The impact of a unified voice:
The world hears too little from us. Important APsaA efforts continue in government advocacy in Washington, with the Veterans Administration, and in specific position statements on social issues. But these efforts seem free-standing or isolated. As an organization, we have a fragmented, echoing, often insecure “voice”. We need a strong psychoanalytic voice that participates actively in conversations about the human mind, social issues and mental health policy. Informed by a common mission (not necessarily a common theory), our participation in those arenas will be unified and therefore more powerful.
Our public relations:
Plans are afoot to improve our APsaA website, to engage social media effectively, and to access and engage the press effectively. We have developed practice toolkits but have not adequately used them. We need media and public relations toolkits for regional use and subspecialty use. I will make sure the promise gets fulfilled and pursue effective evaluation of the success of PR efforts.
Many members would benefit from orientation to the task of public speaking and instruction on effective presentation of psychoanalytic points of view. The small but important detail of identifying oneself as a psychoanalyst whenever speaking publicly becomes a big speedbump when one is insecure about the nature of the task and the best method of approaching it.
Our place in mental health:
Our public actions related to privacy have been dogged and successful, but there are other mental health policy areas that need our input. For example, we seem to deplore the absence of psychoanalytic input into diagnostic manuals. We need to determine why it isn’t happening and fix it.
Internally, our Association made the new insurance codes available, but for a short while. It is hard to find reliable, updated guidance on our website. Sometimes members ask each other for help on the listserv. While that is always an option, important information is easy to miss and unavailable at the moment it’s needed.
I propose we require a place at the table in discussions that define categories of mental illness and mechanisms of treatment. We are likely to be most effective by joining the Consortium’s necessary participation in the setting of mental health policy. We have data to support the effectiveness of long term psychodynamic treatment (see for example: Leichsenring F, Rabung S. 2008. JAMA 13: 1551-165; Schedler J. 2010. Am Psychol. 65:98-109). We need to use the data that underline the relevance of our contributions.
I agree with recent calls for development of an official set of indications (i.e., a list of applicable diagnoses) and endorsed treatment parameters for psychoanalytic treatment. This would be part of an important APsaA tradition that has become dormant – the promulgation of practice guidelines. The last practice guidelines written and approved by APsaA is over five years old. We need to establish a structure that can regularly review and update guidelines we already have in place as well as create/recommend new ones as our knowledge and skills advance.
These are the areas I want us to pursue:
- Definition of diagnostic categories and criteria for psychoanalytic treatment
- Broad relevance of psychologically informed treatments
- Integration of neuroscientific advances with understanding of mind and behavior
- Insurance corruption of professional decision-making
- Psychoanalytic understanding and treatment of severe mental illness
Our place in academia:
Though we have worked for a long time to make links to the academic world through programs such as CORST and the Committee on Psychoanalysis and the Academy, much more needs to be done in this arena. Several psychoanalysts have observed that the conceptual framework that informs many academics who profess an interest in psychoanalysis is based on the Freud of 1920, not on his later thinking and certainly not on modern psychoanalytic theory.
Psychoanalysts need to engage in conversation with academics, say what they know and realize they know a lot more than non-analysts about the theories that inform their clinical work and modern understandings of human behavior and mind. At the same time, we need to be humble enough to know there is a great deal we can learn about our work from experts in other fields.