Psyche & Sol - Summer 2009, Issue 16, Volume 1

President’s Message - Richard Steinberg, Ph.D.   

 This year I attended the Spring Meeting of Division 39 in San Antonio Texas, as SEFAPP’s representative to Section IV, (Local Chapters).     There are 30 local chapters around the country representing over 3,000 psychoanalytically-oriented psychotherapists from Seattle to Florida, with around 20 chapters represented at the meeting. 

      Compared to some of the smaller chapters like Rhode Island and Oklahoma with 60 members, the larger chapters like Philadelphia and Boston with 250 members, or the gargantuan group in San Francisco with around 650, we are a moderately sized chapter at 108 members.   

      At the Section IV Senate meeting, each chapter presents a summary of its activities.  The reception to our busy year was very well received (4 major conferences, 3 symposium brunches, a New Members Networking Brunch, our annual Fundraiser and the launch of The Veteran’s Project, in conjunction with the Florida Psychoanalytic Society).   

Education

  I learned a great deal this year about trauma suffered in war and the enduring consequences for soldiers and their families.  One takes different things home from each program and many treasures were shared by Drs. Akhtar, Bentolila, and Good on psychoanalytic technique, and by Sherby, Ferrante and Steinberg, (hopefully) in the theoretical realm.   Subjects varied, ranging from analytic listening and talking, to treatment of deeply wounded patients, analytic approaches and couples work.  Our series of Sunday Brunches touched on love in the countertransference, primal scene, guilt and reparation and psychological freedom.  I imagine you each had positive and critical responses to the programs, but I trust that you were impacted in some ways that have helped you in your work with patients and stimulated you to expand your views.

   On behalf of the membership, I want to thank the members of the Scientific Committee and the Education Committee for their dedicated and excellent work which made these programs possible.  The Scientific Committee members are Marshall Fenster, Psy.D. as Chair, Antonio Virsida, Ph.D.,  Emily Krestow, Ph.D., and myself.  The Educational Committee members are Lisa Schulman, Ph.D., Chair, Larry Levy, Psy.D.  Marshall Fenster, Psy.D. and Scott Winfield, L.C.S.W.                 

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 Social

  The New Members Brunch and the 16th Annual “Freud Amongst The Arts” Fundraiser were both great successes with a Fundraiser profit of  $4,600. Warm appreciation goes to Dr. Barbara Lurie for graciously hosting the Brunch and many other SEFAPP events in her beautiful home.  Immense thanks to an energetic and creative Fund Raising Committee: My Co-Chair, Emily Krestow, Ph.D., Shirley Malove, L.C.S.W., Cathy Stamm-Kaufman, L.C.S.W., Antonio Virsida, Ph.D.,  and Scott Winfield, LC.S.W.  We owe special gratitude to SEFAPP’s Administrator Cristina Virsida who worked tirelessly and enabled us to “pull the rabbit out of the hat” over the last few weeks.  These social activities give us all a chance to renew ties, network, and I believe, reinforce our professional and personal identities. 

Service

  The activity that garnered the most kudos at the Section IV meeting this year was our development of the Veterans Project of South Florida (VPOSF) in conjunction with the Florida Psychoanalytic Society (FPS).  Chapters congratulated us on our purpose and on the serious and professional way we implemented education and training through Scientific presentations and the 3 meetings geared specifically for volunteers.  They were also impressed with our cooperation with the local American Psychoanalytic Association (APsaA) and with other community agencies and organizations.  Thanks to all who have volunteered, over 40 combined mental health professionals from both SEFAPP and FPS, and much appreciation to the persistent and able work of the Steering Committee who have been meeting monthly over the past year.  Fred Levine, Ph.D. is the Co-Chair from     SEFAPP & FPS , Ana Erikson, MD (FPS), Antonio Virsida, Ph.D., Cathy Stamm-Kaufman, L.C.S.W., Emily Krestow, Ph.D., John McCauley, Ph.D. and myself, Co-Chair, from SEFAPP.                                                                                

                                                                                                                                                          This project is ‘taking off’.  Due to the efforts of the Committee we have begun to establish a voice in the community of programs that offer mental health services to veterans (Vet Centers in Dade, Broward and Palm Beach and the VA clinic in Broward). We have also affiliated with the Strategic Outreach for Families of All Reservists (SOFAR, on the web at www.sofarusa.com) and the APsaA’s Soldier’s Initiative.

