The Analytic Observer
Newsletter of the Chicago Psychoanalytic Society
VOLUME 6, NUMBER 4
December 1998
Contents
The President's Page by Henry Evans, MD
Confidentiality by Jerome Beigler, MD
PR
Remarks by Mark Smaller, Ph.D.
Coming Events!
Editor: Richard
I. Herron, MD
Assistant Editor:
Phil S. Lebovitz, MD
Assistants to
the Editors: Ms. Lucy Wrobel, Ms. Eva Sandberg
(c)1998 The
Chicago Psychoanalytic Society
President's Message by
Henry Evans, MD
I hope the holiday season
just past has been a rewarding one for you and yours. As we begin this
last year of the millennium we face much upheaval and uncertainty on the
national political level. The impacts of this process are already
reverberating locally and personally. I suspect many of you have been
approached by friends, family and/or neighbors for your views on this
turbulent time. As analysts we can bring potentially helpful
perspectives on such issues as the psychology of leadership,
disillusionment with leaders, factors which can contribute to abuse of
power, et cetera. If you feel your thoughts on some aspect of this
crisis could be of help to others, I encourage you to contact Dottie
Jeffries (312/938-1969). As our Public Relations expert, she can help
determine whether your ideas could usefully be brought to the attention
of one of her media contacts. In keeping with this theme of representing
psychoanalytic views, I also urge you to consider how you can become
active on one or another committee of the American. Increasing our
representation automatically increases dialog with analysts from other
parts of the country, giving opportunities for individual Societies to
benefit from one another. If you are interested, please contact me, our
Councilor Mark Levey, or Bob Gordon, our Alternate.
Locally, we have been and
continue to be busy with agendas for our membership. The vote concerning
establishment of a Psychoanalyst Assistance Committee passed by a large
margin, making it a new Standing Committee of the Society. We will be
making all efforts to insure that any member-related concerns brought to
the attention of this committee will be handled in a careful, thoughtful
manner aiming first to be of assistance to that member.
You have probably heard
discussion concerning establishment of "professional wills" by our
members. In such a will, each Society member would be asked to specify
one or more individuals who would be available to help family, patients
and colleagues when a member becomes incapable of carrying on the
responsibilities of his or her practice, or dies. In the midst of
inevitably difficult circumstances, a professional will would be of
significant help to all concerned. An article in TAP has enumerated many
points that can usefully be included in such a will. The Executive
Committee has discussed this proposal and is unanimously in support of
establishing a policy for our members, using the article as a model. You
will receive a copy of the TAP proposal in the near future for your
study. We plan to invite discussion of this proposal at our Business
Meeting in April and to submit some form of it for a vote as soon
thereafter as feasible.
In another agenda, the
Executive Committee has voted to consider creation of an Association for
Psychoanalytic Thought. This is a program developing under the auspices
of The American and created through efforts from local Societies.
Membership is generally open to a large variety of individuals
interested in psychoanalytic ideas and in applying those ideas to their
own fields. Master's level clinicians, educators, lawyers, religious
leaders, psychiatric nurses, et cetera have been among the members in
other locations. Existing APT organizations have drawn up to a few
hundred members in individual cities. These are typically freestanding
organizations which develop their own programs and sources of funding.
In some locations the members have been granted a special category of
nonvoting membership in a local Society. In several locations some
Society members participate in the APT programs. Societies and
Institutes have benefited from the existence of APTs. APT members have
generally been enthusiastic about analytic practitioners and educational
programs. They have generated increased requests for supervision,
treatment, and applications for participation in educational programs,
including analytic training in some cases. We are gathering information
about this program and will keep you informed.
After further discussion in
the November Business Meeting and in the Executive Committee, we have
also decided to change the Society Matinees program. The programs held
so far have only been usable by a limited segment of our members. My
requests for new program ideas have brought suggestions which will
likely appeal to the group already being served. Since the program was
intended to draw wide participation from within our membership we have
deemed it unfair for the Society to pay for programs enjoyed largely by
one segment of our members. The Matinees program can continue if those
attending are willing to split the cost of light food and beverages,
probably amounting to $10-15/person. We already have music and opera
programs in the wings for such gatherings.
We are also proposing a
series of small dinner gatherings to be held at the homes of Society
members in the city and suburbs. We are looking for ways to advance
relationships among Society members, in the interest of increasing
cohesiveness in our organization. The dinners would be hosted by one or
two members who, together with any partners, would invite a few/several
other Society members and any partners of different ages from a list of
those who have voiced interest in participating in this program. The
dinners might well be done potluck. I will be sending a questionnaire
concerning this agenda in the near future.
Confidentiality by Jerome Beigler, MD
Editor's note: This article
first appeared on the American Psychoanalytic Association's Bulletin
Board as a response to the numerous postings regarding the issue of
confidentiality. The discussions were an outgrowth of the Monica
Lewinsky affair. This is an edited version of the original posting.
