Young, Ph.D. - 2007 Annual Letter to the Membership

2007 Annual Letter to the Membership 

February 26, 2007

To current and Prospective Members of the Academy for the Study of the Psychoanalytic Arts,

Once again, on behalf of the Board of the Academy, I would like to take the opportunity to wish each of you a happy new year. May it be a richly satisfying, prosperous, and joyous one for you and those dear to you. 

As many of you know, the Academy for the Study of the Psychoanalytic Arts was founded over a decade ago, in response to powerful social, political, and economic forces that were narrowing the definition and practice of psychoanalytic psychology into those of a "health-care profession." Back in 1995, the founders of the Academy cautioned that ever-increasing regulation and standardization in the health-care industry posed serious threats to the privacy and autonomy necessary for independent practice. It should be obvious, that these threats are not only still in existence, but have increased, and that important encroachments upon independent and privately configured practice, as well as education are very much with us in the present moment.

Given limited resources in terms of financial and human capital, the Board of the Academy has needed to limit its focus on just a few issues that are of concern and relevance to our professional lives. One of these issues, particularly relevant to psychological practitioners in Michigan but very much a specific and local manifestation of larger ideological trends, is the issue of mandatory educational requirements, whether packaged in the form of educational credits, accrued units of "competency," or "continuous professional development" requirements. As many of you know, the Bureau of Health Professionals, the licensing authority for health professionals in Michigan, has now completed its proposal for these requirements, which awaits approval by Governor Granholm. If approved, the final form for these requirements will be determined by the Psychology Licensing Board. The Academy Board has been clear and very vocal in strongly opposing these regulations and, unlike other professional groups, does not see this as a sign of progress for the profession. While we believe that continuing education is an important endeavor, we also believe that it is in the best interest of professionals, consumers and the discipline itself to allow professionals to pursue their education without external stipulation and management by state regulatory agencies.

The Academy Board and its members have made contact with governor Granholm regarding our opposition to these regulations and the governor has taken our concerns seriously. In response to a letter sent to her on behalf of the Academy and its members, Governor Granholm contacted me, expressing her interest in having our group meet with her health care policy advisor, Pamela Yager. Subsequent to this invitation, the Academy organized a meeting of professionals with organizational leadership background (MPA, Division 39, APA, the Academy, and the MSPP), university teaching and administrative experience, and clinical expertise in private practice, hospital, and community mental health settings. Given that the group included as well, an APA accreditation site visitor as well as a past MPA president, it was very evident to Ms. Yager, that while united in our deep concerns about mandatory and state regulated educational requirements for licensed professionals, the group members have been extremely active and committed to promoting ongoing and continuing education for psychologists.

In this meeting, many issues were discussed. One of the central issues, and one quite pertinent to the mission of the Academy is the idea that psychology, while viewed and regulated as an health care profession, is unique in myriad ways and differs importantly from other professions included in the pilot program which are newly licensed and asking for  MCE to regulate themselves and to gain legitimacy. In addition to the expense of this unnecessary regulation, it was also stressed that such regulation is likely to lead ultimately to qualitative changes in practice as well as educational programs, and is likely to contribute to the shrinking diversity of the profession, as such regulations are seized upon by insurance companies, managed care entities, and other regulatory bureaucracies. 

The abovementioned meeting, while not an Academy meeting per se, was organized by the Academy, because it has felt crucial to the Board to bring to the attention of professionals, regulatory agencies and the lay public, issues of concern that greatly affect our profession. One of the important reasons why the Academy is so concerned about the issue of MCE is that judgments as to what will qualify as 'appropriate' educational or competency requirements are necessarily made in concert with whatever ideological perspectives are currently in ascendancy. Presently, the movement toward Evidence Based Practice is quite in vogue. Indeed, we have already been informed by the Director of the Bureau of Health Professions that guidelines for designating such things as competency requirements will derive from current "standards of care" in the profession. These "standards of care, very much derived from the current E.B.T. movement and promoted by third-party payers, are biased toward privileging certain treatment modalities i.e. short term, problem-focused, cognitive-behavioral protocols, as well as certain validating research methodologies (i.e. randomized controlled trials). 