We have also affiliated with the Strategic Outreach for Families of All Reservists (SOFAR, www.sofarusa.com) and the American Psychoanalytic Associations Initiative for mental health services for veterans. 

  We have received a grant for $5,000 from the American Psychoanalytic Association (APsaA) and were awarded a larger grant ($54,000) from the Florida Braive fund.  We welcome your participation and are very gratified by the generous response from both the SEFAPP and FPS membership. (See left for contact information)

   In my memory going back to 1996,    SEFAPP has not had a sustained social service initiative.  I think that our effort this past year in this direction is healthy for our organization and is a good step towards enhancing the image and visibility of psychoanalytic institutions in our community.  It is also in keeping with a tradition of psychoanalytic organizations of the past to respond to social crises, i.e., Anna Freud’s Hampstead Clinic in London during World War II.  I also believe that there is great satisfaction and personal reward when giving pro-bono services.

Division 39

  Now I want to let you know a little bit about what I learned at the Section IV meeting.  It was a great surprise to me, coming from New York and moving to South Florida, that there are psychoanalysts in Texas, New Mexico and Oklahoma.  My provincialism aside, they are like you and I reflective, conflicted (neurotic) and are generally indistinguishable from other analytic types we know and love.  Some are doing innovative work such as Ricardo Ainslie, Ph.D. from Austin who has applied his analytic training background to documentary film making or Marcia Landau, Ph.D., from New Mexico who has found a way to offer CME for their programs through contacts at the local medical school. 

 The section is socially conscious led by the efforts of William MacGillivray, Ph.D., ABPP from Tennessee.  Bill is very concerned about the unfair treatment mental health receives from insurance companies  and the unscrupulous practices of drug companies.  He is the President of the National Coalition of Mental Health Professionals & Consumers Inc. and can be reached at his e-mail drmacg@bellsouth.net.  Another thrust is towards support for graduate students and Early Career Professionals (within 7 years of graduation).  Stipends to pay for attendance at the Spring Meeting of Division 39 are available from the Division. Efforts are also being made by several chapters to mentor graduate students by being available to discuss educational development and career choices.  Some chapters are providing faculty to present classes at the undergraduate level.  All these efforts are aimed at introducing and educating students about the field of psychoanalysis which is not otherwise taught in many academic departments.  If you are interested in applying for a stipend or would like to get involved, contact me at rstein1426@aol.com.

   The last area discussed that I’d like to pass on to you is about membership and equality of membership for Non-Psychologists.  Division 39 membership is open to all graduates degree holders who are licensed in a mental profession.  The dues are $95/year ($25 for students) and qualify you as a full and equal voting member.  There are also some nice benefits such as receiving the excellent journal Psychoanalytic Psychology and for a small fee ($55/year) having access to the Psychoanalytic Publishing Archives. Psychologists must belong to APA if you wish to have voting rights.  A psychologist who is not a member of APA can join as an Affiliate member, however, without voting rights.  For further information contact  www.division39.org on the web.

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  Before closing I want to acknowledge our Board Members for their dedicated and excellent work: our Secretary Michelle Channing, Ph.D., Treasurer, Aaryn Gottesfeld, M.A., Board members Linda Sherby, Ph.D., Cathy Stamm-Kaufman, L.C.S.W., Len Ferrante, Psy.D., Scott Winfield, L.C.S.W., Lawrence Levy, Psy.D., Emily Krestow, Ph.D., Past-President Antonio Virsida, Ph.D. and President-Elect Marshall Fenster, Psy.D.  Please also join me in welcoming our newest Board members Bruce Saltz, M.D. and Leif Weig, M.A.

   As you can see we are an active chapter and our national organization represents us on broader issues.  I hope that you choose to get involved and continue to participate on both levels.  It’s been an exciting and rewarding year and for the SEFAPP Board.

 I hope you all had an enjoyable and rejuvenating summer.  See you in September.

Editor's Column - Antonio R. Virsida, Ph.D., ABPP

 “Sun, sun, sun …  here it comes!” - The Beatles 

This is SEFAPP’s first online Psyche & Sol newsletter and our first Psyche & Sol since Fall, 2005.   This issue, which is Number 1 of  Volume 16, means that SEFAPP had previously published Psyche & Sol for fifteen  years.  We’ll be publishing Psyche & Sol three times per year, Summer, Fall and Winter. 

