Psychoanalytic Consortium Report: Licensure, Accreditation, Certification, and Beyond

Recently it came to my attention that my previous comments about accreditation formed the basis of a warning to members of the National Association for the Advancement of Psychoanalysis (NAAP) by its president, Doug Maxwell. He described me as making a “sweeping plea,” promoting the idea that “all tri-discipline institutes [should] . .  .  accredit with the Accreditation Council for Psychoanalytic Education.” He inferred that my comments reflected a larger attempt to “regulate psychoanalysis to the scope of other professions, and at worst to eliminate us as practitioners completely.”

 It is a sad fact that my “sweeping plea,” is seems, has only served to alarm the NAAP president, whereas many institutes around the country have failed to follow my marching orders. Here’s why. The Psychoanalytic Consortium is made up of four psychoanalytic membership organizations,[1] none of which have any direct power over institutes. While the American Psychoanalytic Association (APsaA) certainly has some leverage over its constituent bodies, it cannot dictate to these institutes, especially concerning issues of accreditation. The Accreditation Council for Psychoanalytic Education (ACPE) that emerged after years of discussion is also a completely independent organization and sets is own rules and policies. As a result, the opinion of one psychologist member of the Psychoanalytic Consortium carries very little weight indeed, however sweeping.

 It is incorrect to assume that I want to “regulate psychoanalysis . .  . and at worst to eliminate . . . completely” psychoanalysts who teach and practice from traditions and standards different from ACPE. I was trying to make the point that there might be more common ground between psychoanalytic traditions than appears evident and that the efforts of the Psychoanalytic Consortium have in fact worked toward creating this common ground. I will try again later in this article.

 It is true that ACPE seeks to attract as many psychoanalytic institutes as possible that agree to follow the standards document that forms the basis for its accreditation guidelines. More than that, ACPE hopes to have its authority to accredit recognized by the Department of Education (DoE). While this may alarm some, the fact remains that ACPE was developed in part in response to the efforts of the American Board for Accreditation in Psychoanalysis (ABAP) to accredit institutes; and ABAP has also had plans to seek recognition from the DoE.

So in this article I will review three areas of controversy, licensure, accreditation, and certification that have occupied Consortium discussions and decisions. At the same time, I want to be clear that these are my views only and do not represent the views of the Consortium or the Division of Psychoanalysis. Hopefully, I will get most of the facts right, feel free to correct me.

Licensure

The Consortium has taken the position that psychoanalysis is an advanced specialty of the mental health disciplines and that accreditation, certification, and licensure should be guided by this basic proposition. The Consortium also has a policy statement that psychoanalysis is not an independent profession and should not be separately licensed, a position that has not stopped states from developing licensing laws to regulate psychoanalysis in Vermont, New York, and New Jersey.

 Ultimately, licensing is a political process rarely informed by the specific arguments concerning the status of psychoanalysis as a practice. Since licensing is solely the purview of state government, efforts to establish psychoanalysis as a separately licensed profession have been advocated or opposed by varying coalitions and forces, based upon the interests of those involved. Psychoanalytic organizations are relatively insignificant politically and have sought allies in these conflicts. An example may suffice. In Massachusetts members of APsaA, Division 39, etc., have turned to other mental health organizations (that is, the state psychological and psychiatric associations) to oppose a certification law that would establish psychoanalysis as an independent practice, while those associated with NAAP have allied with groups (marriage and family counselors, art and dance therapists, and so on) seeking to expand independent licensure, scope of practice, etc.

 I offer this necessarily superficial survey only to make a particular point. While the original purpose of licensure was to establish a discipline as capable of regulating itself, the economic point of licensure has overshadowed this aim. Holding a license is considered essential to financial reimbursement by insurance companies and other third-party groups. Physicians, psychologists, social workers, and nurse practitioners, each in their turn, have fought for and won the right to regulate their professions (almost always after bitter fighting with already-licensed professions) primarily for their financial survival.

The fact is that in many states a person can set up a practice as a psychotherapist or, in this case, a psychoanalyst, and not be licensed. Whether this is a good thing or not may depend upon how many incompetent licensed clinicians you have had dealings with over the years.

 Despite the position advanced by NAAP and others that psychoanalysis is a separate discipline, the actual laws require a licensed psychoanalyst also to be trained as a mental health professional. To cite the New York law as an example,”The program of study in a psychoanalytic institute shall include coursework substantially equivalent to coursework required for a master's degree in a health or mental health field of study.” This is a curious outcome, since many of those promoting licensure have strongly advocated psychoanalytic training for anyone, regardless of mental health background or degree.

 So advocates of separate licensure for psychoanalysts end up in curious agreement with the Consortium position advocating that psychoanalysts must be mental health professionals as well. They disagree only about the level of training necessary to be considered an independent mental health professional.

I am puzzled what it can mean to be a licensed psychoanalyst. As a clinical psychologist, I have been trained to understand and work with people through assessment, diagnosis and treatment of emotional and psychological difficulties. Although there are important differences, clinical social workers and psychiatrists have roughly the same basic role and therefore an educational background steeped in an understanding of the broad range of human difficulties. As a psychoanalytic practitioner, the theory and practice of psychoanalysis informs my understanding and structures the way I work with others. One of the ways I work with others more or less conforms to a “standard” of psychoanalytic treatment, that is, seeing patients multiple times a week, using the couch, etc. I am licensed to deliver mental health services; but my training and orientation reflects my commitment to psychoanalytic thought.

 Under current laws in most states, a potential analysand can be relatively sure that someone offering psychoanalysis has completed three to five years of postgraduate education and been supervised and trained in a variety of mental health venues (that is, hospitals, outpatient clinics, etc.) and has then undergone further years of education, supervision and training to become a psychoanalyst.

This will no longer be the case in states that enact laws similar to New York’s. There, a licensed psychoanalyst need not have had the breadth, depth, or length of experiences that have typically been considered required. Under the New York law, someone who wants to be a licensed psychoanalyst must acquire both the equivalent of mental health training and psychoanalytic training within the same institution, over approximately the same period of time spent by a mental health professional in similar analytic training.

Does it matter? That is hard to say. Psychologists were told they did not have the medical background to justify independent practice. Social workers were told they did not have the social science and research background to justify private practice. And our psychoanalytic institutes, including the so-called “tri-discipline” institutes are eagerly willing to adapt their curriculum to accommodate non-mental health trained candidates. We have now created a new kind of mental health professional, called a psychoanalyst. As a result, the definition of who is and who is not a psychoanalyst has changed and whether it serves the larger purpose of advancing psychoanalytic theory, practice, and public acceptance remains to be seen.

