoanalytic treatment. that are alleged not to meet community stan- amount of subsidy that the third party is likely (The American Psychoanalyst,Vol. 34, No. dards. Often when our members contacted us, to provide for psychoanalytic treatment.When 2, 2000) they shared how surprised they were to find a third party criticizes an analyst who does not 5. Appointment Records—how appoint- themselves embroiled in these distressing cir- chart progress notes or charges for missed ment and financial records, if kept, are cumstances.They reported that such disputes sessions, the practice guidelines provide some considered to be part of a patient’s have had chilling effects on their lives and support to verify that the analyst’s approach health-care record; also the customary imposed a siege-like state on their patient’s is recognized and approved by our national practice of charging a fee for missed treatment that frequently resulted in a pre- organization. appointments, the need to clarify such mature and clinically unsatisfactory ending of policies with the patient, and the rec- the treatment. THE SIX APsaA PSYCHOANALYTIC ommendation that the patient clarify Because our committee’s help does not PRACTICE GUIDELINES these matters with the third party to serve as legal advice, many members have Below are brief descriptions of the guidelines reach agreement about who will be had to seek the help of an attorney to resolve and the publications in which they appear: responsible to pay this fee. (The American these situations. Some analysts have had to 1. Informed Consent to Review—bene- Psychoanalyst,Vol. 34, No. 2, 2000) return several years worth of reimbursements, fits and risks that patients may consider in 6. Interacting with Third Parties—the tech- amounting to many thousands of dollars, to deciding whether or not to give consent nical necessity for establishing a safe, settle these disputes. for the analyst to create and release Continued on page 21

20 THE AMERICAN PSYCHOANALYST • Volume 37, No. 4 • Fall/Winter 2003 PRACTICE GUIDELINES

private, confidential treatment situation The “Charting Psychoanalysis” guideline that a mighty challenge sometimes emerges to conduct psychoanalysis and modified (number 2 above) establishes the basis for from outside the consulting room. For exam- psychoanalytic treatment (CPT 90845). the recommendation that psychoanalysts ple, during World War II and for many years This comprehensive document presents refrain from documenting psychoanalytic treat- afterward, Eastern Europe’s psychoanalysts ten conditions that serve to create such ment session-by-session. It explains why the faced successive governments that outlawed a safe environment to conduct treat- creation of session-by-session progress notes endeavors like psychoanalysis that aimed to ment in conjunction with third-party can be detrimental to the treatment process help individuals think more freely and clearly for authorization and subsidy. It also includes and is unnecessary. In the Clinic, we try to themselves. Many psychoanalysts chose emi- solutions to a variety of problems and help colleagues identify information that is gration as their only viable choice. dilemmas that members have encoun- appropriate to chart and that which is inap- Now in this country, our committee’s efforts tered over the past two decades while propriate. For example, in charting the clinical to research and develop these six practice conducting treatment that involved third evaluation and treatment planning process, guidelines have vividly informed us of the expe- parties. (Cummings and Gray, in publica- psychodynamic formulations and clinical spec- rience of many analysts and analysands who tion,TAP, Vol. 36, No. 4, 2002. ulations are inappropriate because they are engage in psychoanalytic work in a culture hypotheses rather than facts. whose socio-economic leadership has shown PEER REVIEW CLINIC DISCUSSION ABOUT CHARTING The Committee on Peer Review offers a When the challenge has stemmed from third-party goals to clinic at each national meeting, where members maximize profits by denying care wherever possible, or from ideologies have discussed models for a health care record that view a freedom-seeking treatment like psychoanalysis in a for psychoanalytic treatment that would be negative light, the six practice guidelines have been used effectively consistent with APsaA practice guidelines on by many courageous members in legal proceedings. charting (numbers 2, 4, and 5 above) and allow for clear differentiation between the official record and any private notes the ana- ACCESS TO HEALTH-CARE RECORDS suspicion and sometimes active hostility rather lyst may keep separately. In today’s practice environment, any written than support for psychoanalytic work in recent Such a model might include five items: (1) the record is discoverable. By law, many outside years.We have come to understand some of the financial record, (2) documentation of a clinical parties have gained rights and abilities to access economic and ideological motivations for this assessment (or evaluation), the treatment plan- individually identifiable health-care records, in active non-support.That understanding has influ- ning process, and the treatment plan on which some cases without the patient’s informed con- enced the development of these guidelines. the patient and analyst agreed, (3) notes to sent.They include private insurance companies When challenge arises from misunder- document the occurrence of forms of treat- and government entitlement programs like standing of psychoanalysis, unfounded fears ment or recommendations by the analyst that Medicare and Medicaid. Even with legal pro- that psychoanalysis will harm patients, or legit- the analyst believes are outside the usual scope tections like the psychotherapist-patient privilege imate concerns to guard against fraudulent, of psychoanalysis (e.g. prescription of medication, (Jaffee-Redmond case), statutory protection of wasteful, and exorbitant expenditure of limited psychological testing, referral to a neurologist, “psychotherapy notes,” and various state pro- resources, these guidelines offer ways that etc.) (4) any third-party correspondence and a visions supporting confidentiality for mental psychoanalysts and analysands can cooperate note documenting the patient’s consent for health-care treatment, all existing health-care with third parties to allay these concerns. this correspondence, and (5) a discharge note. records are discoverable if ordered by a court When the challenge has stemmed from third- The six APsaA guidelines also point to a few of law, including the clinician’s private notes on party goals to maximize profits by denying care general considerations that might guide indi- the case.The APsaA guidelines can help clinicians wherever possible, or from ideologies that view vidual clinicians as they develop their model for protect the separateness of their private notes a freedom-seeking treatment like psychoanaly- creating psychoanalytic health-care records. from the official case chart. State statutes of lim- sis in a negative light, the six practice guidelines The guidelines recognize that confidentiality for itation can guide clinicians who choose to elim- have been used effectively by many courageous individually identifiable health-care records inate out-of-date charts from their files. members in legal proceedings.Their efforts as belongs to the patient, not to the analyst. well as APsaA’s organized program to address Since the patient has the right to review any- FACING TODAY’S CHALLENGES and inform government actions are helping to thing in the chart, it is reasonable to conclude Engaging in good psychoanalytic work often substantiate the quality, aims, and effectiveness that everything in an official health-care record requires courage to face seemingly impossible of psychoanalytic work, maintain freedom to should be written with the understanding that challenges. The most formidable challenges offer private, confidential treatment to patients, the patient will read it during treatment or in commonly emerge from the psychoanalytic and highlight the motivations of the opposition the future. exploration of inner life.Also, history shows us for all to see.

THE AMERICAN PSYCHOANALYST • Volume 37, No. 4 • Fall/Winter 2003 21 PSYCHOANALYSIS AND POPULAR CULTURE

SHRINKwatch Therapy Room Stars in Award-Winning Commercials Dottie Jeffries

Empathy. PITCHING EMPATHY Psychoanalysts for years have debated the Viewers cannot help but feel the empathy. role it should play in treatment: how empathy Even if one doesn’t understand exactly what does or does not, should or should not, impact IBM’s e-Business Solutions are about, one their work with patients. But recently, in the still has a sense that the commercials are world of advertising it’s been empathy—hands about people’s anxiety—but that yes, with down, no debate—that enabled an interna- the right kind of support, there just might be tionally renowned ad agency to build a suc- a solution. Chris Wall, ad agency Ogilvy and Mather cessful and sophisticated campaign for its “We’ve worked with IBM for a number of senior partner and creator of the “Dream” Fortune 100 client. years,” remarked Chris Wall, senior partner and ad campaign for IBM. If you tuned into the television broadcasts co-creative head of Ogilvy, who has been of Wimbledon 2003 or the U.S. Open, you behind most of the agency’s work with this BEYOND GIZMOS TO might have caught the clever campaign for company.“Increasingly, we had become aware HUMAN SOLUTIONS IBM e-Business on Demand Solutions, devel- of our empathy for the poor schmuck who has In the IBM commercials, Ogilvy has used oped by Ogilvy & Mather, New York.The set- to make the decision for his/her firm of choos- the same cast for a year. Last October, Ogilvy ting for the award-winning commercials ing a company who can work with them in began the campaign with a “gizmos” cam- (Adweek Campaign of the Year) was none solving particular business problems that paign, a series of ads in which inventions were other than the “therapy room.” Here a shrink, require extensive levels of services. pitched to the management team to solve all personifying IBM, is the listener who proj- “These decision-makers have nightmares,” problems. But this year, Ogilvy wanted to take ects a sense of caring and support to the continued Wall. “The scale of their decision the ad campaign beyond gizmos, recognizing “patient,” i.e., the IBM customer or potential really grips them, as well as the decision- that business solutions come about by people customer. making process itself. These people are often helping other people, and so came up with the writing seven-figure checks and their anxiety at idea of the “Dreams” campaign. times seems to them almost unbearable.” Seeking a top notch cast for this campaign, Ogilvy wanted a campaign that conveyed Ogilvy reviewed the character actors who had IBM’s empathy for and support of its cus- appeared in the previous IBM ads.They chose tomers.To do that in the realm of television “the best of the best of these actors—kind of commercials, what came to mind for Ogilvy the greatest hits of the IBM cast,” Wall said. was the therapy room with a patient telling a Through the well-chosen character actors In the commercials’ therapy room, these shrink about his/her dreams and anxieties … and the therapy room venue, the audience customers emote about their anxieties, and finding a listening ear. experiences the anxiety of the patients as real describing to the shrink an actual business “The use of dreams gives us permission to and feels that the shrink ( IBM) is there to help situation topped off by the all-too-familiar make the anxiety real,” Wall said. “And the and LISTEN. “What does it mean?” “What do I do?” The use of a shrink and therapy gives us per- According to his Ogilvy bio,Wall’s first love well-cast actor playing the shrink calmly replies mission to say that the service provider is is technology, especially as it relates to popular with a statement or two of support and empathetic to the customers’ business situ- culture. He’s been the creative director on observation, often imbued with a subtle twist ations.These are sophisticated ads that speak IBM, Lotus Development, Microsoft, and Apple of humor. to a sophisticated audience. The ads also Computer. show that high-level business executives are Imbued with humor and speaking to a no different than you and me—that they human truth, this most effective use of the Dottie Jeffries is staff director of public affairs are just as anxiety-ridden as we are and shrink and therapy room in popular culture for the American Psychoanalytic Association. share the same vulnerabilities.” works to engage the public.