  Our Editorial Board has structured   Psyche & Sol around regular columns; President’s Message, Treasurer’s Report, Editor’s Column, Clinical Vignettes, Summaries of our Scientific Meetings and Symposium/Brunches, Book Reviews,  a Student’s Column, a New Members Column, an Upcoming Events article and the Southeast Florida Institute for Psychoanalysis & Psychotherapy (SEFIPP) Updates.  We’ll, from time to time, include noteworthy articles from SEFAPP members and other sources.  We welcome submissions to Psyche & Sol.  Just send your articles to me in word format (.doc) at arvirsida@aol.com.

   In this issue Richard Steinberg, Ph.D., our President, reports on the status and extensive activities of SEFAPP.   Aaryn Gottesfeld,  M.A., our Treasurer reports that we are on good financial footing. This is owing to our growing membership and that attendance at our Scientific Meetings has increased.  Ms. Gottesfeld also writes Part I about her unique dissertation, Mothers and Nannies.  She movingly includes personal motives for her interest in the topic, in the Student’s Column,  The Clinical Vignettes column by Linda Sherby, Ph.D. illustrates the way that Dr. Sherby assists herself and her envious patient in untangling them both from painful enactments.  Emily Krestow, Ph.D. succinctly and clearly summarizes Glenn Good’s Ph.D. April 18, 2009 informative presentation, entitled, Psychoanalytic Perspectives on Couple Therapy.   Leonard Ferrante, Psy.D. lists our new members and reports on our first annual New and Old Members Brunch which was held on March 7 at Dr. Barbara Lurie’s home.  Marshall Fenster, Psy.D., SEFAPP’s President-Elect and Chair of the Scientific Program Committee, reports on our upcoming 2009 and 2010 schedule of Scientific Meetings and Symposium/Brunch presentations.  I offer a Status and Update on SEFIPP, outlining curriculum and training requirements revisions, new program offerings, faculty and visiting faculty additions. 

  Fredric J. Levine, Ph.D. has written a summary of activities and current status of our outreach service project, The Veterans Project of South Florida – Strategic Outreach for Families of All Reservists (VPOSF –SOFAR).  This community service project is the result of our successful and productive partnership with the Florida Psychoanalytic Society.  We have reprinted, with permission of the author, Christine C. Keifer, Ph.D. and the Division of Psychoanalysis (39) newsletter editor William A. MacGillivray, Ph.D., A.B.P.P. a review of a book by Joyce Slochower Ph.D. entitled, Psychoanalytic Collisions. 

  Finally, we have contributions from    William A. MacGillivray, Ph.D., A.B.P.P. not only the Editor of Division 39’s newsletter but it’s President-Elect.  He asked us to  include a description of Division 39 and it’s Sections, urging those of us who are not members to join Division 39.  He entices us with Division 39’s most valuable and important membership benefit; subscription to PEP-WEB for only $55.  Please read the ad and learn what is included in this offering.  He also asked us to include a position paper written by the National Coalition of Mental Health Professionals and Consumers, Inc., describing the work and mission of that organization, and an enrollment form.

   As you can see from the richness of this edition of Psyche & Sol, the sun is out and quite bright!

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Student’s Corner - Aaryn Gottesfeld, M.A.

            As a student member of the board of directors , I have been asked to write the student’s corner column.    I am a PhD candidate in Clinical Psychology at the City University of New York.  After finishing my coursework, my family relocated to South Florida where I am currently working on my dissertation.

My dissertation is a qualitative study that examines the relationship between working moms and their nannies.  The transition to parenthood, in general, has been the subject of scores of research studies.  The research supports the now generally accepted notion that the transition to parenthood is extremely stressful, often unsettling the couple’s relationship. 

While studies have looked at how this transformation and transition impacts the marital relationship, as well as the parent-child relationship, an area of research that has yet to be explored is the relationship between new mothers and the women who they hire to care for their children – their nannies.  Many women who return to work, as well as women who do not, decide to employ a nanny to help care for their children full- or part-time in their family’s home.     (In using the term “nanny” I mean generally a person who is hired to care for children full- or part-time in the family’s home.  I am not referring exclusively to live-in caregivers.) 

For so many mothers, the relationship is unlike any other they’ve had, and it is often fraught with powerful emotions typically reserved for spouses and immediate family members.  Mothers form a relationship in which issues of trust, dependency, jealousy, and class differences are at the fore.  In some cases, the level of dependency a woman feels in relation to her nanny has not been experienced since she was a child herself.