Accreditation

We are entering a new phase of the Consortium’s relationship with ACPE. The Consortium does not plan to make further contributions to ACPE operations. We have reached the point that this organization will thrive (or not) depending upon the fees and contributions from the institutes they will serve. In the last year there has been progress on that front. Although ACPE has yet to acquire the all-important “federal link” that would allow it to initiate a request for recognition by the Department of Education (DoE), it has begun to accredit a sufficient number of institutes that would make ACPE a viable proposition.

For those who find such details absorbing, this is what the “federal link” is. To have a “federal link” means that someone in the government sees the value in having a new accrediting body. In practical terms, this means getting someone high up in government to agree that psychoanalytic training at an accredited institute is important for this government organization. If the head of the Veteran’s Administration wanted its mental health professionals trained as psychoanalysts in accredited institutes, for example, this would constitute the “federal link” that would allow ACPE to make a valid claim to the DoE that ACPE application should go forward. This would, of course, only be a start. Since, as noted above, ABAP has also explored becoming a recognized by the DoE, they would have to go through the same process.

 There are many remaining obstacles to the success of ACPE, including the perceived desirability of even having accreditation. Many institutes, certainly the APsaA institutes, are accredited in various ways. Some are accredited as educational degree granting organizations, for example, and must periodically undergo reaccrediting. ACPE Trustees have worked hard to streamline the process and coordinate site visits, for example, to coincide with other accrediting body visits.

 Another obstacle is getting information out to institutes regarding the value and process of accreditation. In the last few years, ACPE Trustees have worked hard to schedule workshops explaining the process. There was and is a great deal of misinformation about the ACPE guidelines and the flexibility inherent in these guidelines to address the needs of various training philosophies and traditions.

There remains, of course, the core issue of the frequency and length of the personal and training analyses. While the requirement of “at least three sessions weekly on separate days” was adopted primarily to insist upon the depth and intensity of training, it is certainly true that this is an aspirational statement about psychoanalytic practice that can easily feel like hegemony. My own very limited survey of some institutes that cannot meet this expectation, however, is that the three-times-per-week standard is considered valuable but impractical in today’s marketplace. I know at least one training program did change their policy to conform to the standard and the world did not collapse. While the standard of frequency of sessions has some empirical support and broad acceptance as an ideal, the fact remains that it is a much harder “sell” to analysands than in the past, and not solely because of financial considerations.

Certification

This brings me to the last of the “big three” and the last to be taken up by the Consortium. In the last few years, we have been discussing the advisability and feasibility of developing a mechanism that would provide a common standard to certify that someone has completed psychoanalytic training. As I wrote about in an earlier column, there are three competing organizations that certify someone as a psychoanalyst.

 The American Board of Professional Psychology (ABPP) recognizes a specialty of Psychoanalysis in Psychology. While primarily designed to certify graduates of psychoanalytic training organizations, the ABPP also offers a pathway for psychologists who have completed the equivalent of a training institute. Once certified, the ABPP is expected to continue education but there are no further specific requirements of oversight (other than yearly dues!). The American Board of Examiners in Clinical Social Work (ABE) has a certifying process roughly similar to the ABPP, but does have ongoing expectations concerning both education and experience in conducting psychoanalytic practice. Importantly, these specialty designations are profession specific and only psychologists are eligible for an ABPP and only social workers may obtain certification through ABE. Both certifications confer status of “diplomate” in psychoanalysis.

 In contrast, APsaA has a very different process whereby graduates of American institutes are recognized as competent and capable of become supervising and training analysts. The process is separately run through the Board of Professional Standards (BOPS), but is essentially a process of peer recognition and anyone reaching training analyst status acquires clear power and authority within a given institute. In other words, the BOPS process is aimed at identifying superior psychoanalysts, however defined, whereas the other certifying agencies are content to identify the psychoanalyst as competent. Finally, APsaA “certification” is offered only to graduates of American institutes, but is offered regardless of discipline.[2]

 So the Consortium’s task has been to identify how and whether there could be a process that would 1) allow for the development of an independent certifying body that would be open to any psychoanalytically competent individual regardless of profession or institute training; and 2) provide for essential equivalence of certification status with the currently established, profession-based agencies. It is the position of the Psychoanalytic Consortium that both conditions above would have to be met. This could be met, for example by developing a “super board” with representatives from the three certifying boards that would act primarily as a clearinghouse recognizing all certifications as equivalent.

 This position of the Consortium is important since there appears to be continuing debate and controversy within APsaA over the status of BOPS and the possible establishment of an independent certifying body. There are some within APsaA who want to essentially transform BOPS into an independent agency while retaining its mission of identifying training and supervising analysts. This would presumably mean that the vast majority of institute graduates could only apply for specialty certification, that is, diplomate status, within their profession of psychology or clinical social work[3].

Development of an independent body that would essentially reproduce the BOPS process is seen as a nonstarter for the Consortium. Although some of those associated with this plan have indicated this independent body would certify any graduate of any institution, this ambition seems improbable given the very different purpose of BOPS in identifying training analysts. Ho that would work is a mystery. At the same time the only psychologists and social workers would have access to a specialty designation that fits ACPE criteria and is similar to other specialty designations. Finally, this would introduce two levels of specialty designation, with one perceived as the more “real” and valuable, essentially re-instantiating turf conflicts that have been minimized over the last twenty or so years..

Why Licensure, Accreditation, and Certification?

In the interests of full disclosure I will point out that I never attended a psychoanalytic institute, my personal therapy was with someone who was not a certified psychoanalyst, and my education in psychoanalytic ideas, begun in graduate school, has continued through supervision, consultation, and conferences/seminars. To the extent I am a psychoanalyst, I am a most unregulated psychoanalyst. My education does not conform to the standards advocated either by ABAP or ACPE. Both organizations seek to regulate who is and who is not a psychoanalyst and under their regulations I am not.

As someone who has participated in the Consortium meetings over the last three years, I marvel at the effort, dedication, and perseverance of so many of our colleagues struggling to influence licensing laws, develop accreditation standards and support recognition of the value of certification. Their ongoing efforts to regulate our professions, to regularize our standards, and to promote professional recognition of competence inspire my admiration. At the same time, I wonder about the value of increasing regulation, increasing “hurdles” in the way of professional development. We have seen the rampant “bean-counting” mentality inflicted upon our graduate schools and internships sites, all in the name of demonstrating that the stamped-out products of our teaching are competent and efficient, able to draw upon the latest scientific studies to fashion time-saving approaches to treatment of human ills.