22 THE AMERICAN PSYCHOANALYST • Volume 37, No. 4 • Fall/Winter 2003 HIPAA

POLITICS and 45 CFR 160.202 More stringent means, in the context of a compari- PUBLIC POLICY son of a provision of state law and a standard, requirement, or imple- mentation of specification adopted Illegal Privacy Notices under … this subchapter, a State law that meets one or more of the Fail to Protect Medical Privacy following criteria: Deborah C. Peel (4) With respect to the form, sub- stance, or the need for express legal As we feared and predicted, the effects of Few Privacy Notices even offer the option permission from an individual, who requiring over 600,000-plus “covered entities” of consent. Most notices inform patients that is the subject of the individually iden- to comply with the Amended Health Insurance they have the right to request restrictions, tifiable health information, for use Por tability and Accountability Act (HIPAA) BUT all carefully stated that covered entities or disclosure of individually identi- Privacy Rule led immediately to the loss of pri- do not have to honor such requests. That fiable health information, provides vacy rights and dismantling of medical ethics point was often emphasized in intimidating requirements that narrow the scope across our nation. caps, such as,“We do NOT have to agree to or duration, increase the privacy The diabolical complexity and apparent this restriction.” protections afforded (such as by contradictions in the 1,500 pages of dense The preamble to the Amended Rule states expanding the criteria for), or reduce bureaucratic regulations caused the worst clearly:“The Privacy Rule provides a floor of the coercive effect of the circum- possible outcome: Attorneys in every state privacy protection. State laws that are more stances surrounding the express wrote Privacy Notices that simply omitted stringent remain in force. In order not to legal permission, as applicable. mention of the state laws and medical ethics interfere with such laws and ethical stan- that are more protective of privacy, even dards, this Rule permits covered entities to Jim Pyles, our attorney on privacy and lob- though HIPAA requires notices to include obtain consent. Nor is the Privacy Rule bying issues, explains the effects of the forego- them. HIPAA, intended as the “floor” for med- intended to serve as a ‘best practices’ stan- ing language:“It is to require covered entities to ical privacy protections, has instead become dard. Thus, professional standards that are include in their written notice to patients any the “ceiling.” more protective of privacy retain their vital- state law (constitution, statute, regulation, rule, Take a close look at the Privacy Notices ity.” 67 Fed. Reg. at 53,212. common law, or other State action having the you have received.They are so authoritatively The citations from HIPAA which require force and effect of law) that prohibits or mate- written that they make the loss of privacy notices to include the stronger privacy pro- rially limits any disclosure that is permitted with- seem like a done deal. tections in state laws and medical ethics out authorization by the Amended Privacy Since the April 14, 2003 compliance date, follow: Rule.The required elements for the notice do most Americans have received multiple not include more protective ethical standards, 45 CFR 164.520(b)(1) Required Privacy Notices from “covered entities” but the notice is required to include the indi- elements.The covered entity must informing them that their personal health vidual’s rights and the covered entity’s legal provide a notice that is written in information is being used and disclosed for duties with respect to protected health infor- plain language and that contains routine purposes without their permission. mation. Ethical standards would seem to fall the elements required by this The notices come from every kind of cov- into the category of legal duties since practi- paragraph. ered entity, including health professionals, tioners can be held liable for malpractice for clinics, labs, hospitals, pharmacies, dentists, (ii)(C) If a use or disclosure for any failing to abide by their ethical standards.” and insurers. purpose described in paragraphs He concludes, “Any notice that does not We reviewed dozens of Privacy Notices (b)(1)(ii)(A) and (B) of this section include mention of more privacy-protective from around the nation in researching our [treatment, payment and health care state laws and ethical standards is in violation federal lawsuit against the U.S. Department of operations and other uses and dis- of the Privacy Rule.” Health and Human Services (HHS), filed April closures permitted by the Rule with- The public has reacted to Privacy Notices 10, 2003. Not a single one is legal. out authorization] is prohibited or with dismay and resignation. Most people have materially limited by other applicable no idea that they received illegal notices or that law, the description of such use or the notices were supposed to tell them how Deborah C. Peel, M.D., is co-chair of disclosure must reflect the more to protect their personal health information. the Committee on Government Relations stringent law as defined in 160.202 So the public has been mistakenly led to and Insurance. of this subchapter. Continued on page 25

THE AMERICAN PSYCHOANALYST • Volume 37, No. 4 • Fall/Winter 2003 23 HIPAA

WHAT ARE PATIENTS’ RIGHTS Everything You Wanted to Know UNDER THE PRIVACY RULE? • To receive adequate notice of PHI uses about HIPAA and Were Afraid to Ask and disclosures. Robert S. White • To know how to exercise their rights. • To disclose only the minimum PHI WHAT IS HIPAA? necessary. The Health Insurance Portability and • To request restrictions on uses and dis- Accountability Act of 1996 includes mandates closure of PHI and to know when that on privacy standards, electronic transmission right may not be granted. standards, and unique health identifier stan- • To receive confidential communications. dards. The privacy standards, known as the • To inspect and copy the medical record, Privacy Rule, were finalized in August 2002 with some exceptions. and went into effect on April 14, 2003. It is this • To amend the medical record, with some Privacy Rule that most affects analysts and exceptions. other mental health clinicians. • To receive an accounting of any disclo- sures, with some exceptions. WHO DOES HIPAA COVER? If you are a healthcare provider and you WHAT ARE THE PROVIDERS’ engage in at least one “standard electronic RESPONSIBILITIES UNDER THE transaction” during the year, you are a “covered PRIVACY RULE? entity.” A standard electronic transaction includes • To provide the patient with a written Photo: logo/image supplied by HIPAASummit.com any transmission of information between two Notice of Privacy practices. parties to carry out financial or administrative a standard by which to measure privacy issues. • To make a good faith attempt to obtain activities related to health care, by use of the Medicare has indicated its intent to require written acknowledgment of receipt of the Internet, leased lines, and dial-up lines, as well electronic submission in the next several years, notice. as use of tape or disk. It does not include faxing but practices with fewer than ten full-time • To have written policies and procedures information from a paper fax machine. equivalent employees are likely to be excluded. for the use and disclosure of PHI. The most common example of a covered • To obtain written authorization for certain analyst is a clinician in private practice who WHAT IS THE HIPAA PRIVACY RULE? non-routine uses and disclosures. accepts insurance and uses electronic trans- The Privacy Rule establishes a federal “floor” • To provide an accounting to the patient mission to submit insurance claims. If you send of rights that individuals have with respect to upon request for certain non-routine all your insurance claims by paper submission, privacy and access to “protected health infor- disclosures. you are not covered.You also may be covered, mation” (PHI). PHI is any information that both • To provide patients with access to medical even if you do not use electronic submission in identifies an individual and contains health records, with certain exceptions. your private practice, if you work in a clinic or information. Health-care providers remain sub- • To maintain written documents for a hospital that uses your name and provider ID ject to state law, which may provide stronger period of 6 years. to electronically bill for services. (This question privacy protections. In addition, health-care is currently under review.) providers are subject to ethical and profes- WHEN CAN THE PROVIDER Even if you are not a covered provider, you sional practice standards. Health-care providers USE OR DISCLOSE PROTECTED should know the requirements of the Privacy may decide to offer greater protections than HEALTH INFORMATION WITHOUT Rule. Each health-care provider needs his/her those required by HIPAA. WRITTEN CONSENT? own privacy policies and procedures. These When the patient consults with a health- are, of course, subject to state law, but the WHAT IS REQUIRED TO COMPLY care provider, he or she is considered to give federal law provides a useful guideline. The WITH THE PRIVACY RULE? consent for routine disclosures of protected Privacy Rule may be used by the courts to set • A written Notice of Privacy practices to health information for the following purposes: be given to patients • Treatment—For example, discussion with Robert S. White, M.D., is a member of the • A written set of privacy policies and others currently providing treatment, con- TAP editorial board. He is the president of the procedures sultation on or supervision of treatment Western New England Psychoanalytic Society • A “business associate” contract with any issues, obtaining and making referrals, and an assistant professor of psychiatry at entity that handles identifiable health discussion with medical doctors. Yale University. information on behalf of the provider. Continued on page 25

