Power and Authority in Institute Life
Let me begin by telling you about my background in dealing with authority in educational settings. I have been a Director of a psychiatric residency training program (6 years), a Dean and EC Chair of a psychoanalytic institute (5 years), and a Trustee of a college (9 years).
I’d like to take a moment to describe my observations and my reaction to the educational milieu when I returned to my college as a Trustee 31 years after I graduated. During my undergraduate years, Wagner College was a very traditional and conservative institution. At one time it had been affiliated with the Lutheran Church. Instruction occurred in typical classroom settings, utilizing formal lectures and standard textbooks and other readings. Upon my return in 1999 I found a world of change. Wagner had adopted a “Learning Community” (LC) model for a good portion of its instruction. LC’s include a cluster of courses linked by a single theme and taken by the same students. The LC’s were joined by a reflexive tutorial (RFT) where emphasis is placed on experiential learning in “real world” internship like settings. Writing skills and teamwork were essential RFT elements.
In the world of most psychoanalytic institutes, there probably is not such a contrast between learning today and the way it occurred in 1968. Indeed one could probably trace long term stability in the nature of psychoanalytic education back to the 1920’s with the introduction and development of the Eitingon model. While I think much of the tripartite model is extraordinarily valuable, I also think it highly probable that most educators would find our persistent adherence to one educational approach remarkable. While LC’s and RFT’s may or may not be a useful model for psychoanalytic education, I believe our slowness, perhaps even our inability, to innovate is highly problematic and stifling. As I’ve mentioned in other settings, our psychoanalytic educational programs are running the risk of becoming museums and not incubators of new ideas.
I would hardly be alone in seeing the concept of authority as a culprit in this stasis. There are many diverse key values that are part of an educational process, such as: respect for learning, capacity for innovation, development of new ideas, acquisition of skills, development of professionalism, understanding the value of influence and being influenced to name just a few. Authority does have a role, and an important one at that, in the educational process but it can also stifle, with deadly efficiency at times. We have not been particularly effective at balancing our use of authority or finding its best uses in psychoanalytic education.
Looking over Webster’s I found 8 different uses for the word “authority”, each with a nuanced difference. The meaning for authority I found most problematic for purposes of this discussion, and unfortunately one which I think we utilize too much in psychoanalytic education, perhaps not always knowingly, but at least at some times quite knowingly, is the idea of “a power to require and receive submissiveness”.
While most of us would no doubt not want to see this aspect of authority as having a major role in institute life there is in fact a legitimate place for this concept of authority, and one which is quite problematic for many of us. I am referring to those instances where we need to deal with issues of candidates or colleagues not conforming to various educational or professional requirements and even some extremely serious cases which would require sanctions, disciplinary action, etc. such as cases involving boundary violations, ethical lapses, etc. These are important responsibilities in institute life and areas where we need to exercise this form of authority. Yet it is often difficult for us to adequately discharge our responsibilities regarding these uses. In more serious situations, it can be almost impossible to find colleagues willing to serve on appropriate committees. It does strongly suggest, especially when paired with other difficulties we have with the exercise of authority, that there may be something problematic for many of us when put in positions where we need to exercise authority. While I think that these problems are also endemic to other professional endeavors, I do sense that the exercise of this form of authority may be particularly difficult for many of us as analysts. I am sure many of you will also recognize how hard it is to get faculty members to write “honest” evaluations on our candidates, either for the classroom or for the supervisory setting, and how it can be very hard to accept responsibility for managing candidates’ progression. All of us are no doubt aware of the more than occasional “compassionate graduations”. Yet if we are to be taken seriously as a profession, it is necessary that we be capable of exercising this form of authority.