 Of course the argument cogently made is that unless we regulate ourselves, someone else will regulate us. To the regulated, however, it rarely feels that we are being regulated by “us.” Few of us see our State Boards of Healing Arts as on our side when it comes to regulating our profession. Most of us groan at the prospect of site visits and the hours of preparation put into writing policies and procedures that demonstrate our multicultural, science-driven, approach to vital issues such as the correct placement of fire extinguishers. And the prospect of having one more group of Solons grill us on our understanding of psychoanalytic process and technique is mainly just annoying.

 It is true, however, that we are “regulated” all the time by those whom we trust and rely upon. I applied to graduate school because my school principal at Irving Schwartz Psychiatric Institute told me I couldn’t do the work I loved without moving on from teaching. I became a clinical psychologist because the teacher who became my dissertation chair told me I was a “schmuck” if I didn’t apply for an open position in that program. I went to my internship because a friend told me all the supervisors there were great (failing to inquire further to learn that they were “great” lovers of opera and lousy supervisors!). I got involved with Division 39 because Gemma Ainslie wrote to say someone from our local chapter needed to attend Section IV meetings. I sat for the ABPP because Johanna Tabin and Dolores Morris threatened to never leave me alone until I did so. At each juncture of my life, someone encouraged, prodded, or cajoled me to stretch my view of who I was and what I could do.

I bring this up not because my experiences are unique, but because they are so utterly ordinary. We are constantly challenged by others to do our best. Maybe at its best all our regulations and demands are institutionalized ways to force us to connect with others, to remind us that we only grow and change in connection with others. To request licensure, accreditation and certification, not to speak of the yearly grind of continuing education and conferences, affords us at the very least opportunity to demonstrate to ourselves that the work we do is important and vital and can stand up to, and perhaps benefit from, the scrutiny of others.

In fact my actual experiences with institutional hurdles have been positive, except for my own grumblings, resistance, and paranoia. I found completing a dissertation to be an insuperable task until I submitted to my dissertation chair’s invitation to finally join his research group and accept the help, support, and ideas of my fellow students. My ABPP exam was actually a pleasant and collegial experience. My time as newsletter editor was not without its moments of being called on the carpet, but it was a soft carpet and no bones were broken in the process. Perhaps I have been lucky, but institutional regulations do not always result in power plays and conflicts.

I think that at least at times our institutional restraints and resulting conflicts provide opportunities to bridge divides of training, philosophy and perceived power differences. I think the Psychoanalytic Consortium itself is a model of how four professional groups warily came together and not without some drama proved able to see past our institutional and historical divides to work together. At our last meeting, another psychoanalytic group requested to join the Consortium, suggesting further lowering of old animosities.

 As noted at the beginning of the article, I had several colleagues from the “other camp” (NAAP, ABAP, etc.) contact me about the earlier article on accreditation. I felt we had a good dialog about the issues we both face, whether or not we can ultimately come to an agreement. I think it helps when we can speak honestly and recognize, for example, that financial considerations underlie the concerns of both sides in the licensure conflicts. Unlike the “bean counters” of the DoE, we do not need to cling to an illusion that any particular standard of psychoanalytic training or dimension of psychoanalytic care is clearly superior. We can recognize that we are doing the best we can and that differences of opinion, however firmly held, are ultimately just that.

So I plead guilty to making a “sweeping plea” that our psychoanalytic organizations and institutions develop ways of valuing our diversity, recognizing our similarities, respecting our differences. This necessarily includes developing a measure of humility and irony about our cherished ideas about what constitutes “real” psychoanalysis, psychoanalytic training, and psychoanalytic practice. It also means letting go of something we often prize even more: our grievances. Not all differences can be resolved; but many can be ameliorated by acceptance of our common interests. Given the struggles we really face to inform and educate the public about the value and importance of our work, our interests certainly must outweigh our conflicts.

 

---

[1] American Psychoanalytic Association (APsaA), American Academy of Psychoanalysis and Dynamic Psychiatry (AAPDP), American Association for Psychoanalysis for Clinical Social Work (AAPCSW), and the Division of Psychoanalysis (39) of the American Psychological Association.

 

[2] There is an important variable in addressing the issue of certification. For the vast majority of applicants, the acquisition of diplomate status carries very little concrete reward, let alone remuneration. Academics and employees of large organizations (such as the Veterans Administration) do experience some benefit with increased pay and status. ACPE guidelines state that instructors and supervisors should be certified psychoanalysts. But for most the benefits are primarily rooted in a sense of accomplishment and a contribution to the profession. In contrast, graduates of APsaA institutes who undergo the certifying process through BOPS do obtain the specific benefits of becoming training and supervising analysts; and there is an inherent incentive for those who wish to do this. While there is a value to the profession in having psychoanalysis recognized as a specialty by an independent board (e.g., ABPP or ABE), candidates for diplomate status do not appear to have an immediate incentive to apply.

 

[3] The American Psychiatric Association has a moratorium on establishing any new specialty board.

President’s Report: Highlights from the August 2012 Board of Directors (BoD) Meeting

T

he August meetings are usually sultry affairs and never more so than when APA selects a southern city to hold its Annual Convention. That was never more true than this August, on surely one of the hottest (take-your-breath-away hot) weeks of the year. The other thing about Orlando is that it is big, very big. While I was able to eventually find my way around, I never had any clear sense of where I was in the hotel, constantly surprised to find myself lost and found without knowing exactly how I got there. The Convention Center was somewhat more navigable, thanks largely to the fact that about 80% of the place was unoccupied and APA meetings there took up only a compact fraction of the available space.

Another thing about August Board meetings is that a large portion of our time is spent welcoming visitors; and this year was no exception. We had four guests: Don Bersoff, Katherine Nordal, Doug Haldeman, and Nadine Kaslow.

APA President-Elect

Dr. Bersoff is president-elect of APA and he came to tell us about his initiatives as president. He wants to highlight the role of psychologists working with military personnel, reservists and their families to address medical, physical, and psychological impact of war as well as issues of suicide, domestic violence, and sexual victimization.

He asked the Division to provide him with some of our program hours for next year’s Annual Convention in Hawai’i. This has become a routine practice in recent years as presidents have tried to carve out program time to advance particular concerns. Since APA is busy revising how is allocates Division hours, we will have to wait until the fall before knowing if we can support Dr. Bersoff’s request.

His other initiative is to invite and retain academics and researchers within APA. While this is a laudable goal, and Dr. Bersoff agreed the psychodynamic researchers were included in this initiative, I cannot but be wary of the attitude so ably expressed by Alan Kazdin last year that practitioners are of only marginal use to APA. It is certainly no surprise that researchers and practitioners both feel misunderstood by the other (the Division has had and continues to have similar complaints from each group) and I will welcome an effort to genuinely address these concerns.