24 THE AMERICAN PSYCHOANALYST • Volume 37, No. 4 • Fall/Winter 2003 HIPAA

• Payment—For example, sending a claim • Law enforcement or court subpoena the article on the members section of the to an insurance company or submitting a • Research APsaA website, Directions for Complying with managed care treatment plan. Note that • Workers’ compensation HIPAA Privacy Standards. the American Psychoanalytic Association ethical standards prohibit the psychoana- WHAT ARE “PSYCHOTHERAPY NOTES”? lyst from ever sharing confidential infor- These are notes by a mental health profes- mation with non-clinical third-parties sional documenting or analyzing the contents Research without the patient’s consent. of a private counseling session. Psychotherapy Training Program • Health-care Operations—For example, notes are intended to contain information quality assessment, hospital privileges, and that is sensitive and to be used only by the The Anna Freud Centre training programs. treating provider.These notes must be sepa- Program at the Yale Child Study The health-care provider is encouraged, rated from the rest of the medical record. Center announces the first New but not required to notify the patient or take Psychotherapy notes may not contain pre- patient preferences into account. State law scription information, time of sessions, modal- Haven Psychoanalytic Research takes precedence if its requirements are stricter. ity of treatment, clinical tests, diagnoses, or Training Program to be held April In mental health practice, it is always best to summary of progress. (All these belong in the 20-24, 2004.The program is modeled inform patients of these routine disclosures official medical record.) after the successful summer research and obtain their informal or formal consent. Psychotherapy notes may not be disclosed training programs that have been without a separate written authorization. More- sponsored by the IPA at University WHEN MUST THE PROVIDER OBTAIN over, providers are not required to grant College London, for the past several WRITTEN AUTHORIZATION? patients access to psychotherapy notes unless years.APsaA and the American Most non-routine use and disclosure of PHI required by state law. Health-care plans may Psychoanalytic Foundation cosponsor require a written authorization. not make benefits conditional on the patient’s the training program. authorization of the release of psychotherapy ARE THERE EXCEPTIONS TO OBTAINING notes. It is not yet clear if psychotherapy notes The program aims to provide WRITTEN CONSENT FOR NON- are discoverable in litigation, so the absolute pri- intensive training in empirical ROUTINE USES AND DISCLOSURES? vacy of such notes is also unclear.This is gov- approaches to psychoanalytic Subject to state law, there may be a number erned by state law. Some state laws do allow research.The faculty consists of of exceptions, such as those listed below, when more liberal disclosure of psychotherapy notes. investigators with experience in study the provider may disclose information without If you are a covered provider and need to design and implementation in the written consent. However, it is always good develop these documents, most professional areas of development, process, practice to inform the patient when possible. associations have specific guidelines and sample and outcome. • Danger to self or others forms. You should consult these sources and Participants will have the • Communication with family in an emergency legal counsel, as the requirements are compli- opportunity to present and discuss • Public health activities cated and much more detailed than I can indi- their own research projects and goals • Prevention of abuse or neglect cate here. For more detailed information, see with faculty and other attendees. The program will include practical feedback that should facilitate grant Illegal Privacy Notices Your help is essential to correct the wide- writing and fund-raising. Continued from page 23 spread public belief that medical privacy Applications are due by March 1, ended and to make sure people understand 2004 and should be submitted to believe they lost the right to consent to the that state laws and medical ethics actually [email protected]. Questions release of personal health information.After all, prevail. More than any other group, psycho- can be directed to the same address. official looking Privacy Notices appear to say analysts understand the effects of privacy Applications, which should not exceed they have no rights under federal law. violations: discrimination, job loss, shame and six pages, should include a brief CV, HHS never intended for citizens to have humiliation, and the elimination of effective and details of the applicant’s research to become experts on the medical privacy psychotherapy and analysis. Speak out and laws of their states. But unless citizens already write. Publicize our lawsuit and our efforts to interests and goals, current research happen to be experts on state privacy laws restore every American’s right of consent and involvement, and the project he or and medical ethics, they will conclude the right constitutional right of privacy. Help save pri- she plans to present at the meeting. to medical privacy has been eliminated. vacy, a basic human right.

THE AMERICAN PSYCHOANALYST • Volume 37, No. 4 • Fall/Winter 2003 25 In addition to the critical importance of always running a virus checking program, keeping the data files for the virus checker (a.k.a. “defini- TECHnotes tions”) up-to-date on a weekly basis, and check- ing your computer regularly for “spyware” (described in the previous column), you must Protecting Your Computer also be certain that your computer is sealed off Paul W. Mosher from attempts to access it through the Internet. On a PC, this access could be gained through As the percentage of computer users with required by the new Security Rule (not to be “open ports.” These are not physical connections, high-speed Internet connections gradually confused with the Privacy Rule) reasonably but various protocol numbers that allow con- increases, the dangers to those connected to protect any computer which has any iden- nections from other computers, including those computers are growing as well. It’s your tifiable patient data on it (such as copies of let- of hackers, through your single Internet cable. responsibility to protect your computer, par- ters or email you have written or received, To check if your computer is vulnerable to such ticularly if you have an always-connected high- billing information, and, of course, any clinical attacks, I suggest you use the free “Shields Up” speed link to the Internet. If you are a “covered records).You must also document the steps program, which can be accessed directly from entity” under HIPAA, you are also legally you have taken to create such protection, the www site of Gibson Research Corpora- including from unauthorized access and data tion at http://grc.com. If you find that your com- “TechNotes” runs in each issue of TAP, loss.These steps must also include a reasonable puter is vulnerable, then you must install either with the aim of educating us about aspects backup plan and a disaster recovery plan.You a hardware or software “firewall.” One well- of technology and communications relevant need to do these things even if you use a respected free software firewall is “Zone Alarm” to our work. slower dial-up connection. available at http://zonelabs.com.

Writing and presenting works in progress: We discussed procedures for presenting and discussing papers at APsaA meetings.We also talked about making this Mid-Career Analyst membershipmeeting a setting where analysts could present papers that are deliberately still unfinished or in a rough stage.This would not only motivate Finding a Voice for Mid-Career people but also encourage them to share and develop ideas as well as exchange views on Analysts at APsaA how psychoanalytic papers can become more Zoe Grusky experimental and innovatively written. Presenting unconventional cases: Several The Mid-Career Analyst Discussion Group being an analyst, to add new topics to our analysts raised the dilemma of where and how met for the first time at the 92nd Annual agenda, ask questions, or just get acquainted. to talk about cases that question our usual Meeting this past June in Boston.The group, Three topic areas of particular interest conventions and techniques and push the lim- which plans to convene annually at the Spring emerged from our discussion group: its of our assumptions about our roles as ana- meeting, welcomes graduates at any stage of • Committee work lysts. We all agreed that we needed a place their careers who have questions about their • Writing and presenting papers or works in where we could talk about cases of this kind in role and involvement in APsaA. progress an open, non-judgmental setting.We called for Please come to our meeting to raise any of • Presenting unconventional cases that don’t discussions that go beyond the limits of theory your concerns about the mid- career phase of fit into defined theories and technique. In addition, we expressed the Committee work: Everyone at the meeting need for an atmosphere that was exploratory Zenobia Grusky, Ph.D., who chairs the shared information and questions about the rather than competitive, plus an approach to Council Membership Committee, is a graduate workings of various committees, who can and cases that involved more acknowledgement of and faculty member at the San Francisco cannot join, and the appointment process. of confusion, and acceptance of feelings about Psychoanalytic Institute. She is on the Lists were circulated so we could become our mistakes as well as pride in clinical work clinical and teaching faculty at UCSF and more familiar with names and functions of that is both unconventional and controversial. California Pacific Medical Center and has various committees and explore expressing an If anyone would like to present a paper or a a psychoanalytic practice in San Francisco. interest in joining one or more of them. case, contact me at 415-824-8432.

26 THE AMERICAN PSYCHOANALYST • Volume 37, No. 4 • Fall/Winter 2003 APsaA FELLOWS

APsaA’s Stunning New Fellows for 2003-2004

The American Psychoanalytic Association Fellowship Program is designed to bring mental health professionals in training or immediately post training, and also early career academics who are interested in psychoanalysis and applied psychoanalysis to APsaA to facilitate their exposure to our field. Seventeen individuals are selected each year from close to a hundred applicants.The biographies below of the Fellows for 2003- 2004 describe a group with substantial achievement, scholarly activity, diversity of interests and backgrounds.We enthusiastically welcome them to APsaA.