I first want to acknowledge
Paul Mosher for his incredible energy and devotion to educating us
further to the importance of confidentiality as a prerequisite to the
effectiveness of our profession (and, also, incidentally to the survival
of our Democracy). I wanted to call everyone's attention to a recent
court decision entitled Jaffe, Redmond and Hawaii P.S. v. Ariyoshi. This
ruling, by the U.S. Supreme Court established by a 7-2 majority, states
that society must provide a circumstance in which injured or ill
citizens have access to appropriate treatment. If the treatment is
psychotherapy, absolute confidentiality is a pre-requisite. This
decision helps all of us to actively assert our ability to maintain
confidentiality in the face of strong opposing views and already has
been supported by a ruling in the District of Columbia. It emphasizes
the psychiatrist's responsibility to protect the confidentiality of his
records from incursions (as from Medicaid). For example, there is
currently a campaign from "so called" researchers to obtain APA's (The
American Psychiatric Association) approval for unimpaired access to
identifiable clinical records, all of which would be computerized and
thus automatically exposed to public accessibility. Paul Mosher says
"this can erode the need for strict privacy." One should call their APA
representative, APA Trustee, APA President, Vice President or
Trustee-at-Large to voice our opinion.
I also want to comment upon
an often heard remark that "The privilege of confidentiality belongs to
the patient." In 49 of our States, it is true the privilege belongs only
to the patient. But, in the state of Illinois, our statute for over 30
years provides for a supra-ordinate privilege to the therapist when it
is exercised "on behalf of and in the interest of the patient." This
statute was enacted to protect the unauthorized disclosures by the
patient of events of treatment, thereby providing the therapists with
the privacy to become optimally therapeutic. The law also enables the
therapist to over-ride a patient's uninformed permission for the release
of information the patient either doesn't remember or whose significance
is not understood. Often a patient will agree to disclosure without
realizing the entire record will be released. There have been cases in
the past in which the therapist's privilege has enabled interventions to
their patient's benefit. The law does not impair the patients' right for
legal redress when it is appropriate while placing a sense of equal
responsibility to maintain professional confidentiality.
We have a great profession
and a great cause. Let's do what we can. There is a word of good news:
At the September meeting of the Managed-care Association in Chicago,
their president, who originated the system and is revered by its
members, announced that managed care has succeeded in alienating the
public and that there are thousands of legal cases all over the country
suing managed care entities. This illustrates the effectiveness of
individual attention. The American Psychiatric Association has been
active at the grass-roots level in promulgating these cases. We don't
know what system will succeed managed care, but we must learn to be
active, learn where the channels of power are and how to influence them.
WHY A PSYCHOANALYTIC FOUNDATION?
The Institute for
Psychoanalysis in Chicago is one of the oldest, largest, and best known
Institutes in the country. Known for its innovations in the advancement
of psychoanalytic treatment and theory, education of candidates,
training programs for therapists, and adult and child clinical services,
our Institute has been a model for many younger Institutes across the
country. In recent years we have developed better community and public
relations, and therefore are on the verge of finally being what we
should have been years ago: friendly, usable, and available. Our
Institute is finally to be trusted again by the community, by potential
mental health professionals seeking our training, by potential patients
seeking our clinical services and by potential donors interested in
contributing to psychoanalytically informed programs that help people in
the community. Yet, with all that we have finally accomplished, we are
having problems-- serious problems in the areas of development, internal
tensions, and following through in making known to the public who we
really are, and what our cause or mission is.
In the area of development,
we have a Board made up of thoughtful, successful, and creative people
who are committed to psychoanalysis. Yet something interferes with our
motivation and ability to raise money, convincing our friends, and
others in the community to contribute to our cause. But, what is our
cause? What is our mission, individually and as a Board? Why is it that
we cannot raise money for our programs that benefit the community and
the advancement of psychoanalysis?
We have one of the most
creative psychoanalytic faculties in the country. Members of our past
and current faculties have made some of the most significant clinical
and theoretical contributions in the history of psychoanalysis. Sadly,
these days, if we are all in a room together, the tension, if converted
to electricity, could light up the city for weeks. What is that tension
about? What is the Institute's cause? What is the Institutes mission? We
have reporters from the media who are hungry for what we have to say,
mental health professionals starving for psychoanalytic knowledge, and
cultural institutions which, once opportunities are created to offer
psychoanalytic ideas, value our thoughtfulness about art, literature,
film, and music. Our clinic has created affordable opportunities for
adults and children to be treated and move on toward symptom free and
productive lives. Yet, we have faculty members, candidates, graduates of
our programs, who themselves publicly and privately devalue what we do.
How many of our recent graduates and alumni contribute to our annual
campaign? We must ask, again, what is our cause? What is our mission?
