Psychoanalytic Psychology and the APA--Part 2

Psychoanalysts in the News

Hedda Bolgar, recent recipient of the Division 39 Leadership Award, has been honored once again, this time for her further contributions late in life with the Outstanding Oldest Worker Award from Washington DC-based organization Experience Counts. Dr. Bolgar remains, at the age of 102, active, engaged and fascinating. Profiled recently in the LATimes, reporter Steve Lopez described her as having a “healthy cynicism and unflagging energy.” She continues to work and teach at the Wright Institute, an organization she co-founded many years ago. I hope she remains a vital presence in the Division for many more years. To read the article, go to www.latimes.com/news/local/la-me-1002-lopez-bolgar-20111002,0,5869414.column

And While We are at It

Belated birthday wishes to Sylvia Brody, who turned a mere 98 years of age this month. Dr. Brody, psychologist, psychoanalyst, and developmental researcher, came to prominence with her books documenting her observational, clinical, and theoretical studies on maternal behavior and child development. Among her contributions were Patterns of Mothering (1950), Anxiety and Ego Formation in Infancy (1970), Mothers, Fathers, and Children: Explorations in the Formation of Character in the First Seven Years (1978) and the follow-up study of the sample at eighteen years, Evolution of Character (1992). In 2002, Dr. Brody published The Development of Anorexia Nervosa; a second edition came out in 2007. Her latest book is Beginning to Grow: Five Studies published by International Psychoanalytic Books.

The DSM-V and the ICD-9

There is continuing controversy concerning the development of the revision of the DSM. The APA has been following these developments, although you should be aware that the DSM is a wholly owned subsidiary of the American Psychiatric Association and it is this organization that will decide how and when the revision is published. At a recent discussion during the APA Convention, Ken Levy noted that the Axis II Diagnoses have aroused some controversy and criticism, although in general he felt there was sufficient recognition of the psychodynamic perspective that we could live with this section.

The leadership of Division 32 (Humanistic Psychology) has recently circulated an initiative requesting Divisions to sign an open letter to the DSM Committee to address the problems that may arise if the revisions go forward. In part the letter reads:

“We are concerned about the lowering of diagnostic thresholds for multiple disorder categories, about the introduction of disorders that may lead to inappropriate medical treatment of vulnerable populations, and about specific proposals that appear to lack empirical grounding. In addition, we question proposed changes to the definition(s) of mental disorder that deemphasize sociocultural variation while placing more emphasis on biological theory.”

Division 32 is asking psychologists and others to sign onto this letter and join the British Psychological Society and the American Counseling Association in raising these concerns. The Practice Directorate and APA Board have been promoting the idea of actually replacing the DSM with the new ICD-9, but it is uncertain what impact this would have as long as the DSM reigns supreme in its original purpose to support psychiatrist reimbursement from insurance companies. To read the petition, go to http://www.ipetitions.com/petition/dsm5/ and decide whether or not to support this campaign.

Corporations and Not People

Psychologists for Social Responsibility (PsySR) is an independent organization composed of psychologists concerned with social justice issues. Although not formally affiliated with APA, it works closely with other APA Divisions. It has sent around a position statement on corporations and would like psychologists to review this document, which begins:

”In recent years, a groundswell of movement in diverse areas has brought critical attention to the notion of corporate personhood, which bestows upon for-profit corporations the same protections afforded to real people. Psychologists for Social Responsibility (PsySR) believes that corporations deserve legal protections, but only as artificial entities—the original designation for corporations, prior to being deemed “persons” by the nation’s courts. PsySR therefore stands alongside the growing number of voices calling for broader action against corporate personhood.”

Go to http://www.psysr.org/corporate-personhood to review the entire document.

On a More Horrific Note

International psychoanalytic organizations and others are trying to raise concerns about a Syrian psychoanalyst, Rafah Nached, currently being held in solitary confinement in a women’s prison in Damascus. Jacques-Alain Miller of the Association Mondiale de Psychanalyse in Paris, established the Free Rafah Nached campaign to call attention to her plight. She appears to have been arrested solely due to her work as a psychoanalyst. The petition (in French, I couldn’t on in English; but it is easy to figure out) is http://www.oedipe.org/phpPetitions/index.php?petition=3

Let’s End on Some Good News

This from Nina Levitt, EdD, Associate Director of the Education Directorate: We want to share some good news with you regarding funding for the Graduate Psychology Education (GPE) Program and the Garrett Lee Smith Memorial Act (GLSMA) Campus Suicide Prevention Program. While work on Fiscal Year 2012 appropriations is far from over in terms of determining the final appropriations levels for these programs and others, positive advancements have been made.

As some of you already know, one of our Champions, Senator Jack Reed (D-RI), pushed very hard on behalf of the GPE Program during this appropriations FY 2012 cycle. Not only was he able to protect the program at its currently funded level ($2.927 million), he also personally requested that very strong Report Language be included in support of the program. More specifically, language was included in the Senate Labor, Health and Human Services, Education and Related Agencies (Labor-HHS) Appropriations Subcommittee report to reinstate the geropsychology component, initiate a focus on veterans and help integrate health service psychology trainees at Federally Qualified Health Centers to provide mental and behavioral health services to underserved populations.