Debra Anderson, standards of practice for this emerging profes- University. He has special interests in philosophy, M.S.W., Ph.D., is an sion. Her work has been informed by a study of molecular biology, neuroscience, and transcul- assistant professor of British Object Relations. She credits being pres- tural studies. He worked as a postdoctoral social work at the Uni- ent for the labor, birth, and early postpartum life fellow on an Intramural Research Training versity of Nebraska, of many new families with a growing ability to Award at the NIMH Division of Cellular and Omaha. Long interested tolerate and learn from intense affective states, Molecular Regulation 2000-01. He is also in applying psychoanaly- and her writing and teaching reflect this under- studying Spanish to become more familiar sis at a macro level, she standing of primitive emotional development. with the Latino cultural world. His goals are completed a doctoral Debra K. Anderson to combine his interest in research with his dissertation in public administration entitled, Rebecca Brendel, passion for psychoanalysis in the context of “The Application of Psychoanalysis to Public M.D., J.D., is a graduate validation studies and to advance a synthesis of Organizations: Method, Practice and Theory.” of Yale College, where the broad but unintegrated body of research Since then, she has published articles about she earned a bachelor’s knowledge pertinent to psychoanalysis. psychoanalysis and organizations in the journals, degree in philosophy. She Free Associations, Administrative Theory and earned her medical and Gabriele Dillmann, Praxis, and The American Review of Public Admin- law degrees from the Ph.D., is assistant pro- istration. Other research interests include orga- University of Chicago. fessor of German at nizational identity, organizational change, and She is a fourth-year res- Rebecca W. Brendel Denison University in the teaching of social work.A founding board ident in adult psychiatry at Massachusetts Gen- Granville, Ohio, where member of the Center for Psychotherapy and eral and McLean Hospitals, where she is chief she teaches courses in Psychoanalysis, she serves as the coordinator resident in consultation-liaison psychiatry. Her German and Austrian for continuing education. She also maintains a areas of interest include law and psychiatry, literature as well as Ger- consulting practice, using psychoanalysis to psychiatric ethics, human rights and psycho- man language and cul- Gabriele Dillmann work with non-profit and public organizations. dynamic psychiatry. She sits on ethics commit- ture.After studying philosophy and psychology tees at Massachusetts General and McLean in Heidelberg, Germany, she earned her doc- Dana Blue, M.S.W., is Hospitals and is the chair of the Human Rights torate in Germanic Languages at the Uni- a doula and doula Committee at Massachusetts Mental Health versity of California at Los Angeles with a teacher for the Seattle Center. She hopes to combine her broad dissertation on a self-psychological interpre- Midwifery School and a interests in psychiatry and law in clinical prac- tation of the work of Austrian poet and writer psychotherapist in pri- tice and public policy roles, beginning with a Ingeborg Bachmann. At the same time, she vate practice. Blue spent fellowship in forensic psychiatry during the was also studying contemporary psychoanalytic more than a decade 2004–05 academic year. theory with a special emphasis on Kohutian working in child welfare self-psychology. Dillmann’s current literary agencies, and in 1996 Dana M. Blue Tiziano Colibazzi, interests are centered in the period of German was named Pediatric Pulmonary Fellow in M.D., received his med- Romanticism, but further include authors of Social Work at Children’s Hospital and Medical ical degree from the later periods whose works illuminate and Center. She is a founding member and past Universita’ Cattolica del enhance our understanding of the human psy- president of the Pacific Association for Labor Sacro Cuore in Rome in che and individual pathology. She is working on Support, and founding member and longtime 1999. He is currently a a book project that investigates the conjunction education committee member of Doulas of PGY3 psychiatry resi- of narcissistic injury and suicide in literary North America (DONA); as such she has had dent at McGaw Medical works of the Romantic period and beyond. Tiziano Colibazzi the opportunity to help shape the ethics and Center of Northwestern Continued on page 28

THE AMERICAN PSYCHOANALYST • Volume 37, No. 4 • Fall/Winter 2003 27 APsaA FELLOWS

2003-2004 Fellows Michael Groat, M.S., David Huang, M.D., Continued from page 27 is a Clinical Psychology is a graduate of the Fellow at the Capital Uniformed Services Peter Freed, M.S., District Psychiatric Cen- University of the Health M.D., is co-chief resident ter, Albany, New York, Sciences and is cur- in psychiatry at New and a Ph.D. candidate rently a PGY3 psychia- Yo rk Presbyterian Hos- in the Department of try resident at the pital—Cornell Payne Counseling Psychology University of Texas Whitney Clinic. His in- at the University at Michael D. Groat Health Science Center, David L. Huang terest in psychiatry, and Albany. Groat has helped rekindle psycho- San Antonio. Originally interested in ortho- the interface between analytic dialogue in the Albany region. As a pedic surgery, Capt. Huang studied bio- neurobiology, culture, Peter J. Freed doctoral student, he has taken a significant medical engineering as an undergraduate at and individual psychology, began in college, leadership role in working to create study Harvard College. During medical school he where he spent several years teaching English groups, case conferences, and presentations became increasingly interested in the contri- and math to prison inmates. During medical on psychoanalytic topics in the Albany area. butions of psychodynamic theory and clinical school, he worked extensively with homeless Using cross-cultural migration theory as a interventions to understanding patients and families, and his experiences led him to be- guide for understanding adaptation to cultural improving patient care. As a PGY2 resident, come interested in correlating psychodynamic change, Groat’s dissertation addresses the he presented a paper, “Psychodynamics in hypotheses with neurobiological findings. His shifts in identity that upwardly socially mobile Medical Education: A Medical Student’s Per- senior project as a resident will be to develop individuals face as they move from one spective,” to the American Academy of Psy- a neuropsychoanalytic hypothesis of adult socioeconomic “culture” to another. His inter- choanalysis and Dynamic Psychiatry. He looks crying that could be tested empirically using est in the intersection of psychoanalysis and forward to the study and practice of both fMRI. Freed was a recipient of the NIMH Out- socioeconomic cultural transition evolves child and adult psychiatry. standing Resident Award in 2002. from his own experience as a first-generation college student. Meg Jay, M.A., is a Adam Goldyne, M.D., Ph.D. candidate in is a fourth-year psychia- Simone Hoermann, clinical psychology and try resident at Colum- Ph.D., is a psychologist women’s studies at the bia University. Goldyne at Columbia Presbyter- University of California, completed medical ian Medical Center in Berkeley. Her interdis- school at the University New York, where she ciplinary dissertation— of California, San Fran- conducts research on “A Feminist Object cisco. While a medical the effects of psycholog- Relations and Empirical Meg Jay student, he helped inte- Adam J. Goldyne ical assessments. Born Analysis of Melancholy Gender: A Forty-Year grate psychiatric services into a student-run and raised in Austria, Simone Hoermann Study of Adult Development in Women”— homeless clinic.As a resident at Columbia, he she received her Ph.D. in clinical psychology uses Chodorow’s feminist object relations has been very involved in medical student from the University of Innsbruck. A grant theory to add nuance to Butler’s concept of education. He created and now teaches a from that university enabled her to do a Vis- melancholy gender, which was inspired by course which has become part of the third- iting Fellowship at the Personality Disorders Freud’s Mourning and Melancholia.Jay’s object- year medical student psychiatry clerkship, enti- Institute of New York Presbyterian Hospital- related understanding of melancholy gen- tled “Psychodynamics: Mind, Personality and Weill Cornell Medical Center. During this der suggests that the relationship between Formulation.” The course focuses on the clini- fellowship, Hoermann investigated health gender and depression is moderated by cal utility of psychoanalytic understanding for service utilization and attachment styles in attachment, and this relationship is exam- managing patients in all medical specialties. individuals with personality disorders, and ined empirically in a longitudinal study of In the past year, Goldyne has received the became interested in psychoanalysis and psy- women begun in 1958. Jay also conducts Arnold P.Gold Humanism in Medicine Teaching chotherapy research. During her subsequent assessments and psychoanalytic psycho- Award from the Columbia College of Physicians postdoctoral fellowship at the same institute, therapy with children and adults, teaches and Surgeons, as well as the Association for Hoermann was involved in a treatment study undergraduate courses on women and gender, Academic Psychiatry Fellowship. His clinical for borderline personality disorder, and, in and participates in a study of psychoanalytic interests include psychotherapy, forensic psy- this context, also investigated neurocognitive therapeutic process. chiatry, and psychosomatic medicine. aspects of borderline pathology. Continued on page 29