 APA Practice Organization

Katherine Nordal had some uncommonly cheerful news to offer as the Practice Directorate is getting ready to launch a new public education campaign that specifically addresses psychotherapy as a viable and effective treatment for emotional problems. She warned us that we may not like the ads, assuring us that market testing of ads typically finds that the public likes what the psychologist hates and vice versa. Regardless, this new campaign is an extension of previous efforts; but the addition of a specific focus on psychotherapy is a real step forward. We have a long way to go to break the hold of Big Pharma over the public’s imagination; but perhaps this will help. The ads directly take on the drug ads by having a physician “prescribe” psychotherapy for the patient’s difficulties.

While we are on the subject, APA Council passed a motion “Resolution on Recognition of Psychotherapy Effectiveness,” which is the first time APA has gone on record endorsing the effectiveness of psychotherapy. The resolution is worth reviewing and noticing how many of the citations are from psychodynamic researchers. The full text is at http://www.apa.org/news/press/releases/2012/08/resolution-psychotherapy.aspx.  Thanks to APA past-president Melba Vasquez and Council Representative Linda Campbell for spearheading this initiative.

Never one to leave us feeling too cheerful, however, Katherine reviewed the increasing threats to adequate reimbursement and in particular the likely impact of Medicare cuts as insurance companies gleefully follow a “race to the bottom” in limiting compensation. While there are some ways to hit back under the protection of parity and other laws/regulations, psychotherapists are facing continued ratcheting of rates downward. There remains the (slight) possibility that a review of Medicare codes scheduled this year to address “psychotherapy” and the relative value of this code compared to every other will result in a slight uptick in the perceived relative value.

If you want more information, read on, but it gets tedious about now. I actually participated in the review of the “psychoanalysis” code last year and have some idea how it works. First of all, this is a process dominated by American Psychiatric Association and the overall code revision is more or less controlled by the American Medical Association. The value of “psychotherapy” will be computed against the relative value of every other code, that is, every other medical procedure. The medical codes are equally geared up, of course, to protect the relative value of “their” codes and one of the ways this is accomplished is by invoking two mantras dear to the heart of bureaucracy: technology and new and innovative procedures. Since “psychotherapy” does not typically claim to rely upon new technologies and innovations, it tends to lose out in the valuation game.

I will note, however, that our team that addressed the value of the “psychoanalysis” code, made the argument that psychoanalysts are treating far more troubled individuals with far fewer resources (e.g., hospitalization) than in the past and proposed that this constitutes an innovation, and secondly that our “technology” has changed in that analysts are much more open, emotionally available, and so on. It was amusing to consider that relational approaches in psychoanalysis can be touted as a “new technology” that all analysts have embraced. More to the point, however, these arguments carried the day and “psychoanalysis” may be in for an uptick in relative value once the government completes its reviews of the other codes up for examination, including “psychotherapy.”

 APA Candidates for President Elect

The next two guests were candidates competing to become APA president-elect beginning in 2013. Both Doug Haldeman and Nadine Kaslow are Division 39 members and both described their plans should they be elected. While Doug is well known to us, having run for president last year, Nadine is also a long time member of the Division.  

Both candidates addressed the failure of APA to fully implement the policy on psychologist participation in illegal detention settings and both promised to review and do their utmost to carry out the policy. Doug addressed the need to develop one “final” policy on psychologist involvement in interrogations, which he felt would supersede the PENS Report. Nadine spoke forcefully on what she sees as a failure of leadership on the part of APA and a need to fully address and apologize for this failure, specifically a failure to align our organization solidly behind the other professional organizations that took much more forceful measures to oppose involvement of behavioral and psychiatric interventions with detainees.

 Nadine Kaslow, PhD

Nadine Kaslow work at Emory University School of Medicine has been primarily in the area of family violence, cultural diversity, women’s issues, and training concerns, including supervision. She is the editor of Family Psychology. Her presidential initiatives include addressing the role of psychology within a health care system that will greatly change as a result of impact of ACA, developing new and innovative ways to ensure that graduate students and ECPs are able to successfully navigate the “pipeline” (graduate school to internship to postdoctoral to career), and working to sustain APA’s vision as an organization dedicated to science, practice, and public service. Nadine’s campaign information may be accessed at http://www.nadinekaslow.com/campaign/.

Doug Haldeman, PhD

Doug Haldeman at the University of Washington has worked and taught primarily in the area of cultural and sexual diversity. He has been instrumental in bringing issues of cultural, ethnic, and sexual diversity to the forefront of APA policy including development of APA Guidelines for Psychotherapy Practice with Lesbian, Gay and Bisexual Clients. His presidential initiatives include expanding the definition of family in research and treatment efforts (that is, to provide a more inclusive and culturally sensitive definition of family), addressing the “mind-body” connection in developing comprehensive approaches to treatment (for example, including the role of exercise, diet, body work and breathing techniques, and so on), and developing interventions to address “ordinary life traumas,” such as bullying, subtle racism/sexism/ageism, etc. Doug’s campaign information may be accessed at http://president.drdoughaldeman.com/.

Both candidates are extremely well versed in APA governance and politics, an essential for success of any presidency. While we had set aside time to discuss possibility of endorsing one or the other candidate, the BoD quickly came to the decision that both candidates would be excellent in various ways and we voted to support each of them.

Please remember to vote (balloting begins on September 14) and we urge you to vote for both of these candidates. Also remember to completely fill out your ballot. Although I have no idea why APA uses the Hare system, or how it works the one thing I know (or have been told) is that filling out the ballot completely actually helps elect your preferred candidate.

Transitions

We also had some basic housekeeping items to announce.  Shortly after the Spring Meeting, Tamara McClintock Greenberg announced she was resigning from the Board and from editorship of InSight. This left some important positions to fill and Marsha McCary was appointed by the Board to complete Tamara’s term on APA Council. Kristi Pikewiecz was appointed by Henry Seiden for the Publications Committee to assume role of editor of InSight. Tamara conceived and launched our online newsletter, InSight, and her contributions in this role as well as her work on the BoD and APA Council will be missed.

As previously announced, we will be welcoming a new BoD member in January, Dana Castellano, as secretary (who helpfully subbed as secretary for part of the August meeting). While Past President Mary Beth Cresci, Secretary Dennis Debiak, and Members-at-Large Marilyn Charles and Jill Bellinson will be completing their terms at the end of the year, they will return as newly minted members in January, with Marilyn as APA Council Representative and Mary Beth, Dennis, and Jill serving as Members-at-Large.

And All the Rest . . .

You should be able to delve further into some of the following issues by reading reports on the web site, but I want to highlight some important news and initiatives.