Regarding the GLSMA FY 2012 funding, the Campus Suicide Prevention Program received nearly $5 million in funds from the Senate Labor-HHS Appropriations Subcommittee and, in addition, will receive $10 million from the Prevention and Public Health fund. This, too, was largely the work of Senator Reed. These competitive funds, administered by the Substance Abuse and Mental Health Services Administration, are available to centers on college campuses that provide mental and behavioral health services.

On a related note, Senators Jack Reed, Lisa Murkowski (R-AK), Dick Durbin (D-IL) and Tom Udall (D-NM) introduced a strong reauthorization bill for the Garrett Lee Smith Memorial Act programs (S.740), championing both the authority and the funding for the programs, especially the Campus Suicide Prevention Program. To date, there are a number of additional co-sponsors.

Psychoanalytic Psychology and the APA: Part I

Psychoanalysis has had a curious relationship within American psychology and the APA in particular for over a century. As is well-known, J. B. Watson saw psychoanalytic ideas largely as a challenge to be met and defeated in advancing a strictly behaviorist approach to understanding people; but that is not the whole story. Clark Hull, John Dollard and Neal Miller, among others, viewed psychoanalysis as largely compatible with learning theory and sought to integrate Freudian concepts into their work . B.F. Skinner, and following him the radical behaviorists, were attracted to many aspects of a psychoanalytic approach and reportedly Skinner applied to the Boston Psychoanalytic Institute for training but was turned down.  So much for the spirit of inclusion within American Psychoanalysis!

Despite these important connections (and a review of former presidents also suggests that psychoanalytic psychologists have played a prominent role in the APA), it seems fair to say that psychoanalytic theory, therapy, and research have been consistently marginalized over the years within the APA and American psychology generally, never more so now than before. While many of the criticisms leveled against psychoanalysis have accurately noted the absence of rigorous, controlled studies demonstrating the efficacy of psychoanalytic therapy, this has actually changed quite a lot in recent years and there have been numerous studies and meta-analyses demonstrating that psychoanalytic therapy works, and in many ways works better that other approaches (e.g., more qualitative improvement, more sustained improvement, more emotional growth following completion of treatment, and so on. Despite this, the dismissal of psychoanalytic treatment has continued apace and increasingly reveals the ideological biases within American psychology. See Jonathan Shedler’s article, “Science or Ideology”  for a clear exposition of what psychoanalytic researchers must face. While increasingly demonstrating that psychodynamic researchers can “play the game” and use RCTs and other presumably “gold standard” procedures, Shedler concludes that the ideology of those committed to CBT trumps any fair evaluation of the results obtained.

The animus within the hierarchy of American psychology has been expanded beyond psychoanalytic treatment to encompass all of psychotherapy. Only recently a former president of APA, Alan Kazdin, was quoted in Time disparaging individual psychotherapy as largely unhelpful and psychotherapists as unskilled to deliver “evidence based treatments.”  His comments largely echo the position of the Association for Psychological Science  as well, which has recently proposed taking over the APA’s role in accrediting clinical programs due to the presumed incompetence of psychotherapists currently trained under APA guidelines. I need not comment further on the Kazdin article, since Jared DeFife’s blog in Psychology Today “Is This the End of Individual Psychotherapy?”   covers that ground, except to note that once again the critics of psychotherapy feel no need to provide the evidence basis for their observations.

It will not come as a surprise to you that the APA and the Practice Directorate have been less than helpful in addressing these ongoing and expanded assaults against psychotherapy. Wedded in recent years to the new mantra of “integrated health care,” the idea that individual and family psychotherapy focusing on developing trust and sustained commitment to change within a context of privacy almost certainly cannot be delivered in the hot house of an outpatient clinic. Literally advocates tout that access to psychotherapy will be as easy as sending the patient “down the hall” after being seen by the “real” doctor, scheduled as just another stop along the way to, say, the nutritionist. Efforts to address this fundamental incompatibility of this model (however useful in some contexts, with some patient populations) is simply ignored in favor of this one-size-fits-all approach with the patronizing insistence that we psychotherapists need to catch the “second wave,” forgetting that tsunamis are best dealt with by running as fast as you can in the other direction.

So on this cheery note, I want to emphasize that there are things that you can do. While the Division Board and other leaders in the Division have taken active steps in many ways, it is also up to you as individuals to make your needs and ideas known to APA leadership, to your colleagues, and to the general public. The following are some ways to get active.

Have You Voted for APA President Elect?

Time is running out on the APA President-Elect elections, ending November 1. Please consider the Division Board’s recommendation to endorse Steven Reisner and Doug Haldeman equally. We encourage you to vote for both Haldeman and Reisner, listing them as your first or second choice. Regardless, we need you to vote.

Will You Vote for Division 39 Representation for APA Council on the Upcoming Apportionment Ballot?