28 THE AMERICAN PSYCHOANALYST • Volume 37, No. 4 • Fall/Winter 2003 APsaA FELLOWS

Madeleine Lansky, Professional Network of Amnesty Interna- Adam Spivack, M.D., M.D., is a recent gradu- tional, and is a member of the International is a staff psychiatrist at ate of University of Cal- Network for Interdisciplinary Research about Yale University Health ifornia, San Francisco/ the Impact of Trauma of the Hamburg Institute Services and an assistant Langley Porter Psychi- for Social Research. clinical professor in the atric Institute, where she Department of Psychia- completed both her gen- Andrés Nader,Ph.D., try,Yale School of Medi- eral psychiatry residency is an assistant professor cine. Born and raised in and child and adoles- Madeleine Lansky of German Studies and New York City, Spivack Adam D. Spivack cent psychiatry fellowship. A long-standing Comparative Literature received a bachelor’s degree at Yale before interest in psychoanalysis has inspired Lansky at the University of completing medical school at the University of to find bridges in her clinical work between Rochester. In 1999 he Rochester and psychiatry residency training at somatic, psychiatric, and psychodynamic realms. received his doctorate Yale.While in college and medical school, Spivack She has served as a consultant to hospitals, from Cornell University had a strong interest in AIDS activism. He medical practices, and schools regarding the for a dissertation that Andrés J. Nader received a public policy internship at the Amer- management of psychiatric issues. She enjoys analyzed, from a psychoanalytic perspective, ican Foundation for AIDS Research (AmFAR) in teaching practical, psychodynamically-informed poems written by inmates in the Nazi concen- Washington, D.C. Spivack is interested in resi- interventions to professionals outside of the tration camps. A book on the same topic is dency training and medical student education. mental health care world. Lansky has research forthcoming under the title, Traumatic Verse. At Yale, he has participated in residency recruit- interests in intrapsychic responses to medical His interest in trauma studies developed from ment and served on the Graduate Education illness and in somatoform disorders as a interviewing survivors of the Shoah in Berlin Committee and Medical Student Education projective process. She currently practices under the supervision of Dori Laub. His interest Committee. Spivack has an interest in film, and adult, child, and adolescent psychiatry in in psychoanalysis stems from growing up in a is involved with Film Fest New Haven, New Berkeley, California. She also teaches medical family of psychoanalysts in Argentina. He has Haven’s annual independent film festival. students at UCSF and provides consultation published and presented on trauma, psycho- to an agency specializing in psychotherapy for analysis, and poetry; on images of the enemy and William Wood, M.D., foster youth. homophobia after 9/11; and on the historical M.A., is a PGY-IV resi- and political contexts of psychoanalysis. dent and the Massachu- Birgit Möller, psy- setts General Hospital chologist, is a visiting Ann Schwartz, M.D., administrative chief res- researcher in the De- is an assistant profes- ident in the Massachu- partment of History at sor of psychiatry and setts General/McLean University California, behavioral Sciences at Psychiatry Program. Los Angeles. She is Emory University School Prior to completing William C. Wood writing her dissertation, of Medicine in Atlanta, medical studies at the University of California, ”Psychotherapy with Georgia. Her primary San Francisco,Wood worked as an economist Traumatized Refugee Birgit Möller clinical responsibilities at the World Bank and developed intervention Children and Their Families,” in which she are as director of the Ann C. Schwartz programs for women with infants at risk for analyzes psychotherapeutic treatments in an Consultation-Liaison (C/L) Service at Grady poor growth as a Fulbright Scholar in Chile. outpatient clinic for refugee children at the Memorial Hospital. Her primary research inter- While at UCSF, he conducted research on University of Hamburg, where she is a research ests are in trauma and PTSD. She presented screening of early childhood mental health associate. Her dissertation is advised by the her research data in a poster entitled,“Trauma problems. His current focus is exploring how Sigmund-Freud-Institut Germany. Möller is the in the Inner City: Prevalence and Group Treat- psychoanalytic theory can inform the design project manager of a psychotherapeutic proj- ment of an African- American Mental Health of preventive mental health programs, public ect for traumatized children in Kosovo. She is Community,” at the APsaA 2003 Winter Meet- policy, and media campaigns to promote edu- also coordinator of the Network Southeast ing. She has an interest in learning more about cation about mental health.Wood is chair of Europe, which promotes and supports psy- psychoanalytic approaches to the mind in the American Psychiatric Association Com- chodynamic child psychiatry and psychotherapy order to bring a unique perspective to her clin- mittee on Residents and Fellows and is a rep- in Southeast European countries, where she has ical and research work and provide another resentative on the APA Board of Trustees. His organized and directed several seminars. She way of understanding the role of trauma in passions include playing the bass, composing has been spokesperson for the German Health personality and the mind. music, and learning Chinese.

THE AMERICAN PSYCHOANALYST • Volume 37, No. 4 • Fall/Winter 2003 29 MARKETING PSYCHOANALYSIS

Diagnosis: Arrogance and Exclusivity Treatment: Public Information, Humble Pie, Outreach

Strategic marketing studies, strategic plans, siecle Vienna? He pointed to other possible contact (publication or phone call) through retreats, and task forces are all tools organiza- themes.The data of psychoanalysis are based delivery of service. Summarizing Stershic’s tions, including ours, use to promote change.A on secret relationships, causing knowledge to perspective in a report to the membership, couple of years ago, APsaA invested heavily be transmitted “esoterically.” (The dictionary Jim Hansell, who chaired a briefer symposium in a strategic marketing project, coordinated definition of “esoteric” is “private, secret, based on the all-day session at the June meet- by committee chair Glenn Good and profes- belonging to the select few.”) Analysts as a ing, reported on the symposium’s finding to the sional consultant Lee Zacharias.The report, group are self-preoccupied and tend to not membership. He said,“We need to be aware formally issued in August 2002, delivered the pay sufficient attention to outcome or effec- that every interaction we engage in repre- distressing news that as an organization and a tiveness, says Kirsner.This internal focus, Kirsner sents our ’brand’ and shapes our public image.” profession we are seen by non-analytic men- believes, leads to haughtiness and causes peo- What has happened concretely since the tal health colleagues as arrogant, close-minded, ple to see us as unintellectual. Fundamentally, marketing report was issued to address the elitist, exclusive, unwelcoming, and insular. there is too big a gap between the level of issues raised? On a national level: Some of us were shocked, others not sur- claimed knowledge and actual knowledge. • We have a new quarterly publication, prised, others probably not interested. Claimed knowledge is the basis of accredita- Forward!, edited by Sandy Walker, that The problem with such big investments in tion, certification, training analyst anointment. reports on “best practices”—successful organizational change is follow-through. And Our hierarchical structures are rife with this. local outreach and marketing efforts that follow-up. Does change actually occur after a Kirsner’s prescription: We must change the are exportable to other locales. plan or a retreat or a task force report? Does organizational mindset vis-à-vis claimed vs. • APsaA hired Dottie Jeffries as staff direc- a diagnosis lead to treatment? The last TAP real knowledge. tor of Public Affairs. included a report by Allan Compton on the Bernard Gertler is a group relations expert • President Newell Fischer has been trav- Omnibus Science Initiative, a plan to increase and an analyst with the William Alanson White eling around the country visiting nearly the presence of psychoanalytic science within Institute. He charged us to pay more attention 40 societies and institutes and holding our organization that culminated in a set of to group processes within our organization. town meetings to present the report recommendations in 2000.The report card on The individual model of psychoanalysis and discuss local responses. Newell the effectiveness of the Omnibus Science Ini- overemphasizes the individual at the expense shows a video of the non-analyst mental tiative is excellent. of the organizational levels of understanding. health professional focus groups, where How have the findings and recommenda- Gertler’s main point was that we have many our colleagues dissect us in most unflat- tions of the Strategic Marketing Report fared competing tasks that should be clearly artic- tering terms. in the year since their delivery? At an all-day ulated. A systems framework is needed to • Each TAP is now reviewed by a board symposium on marketing held at the June understand our problems more thoroughly, member looking solely for unwitting 2003 APsaA meeting, a gathering of experts and there needs to be greater permeability instances of “arrogance.” Our aim is to each gave an answer to the question: What between the organization and its external have one of the organization’s most visible struck you most about the strategic marketing environment. publications avoid unwitting instances of report? Sybil Stershic, speaking as a marketing pro- arrogance or exclusivity in our language Mel Bornstein, the sole analyst on the panel, fessional, explained the special features involved or focus. urged that we give attention to the meanings in marketing a service such as analysis or train- • A new membership proposal is in the and motivations among members that con- ing. Services, as opposed to commodities, are works, with the aim of making it easier for tribute to the situations cited in the market- intangible, created and consumed simultane- non-APsaA graduates who are qualified ing report. Bornstein described a pervasive ously, time-perishable, and have uneven quality analysts to join the organization. insular attitude that he feels is antithetical to because of human factors. Consumers evalu- • A network of local analysts has been the genuine ideals of psychoanalysis and our ate services based on reliability (doing what established to promote marketing and organization and leads to splits and difficulty was promised), assurance (conveying trust outreach locally and to share ideas. dealing with narcissistic injuries, humiliation, and confidence), tangible factors (e.g., clean, • Training workshops in marketing, as and betrayals. attractive spaces), empathy (do staff care?), described above, are held annually at the Author/social historian Douglas Kirsner and responsiveness. This list highlighted the national meetings. A new brochure on wondered: Were our problems due to an crucial task of evaluating our potential patient’s child analysis has been published. authoritarian structure left over from fin de or student’s experience from initial point of Continued on page 38

30 THE AMERICAN PSYCHOANALYST • Volume 37, No. 4 • Fall/Winter 2003 Thurber Interview Q. Roland Barthes wrote of the photograph, Continued from page 4 “Its testimony bears not on the object but on time.” Abandoned houses and psychoanalysis no longer around. What I was surprised by, are both about time. both during my time in these houses and A. When I think about the abandoned once I got back home, was how much I had homes, I definitely think about time, a time personally identified with these structures. that is no longer. When I think about the I have often thought of constructed space as analytic interiors, I think about the notion of another kind of body, especially these domes- time in a different way.There seems to be a tic dwellings that have been witness to human way in which the process of analysis involves drama and activity of all sorts.As a middle-aged suspending time in the linear sense. The woman, I found these spaces particularly energy in the offices I photographed often poignant and easy to relate to—one middle- manifested itself as a palpable sense of imme- aged body to another older one, a body in diacy and anticipation, very different from decline. In some way I felt that by photo- what I experienced in the abandoned homes. graphing these spaces, I was bearing witness Having said that, there is a way that time and paying homage to lives that I knew noth- seems to stand still in these abandoned ing about and to the structures, the bodies that structures that feels similar to the kind of sus- had housed them. pension of time that I talk about in the ana- The analytic offices were very different. First lytic offices. of all, I was dealing with spaces that were still very much inhabited and inhabited by many, many people. And I was dealing with objects, BPSI Library National and objects, like space, have a charge and strong presence of their own. So I felt that I Remote Resource was definitely dealing with a situation that allowed less room for my own projections. In The Hanns Sachs some sense, I felt that I had come full circle to Library and Archives, the first images that I made in my grand- a part of the Boston mother’s house a few decades earlier. Psychoanalytic Society and Institute, welcomes analysts Q. Tell me a little about light. Photography is outside the BPSI community to about light. It pulses in the analytic office and the become a Friend of the Library. window of the abandoned house. Library Friends have borrowing A. Light has always been an important ele- privileges and are able to visit the ment in my interior work. I trace that to a library and use the extensive collections, series of images that I made around the death both in person and remotely. of my close friend and surrogate mother,Anna To see what the Sachs library Stearns.When Anna died in the late 80’s, I went contains, go to the BPSI website into her home to make a record of it.Without at www.bostonpsychoanalytic.org thinking about it, I made one set of images and enter the library page. Click on before the furniture was removed and then “access the library collection.” The went back in once the house was stripped to library continues to acquire new make another set. I was stunned to discover journals and books. It has recently that the images of her house with all the fur- acquired the capacity to allow niture removed spoke more about her spirit remote access to ten or so of their than the furnished shots did. I think it had a lot subscription journals. For information to do with the way the light raked throughout on becoming a Friend of the Library, these spaces. It felt like the light was a stand-in contact librarian Vivien Goldman at for her presence. She was an amazing person, [email protected] so it made perfect sense to me that she would or phone at 617-266-0953. show herself in such a way.