My interest in this topic was borne out of personal experience.  As I made the transition to parenthood, I experienced much of the phenomenon described in the literature.  However, while there were shifts in my relationship with my husband, the impact this had on me was much less powerful than the relationship that I developed with the woman I hired to care for my daughter while I went to school.  I had strong feelings about this relationship before I even knew who would fill the job.  Just the notion of trusting someone enough to care for my infant daughter filled me with anxiety. 

When I eventually did hire a nanny, I hired the woman who had cared for my two nephews for four years, since infancy.  Before hiring her, much of my anxiety had been free-floating, however, once Dora began work my anxiety got transferred to this relationship. 

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After Dora gave birth to her son, five months before the birth of my daughter, she stopped working for my sister-in-law.  Therefore, when she came to my home to care for my four-month old daughter, she was leaving her 9-month old son with her sister-in-law. 

Before I had a chance to get to know Dora as a person, I was already filled with feelings of guilt about her need to leave her young son, as well as being wary that because she had her own young child, she would not be interested in caring for my daughter.  Somehow, I found comfort in the knowledge that at least the sexes of our children were different.  As if caring for a baby girl was separate and different than caring for her own son.

The emotional tumult was most intense during the first few months of our relationship.  A certain level of anxiety was always present, just in varying degrees of magnitude.  After three months of working with my family, she developed a rapport with my infant daughter, despite my daughter’s protests whenever I left the house.  My daughter was less than six weeks old when she began to express her desire to be held only by me.  She was not a baby who enjoyed strangers, or for that matter, even tolerated them.  My daughter’s nature thus made it more difficult for her to forge a relationship with Dora, though eventually they did.  My daughter’s temperament also exacerbated my own difficult feelings around leaving her.

There were a number of early incidents that highlighted the fact that Dora had her own complicated life to tend to, and therefore she occasionally came late or needed to take days off.  When this happened, I would become anxious about whether Dora really wanted the job, and whether she was able to perform the job.  I worried about who else could care for my daughter after it took so long for her to form a relationship with Dora.  I am not a person who worries excessively about things, in general, so my reaction to and feelings towards Dora were remarkable to me.  Dora had the ability to disrupt my emotional equilibrium like no one else, not even my husband or immediate family.

As a new mother, I was utterly committed to caring for my daughter as best as I possibly could.  I felt guilty about leaving her to go to school, and it took many months before I could openly admit to myself, and anyone else, that I liked to get out of the house and go to school and its related commitments. 

My ability to acknowledge my feelings about wanting to go to school was precarious to begin with, but it was also completely intertwined with my trust and dependence on Dora.  I had not been so completely dependent on someone since I was a very young child.  And the feeling that I could truly depend on my own parents became compromised at the age of five when they divorced and both became very needy themselves.  Thus, my own history and relationship with my parents mingled with and influenced my relationship with Dora.  I hypothesize that the nature of this dynamic varies from individual to individual, but the paradigm exists for everyone.

Now that years have passed and I now have two daughters, I’m much more relaxed about my relationship with their nanny.  My original intention was to find a sample of first time mothers with children under 12-months of age in order to explore the anxiety that inevitably dissipates as children age and more children are born.  Unfortunately, it wasn’t easy for me to find women who met this demographic, so I eventually relaxed my requirements.  I have now completed my data collection and I am in the process of transcribing over twelve hours of recorded interviews.  All of the participants were working moms, most with very high levels of education.

The interview consists of open ended questions that explore four different domains: mother’s conception of nanny and her relationship with nanny, mother’s conception of her child and her childs’s relationship with nanny, mother’s conception of herself as a mother, and mother’s conception of her own mother.  Since there is no space left in this column, perhaps I can explain how and why I chose these four domains in a future student’s corner column. 

Thus far, however, I can say that the data is extremely nuanced and interesting and I’m confident that it will reveal new understanding about a working mother’s relationship with her child’s caregiver.   

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Conference Summary - Emily Krestow, Ph.D.

April 18, 2009 Conference:

Psychoanalytic Perspectives on Couple Therapy

Presenters: Glenn E Good, Ph.D. and Leonard J Ferrante, Psy.D.

      On April 18th, 2009, Drs. Good and Ferrante presented the conference “Psychoanalytic Perspectives on Couple Therapy” at Memorial Regional Hospital in Hollywood, FL, to an audience of over 40 psychologists, social workers, therapists and students.

  Glenn E. Good, Ph.D. presented an interweaving of theoretical and clinical material from his own clinical work and Leonard J Ferrante, Psy.D. provided rich clinical material from his work with a married couple. 