On November 1 the APA Apportionment ballots will be sent to all Members and Associates. You are entitled to give ten votes to any Division or SPTA  of your choice. I urge you to give all ten votes to Division 39 to retain our six APA Council seats and perhaps win back our 7th seat that we lost last year. Every vote counts, and for the last three years, only about 1/3rd of our members have given us one or more votes. If every member votes, we will surely retain the largest divisional representation on APA Council.

Division Board Members and other volunteers will be calling every voting member the week of November 1 to remind you to vote; and we hope to be able to talk to you then about the Division and its goals. If not, please send your thoughts and comments to us, either by writing Ruth Helein, our administrator at div39@namgmt.com or me at drmacg@comcast.net

Take Part in a Survey of Experience With Mental Health Parity Law Implementation

APA's Division 42 (Psychologists in Independent Practice) Advocacy Committee is conducting a survey on psychologists' early experiences with the implementation of mental health parity around the country. We would greatly appreciate your informing your constituents and members about the availability of this survey. The deadline for taking the survey is December 4th. The data will be tallied and reported to the Division 42 Board of Directors after which time it will be reported on the Division's website at Division42.org and distributed to other interested parties and entities.

Go to https://www.surveymonkey.com/s/Div42MHParity. Your participation will provide valuable information to assist with our future advocacy activities.

Make Your Views Known on the Ethics Casebook

The Ethics Committee has posted a series of questions to guide psychologists in making ethical decisions when working with detainees. The casebook has been “in the works” for years and was initially based upon the PENS Report that held that psychologists should be able to work ethically in detention settings and to assist in interrogations. Since this policy has been superceded by the referendum passed by APA membership and subsequent action of APA Council, the Casebook questions (and answers) need to be reviewed and revised. Initially, the review process was to be concluded this month, but has been extended into next year, following strong protests from our members and others.

There are many in the Division who find the entire enterprise confounded by the failure of APA to clearly articulate the actual policy psychologists are to follow and see the Casebook as another way to avoid this articulation. Given the actual question and answers in the current Casebook, this view seems warranted in that there are references to the PENS Report as sanctioning psychologist involvement in interrogations and statements that appear to leave it up to the psychologist to determine whether or not detainees are being held illegally and to determine whether or not a particular procedure constitutes torture. These and other comments in the Casebook appear to completely undermine current APA policy in favor of a return to the PENS policy that if a psychologist thinks what he is doing is ethical then it is ethical.

I believe it is a fair assumption that many in APA leadership simply want the controversy over the PENS report and other evidence of APA support for psychologist involvement in interrogations to “go away.” There was palpable relief when APA Council voted to accept the results of the referendum and Laurie Wagner and others who had worked so tirelessly to address the interrogations issue were given a standing ovation. At the same time, there has been little evidence that APA leadership has taken active steps to make clear that we are under a new policy that supplants the PENS report and which stands in direct contradiction in important respects from this report. As members you will have the most impact if you directly address the issues raised by the Ethics Casebook.

Please go to http://www.apa.org/monitor/dec07/ethics.aspx to review the Ethics Casebook and provide your comments. It is vital that members contribute to this process. While written before the Ethics Committee agreed to extend the comment period, go to http://dissenter.firedoglake.com/2011/08/24/apa-casebook-on-psychologist-ethics-and-interrogations-fails-to-convince/ for an excellent review of the issues involved. Please keep in mind that APA is a democratic organization and it takes the weight of numbers and clear opinions to get the attention of APA leaders.

Information Item: A Call for Annulment of the PENS Report

The Coalition for an Ethical Psychology is spearheading a call for annulment of the American Psychological Association’s deeply flawed 2005 Presidential Task Force Report on Psychological Ethics and National Security (PENS). The key conclusion of the PENS Report, despite clear evidence to the contrary, is that psychologists play a critical role in keeping national security detainee interrogations “safe, legal, ethical and effective.” The PENS Report continues to be used as an authoritative document today, especially in national security contexts. Leading human rights groups and professionals from a range of fields, including psychology, medicine, law, military, and intelligence, have therefore joined together in this important annulment effort. A background statement with detailed documentation is available online at www.ethicalpsychology.org/PENS_Annulment_Background_Statement.pdf

Final Comments

While many of our members support this petition, it is also important that we work within APA governance structure on a sustained and continuing basis to address this and other issues of importance to us. The best examples of this are the successful efforts (however mixed the results) that led to the current APA policy that psychologists should not be involved in interrogation of illegally held detainees under any circumstances and the change in the ethics code to make clear that psychologists following valid orders are still obligated to avoid any action that violates basic human rights.

These efforts were certainly championed by members outside the governance structure, but beginning with Neil Altman’s original motion places before APA Council, many Council members worked to keep the issue alive and brought it to the vote alluded to above. Even the referendum was an extremely clever way to work within the governance structure, to find the means within the bylaws to bring about change through direct appeal to the membership.

I hope that I will have more to report on this after our Executive Committee Meeting in November and in particular our efforts to engage other Divisions and other APA Council representatives to address both the flaws in the Ethics Casebook and the continued reliance on the PENS report within the Department of Defense.

To comment on this column or any other aspect of Division 39, please do so on my blog www.chimneysweeping2.blogspot.com