THE AMERICAN PSYCHOANALYST • Volume 37, No. 4 • Fall/Winter 2003 31 APsaA AT WORK

The Curriculum Column

We at TAP are pleased to introduce a new column that we hope will become a regular feature. Each “Curriculum Column” will take up different aspects of the psychoanalytic curricula from our various training programs around the country. By making this information more available through TAP, we hope to provide candidates and analysts with useful information that can enrich their discussions about educational planning. Please let us know if you would like to feature some aspect of your curriculum in a future column, or if there is another topic you would like us to consider. We welcome your reactions and recommendations. Lee Jaffe ([email protected])

know about the thinking that went into choos- ing the Freud that they read, the better they curriculum will be able to understand his ideas, and the better they will be able to integrate Freud’s ideas as they learn about psychoanalysis. Beginning with Freud As an illustration, consider an educational Lee Jaffe and Ellen Rees strategy that emphasizes Freud’s relevance for contemporary psychoanalytic thinking. Several years ago, the Project 2000 Com- which Freud’s thinking and theorizing were While analysts may not share a consensus, mission of the Board on Professional Stan- included varied considerably. some agreement is likely if we try to articulate dards (BOPS) investigated the educational Freud’s essential contributions to current psy- methods of our APsaA institutes. Among CHOICES choanalytic theorizing. Compiling such a list other things, institutes were surveyed about Because the field of psychoanalysis contin- could be of help to institutes in planning their the inclusion of Freud’s writings in the cur- ues to evolve, rethinking the curriculum in curricula and their bibliographies, particularly riculum. Most institutes presented Freud in analytical training programs will be an ongo- new institutes and those with limited resources. well-developed, specific courses, but no longer ing effort. Deciding on the most effective ways As a start, consider the following four in the spirit of Talmudic scholarship. Some to teach Freud’s ideas will continue to be an contributions: institutes organized courses around the his- important part of reworking that curriculum. • Freud recognized the primacy of uncon- torical development of Freud’s thinking, others The educational goals, pedagogical approaches, scious mental life, of psychic reality, and focused on basic concepts and topics, and a and faculty resources of an institute will influ- unconscious fantasy. few sought to understand how Freud derived ence choices about which of Freud’s writings • He elaborated a theory of unconscious his theories from his clinical observations. In to include, when to include them, and in what motivation and defense, developed the general, the trend seemed to be to read ways. For example, a curriculum committee concept of a dynamic unconscious, and Freud more sparingly than in the past.While might choose to emphasize the historical delineated its operational rules. his writings were still considered to be essen- development of Freud’s thinking or to empha- • He discovered that dreams were motivated, tial reading at most institutes, the manner in size his way of thinking, how he derived his had meaning and could be interpreted. conceptual formulations from his clinical obser- • He also made the body integral to psy- vations, or to emphasize his ideas and concepts choanalytic theory. Lee Jaffe, Ph.D., is senior faculty at the San that are considered essential to contemporary To initiate this column, we are planning Diego Psychoanalytic Institute, editorial psychoanalytic thought. several articles that we hope will stimulate associate for JAPA, a member of the editorial Curriculum committees might use other discussion about various ways to teach staff of TAP, and a member of the Project 2000 criteria as well. Favorite papers by Freud might Freud’s monumental contribution to psycho- BOPS Task Force. Ellen Rees, M.D., is a be chosen, or those deemed to be the most analytic knowledge.We will present different training and supervising analyst and former significant of his contributions, or those that points of view along with some examples of chair of the Curriculum Committee at the best demonstrate the emergence of a model Freud’s papers to illustrate a given approach. Columbia Center for Psychoanalytic Training of mind, of a concept, clinical phenomenon, In future issues, we will cover other topics and and Research. She is on the Editorial Board technique, or cultural observation.Whichever share examples of curricula from various of JAPA and a member of Project 2000. strategy is decided upon, the more candidates institutes.

32 THE AMERICAN PSYCHOANALYST • Volume 37, No. 4 • Fall/Winter 2003 APsaA AT WORK

Collins, Stuart New Committee to Promote Feder, Phillip Freeman, Bill Psychoanalysis through the Arts Jeffrey, Esther Laurie Wilson Dreifuss-Kattan, Donald Kuspit, The American Psychoanalytic Association The initial goals for these teams will be to Janice Lieberman, has decided to establish a Committee for Arts identify current and forthcoming events about Peter Loewen- and Psychoanalysis. I have been asked to chair which conferences and symposia could be berg, Rose Carol the group. organized.Additionally, the teams might con- Washton Long, Laurie Wilson The committee’s mission will be: tact university departments to arrange for a Humphrey Mor- • To promote outreach through interdisci- variety of other interdisciplinary activities and ris, Julie Nagel, Louis Nagel, Martin Nass, Nancy plinary work in the arts and psychoanalysis. to promote teaching that includes a psycho- Olson, Lois Oppenheim, Gilbert Rose, Alina • To create a cadre of professionals who can analytic perspective.The teams will be invited Rubenstein, Fred Sander, Paul Schwaber, Nellie publicize the value of a psychoanalytic to set other goals according to their expert- Thomson, and Joann Turo. approach in the arts by identifying and cre- ise and positions in academia and the art There are undoubtedly many more APA ating teams of analysts/arts professionals in world. The committee will put together a members with a strong interest in the arts. I each field: music, visual art, performance/ speaker’s bureau prepared to participate in am hoping that they will want to participate drama, film, and literature. museum exhibitions, lecture series, and other in this broad effort that can simultaneously public events. serve as outreach and ongoing development The committee, which will be under the in interdisciplinary work. Laurie Wilson, Ph.D., earned her art history Division on Societal Issues, was the brain- To be effective, we shall need both psy- doctorate from CUNY. Trained at NYU storm of Kerry Sulkowicz, who initiated the choanalysts and individuals from the arts Psychoanalytic Institute, she is faculty member proposal. It has already generated considerable and academia. I expect to begin with a small and clinical associate professor of psychiatry, enthusiasm within the organization. working group but expand as time goes on. NYU Medical Center. She practices in The membership of the committee thus Please contact me if you or anyone you know New York City. Her recent book is Alberto far includes: Leon Balter, Frank Baudry, Hillary might be willing to be part of this activity, Giacometti: Myth, Magic and the Man. Beattie, Harold Blum, Vera Camden, Bradley [email protected].

Crisis on Our Threshold to five years needed to complete a com- can predict that by then our organization’s Continued from page 3 prehensive reorganization plan. For instance, demographics will look like this: we must move forward NOW in opening • The average age of our total membership “We should not do things in a piecemeal fash- new avenues for membership, and for devel- will be 65 ion.” Such a position proposes that we avoid oping new alliances with groups that do not • The average age of our TA’s will be 73 any changes in our current governance or the fit our mold.These efforts may well require • 14% of our members will be 80+ way we function because such changes will amendments to our bylaws.We must rethink • 30% of our members will be 70+ undermine and confuse the more compre- our financial priorities if we are to seriously • 28% of our members will not be paying hensive planning process now unfolding.The invest in the future and do effective out- dues contention is a piecemeal approach will result reach. We must strive for a greater level of This is alarming! A professional association in a patchwork of alterations that will prove professionalism within our Association and with these demographics will be unable to contradictory and inconsistent with a broader develop our organization’s infrastructure if support an aggressive, creative, and forward- plan of governance. I fear this reasonable- we are to meet the future—before it is looking agenda. sounding proposition is a prescription for orga- behind us.We simply cannot afford to wait for Though introspection and contemplation nizational inertia. a comprehensive organizational plan to take have great appeal in our professional lives, Yes, we may have to undo or modify form and congeal. our vitality and indeed our survival will require changes implemented now if they prove to If we continue to wait until June 2006 (less risk taking, innovation, and some chutzpah. be inconsistent with a more comprehensive than 3 years from now) and do not aggres- We must carefully and thoughtfully plan for reorganization plan. But the difficulties that sively and effectively market ourselves, find the future, but at the same time boldly deal may eventuate are far less dangerous than new avenues to membership, and interest and with the challenges and crises that are on the prospect of treading water for the three facilitate young people to seek training, we our threshold.