  The focus of Dr. Good’s presentation was to demonstrate the importance of a diagnostic evaluation, which thus informs the basis of the couple’s treatment.  

  By diagnosis, Dr. Good meant that the treating therapist must have a clear idea when the relationship is the designated patient or the individual is the designated patient.  In order to diagnose couples from individuals, the therapist must ask him/herself the following : 

      a) Are the two people seeking to use the relationship to serve the pathology?  In this case, they are simply replaying over and over again patterns of the past; and the goal for them is to get you, the therapist, to make the other comply.  If this is so, then the motivation of the couple (either of one or both) is to bring about a change in the other, and not to help the relationship.  The individual is the patient, not the couple. Or 

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b) Is the presented pain about the disruption of a valued relationship.  And in this case, the goal of the couple is the repair of a valued relationship which will involve changes in both individuals for the sake of the relationship.  The couple is the patient.

 Dr. Good described his method of evaluation.  There are questions he asks the couple.  One is “What will be different when we finish.”  Phrased another way:  “What is right about your relationship and motivates you to work on it, and what is broken that needs to be fixed.”  He looks to see if      answers to these questions are expressed in terms of plural pronouns or singular pronouns.   If the therapist hears “we we we,” that is hopeful.  If singular pronouns are utilized, such as I want to feel better, or I want him to be more thoughtful, then these are individual goals and not relationship goals.

Additional areas to be evaluated are the internal resources of the couple.  Do they have the capacity to reflect, to have second thoughts?  Can they step back and look at their interaction?  The therapist invites reflection, and will thus ask “Can you put in words what the other is trying to say?”  Are they thus able to understand the other person’s point of view? 

In the mode of helping them be reflective, another question would be “In the ideal world, if we work together, what will your relationship be like?”  Again, the answer to this will help diagnose whether the couple is the designated patient, or the individual is.  Inherent in this is the degree of narcissism: can each of the couple subsume individual needs in a healthy manner to the relationship?

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According to Dr. Good, if the therapist is clear that the couple is the relationship, then everything the therapist does should be about the relationship.  Enter here the question as whether to see each individually, in addition to meeting with the couple.   

Dr. Good strongly feels that if the relationship is the patient, meeting individually sends a contradictory message: it implies that meeting with you, the therapist, is going to solve the relationship problems.  

He firmly believes that information will come from the couple session, and when it does, they share it.  The role is to help them talk together, not through the therapist.

 Len Ferrante, PsyD, was asked to think of the couple he presented in relation to two questions: was it a couple problem or an individual problem,  and what did he think they hoped they would get out of it.  Viewed with this lens, his couple was not the patient, the individual was the patient.  The husband saw the wife as anxious and that she needed to deal with that specifically.  If she did, their marriage would then be okay.

While diagnosing this couple as not the patient, therapeutic work could still be done with the two together.  The drama being played out by each individual involved the role of the husband as the logical, cold, detached parent, while the wife was the needy desperate irrational child.    Dr. Good would want to help them see the role each is playing in the relationship, and the role of the other.   Therapy requires that they each experience how they are being affected by as well as how each affects the other.   Furthermore, the wife could  be coached as to how to make him more reflective, e.g., instead of dismissing her concerns, the question is “How does he feel when she says she is scared?” This helps shift the focus therapeutically to his feelings, not her fearfulness

Many thanks to both of Dr. Good and Dr. Ferrante  for their thoughtful and instructive use of psychoanalytic thinking with couples.

About the Presenters

   *Glenn E. Good, Ph.D. is a licensed psychologist and board certified psychoanalyst.  He is coordinator of marriage and family training for the Department of Psychiatry at Wayne State University School of Medicine, and a lecturer at the Michigan Psychoanalytic Institute.  He has been in private practice in Birmingham, Michigan for 25 years.

   *Leonard J. Ferrante, Psy.D., NCSP is a Certified Psychoanalyst, Licensed Psychologist and Nationally Certified School Psychologist.  Dr. Ferrante is past President and current Board Member of SEFAPP, Faculty Member of SEFIPP and Nova Southeastern University.   