·         We have a new Task Force, Psychoanalysis and the Humanities, with Spyros Orfanos as chair. Frank Summers has been working with Spyros and other task force members to increase integration of the humanities in our overall mission, for example, to have a wider range of the liberal arts professions represented as both presenters and participants at our meetings.

·         While the budget situation for 2013 is uncertain at this point, the BoD approved in principle a request from the Multicultural Committee (and an initiative from Frank Summers as incoming president) to greatly increase support for minority graduate students and ECPs to attend the Spring Meeting. This is part of our larger commitment to diversity and development of a new generation of members and leaders to keep the mission of the Division alive and revitalized by being more inclusive in reaching out to new members. While we will need to plan and evaluate this investment (for example, should we focus more on ECPs versus graduate students, we have certainly found that reaching out with financial support has paid dividends in retaining those awarded support as members, and has led to their increased involvement in Division leadership.

 

·         Also, the Multicultural Committee has worked with the Awards Committee to develop a new award that will be announced in 2013 for members who have made significant contributions in the area of racial, cultural and sexual diversity.

 

·         Our Fund for Psychoanalysis initiative has been successful in that we currently have more than enough in pledges to begin thinking about the actual mechanics of distributing funds once available. We still need some contributions to get us “over the top” and hope to be in operation by 2014. Dennis Debiak reported on some of the details we will need to address before sending out a “call” for grant requests.

·         The BoD approved a contribution to the 2013 Child Mental Health Summit. In the two years since the last Summit, Jill Bellinson has been working actively with this group and has been able to make the case that psychoanalytic thought and treatment need to be represented at the Summit next year. Her participation with this group has yielded significant recognition of the importance of a psychoanalytic perspective within APA governance.

·         We had what we hope is only the first of many future meetings of Division members who are also Directors of Clinical Training (DCT) as they came together to share their troubles, concerns, and successes in maintaining psychoanalytic theory and training as part of their graduate programs. There was a lively discussion and a wide range of experiences, from those who felt the accreditation process by the Committee on Accreditation (CoA) to be wholly biased against psychoanalytic programs, to those who had more positive (or at least neutral) experiences. Nancy McWilliams has previously written about this meeting and her summary can be found on our web site under Education and Training Committee Reports. The important point is that our Division may help spearhead efforts to both assist DCTs in their task of coping with CoA, as well as work to have more influence with CoA. We are also considering either including internship directors in these discussions or developing separate venue, since they are facing similar concerns in meeting APA accreditation standards while being true to a psychoanalytic vision for training interns.

·         The Publications Report is also on the web site but some quick observations. First of all, the journal has vastly improved on a number of measures, with the most understandable being that it is the third most cited psychoanalytic  journal, that is, our journal articles have been cited by other articles at a rate that places us third (and ahead of JAPA!). Also, our editor, Elliot Jurist, reported substantial submissions from graduate students and early career professionals applying for the Stephen Mitchell Prize, a vast increase over past years.

There were many other issues discussed at the meeting, some of which may be found under committee reports on the web site, some of which I will address in future blogs. As always, you may comment directly at this site, or write to me at drmacg@comcast.net. Hope the rest of your summer goes well.

Psychoanalytic Consortium

President’s Column

Psychoanalytic Consortium Meeting

May 2012

The Psychoanalytic Consortium consists of the four major psychoanalytic organizations in this country[1]. It was formed after the settlement of the lawsuit brought by a group of psychologists (GAPPP) affiliated with Division 39 against the American Psychoanalytic Association to open training resources to psychologists. Its purpose was to develop improved communication and collaboration among these organizations. The Consortium developed guidelines for public officials and the public clearly describing the nature and purpose of psychoanalytic training (more on that later).

Its primary accomplishment over the last twenty years has been the development of guidelines for psychoanalytic education that led to the formation of the Accreditation Council for Psychoanalytic Education (ACPEInc.org), an independent accreditation body for psychoanalysis. While ACPE continues its efforts to both accredit institutes and win recognition from the Department of Education (DoE) as an accrediting body, these tasks increasingly will be supported by the funds generated by ACPE rather than by the Psychoanalytic Consortium.

Why Accreditation? For some of our members, the issue of accreditation has been received with indifference and even opposition. For those members who are not institute-trained the concerns about accreditation seem distant, even arcane. For some institute leaders, accreditation has seemed like an additional “hurdle” for both the institute and candidates. Obviously the Division’s financial support for ACPE has limited our ability to fund other worthy projects.

We have pursued this aim to establish ACPE for several reasons. The first has been to provide a “level playing field,” that is, a definition of psychoanalytic training that is flexible enough to accommodate different traditions, theories, and approaches while providing a transparent process that would enable institutes to be on an equal footing with other institutes. By seeking recognition of ACPE by the DoE, we will also have a nationally recognized standard for psychoanalytic training that both the public and legislators can rely upon in addressing issues such as education loans and state licensure.

Why should we care? One reason to care is largely defensive. Without a nationally recognized standard for psychoanalytic training, individuals and organizations will increasingly attempt to impose their own standards as definitive. More and more state legislatures are being asked to define psychoanalysis as a separate practice subject to separate licensure. The “standard of care” for psychoanalytic practice could be increasingly defined as a sub-doctoral and non-mental health profession requiring medical oversight. In addition, if once-a-week psychoanalyses are defined as “standard,” seeing analysands more than once a week might be considered non-standard.

Another reason to care is for our profession. Even for those who will not attend an institute, the development of clear and transparent standards for psychoanalytic training will mean that psychoanalytic education will be seen as a “normal” advanced specialization of the mental health disciplines, providing a clear rationale for psychoanalysis as only one of many mental health specialties rather than seen as a separate discipline unrelated to mental health. While psychoanalysis has been and continues to be informed by the liberal and scientific arts in the widest sense, as a treatment its basis is in relief of suffering and the nurturance of emotional and interpersonal growth and change.

Whither the Consortium? The establishment of ACPE as a separate organization has clearly been a successful effort on the part of our organizations and from what I have learned of the “early days” in the Consortium, one that would not have necessarily been predicted at the beginning. I believe that our Division 39 leaders, among them Jonathan Slavin, Laurie Wagner, and Lew Aron played pivotal roles in moving the Consortium toward this resolution. In this column I will review some additional projects and potential projects we have been discussing.

Before doing so, however, I want to make a personal observation about my experience on the Consortium. I came with a whole set of ideas and fantasies of the role of the American Psychoanalytic Association within psychoanalysis. While I was aware that the “old days” when members (almost) came to blows were long past, I was certainly wary enough that even the friendliest of gestures might mask ongoing efforts to advance an agenda and monopolize issues for APsaA’s benefit. And regardless, APsaA is the elephant in the room. Although is has as many members as Division 39, it has a budget that allows it to offer $100,000 yearly in research grants, that allows it to hire a publicist, and so on, resources we cannot hope to approximate. They cannot help stepping on a few toes!