We live in one of the most
racially and ethnically diverse cities in the world. Have we ever had a
program at the DuSable Museum on the South Side? Have we ever had a film
program in a South Asian, or Arab/Chaldean community? How many minority
candidates have graduated from our Institute since we opened our doors
in 1932? Three? Four? How many African American patients, South Asian,
or Hispanic patients utilize our clinic services? How many know about
them?
Creating a Psychoanalytic
Foundation WILL NOT solve these problems. But, it could begin to address
some of the serious problems we are having and create an atmosphere
fostering an entire attitudinal change needed here at our Institute and
Society. When a small group of analysts and community people met to form
the Michigan Psychoanalytic Foundation back in 1987, the goal was to
create an organization that would provide financial support for the
educational, clinical and research programs of the Michigan Institute.
The Foundation would be responsible for increasing the community's
awareness and appreciation of psychoanalysis. When a similar group met
in San Francisco six years ago, the goal was to form a foundation that
would have the triadic purpose of Public Service, Public Information,
and Fundraising. By isolating the San Francisco Institute and Society's
assets (endowment and segregated funds) from liability generating
operations of the Institute's and putting those funds into a foundation,
this money would be used only for the advancement of psychoanalysis and
psychoanalytic ideas in the Bay Area. All teaching, training, treatment
and clinic, and extension division activities would remain under the
auspices of the Institute and its Board, while the Foundation would have
its own board. In other words, the training of analysts, the central
mission of every Institute in the country becomes separate from the
fundraising, outreach programs and the advancement of psychoanalysis in
the community. Currently, in Los Angeles, three and possibly four
institutes are meeting to see if they can form one foundation rather
than forming separate ones, with the goal of advancing psychoanalysis in
the community. Each institute will benefit.
The most exciting aspect of
a foundation is that community members of the board of the foundation
are in charge of activities that most analysts have little interest or
time in pursuing. However, this does not suggest that all analysts are
not involved. In Michigan, analysts, on the average, donate ten hours a
week toward Foundation activities and programs. Ten hours per week--it's
expected. But then, the Michigan Psychoanalytic Institute has one of the
most successful programs in the country, with a community being served
by psychoanalytic treatment and programs, and an institute with large
classes of candidates, and analysts with full psychoanalytic practices!
To create a Foundation here
in Chicago would be revolutionary for the Institute. Aside from the
practical aspects of what would need to be done to change to new
organizational structures, it would mean creating a whole new attitude.
If we value psychoanalysis, if we are committed to its future, we must
come to recognize how connected we must be to the community, through our
clinic, our programs and our expertise. We must invite the community and
other experts to share their expertise in order for us to learn and
advance our cause.
I call this "the new
psychoanalysis," psychoanalysis that advances by its usefulness to all
individuals regardless of race and socioeconomic levels. The new
psychoanalysis is one that can be applied to serious social problems in
our community; violence, the problems of children and families, and
disappointment with leadership. The new psychoanalysis advances
theoretically and clinically from these applications. Ironically, this
is not new in the history of our psychoanalytic cause. Freud was always
interested and committed to the application of psychoanalysis to the
problems of the world. His writings on leaders, war, education related
to child development, and his ideas about art and literature, are some
of his finest. Without a commitment to this new attitude we will be
stuck in psychoanalysis of the past and our survival as a profession and
Institute will remain uncertain.
Creating a Foundation would
allow the Institute to get back on course and focus on its mission: to
train analysts and others in psychoanalytic treatment. Public relations,
outreach, and fundraising would be the responsibility, cause and mission
of the Foundation and its Board. Contributors in the community do not
want to contribute to the training of analysts who are charging $150 an
hour. People WILL contribute; psychoanalysts WILL contribute, knowing
that funds go for a low fee clinic for children and adults, and
meaningful outreach programs that speak to critical social issues.
I am not reporting anything
new. We have discussed these issues over and over again in our Board and
Faculty meetings. I am suggesting a concrete way to achieve our goals, a
new means to take us where we need to go, where other Institutes have
gone and with great success. We have the leadership-- on the Board, in
our new Director, our Society President, on our Faculty, and among our
Candidates.
Therefore, I am
recommending to the Board that a committee be formed to study this issue
of a psychoanalytic foundation, and report back to the Board in the
early spring and make a recommendation about the feasibility of such a
change. I believe that the Chicago Psychoanalytic Foundation is the way
of our future.
Coming Events!
Chicago Psychoanalytic
Society Evening Meetings
OPEN TO ALL MEMBERS OF THE
COMMUNITY
February 23, 1999
Arnold Wilson, M.D.
Kindling a Passion for
Analysis: Analytic Preparation and the Opening Phase
Discussant: Barbara Rocah,
M.D.
March
Regional Meeting
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