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Title: Psychoanalytic Collisions
Author: Slochower, Joyce Anne
Publisher: The Analytic Press
Reviewed By: Christine C. Kieffer, PhD, ABPP, Fall 2008, XXVIII, No. 4, pp. 45-46

        Psychoanalytic Collisions, a thoughtful and profound book by Joyce Slochower, examines the ongoing dissonance between the analyst’s hopes—professional and personal—and their realization, or the “collision” between illusion and reality, the ideal and the actual. The author, who divides her book into two sections—Part I, which explores the analyst’s “personal/professional” struggles, and Part II, which examines how these struggles impact the clinical encounter—expands her views of the Winnicottian (1965) concept of “holding” which she first developed in an earlier book written in 1996. Throughout, Slochower depicts one of the most complicated dialectics that beset practitioners of our “impossible profession”: that of the tension that the analyst must hold between her professional ideals and her imperfect attainment of those ideals, collisions that Slochower demonstrates are often rooted in the individual analyst’s—and the profession’s—own illusions. Another thread that unites the chapters in the book is the myriad ways in which both analyst and patient co-construct a set of ideals about the analyst herself as well as the nature of treatment—leading to Slochower’s extended meditation on the meaning of these both necessary and countertherapeutic illusions.

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  The first two chapters in Part I summarize and reflect upon psychoanalytic literature on these topics, but one of the most original and intriguing chapters in this section is the one that takes up the question of how psychoanalytic writing mirrors the dialectic between professional ideals and illusions, with the analyst inevitable falling short in fulfilling them. Moreover, the topic of writing highlights the ways in which this very public act “collides” with the group ideals of a profession. Until recently, few analysts have written about the experience of writing, and Slochower provides us with a beacon of clarity and honesty that few of our colleagues have matched. The author believes that gender plays a role in bringing about inhibition in writing about one’s work. That is, writerly ambitions may exacerbate an ongoing tension between the maternal expectation of focusing completely upon others and the inherently solitary and self-focused act of immersing oneself in the act of writing. Slochower also makes some very cogent observations about the kinds of anxieties that interfere with writing, first noting that writing is in itself an inherently relational act. That is, there is an ongoing dialectical tension between recognition and its breakdown in the act of being read. Slochower observes that the author must be able to both “locate her own voice and be able to tolerate the inevitable ‘misreadings’ that occur in communication between subjects” (p. 45). The author identifies two major sources of anxiety in the writer: that of collisions between “doing” and “being.” She links Winnicott’s notions about these two key analytic functions to inhibitions in writing. Writerly anxieties that relate to “doing” refer to concerns about committing one’s thoughts to the page and thus exposing oneself to criticism, while anxieties about “being” interfere with the very capacity to think and thus inhibit creativity. Slochower maintains that the successful writer is able to create a transitional space between these two forms of anxiety. This is a chapter that should be assigned to all students in psychoanalytic training programs (who often falter in writing up case reports, even if they do not engage in scholarly work); and perhaps an adapted version should be written for students of all kinds. I know that I plan to recommend it to the students that I teach at my institute.

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  The fourth chapter in this section, “The Analyst’s Secret Delinquencies,” in which Slochower examines the phenomenon of “misdemeanors”—that is, breaches of professional conduct that include eating meals or reading magazines during sessions, polishing one’s nails or answering the telephone. She contrasts these kinds of breaches with analysts’ “felonies,” which would include sexual boundary violations, dual relationships or stealing, that is, misconduct that would result in malpractice suits. Most of the misdemeanors that Slochower describes—virtually all are learned about through confessions made by supervisees or colleagues—are sins of omission of a sort, that is, acts that are performed to satisfy personal needs and which “steal” time and attention from the patient. This is a work that has evoked much controversy and discussion at recent analytic meetings. Having attended presentations at which Slochower presented earlier versions of this paper, I can attest to the amount of frisson that this work provoked in listeners. As the author notes, psychoanalytic colleagues often react with intense disapproval—even outrage—when they learn of these misdemeanors, a response that Slochower surmises may reflect a desire to distance themselves from identification with the perpetrators that she describes. The author, while acknowledging her surprise and dismay in learning of these breeches, adopts an attitude of inquiry into the underlying circumstances that have given rise to them, in an attempt to help supervisees understand how the intersubjective dimension of the clinical encounter might have influenced the analyst’s behavior. Slochower, however, reaches a perhaps surprising conclusion, given that she resides firmly in the relational camp. She concludes that the various delinquencies described in the book tend to come about as a result of analysts not having sufficiently attended to their own needs, “stealing” time and attention from the patient whom they may either resent or simply tune out as a result of inadequate self-care. Slochower contrasts the conditions that give rise to these delinquencies with those of psychoanalytic “felonies,” noting that analysts who appropriate patients’ time for themselves tend to do so during quiet periods in treatment—or periods that are less demanding of relational engagement. She believes that this phenomenon in fact bolsters the argument that these analysts’ misdemeanors occur when the self is being insufficiently nourished. Slochower asserts that these kinds of delinquencies occur across theoretical camps, and cannot be explained away as simply arising from a contemporary trend towards the blurring of patient-analyst boundaries, a charge that has been hurled with particular force at the relational movement.