My actual experience with APsaA president, Warren Procci, and president elect Bob Pyles did not match my initial wariness. Not only did Warren and Bob take an active interest in developing greater collaboration with our organizations, Warren invited me to speak to their BoD on two occasions in order to present some of the ideas originally developed out of our Division 39 meetings. It occurred to me later that the Division had never extended a similar invitation to an APsaA president. I think it is time for our organizations, or at least the Division 39 leadership, to recognize that a sea change is occurring within psychoanalysis and within APsaA in particular.

I want to emphasize that these changes may spell a new kind of challenge for Division 39. If APsaA becomes a more open organization, it may attract many psychologists and others who would not formerly have associated with APsaA because of its exclusionary practices. In addition, within not very many years, the leadership within institutes and APsaA will be mainly psychologists and social workers (the incoming president-elect is Mark Smaller, a clinical social worker). These changes will make APsaA more “competitive” in attracting members and pose an increasing challenge to the ever challenging question of Division 39: Are we mainly psychologists or mainly psychoanalytic psychotherapists?

Adding one more “pitch” for ACPE: After initial uncertainty whether APsaA institutes would embrace the ACPE process and apply for accreditation, we are now at the point that many more APsaA institutes have applied to ACPE than non-APsaA institutes. If that continues, ACPE will be dominated by APsaA institutes. We have been conducting outreach efforts to “our” institute leaders for several years and hope that they will see the value of contributing to establishing ACPE as representative of the vast majority of psychoanalytic institutes.

Certification: Certification as a psychoanalyst is available to only two professional groups, that is, only clinical social work and psychology have established independent organizations that review and certify members as psychoanalysts. For psychology, of course, it is the ABPP in Psychoanalysis that was established largely through the efforts of Division 39 members. In addition, the American Psychoanalytic Association (APsaA) has a certification process for graduates of its institutes (regardless of profession). Although independent of the individual institutes, certification is very much an ‘in house” process largely connected to APsaA training needs, that is, need to approve supervising and training analysts. Finally, the American Academy of Psychoanalysis and Dynamic Psychiatry (AAPDP) does not have an equivalent certification process available for psychiatrists (the AAPDP is affiliated with the American Psychiatric Association [ApsyA] and the odds of establishing an equivalent certification process within ApsyA is virtually nil).

This lengthy explanation is by way of pointing out that there is no one recognized certification body for psychoanalysis, no equivalent of ACPE for individual analysts. While their respective independent bodies certify clinical social workers and psychologists, psychiatrists (or other medical professionals) not trained in an APsaA institute have no access to certification. While graduates of APsaA institutes may be certified, the process is not truly independent[2].

The Consortium has been struggling with this issue for a few years, attempting to determine if there would be some way of developing a certifying body that would be independent of both institutes and professions. We have explored the possibility of a “super board” that would essentially review and approve certification by other independent organizations. APsaA is likely to move to establish truly independent certification procedures in the next few years. If that happens, at least three of our organizations would be able to recognize as equivalent the certification offered by another group. This would still leave out AAPDP members.

While the goal of a central certification process is appealing, the practicalities remain to be worked out. It is clear that the goal of ACPE is to ensure that eventually all faculty would be certified psychoanalysts and all graduates of ACPE institutes would have certification as a goal for completing training. In fact, however, our current ABPP standards, for example, are quite strict, stricter than most institutes in requiring the applicant to have completed a full analysis before being considered for certification. For APsaA members, their certification process has assured them a way of presenting credentials to supervise and perform training analyses, but would a “super-certificate” make the non-APsaA-trained analyst eligible to do the same at APsaA institutes?

These and other issues remain to be worked out; but they signal the convergence among our organizations for the need for independent agencies to both accredit and certify psychoanalytic institutes and graduates as a way to assure the public of the adequacy of training in this specialty. Within Division 39, of course, we have a long way to go to convince even many of our senior members and leaders to apply for the ABPP and this in turn limits the viability of this certificate to communicate anything of value to the public.[3]

DSM-5: As you know there has been considerable controversy over the new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). While it has not been published and much remains to be decided, many individuals and groups both within and without the mental health field have called for a more transparent process in revising the PDM and an end to the increasing “biologization” of emotional distress and suffering. There were two issues under discussion at the Consortium and the main issue was how and whether APsaA would issue their own response to the new document. The issue originally before the APsaA BoD in January was whether to become a signatory to the letter circulated by Division 32 (Humanistic Psychology) of APA. They have instead decided to draft their own letter to DSM and will share that with the other members.

For me, however, the more interesting discussion, some of which preceded the meeting, was a review of the original purpose of the DSM. Although it has traditionally been described as a document for psychiatrists to use to insist they were treating “real” illnesses and should be reimbursed for this by insurance companies, this is not the whole or even main story. At least by the time of the DSM-III the primary purpose, at least as described by Robert Spitzer and others involved in that revision, was to develop a research-friendly tool that would allow clinicians to come to some reasonable agreement that depression in Walla Walla was the same thing as depression in Boca Raton. Despairing of finding an approach found in ordinary medicine (where, for example, high blood pressure is meaningless without an understanding of the causes for the rise in pressure), psychiatry would “settle” to at least be able to reliably know that the symptoms observed could be consensually validated.

The point of all this exposition, at least for me, was the realization that the DSM in whatever incarnation it chooses to present itself is a document that is useful for what it purports to do, which is to define symptoms (and maybe even syndromes). What it was not supposed to do, what it shouldn’t do, is serve as a guide to treatment. That said, it is clear that not only do clinicians treat the DSM as a treatment manual, the American Psychiatric Association markets the DSM in precisely this way, hence DSM-IV-TR. As a result this organization makes a fortune in royalties from this misuse of the DSM. It seems to me it is long past due for our clinical organizations to call out the American Psychiatric and the DSM for its distortion of clinical practice. Far more than simply advance the “bioligization” of mental health, the DSM continues to rest on the shakiest of foundations and does not meet the criteria of advancing a biological understanding of mental illness. It does, of course, serve the pharmaceutical companies in their quest for more disorders to allow more drug marketing. But that is not the same as medical science. We do not need to “improve” the DSM; we need to replace it entire. Fortunately we have an alternative and that brings us to the next item we discussed.