THE AMERICAN PSYCHOANALYST • Volume 37, No. 4 • Fall/Winter 2003 33 BOARD ON PROFESSIONAL STANDARDS

tried to assume the most mature attitudes An APsaA Fable for Our Times possible.They reflected upon the forces, inner Ronald M. Benson and outer, that compelled them toward their present attitudes and opinions.They did their THE CHALLENGE The stakehold- best to separate past from present, inner and Once upon a time in a galaxy far, far away, a ers in the organ- outer, fantasy and reality. group of psychoanalysts realized they needed ization were to reorganize their association.They were all from differing THE OUTCOME intelligent and learned as well as committed educational back- So the stakeholders wisely chose fair and people who were each devoted to their indi- grounds, had dif- respected representatives to develop an archi- vidual views of psychoanalysis. They wanted ferent degrees, tecture for their newly constituted organization. to call the new association APsaA and wished and were diverse They adopted a detailed plan for constructing it to be representative, comprehensive, and in gender, nation- the organization in its new configuration. Every- inclusive.They also wanted it to value and pro- ality, ethnicity, as one agreed to put their cherished, personal Ronald M. Benson mote high-quality standards, excellent educa- well as racial, beliefs, identifications, and allegiances aside tion, careful and verifiable research, and economic, and social backgrounds.Their ages and really listen to one another’s points of pluralistic theoretical positions. They further ranged from fairly early adulthood to quite old view. They agreed to be open-minded and wanted it to be national in scope; compatible age. Some were clinicians, some researchers, not play identity politics, the politics of radi- with other national, local, and free-standing some academics, some authors. Some were calism, the politics of demonizing people or organizations devoted to similar ideals and deeply involved with psychoanalysis as a pri- positions, or the politics of favoring tactical interests; and to be part of an international mary professional (and personal) identification. victories over long-term solutions based upon organizational structure. For others, it was only a part, sometimes a careful consideration of novel ideas and of They wanted it to be a home for local small part, of their identity. wise, principled compromise and consensus. organizations of similarly minded individuals, Furthermore, many didn’t really know one They all agreed and acted on the premise some of whom were devoted to professional another very well.They often only knew each that immediate personal advantage was always and membership services, some more inter- other through statements made on emails, to be subordinated to the greatest good for ested in educational and academic matters, and positions taken publicly on political or gover- the greatest number for the long term. Parti- some to both.They wanted it to be collegial nance issues, offices held, or occasionally sanship was seen as an impediment to the and user-friendly and to be responsive and through articles written for publication, some eventual good and not a virtue. dedicated to the public interest, especially in many years ago. Some only knew each other The stakeholders devoted a large amount of clinical and ethical matters. Pragmatically, they via rumors, gossip, or innuendo. Most had energy and their communal financial resources wanted a streamlined, democratic, professional never had the opportunity to really sit down to getting the best and most objective advice governance and management system. They with one another to discuss their ideas, philoso- they could about the possible options available wanted it to conform to all applicable laws, phies, backgrounds, worries, or hopes. Sound to achieve their common goals. They were local and national, and to the laws and customs bites were more usual than deep conversations sufficiently patient so that all proposals were in every state where it operated. Finally, they or extended personal relationships. thoroughly discussed and debated until all wanted it to be fiscally responsible and eco- For those who did know each other well, points of view had been heard and all pros and nomically affordable. many had formed alliances based on friendship cons illuminated. When the process had or other common characteristics that resisted ripened and the final proposals and alternatives THE COMPLICATIONS alterations in “their organization,” even when were brought forth, each variation was impar- The preceding organization had almost 100 good ideas for change were developed.They tially considered and the stakeholders voted years of history and a structure that was last may even have been the teachers or students of their fully informed convictions. revised nearly 60 years ago. Its members and one another. Some had been in analysis with Naturally they succeeded and all issues the local organizations that were included in the others who were now their fellow stakeholders. yielded to wisdom and common sense. After national body were distributed from coast to With all this disparity, consensus was elusive. the vote was tallied and a decision reached, coast and from the far north to the deep south. everyone united and worked diligently to Each local organization had a unique history and THE TRANSFORMATION make the consensus and majority decision all were quite different from one another Yet, somehow, a great transformation took work optimally. despite being roughly similar in function. place. Every stakeholder remembered that Of course, the consensus decision turned they and their fellow stakeholders were col- out to be the best, worked exceedingly well, and Ronald M. Benson, M.D., is chair of the leagues and were all devoted to psychoanaly- accomplished all of the aims of the stakeholders. Board on Professional Standards. sis.They addressed their own motivations and And they all lived happily ever after.

34 THE AMERICAN PSYCHOANALYST • Volume 37, No. 4 • Fall/Winter 2003 APsaA NEWS

Dean Stein Arrives to Take Administrative Helm as Executive Director

With an annual operating budget of $2 mil- who have gone through analysis and it was lion, a national office staff of 13, and the antic- always a fascinating process. ipated 2004 retirement of veteran and beloved I’ve always placed a high priority on work- administrative director Ellen Fertig, APsaA ing with interesting and interested people stood in need of a highly experienced profes- and the Association certainly seems to fit sional organizational director. New Yorker Dean the bill. K. Stein, formerly deputy executive director of the charitable Dyson Foundation and previously Q. What will be your first priorities when you executive director of Chamber Music America, arrive, besides getting oriented and getting to a national, membership-based arts organization, know people? was selected by the search committee. The I don’t think getting oriented and getting to Council approved his hire in June 2003, and he know the people should be minimized.This is arrived for work in November. an organization with a long and distinguished Stein’s tenure at Chamber Music America history. It is also an organization defined by an featured the impressive feats of increasing the extraordinarily involved membership. I see my organization’s earned income tenfold and its first priority as making sure I understand the Photo: Debra Steinke individual membership by a factor of six. history and getting to know as many members Dean Stein, APsaA’s new Executive Director, In the months just before Stein’s arrival, as possible. A membership organization like Arrived November 3. APsaA’s electronic and paper communica- APsaA must reflect the interests and con- tions pathways were replete with references cerns of its members. I can only be effective to while at the same time the Association will to “we’ll wait for Dean Stein to help decide the degree that I understand those interests function more smoothly. this …,” testifying to the eagerness with which and can work to realize them. Having said his arrival was anticipated. Issues that awaited that, it seems clear that a top priority will be Q. What has impressed you most about our him include a major overhaul of our organiza- working with the volunteer leadership to help group; what are our assets from your perspective, tional website, assisting the American Psycho- move the Association back into legal compli- looking at us from the outside as someone with analytic Foundation with problems of staffing, ance regarding its governance and use that a great deal of experience in non-profits? organization, and fundraising, and less reliance process as an opportunity to determine the There have been many things that impressed on consultants in various areas. best operational structure for the organization. me about the Association. First, the members TAP interviewed Stein in the weeks just Beyond that, I would hope that my experience appear to be an incredibly committed group; before he began work at the organization: of leading other membership associations will they care deeply about their profession, about allow me to free up the hundreds of APsaA helping people, about the future of the field, Q. When you first noticed the job posting, members from the organizational/administra- and about the health and strength of their what was your reaction when you saw it was a tive work they’ve been doing on behalf of membership association. Second, the members psychoanalytic organization? Had you much APsaA and allow them to concentrate on the of APsaA are all highly educated and thoughtful of a preconception about psychoanalysis or truly important issues facing the field and the people—that allows for an extremely high level psychoanalysts? Association. of discussion to take place. My first reaction was: (a) this is a professional membership association and I’ve had a great Q. What do you see as our biggest prob- At the Steering Committee meeting in deal of experience leading similar kinds of lem(s) organizationally? October, several people commented that the organizations; (b) the membership is com- From my limited interaction with Association move to an executive director versus an prised of people who are committed to help- leadership so far (and as I alluded to above), administrative director reflected the ongoing ing other people—that sounds like a group I working with the leadership to move the development of the organization. Skills in would want to devote my energy and expert- organization to a place where it is in compli- development (fundraising) and technology ise to; and (c) from my limited knowledge of ance with not-for-profit law appears to be an development are, for example, more com- this field, it appears that there is important issue that needs addressing immediately. In monly expected of an executive director as work to be done and that seems like a valuable doing so, I would hope that the various mem- opposed to an administrator. challenge. I have a number of close friends bership interests will feel well represented, —Prudy Gourguechon

THE AMERICAN PSYCHOANALYST • Volume 37, No. 4 • Fall/Winter 2003 35 APsaA NEWS

Kenneth Calder, M.D., 1918–2003

Kenneth T.Calder, who served as APsaA’s president in the late 1970’s, died on April 23 at the age of 85. Before he became aware of early signs of Alzheimer’s disease a few years ago, he had been enthusiastically engaged in analytic practice and teaching, and deeply involved