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  The second part of Slochower’s book addresses emotional collisions between the ideal and the actual as they pertain to the clinical encounter. The author displays great skill in employing intricate, highly sensitive clinical vignettes to make her ideas come alive. In her chapter entitled simply, “Emotional Collisions,” Slochower provides us with one of the most delicately rendered and deeply reflective papers on erotic transference and countertransference that I have read, revealing the intersubjective co-construction of the “collision” between patient and analyst. Throughout this chapter, the author examines the dialectic tension between affective resonance (n.b., this does not necessarily imply a pleasant experience; even an experience of horror need not involve a sense of affective clash) and the collision that is created when the experience between analyst and patient is affectively dissonant. She cites Josephs’ (1995) critique of analysts who approach experiences in countertransference with naïve realism—precluding a more complex investigation of sources of these affective responses. Slochower asserts that this poses a particular problem in working with erotic transference. She writes movingly of the “pain of finding oneself feeling what seems therapeutically destructive” (p.105), which can lead to a sense of impasse, helplessness and withdrawal on the part of the analyst. Slochower provides us with a frank and detailed depiction of the vicissitudes of her feelings about “Emily,” eventually developing a capacity for holding the feelings of both herself and her patient as she encouraged an exploration of what lay beneath what seemed to be Emily’s oppressively expressed erotic feelings. The impasse seemed to begin to abate when the author finally told her patient that “there seemed to be no good way of responding to Emily’s question (about whether she reciprocated her desire) without either rejecting or seducing her” (p. 111), making a plea that the patient join her in understanding rather than taking such wishes as a given. Together they discovered that Emily’s “vulnerability to scrutiny and penetration (in response to her mother’s aggression) had become assimilated, reversed and had reenacted these dynamics” (p. 115) in the analytic encounter. Slochower helped her patient to become aware that her eroticization and idealization in a maternal attachment had protected her from what would have been an unbearable awareness of her mother’s aggression. This is an example of psychoanalysis at its best.

  In her chapter entitled, “Asymmetric and Colliding Idealization,” Slochower first traces the history of this concept in the psychoanalytic literature, noting its lingering negative connotations in many branches of psychoanalytic theorizing and making a case that permitting the patient’s idealization of the analyst is not necessarily, and not merely, defensive but may instead provide both support and fill in developmental deficits. (Here, she tends to valorize Winnicott at the expense of Kohut [1977], but that is a small quibble.) On the collision between idealization and recognition often cited by relational writers,     Slochower asserts that both experiences are not mutually exclusive and often co-exist. She notes that the analyst’s unconscious rebellion against idealization can lead to the “secret delinquencies” that she writes about in Chapter 4. She also notes that idealization may reflect an unconscious bargain in the psychoanalytic couple:            “I’ll love you if you love me” (p. 131), a stance which can serve both a defensive as well as restitutive purpose. A particularly interesting aspect of Slochower’s contribution to this topic is the insightful section on the analyst’s need to idealize the patient. She concludes this chapter by telling us, “idealization does not so much as dissolve as become complicated by mutuality” (p. 137), a state that Benjamin (1995) has characterized as being one of mutual recognition.

  In summary, Slochower has made another significant contribution to our theoretical as well as clinical literature and I recommend this book highly. In fact, I plan to assign it as an essential text to the candidates that I teach at my Institute.

References
Benjamin, J. (1995) Like subjects, love objects. New Haven: Yale University Press.
Josephs, L. (1995) Countertransference as the expression of the analyst’s narrative strategies, Contemporary Psychoanalysis, 31, 345-379.
Kohut, H.H. (1977) The restoration of the self. New York: International Universities Press.
Slochower, J.A. (1996) Holding and psychoanalysis: A relational perspective. Hillsdale, N.J.: The Analytic Press.
Winnicott, D.W. (1965) Maturational processes and the facilitating environment. New York: International Universities Press.

Christine Kieffer, Ph.D., ABPP, CCKPH.D.@aol.com  

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Committee Report: Treasurer’s Report - Aaryn Gottesfeld, M.A.