The Academy has been very concerned about the implications and ramifications of this E.B.T. movement, and to this end has been publishing articles on this topic in local and national publications. Additionally, the Academy has given input to the APA Task force on Evidence Based practice. Most recently, last spring, the Academy was represented on a panel for the Division 39 Spring meeting, entitled, EST, EBT, EBPP: What might this alphabet soup spell for psychoanalysis? This panel discussed many of the assumptions behind the movement toward Evidence Based Practice, and the presenters addressed the nature of evidence, varieties of evidence, and the privileging of certain forms of evidence. Implications of these assumptions as they related to practice issues concerning psychoanalysis were also discussed. In an upcoming meeting on March 11 in Ann Arbor, a joint meeting of the Academy and the MSPP will be held, during which these important issues will be further explored. In this presentation, I will be demonstrating the insurmountable difficulties likely to be encountered when the theoretical, philosophical, and clinical assumptions of a psychoanalytic treatment are significantly different from those informing the research methodology used to evaluate such work. Clinical material will also be included, in an effort to demonstrate in a very real way, the threats to psychological practice, if standards based on a narrowly defined EBT continue to be adopted in our professional culture.

The Academy is committed to addressing issues such as this, and will continue to present papers and organize conferences on topics that bear on the ways in which the artistry of psychoanalytic practice is being turned into a technician-like application of standardized procedures. Such practices, importantly, also threaten the privacy and confidentiality of those who consult with us. Myriad examples can be found taking place daily. To mention just one example, in a Wall Street Journal article from December 26 , an article entitled, 'Medical Dilemma: Spread of Records Stirs patient Fears of Privacy Erosion" chronicles the way in which an individual who had confided in a psychologist, ended up being turned down for disability benefits by an insurer who cited information contained in her psychologist's notes. Her therapist, she says, had assured her that records from her sessions would remain confidential, and he himself had no knowledge of his notes being used for this purpose. As the patient states, "I feel like now I have no privacy...My most private thoughts, my personal tragedies, secrets about other people, are mere data of a transaction, like a grocery receipt." Alarmingly, erosions of privacy and confidentiality have become so common that clients can no longer take for granted that the private space in which they reveal their confidences is in any way private.

If you are concerned about what all of this bodes for the future of our profession, we ask that you renew your membership and think about joining us in our efforts to address these issues. It is not uncommon for us to hear from professionals in other countries who share our concerns and who are interested in sharing information about similar trends and grass root efforts in other parts of the world. Here in Michigan, a small group of individuals comprises our Board and we would welcome other participants in planning conferences, working on our website, making outreach efforts to the lay public, and working with other concerned professional groups, locally, nationally, and internationally. In addition to our extensive Website coordinated by Kathleen Nelson, PhD. and our Legal and Professional Issues Committee, headed by Cynthia McLoughlin, Ph.D. we have added a new committee, (Inter) National Issues Committee, headed by Terri Egan, Ph.D. that will be serving to assist the Academy in its awareness of local, national, and international issues pertaining to the mission of rethinking psychoanalysis as being outside of a medical model. Specifically, the committee plans on focusing on issues having to do with confidentiality, continuing education, prescription privileges, and regulatory issues affecting the future of the profession. All of these individuals, along with Kate Hitchcock, Ph.D. Treasurer, Sue Gendein Marshall, Ph.D., Secretary, and Bethann Kalt, Ph.D., Membership Chair, are working hard to sustain our organization in a climate that makes such work difficult, and their efforts are greatly appreciated. We also deeply appreciate the ongoing support of MSPP.

 If you are not yet a member of the Academy and are concerned about any of the issues I have spoken to in this letter, please consider joining us at this time. And to those of you who are renewing your membership, thank you for helping to keep our organization alive. The work that we do is precious to us and to the individuals with whom we work. It is worth fighting for.

With my warm regards,
Linda J. Young, PhD --- President of the Academy for the Study of the Psychoanalytic Arts