Psychodynamic Diagnostic Manual (PDM): The PDM was the brainchild of Stanley Greenspan and was developed with the support of the Consortium members as well as the International Psychoanalytic Association. It is an impressive document that was well received when first published in 2006, providing an alternative to the DSM symptom focused approach to treatment and offering a way to conceptualize treatment in a clinically rich and empirically sound framework. Unfortunately two things happened. First the PDM was self-published in order to keep the costs down and this limited institutional support for sales. Secondly and more important, Dr. Greenspan died and with him much of the moving force behind it.

Recently there has been an attempt to “revive” and revise the PDM, that is, to literally revise it to update and streamline its contents and to educate both clinicians and researchers about its merits. Concerning the latter, Bob Gordon and Ken Levy have been active in promoting the PDM as a useful way to look at treatment and treatment results. In brief, the point is that the PDM approach (that personality patterns and psychological/emotional etc. resources must be considered as being at least as important as symptoms) might be a useful way to parse out the differential effects of particular approaches in treatment. In other words, depression in a schizoid character requires a different form of treatment than depression in a paranoid character. In addition, process and outcome measures may need to be different with different kinds of patient characteristics.

In addition, a psychologist in Italy, Vittorio Lingiardi, has begun to form an international group of researchers and clinicians to revise the PDM, updating the research that has emerged in the last 7-8 years, adding important sections inadvertently omitted (such as treatment of the elderly) and developing a more consistent marketing approach to emphasize the PDM’s utility as both a treatment guide and research tool far superior to the DSM. While the original authors were all psychoanalytic theorists and researchers, the core assumptions of this document apply to any approach that relies upon psychological interventions. The PDM, like almost all good clinicians, assumes that the bulk of the treatment will be in understanding the personality dynamics that make the symptoms understandable and that treatment must also be guided by a full understanding the person’s strengths and weakness. To give a trivial example, a behavior therapist who assigns “homework” to a client is more likely in the next session to explore why the client did not complete the assignment rather than simply re-assign the task. To do so means to take into account the client’s reaction to being assigned a task rather than simply focus on the task.

There are lots of immediate goals for a new PDM. The first would be to find a commercial publisher to support advertising. The second would be to develop training modules for professionals to help them understand and then communicate with each other using the structural approach advocated. The third would be to encourage researchers to try out the approaches suggested as a way to better refine research protocols by taking into account the whole person rather than circumscribed symptoms. Ideas beyond that include developing a PDM for physicians, a “dumbed-down” guide with requisite checklists that would help family practice docs understand there are a world of treatment options others than pills. Getting more expansive, the PDM might be turned into a “parent guide” allowing parents to access information by completing online information about their child’s emotional difficulties with the result that a printout of recommendations would include the pros and cons of various treatment possibilities and helping them to access such services (and begin to demand such services from insurance carriers).

Public Education: We have been discussing our educational efforts for some time within the Consortium but we realize we are leaving some essential “players” out of the discussion. As a Consortium, of course, we have no direct authority over our boards and public education efforts have been developed in various ways and with various foci among our organizations. To that end, we plan to have a working meeting at our next session bringing together the key public information committee chairs from our organizations, and others as needed, to spend a day looking at our specific efforts but also developing a common message, a “brand” that we could begin to consistently use to define and describe psychoanalysis. My vote goes to “Psychoanalysis is not only a form of treatment but primarily a way of thinking about self, family and society”[4] although it would need to be distilled further.

We also came out with a specific request for our publication editors to ask authors to consider writing short summaries of their research and/or clinical papers that would be accessible (and interesting) to a general reader and post these articles in a central venue that would clearly represent the viability of psychoanalytic treatment and the relevance of psychoanalytic ideas to a general public who only hears that psychoanalysis is passé at best. I will note that Division 39 has already begun to experiment with this idea by posting a series of articles under our rubric on Psychology Today blog, psychologytoday.com/blog/meaningful-you. Kristi Pikiewicz, the newly appointed editor of our online newsletter, InSight, has taken on this task. Within the last two months over 10,000 “hits” have been made to the site.

To get more expansive, we have begun to explore the possibility of increased collaboration at our scientific meetings and conferences. We might, for example, showcase specific outreach approaches at our different meetings and use these sessions to brainstorm other ways we can collaborate in our public service mission. We might hold a two-day Psychoanalytic Consortium Conference inviting all members to take part in a meeting highlighting the many roads to psychoanalytic education. These are some exciting developments and demonstrate a renewed sense of collaboration among our psychoanalytic organizations.

Psychoanalysis and Licensure: Licensure as a mental health clinician is an issue decided on a state-by-state basis and recent efforts to have psychoanalysis defined as an independent, master’s level, mental health treatment have been going on for some years. The latest effort is in Massachusetts and the problems with this particular effort are too difficult to clearly articulate in a short paragraph. The gist is that the bill before the legislature, originally meant to restrict individuals who had lost their license due to ethics violations, has ballooned into a “back door” licensing act that will have virtually no guarantees to protect the public or to require specific standards for those who seek license as psychoanalysts.

Combating this law has not been easy. Those supporting it have every reason to continue to push in order to gain licensure; those opposed can easily be painted as wanting to restrict commercial activity for their own gain, that is, as members of a self-serving “guild.” In addition, state legislatures are notoriously provincial and tend to be unmoved by the concerns of national “players” including our national organizations. At this point, we continue to support communication among our various members in Massachusetts and Division 39 will also work to enlist APA support in opposing this diminution of the value of our license. As noted earlier, the Consortium has previously developed a clear statement on psychoanalytic training that we will distribute to legislators.

Conclusion: If you have made it thus far, thanks. I hope you will have a better idea why we have a Psychoanalytic Consortium and why we have come to the conclusion that we need to work together in many ways to advance psychoanalytic training, education and outreach to the public and other professionals.

---

[1] American Academy of Psychoanalysis and Dynamic Psychiatry, American Association for Psychoanalysis in Clinical Social Work, American Psychoanalytic Association, and Division of Psychoanalysis of American Psychological Association

[2] I want to emphasize that this is not a criticism of APsaA process. It was developed to meet the training needs of the organization. It was notintended as a public assurance that the person accredited had met standard, transparent criteria to be considered a psychoanalyst.

[3] It would take another article to fully explain and defend the need to have both accreditation and certification of psychoanalytic training. Clearly institutionalizing psychoanalysis has implications for our professions, not all of them positive. Should psychoanalysis become like all other “ordinary” professions, defining who is and who is not a psychoanalyst? Many object strenuously to ACPE’s defining psychoanalysis as a subspecialty of a mental health discipline requiring specific procedures, including having lengthy, multiple weekly session training analyses, viewing this as rigid, limiting innovation, and contrary to the spirit of psychoanalytic inquiry. Many of those so objecting are strenuously pursuing states-sanctioned licensure of psychoanalysts and developing accreditation procedures that define psychoanalysis as a once a week treatment.