We do not however, need to use this component of authority for issues concerned with transmission of knowledge and development of new ideas. We have gotten ourselves into a lot of difficulty when we have. There are many situations where we have brought the “power to require and receive submissiveness” component of authority into our educational processes as opposed to our regulatory processes. Many of our positions concerning requirements for admission, graduation, membership, and TA advancement, all of which may be considered under the rubric of “standards” are prime examples. So often, especially in APsaA Institutes, these are taken as “givens” and not considered as subject to negotiation or open review, discussion and objective consideration. This also creates a general ambience which can be stifling of innovation and creativity in our teaching. My own belief is that our “new” candidates, who are far more likely to represent women, gays, psychologists, social workers, other mental health professionals, and academics, are much less likely to accept the handing down of this form of non-challengeable authority than our traditional candidates have historically been. Missing from this list of new candidates, in my experience, are significant numbers of ethnic and racially diverse groups which should represent a new priority for us. I believe our increasing difficulties, especially in some APsaA Institutes, in recruiting new candidates derives from a sense by potential applicants of the presence of such a stifling environment, i.e. a museum, not an incubator.
A final element of authority, which is constructive, comes from two additional ideas in Webster’s, notably the concept of “justifying grounds” or “convincing force”. For psychoanalysis to be credible as a school of thought and as a healing art, there must be such a justifying, convincing perception or belief about what we do. This cannot be gained by decree, as I believe we have often tried historically, with spectacular lack of success. Rather it can be accomplished only by the transparent, open discussion of our ideas and a willingness to have all of them examined in the crucible of public review.
Perhaps at some future time, a senior psychoanalytic graduate will return to his/her institute of origin and be pleasantly surprised by the flowering of new forms for learning.
Warren R. Procci, Candidate for President-Elect, APsaA
Tuesday, December 4, 2007
Monday, November 26, 2007
It Is a Pleasure to Welcome You to My Website!
It is a great honor and privilege to be a candidate for President-Elect of our Association, and I appreciate your taking the time to visit this site. Here you will find all of my campaign postings to the openlist and the electionlist as well as the regular mail letters I sent to each member of APsaA. I have highlighted here my positions on ten very important issues about bringing psychoanalysis into an even more rewarding future.
It is a great honor and privilege to be a candidate for President-Elect of our Association, and I appreciate your taking the time to visit this site. Here you will find all of my campaign postings to the openlist and the electionlist as well as the regular mail letters I sent to each member of APsaA. I have highlighted here my positions on ten very important issues about bringing psychoanalysis into an even more rewarding future.
- Our Politics of Old Are Inadequate, 11/19, 9/30, 8/12
- Certification/TA Link, Goals, Letter 2, 9/21
- Less Central Regulation, Goals, Letter 2, 11/13
- Strengthening Executive Council, Goals, Letter 2
- Development, Goals, Letter 2, 11/15
- Do We Become an Incubator or a Museum?, 11/2
- Transparency, 11/2, 9/9
- Diversity, 10/10
- My Background and Track Record, Letter 1, Biography, 8/21
- Advocacy, Goals, Letter 2
Sunday, November 25, 2007
Medicare Reimbursement Reductions
Dear Colleagues,
I hope all of you had a very happy Thanksgiving holiday.
Many thanks to Jon Rosenfeld for bringing the Medicare fee schedule cuts to our attention. I reviewed the reimbursement rates for the LA area and found decreases ranging from 6-13% for the services Jon referenced, similar to his findings for Manhattan. I echo Jon’s plea to all of us to immediately contact members of the Senate Finance Committee in an effort to reverse these cuts.
For now there are three points I’d like to make regarding this issue and I will be brief.
First, I think it goes without saying that we need to keep our seats at the appropriate third party reimbursement negotiating tables. We must remain vigorous in our advocacy efforts for the benefit of both psychodynamic psychotherapy and psychoanalysis as treatment modalities. Many of our colleagues work in these systems and these are pathways for many who need our assistance.
Second, we must also fight for parity of reimbursement among all psychoanalytic practitioners. After reading Lori Post’s note I looked again at the reimbursement rates in LA and discovered that Social Workers are reimbursed at a rate about 25% less than that of psychiatrists for the same services. This is not acceptable and we must attempt to correct this. Psychologists, at least in the Medicare system in LA, are reimbursed at rates similar to physicians.