Meetings in the work of several local, national, and international psychoanalytical organizations, often as a leader.Typically, Calendar Calder bore the sufferings that life imposed stoically, with Upcoming an outwardly unemotional acceptance, speaking of them as factual. He was rather allergic to pleas for sympathy, WINTER 2004 MEETING, to demands for help—for himself. Kenneth Calder AMERICAN PSYCHOANALYTIC His realization that he needed to retire from active ASSOCIATION New York, New York professional work was the second great blow Calder had endured in recent years. January 21-25, 2004 The first was the long illness and death of his wife,Abby Knowlton Calder. Knowlton, For information: a much honored physician, was the mainstay of his life.Their love for each other Phone 212-752-0450 and the regard each felt for the other’s qualities of heart and mind, their significant Website http://www.apsa.org accomplishments and contributions, were evident to all who knew them.The differences in their origins, temperaments, social and conversational ease enriched WORKING AT THE FRONTIERS them both. Each sparkled with pride and pleasure when speaking of the other. Annual Congress, International Calder was born in northern Michigan into a working class family. He achieved his Psychoanalytical Association New Orleans education largely by his own efforts; these included caddying on golf courses as a boy. March 10-14, 2004 He developed into an expert, but unusually unboastful, golfer. He had his first psychiatric Website http://www.ipa.org.uk training in Cincinnati in its psychoanalytic heyday. Coming to New York after two years as an Army psychiatrist, he completed psychoanalytic training at the Columbia Center, XIV IFTA WORLD FAMILY and subsequently repeated the academic program at the New York Psychoanalytic THERAPY CONGRESS Institute, graduating in 1954. He was a training and supervising analyst at New York Istanbul,Turkey and later also at Downstate, now the N.Y.U. Psychoanalytic Institute. He was chairman March 24-27, 2004 For information: of the Committee on Psychoanalytic Education of the American Psychoanalytic E-mail [email protected] Association from 1969 to 75, and was president of APsaA from 1976 to 77. He was also treasurer and a vice president of IPA. 93RD ANNUAL MEETING, Among the great pleasures and rewards of his life, one thinks of his love for and AMERICAN PSYCHOANALYTIC pride in his children, Mary and Tom,his cottage in the countryside of West Virginia, ASSOCIATION long evenings spent in conversation with friends in his home, accompanied by his wife’s San Francisco, California superb dinners and wines he selected, often with an eye to their worth, a residue, June 23-27, 2004 For information: perhaps, of the financially straitened boyhood he never forgot. He glowed on seeing Phone 212-752-0450 the pleasure he could give others. Website http://www.apsa.org Although his manner tended to be reserved, he could be fiercely critical of those whom he believed failed to live up to the high standards of character he set for PSYCHOANALYSIS AND THE himself—of honesty, modesty, and authenticity. In his stirring address to the American HUMAN BODY: BEYOND Psychoanalytic Association upon his retirement as president, he told his colleagues THE MIND-BODY DUALISM about his own approach to self-analysis, including revealing glimpses of what he 6th Delphi International Psychoanalytic Symposium regarded as weakness, moral imperfections, remarks he regretted making, actions he Delphi, Greece wished he could take back. He told a dream and showed, again with extraordinary October 27-31, 2004 candor, how the image of his former analyst and a continuing transference relationship For information: were represented in it. It is a classic psychoanalytic paper, memorably portraying E-mail [email protected] Kenneth Calder at his best—intellectually ambitious, truthful, courageous. Website http://delphi.med.upatras.gr —Shelley Orgel

36 THE AMERICAN PSYCHOANALYST • Volume 37, No. 4 • Fall/Winter 2003 THE AMERICAN PSYCHOANALYST • Volume 37, No. 4 • Fall/Winter 2003 37 Chair of Psychoanalysis Organizational Consultation organizations, rather than businesses. Gold Continued from page 10 Continued from page 12 stated that he consults largely to health care organizations, an area with which he has much Finally, there is Leo Rangell, who has held First,“start from where people are”—elim- familiarity and experience. Businesses tend to the title of chair of psychoanalysis since inate any preconceived notions and listen. be empirical and data-driven and it is some- 1971. He had been clinical professor of psy- Second,“double-task”—the content is the pri- times hard to get psychoanalytic concepts chiatry at the University of California, Los mary task and the process is the secondary task. “under the radar.” Angeles, for over 20 years. In 1976, when he Third,“balance and optimize”—pay attention Eisold said a future conference is planned was appointed to the faculty of a second to the swings and round-a-bouts, the posi- where an organizational consultation case University of California campus, in San Fran- tives and negatives, in the larger picture of would be presented and discussed. cisco—at that time the only double appoint- the situation. ment in two branches of the University A lively discussion followed the speakers’ system—he was named clinical professor presentations. Harry Levinson, reflecting on Strategic Marketing of psychiatry (psychoanalysis). Visiting pro- his fifty years of practicing and teaching orga- Continued from page 30 fessorships are another related category of nizational consulting, recalled the resistance honoring psychoanalysts in academia. The to his early interest in this area. He highlighted • Continuing, innumerable public informa- Heinz Kohut Visiting Professorship at the three areas of particular importance: tion successes including the special edition University of Chicago, named after a psy- First, like cultural anthropologists, consultants of U.S. News and World Report that features choanalyst rather than the field of psycho- must immerse themselves in the culture of the Freud, Einstein, and Marx; Kerry Sulkowicz’s analysis , was reported to TAP by Jonathan field that they are studying. appearing in Real Simple; The New York Lear, one of the professors associated with Second, take the time to systematically study Times; and coverage of the Winter 2003 the sponsoring group. Leading thinkers are the organization with some formality and meeting in Psychiatric News,The Wall Street invited for a year to enhance a strong psy- make a diagnosis of the problems. Journal, and Clinical Psychiatry News. choanalytic cadre of professors already Third, there is the continuing need for the • APsaA’s overall graphic image has been teaching at the University of Chicago under problems in psychoanalytic institutes to be care- totally revamped, showing up in our new the rubric of the Committee on Social fully investigated.That is the only way to dimin- logo,TAP, Forward!, and other publications. Thought, chaired by Robert Pippin. Appoint- ish repetitive patterns of splitting and splintering. Designer Andrea Schettino’s graphic ments have included Stanley Cavell from Erik Gann asked whether the panel rec- design is meant to convey a more mod- Harvard, Robert Hinschelwood from Lon- ommended that the prospective organiza- ern, open, and congenial image. don, Robert Paul from Emory, and Bennett tional consultant specialize in a particular size There’s a great deal more to be done.The Simon from Harvard. Future honorees are or type of organization. Eisold commented main task is not to forget that the problem John Riker from Colorado College (philos- that he consults primarily with professional needs ongoing, targeted action. ophy) and Mark Solms from the Anna Freud Centre, London. The number of chairs of psychoanalysis is not large. Some of these positions have been Menninger Clinic Library held through many of the lean years of value Now Available in Houston for psychoanalytic thinking. But also new appointments have been increasing since the The Menninger Foundation donated its world renowned library to the Houston 1990’s into the new century. Academy of Medicine—Texas Medical Center (HAM-TMC) Library in June 2003, Taken together, these represent outstanding the HAM-TMC Library announced in August. people in our field. Their recognition clearly The gift included a clinical library, a historical and rare book collection, and complete reflects on their own exceptional work. More runs of the Menninger publications.The clinical library is a wide-ranging collection of than that, each of them without question books on psychoanalysis, psychiatry, psychology, community mental health, pastoral strengthens the presence of psychoanalysis in academia and well beyond. counseling, and social work. One of the rarest historical volumes is a 1783 German The discussion has focused on psychoanalysts edition of Andreas Vesalius’s anatomy.Archives of the Menninger Clinic and Foundation, who are in positions that directly identify psy- which date to 1919, will be in the Historical Research Center. choanalysis. Not to be overlooked, however, are The Menninger Clinic relocated this year to Houston and now is part of the Baylor the many analysts who function in academia in College of Medicine. Baylor in turn is one of two medical schools in the Texas Medical positions of honor and influence without the Center, a self-described “med-tropolis” comprising some 42 health-care institutions. title of “chair in psychoanalysis.”

38 THE AMERICAN PSYCHOANALYST • Volume 37, No. 4 • Fall/Winter 2003 THE AMERICAN PSYCHOANALYST • Volume 37, No. 4 • Fall/Winter 2003 39 Associating with APsaA

AFFILIATION CATEGORIES FOR EDUCATORS, STUDENTS, PSYCHOTHERAPISTS, RESEARCHERS Over the last several years,APsaA has developed a number of categories of affiliation to allow colleagues and friends interested in psychoanalysis to establish a tie to our organization.Associates of APsaA get more out of the national meetings, can start to network nationally with like-minded professionals, and contribute to the richness and vibrancy of the psychoanalytic community. Each associate category is sponsored and supported by a committee of the American Psychoanalytic Association. EDUCATOR ASSOCIATE—available for teachers and administrators at all levels of education, pre-school through college, who are interested in the application of psychoanalytic principles in classrooms.Any educator who is sponsored by a member of the American Psychoanalytic Association is eligible. Yearly enrollment fee: $25.00 PSYCHOTHERAPIST ASSOCIATE—available for psychoanalytic psychotherapists with a minimum of a master’s level degree and licensed and/or certified by the state in which they practice. Individual Psychotherapist Associates are listed in a National Directory of Psychotherapist Associates, prepared annually. Yearly enrollment fee: $50.00 RESEARCH ASSOCIATE—available for research scientists, research oriented clinicians and others with an interest in psychoanalytically oriented research.The sponsoring committee will facilitate presentations of research at psychoanalytic meetings. Yearly enrollment fee: $40.00 STUDENT ASSOCIATE—available to medical students, psychiatric residents, psychology, social work, and graduate students of all academic disciplines. Yearly enrollment fee: $25.00 Standard benefits provided to associates in all the above categories include reduced APsaA meeting registration fees, advance notification of meetings, and subscriptions to this newsletter. Reduced subscription rates to the Journal of the American Psychoanalytic Association (JAPA) are also available. Contact APsaA’s national office for more information: 212-752-0450 ext. 26. Email: [email protected]. Or go to the APsaA Website, apsa.org, to download the latest brochures.

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