[4] Thanks for Jaine Darwin for coming up with this was of differentiating what we do from how we think. We are able to think (and act) psychoanalytically with out patients even if we are seeing them four times a week, once a week, or having a brief consultation in a nursing home.

President's Blog: June 2012

I am writing to announce the results of the recent election of members and officers to the Board of Directors (BoD). All terms will be for three years. I am pleased to report the following results:

·        Dana Castellano will be our new secretary;

·        Marilyn Charles will be our new representative to APA Council;

·        Jill Bellinson, Mary Beth Cresci, and Dennis Debiak will serve as at-large members.

Thanks to those who competed in this election. We had a very full slate of nominees for this year and their many contributions to the Division will certainly continue. In fact, all candidates this year also serve as committee members or chairs and I trust they will continue their important.

Finally, I would like to express my appreciation for those members who will be leaving the BoD. Usha Tummala-Narra will complete her term as At-Large member at the end of this year; and Tamara McClintock Greenberg has resigned as representative to APA Council and a new representative will be appointed by the BoD later in the month.

That said, I would like to address two issues that arise as I reflect on these results. The first is that very few of our members participated in the election. It looks like only 346 ballots were sent in. While I do not know the exact number of eligible voters, this figure must be less than 15% of our eligible members. I am puzzled why more of our members did not vote, especially in these very competitive elections. I would appreciate any thoughts about this, especially from those who did not vote this year.

My second issue is a broader one and concerns leadership development in the Division. In the past, the primary vehicle for members becoming active in the Division has been through participation at our Spring Meeting and involvement in our Sections. The Sections, in particular, were formed more or less as political entities to bring certain concerns and/or constituents into the Division. To give one example, Section III: Women, Gender and Psychoanalysis, was vital in bringing women into Division leadership and eventually Division governance. In recent years a number of Sections have lost members to the point that two became inactive and several others have lost certain rights and privileges within the Division due to declining numbers. While the sections served and continue to serve as an important function within our organization, we increasingly found that we also needed to appeal to other subgroups within psychoanalysis and the Division.

(Before addressing this issue, I want to make a distinction clear. Sections are independent subgroups of the Division that are able raise funds from their members and who may allocate these funds to advance their mission without any specific oversight or control by the Division. Committees are “creatures” of the Division leadership, appointed by the president for time limited terms for the purpose of carrying out the mission defined by Division leadership Their funds come solely from the Division budget.)

For a number of years a solution evolved to involve subgroups of members through our committee structure. Credit belongs to many in the Division, but probably Jonathan Slavin’s revamping of the Graduate Student Committee provided a model for others to follow. The general idea has been to see these “diversity” committees (Graduate Student, Early Career, Candidate, Multicultural and Gender Identities and Sexualities) as an entrée into Division governance and then to “seed” members of these committees into other, more broad-based committees. As a result, every committee is charged with having either a member or liaison who represents the diverse interests of the Division and members who started our on one of the “diversity” committees are expected to move into other leadership positions. This has worked quite well in having a very lively and diverse committee structure. To take only one example, many of our committee chairs are early career members. A number of our committees meet more frequently than our BoD and have been highly involved in supporting attendance at the Spring Meetings.

We have assumed all along that having more diversity within the committee structure would lead perforce to more diversity among our elected board members. With few exceptions, this has not happened. We have had many nominees in the past few years who have failed to be elected. There are many reasons for this, chief among them the fact that our members are more likely to vote for “known quantities,” and so early career candidates, in particular, tend to be overlooked. In my opinion, this is more or less inevitable and is certainly not likely to change.

The fact is that our campaigns for office rarely rise to the level of a genuine competition between competing visions for the Division and instead depend upon the more intangible and personal. And one reason for the low turnout is that members tend to vote only for those candidates whom they know personally. One example is that only 270 ballots were cast for Secretary and the two candidates were both early career members. As noted above, 346 ballots were cast for the At-Large positions and the candidates who won were among the better-known members of the Division. Again, this is democracy in action and may reflect as much as anything the ambivalence all our candidates have in politicking. Perhaps we need a Karl Rove to help lesser-known candidates. Then again . .

The BoD has begun to address this issue and to explore to what extent the Nominations and Elections Committee has the power to shape ballots in such a way as to increase the likelihood of more diversity on the BoD. Alternatively, we have considered whether and how to go to our membership with suggested changes to our governance structure. One suggestion would be to add members to the BoD by providing for an early career seat and/or a seat for a member of a racial/cultural/sexual minority. Another possibility would be to restrict one of our at-large seats each year to a “diversity” candidate broadly defined. The way this has worked in other Divisions is that this category is open to a defined category of membership, although members in that category might choose to run for another office as well. Either option would require a bylaws change.

We have been pleased in recent years with an active graduate student presence at out meetings and in our committees. I would suggest that it would be important to have a graduate student presence on our BoD and even more important to allow our graduate students to participate in our elections. This would require a change in our bylaws as well.

Another constituency in the Division consists of our Affiliate Members, those members, mainly psychologists, who join the Division but do not join APA. Our membership last year failed to approve a bylaws change that would allow those members voting rights in the Division. Without revisiting this issue, the fact remains that many colleagues who resigned from APA experience affiliate status in the Division as “second class.” One change that might be considered would be to allow Affiliates to have a representative on the BoD. This would also require a bylaws change.

Another set of ideas and concerns that arose from our recent Board and Committee Retreat has been the increasing absence of psychoanalytic ideas from undergraduate education, so that young psychologists come to graduate school with no background in psychoanalytic ideas, or worse a blinkered and inaccurate view of psychoanalysis as “failed science.” While there are a number of ways to reintroduce psychoanalysis into colleges and universities, and local chapters such as the Arizona Society are doing a great job attracting undergraduate students to informal “clubs” where psychoanalytic ideas are explored, one thing the Division might do is open up our membership to undergraduates.

One of the concerns raised last year during the bylaws debate was the fact that members felt surprised by the actions of the BoD, felt the membership had not been adequately informed and had even been deliberately left out of any meaningful input. I believe we have made an effort through these presidential columns, through InSight, and through the president’s lunch during our Spring Meeting to invite all our members to participate in Division governance, to be informed as fully as possible and to have a forum to discuss their concerns. We are considering developing a new interactive listserv for our members that will also provide a vehicle for member participation. I hope that members will review the concerns and suggestions I have reviewed above and offer their thoughts and opinions, either by commenting on my blog, or writing directly to me at drmacg@comcast.net