Third, given the major secular changes occurring in the insurance industry, changes such as; ever declining treatment dollars, ever increasing and more stringent utilization review procedures, and ever fewer units of service provided, we must continue to look for other ways to support psychoanalytic treatment among potential analysands. One small example is that we need to direct the results of our efficacy studies not only towards potential third party reimbursers but also towards members of the public who need our services.
We also need to keep in mind that some of our members wish to work entirely outside of these third party systems and they need to be assured of appropriate confidentiality protections. We must support them as well.
My background has given me the skills to deal with issues such as these. I am a longstanding member of our Committee on Government Relations and Insurance (CGRI) as well as its former Chair (97-00). While Chair I participated in direct discussions with national level Medicare officials including the national Medical Director. As Treasurer for the past five years I have vigorously advocated that we provide CGRI with as much financial support as our budget allows.
You can count on me to put my energies and experience as well as our organizational resources behind efforts such as these.
Warren R. Procci, Candidate for President-Elect, APsaA
I hope all of you had a very happy Thanksgiving holiday.
Many thanks to Jon Rosenfeld for bringing the Medicare fee schedule cuts to our attention. I reviewed the reimbursement rates for the LA area and found decreases ranging from 6-13% for the services Jon referenced, similar to his findings for Manhattan. I echo Jon’s plea to all of us to immediately contact members of the Senate Finance Committee in an effort to reverse these cuts.
For now there are three points I’d like to make regarding this issue and I will be brief.
First, I think it goes without saying that we need to keep our seats at the appropriate third party reimbursement negotiating tables. We must remain vigorous in our advocacy efforts for the benefit of both psychodynamic psychotherapy and psychoanalysis as treatment modalities. Many of our colleagues work in these systems and these are pathways for many who need our assistance.
Second, we must also fight for parity of reimbursement among all psychoanalytic practitioners. After reading Lori Post’s note I looked again at the reimbursement rates in LA and discovered that Social Workers are reimbursed at a rate about 25% less than that of psychiatrists for the same services. This is not acceptable and we must attempt to correct this. Psychologists, at least in the Medicare system in LA, are reimbursed at rates similar to physicians.
Third, given the major secular changes occurring in the insurance industry, changes such as; ever declining treatment dollars, ever increasing and more stringent utilization review procedures, and ever fewer units of service provided, we must continue to look for other ways to support psychoanalytic treatment among potential analysands. One small example is that we need to direct the results of our efficacy studies not only towards potential third party reimbursers but also towards members of the public who need our services.
We also need to keep in mind that some of our members wish to work entirely outside of these third party systems and they need to be assured of appropriate confidentiality protections. We must support them as well.
My background has given me the skills to deal with issues such as these. I am a longstanding member of our Committee on Government Relations and Insurance (CGRI) as well as its former Chair (97-00). While Chair I participated in direct discussions with national level Medicare officials including the national Medical Director. As Treasurer for the past five years I have vigorously advocated that we provide CGRI with as much financial support as our budget allows.
You can count on me to put my energies and experience as well as our organizational resources behind efforts such as these.
Warren R. Procci, Candidate for President-Elect, APsaA
Our Diversity: Openness, Honesty and Reconciliation
Dear Colleagues,
Our organization has moved well beyond the rancor that accompanied the lawsuit which permitted psychologists (and, ultimately, social workers) the freedom to train at APsaA institutes. I am proud of this fact, but disturbed by what I have heard from some of you during this campaign via phone calls and emails.
It is perplexing to me that some members, perhaps many, do not feel fully accepted as equal partners in our organization. Some social workers and psychologists, as well as some of our CORST colleagues, have felt they receive fewer analytic case referrals than their medical colleagues. Others have felt excluded from key committee assignments. Some have felt they were not ‘tapped’ for TA/SA roles at ratios comparable to their medical colleagues. And a number of our social work members have pointed, with some pain, to the fact that a few of our institutes still do not accept licensed social workers for training.
