March 5, 1999

By Robert Pyles, M.D.

Within the next few months, the 106th Congress will very likely enact legislation that may forever change our work, especially in the areas of patient rights and confidentiality. If Congress does not act by August, the highly unfavorable regulations promulgated by the Department of Health and Human Services will take effect. The theme for our association's administrative meetings this month and our meeting in May in Washington, D.C., is "Our Political Awakening" and will feature a number of meetings with political leaders on Capitol Hill. We are fully aware that the most immediate danger to health care in general, and to psychodynamic therapy in particular, is the threat to privacy. It is our hope to work in concert with APA to meet this danger.

The term that most accurately describes the state of the American Psychoanalytic Association at this time is "renaissance." "Renaissance" is defined by Webster's dictionary as a "rebirth" or "revival." The leadership role taken by our association in the fight to achieve protective privacy legislation is only one example of the critical changes in what we are calling the "New American." This new spirit of energy and vitality that has begun to permeate all levels of our association could be seen in most dramatic form at our meetings in New York last December. Not only were our programs deep, they also were broad. It was noticeable that a much greater number of young people and members of other mental health groups were in attendance. The meetings of our Executive Council and Board on Professional Standards were rich, productive, and collegial. The internal frictions and sense of helplessness of the past were almost entirely absent. This sea change in our association and the sense of excitement of our meetings were widely reported in the New York Times, International Herald Tribune, and London Times.

This new vigor has also been evident organizationally. After a period of decline in the 1980s, our numbers are again on the increase. The number of members and candidates in training are now at an all-time high. We recently added our two newest societies in Arizona and Minneapolis, bringing our total number of societies nationwide to 42, with 29 training institutes. We feel confident that other new societies and institutes will join us in the near future.

These changes have not occurred by accident, but as a result of considerable "blood, sweat, and tears" and a deliberate strategic plan. For many decades and a number of analytic generations, psychoanalysts systematically isolated themselves and their training institutes from their professional and public communities. This was done out of an educational philosophy and clinical conviction that, to function properly, psychoanalysis had to exist apart, in a kind of "splendid isolation."

The advent of managed care, but more especially the threat of government intrusion and regulation, changed all that. While declining practices had produced a certain sense of helplessness and despair, the Clinton health plan, with its threat to independent practice and total corporatization of medicine, was our wake-up call. We finally realized that the world was not going to leave us alone; it became clear that it was up to us to protect our patients and our profession.

Accordingly, we began very deliberately to change the concept of psychoanalytic identity and of what a psychoanalyst of the 21st century must be and must be expected to do. In addition to being psychoanalytically well educated, the modern psychoanalyst must also be a social and political activist.

We have put our organizational money and energy squarely behind this effort, creating many new committees and task forces, now numbering 72. We have established committees on racial and ethnic diversity, issues of homosexuality, liaison to schools, and organizational and sports consultation. Our student Affiliate Council is fully included in our governance bodies. Students are active on most of our committees.

In addition, we have established committees to develop new psychoanalytic centers and community clinics. The decline in the teaching of psychodynamic therapy in many training programs has presented us with an opportunity, which many of our institutes have capitalized on by creating a network of psychotherapy training programs across the country. We have also established the category of psychotherapy associate at the national level, in addition to the many which exist locally. Finally, we are forging a network of alliances with psychoanalytic, psychiatric, and other mental health groups. We are working with the Psychoanalytic Consortium (which includes the American Academy of Psychoanalysis) to create a body for external accreditation, which will help greatly in preserving high standards for our field.

We are making a major effort to reintroduce and enhance psychoanalytic teaching in training programs for psychologists and social workers, as well as in graduate schools and universities. We consider strengthening our ties to medicine to be a very high priority, and, through our Committee on Medical Education, we are working to strengthen the teaching of psychodynamic therapy in residency programs and medical schools. In cooperation with APA, we have established a series of joint programs for residents and medical students that will take place at the annual meetings of our two organizations.

We are putting special effort and resources into the particular areas of public information, political action, and scientific research. Our public information effort has already produced many articles favorable to psychoanalysis and psychodynamic therapy. The Freud exhibit at the Library of Congress created much public interest, which will continue as the exhibit travels around the country (see photo on page 3). We expect our new Task Force on Psychoanalytic Science to build upon the many decades of clinical experience and wisdom and to produce major advances in the scientific validation of our field.

It is clear that the relationship between our two organizations has languished in the past. Many of our members allowed their membership in APA to lapse, feeling that APA no longer represented psychodynamic therapy. I have been working closely with Drs. Rodrigo Muņoz and Steven Mirin to remedy this situation. In our association, we have established a greatly strengthened APA Liaison Committee under Barbara Rosenfeld to coordinate this effort. It is my hope that a closer working relationship will help to prevent situations like the one around the recent panic disorder guidelines (Psychiatric News, October 16; also, see page 21).

I believe that it is extremely important for our two organizations to work closely together in a number of areas; however, the arenas of public information and political action are crucial. We are beset with corporate interests for whom the bottom line, and not the welfare of patients, is paramount. In many ways, our professional organizations are all that stand between the patient and corporate exploitation.

Finally, with the recent exciting advances in neurobiology, our two associations have a truly unprecedented opportunity to achieve a true psychobiosocial integration of the understanding of the human mind. Working together, this goal can be achieved. We owe nothing less to our patients and our profession.

Dr. Pyles is president of the American Psychoanalytic Association, supervising and training analyst at the Psychoanalytic Institute of New England, a private practitioner in Wellesley Hills, Mass., and an instructor at Harvard Medical School.