We can add to this the residual animus felt by our mental health colleagues who have not trained at our institutes. Just a few years ago, our expensive market research revealed a strong reluctance by these colleagues to refer patients to us, even and especially those patients who could profit from analysis.
Of course, no organization is without unhappy members, and perhaps these problems are not widespread. To some they may even seem like old news. But those of us who would be elected to our highest office have a special and unremitting responsibility to resolve any and all problems that arise from our organizational struggles with change and diversity. Here are three ways I believe we can catalyze this important process:
First, we must, as an organization, openly and non-defensively acknowledge the errors of our history and the hurt our exclusionary policies have caused.
Second, we must initiate a forum (and a concomitant task force) to explore, discuss, and report on the issues and conflicts that our diverse backgrounds and training may still engender.
Third, we must reach out humbly and respectfully to the psychoanalytic arms of all major psychology and social work organizations, as well as to psychoanalytically-interested academic groups from the humanities and sciences to explore and pursue together areas of common interest and concern.
Some would prefer that we sweep these issues under the carpet. Others would say we are doing the best that we can, or that we must move slowly. And others, sadly, proclaim when these issues are addressed, as I have been addressing them, that it just creates further conflict and hostility. What kind of psychoanalytic attitude is that?!
We must not be afraid to face the errors of our ways, to pursue unhesitatingly our goals of equality and openness, nor especially to work assiduously to resolve the problems and concerns of our many and varied members. With open eyes and honest debate, I think we can continue to be proud of our organization and help it evolve into the larger umbrella of diverse and creative people and ideas that is its full potential.
Please let me know if you would like to discuss these issues further.
Sincerely,
Warren R. Procci, Candidate, President-Elect, APsaA
Our organization has moved well beyond the rancor that accompanied the lawsuit which permitted psychologists (and, ultimately, social workers) the freedom to train at APsaA institutes. I am proud of this fact, but disturbed by what I have heard from some of you during this campaign via phone calls and emails.
It is perplexing to me that some members, perhaps many, do not feel fully accepted as equal partners in our organization. Some social workers and psychologists, as well as some of our CORST colleagues, have felt they receive fewer analytic case referrals than their medical colleagues. Others have felt excluded from key committee assignments. Some have felt they were not ‘tapped’ for TA/SA roles at ratios comparable to their medical colleagues. And a number of our social work members have pointed, with some pain, to the fact that a few of our institutes still do not accept licensed social workers for training.
We can add to this the residual animus felt by our mental health colleagues who have not trained at our institutes. Just a few years ago, our expensive market research revealed a strong reluctance by these colleagues to refer patients to us, even and especially those patients who could profit from analysis.
Of course, no organization is without unhappy members, and perhaps these problems are not widespread. To some they may even seem like old news. But those of us who would be elected to our highest office have a special and unremitting responsibility to resolve any and all problems that arise from our organizational struggles with change and diversity. Here are three ways I believe we can catalyze this important process:
First, we must, as an organization, openly and non-defensively acknowledge the errors of our history and the hurt our exclusionary policies have caused.
Second, we must initiate a forum (and a concomitant task force) to explore, discuss, and report on the issues and conflicts that our diverse backgrounds and training may still engender.
Third, we must reach out humbly and respectfully to the psychoanalytic arms of all major psychology and social work organizations, as well as to psychoanalytically-interested academic groups from the humanities and sciences to explore and pursue together areas of common interest and concern.
Some would prefer that we sweep these issues under the carpet. Others would say we are doing the best that we can, or that we must move slowly. And others, sadly, proclaim when these issues are addressed, as I have been addressing them, that it just creates further conflict and hostility. What kind of psychoanalytic attitude is that?!
We must not be afraid to face the errors of our ways, to pursue unhesitatingly our goals of equality and openness, nor especially to work assiduously to resolve the problems and concerns of our many and varied members. With open eyes and honest debate, I think we can continue to be proud of our organization and help it evolve into the larger umbrella of diverse and creative people and ideas that is its full potential.
Please let me know if you would like to discuss these issues further.
Sincerely,
Warren R. Procci, Candidate, President-Elect, APsaA
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