This is my first report as Treasurer since the baton was passed to me from Dr. Marshall Fenster in January 2009.  SEFAPP has been thriving in the last several months.  Since January, SEFAPP has hosted three conferences, each of which was profitable.  The Board of Directors has worked hard to choose venues that cost little or no money, and this attention to cost has benefited the organization financially.

As you know, SEFAPP has recently developed the Veterans Project of South Florida.  The Veterans Project of South Florida (VPOSF) has been registered with the Florida Department of State and now has a working bank account.  This will enable to us to keep financial track of the Veterans Project separate from the general SEFAPP account.  We opened the VPOSF account with a generous donation of $1000 from Florida Psychoanalytic Society/    Institute, as well as a $500 donation from      SEFAPP.  Thanks to the success of the Freud Amongst the Arts fundraiser, we raised approximately $4600, however the final tally has not yet been processed.

SEFAPP began the year with a balance of $13,535.00.  As of May 15, 2009, the SEFAPP account balance is $13,415.00.  As you can see in the chart below, the income has been steady and has consistently offset the organization’s expenses.  SEFAPP is in a financially stable position as we head into the 2009-2010 season. 

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Membership Committee Report: Leonard J. Ferrante, Psy.D.

Our first annual SEFAPP Member Brunch was held on March 7th at the home of Dr. Barbara Lurie in Delray Beach.  In attendance were members of the SEFAPP Board, and a combination of 50 current and newly signed on members from the tri-county area.

  SEFIPP’s visiting faculty members, one of whom was Dr. Frank Summers, also took advantage of the opportunity to mingle with students, faculty, and both new and current members.

  Please join me in welcoming our newest  members:

Clara Abalo, LMHC

Mayaly Alvarez, LMHC

Denise Brown

Rocio Buechler, MSW

Leslie Cedar, LCSW

Judith Chestler, LCSW, MSW

Erik DeJesus

Lynne Harkless, Ph.D.

Gina Harris, Ph.D.

Sonia Ioannides, M.D. LCSW

Marie Rachelle Jean-Felix

William Larrison, LMFT, M. Div., D. Min.

Joan Magill, Psy.D.

JoAnne Nuccio, LMHC, CAP

Lynda Rose, LCSW

Sherry Roth, Ph.D.

Laurie Schaffer, LCSW

Barbara Simmonds, Ph.D.

Natalie Snyder, LCSW

Frank Summers, Ph.D.

Leif Weig, M.A.

  Although not all of our new members were able to attend the brunch, SEFAPP warmly thanks all of our new members for their support and looks forward to another great year!

  The brunch was not business as usual. Rather, it offered all of SEFAPP members a casual opportunity to get to know each other not only professionally but also personally. While chairpersons representing various committees apprised the group informally about current and new developments, we all enjoyed the conviviality over mimosa, bagels, pie, fruit and freshly brewed coffee.

  Members of the Board found it a positive time to speak with new members as they shared their thoughts and plans, professional interests and activities, and reminisced with current members. Some members even found it a pleasant and comfortable time to gain from each other a new perspective and insight on the treatment of a difficult case.   SEFAPP encourages any new members and current members, who may have missed the commencement of the annual SEFAPP new member brunch, to join us on March 14, 2010!  We look forward to meeting you.

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Scientific Program and Symposium Brunch Presentations - Marshall Fenster, Psy.D.

SEFAPP's scientific and education committees have been working hard to bring you stimulating and useful presentations. We are excited and fortunate to have a distinguished group of presenters, both from out of town and from our local membership, willing to contribute their knowledge and expertise.

 We have scheduled four compelling scientific presentations for the coming year. On October 24th, 2009, SEFAPP will host an all-day seminar entitled The Conflict of Money in Psychotherapy and Practice-Building Methods in Today’s Economy featuring Stefan Pasternack, M.D., Antonio Virsida, Ph.D., A.B.P.P., Michelle Channing, Psy.D., Steven Hein, CPA and Stephen Werble, CPA as our panel of presenters. This engaging presentation will focus on the economics of treatment within the patient/therapist relationship and the business aspects of building and maintaining a private practice. 

On December 5th, 2009 at Imperial Point Hospital in Fort Lauderdale, Alan Sugarman, Ph.D., a Training and Supervising Analyst at the San Diego Psychoanalytic Society and Institute, will be discussing the enhancement of his clinical work with children in a presentation entitled Fostering Mentalization in Child Patients: An Integration of Structural, Object Relations and Attachment Theories in Psychotherapy with Children.

On February 27th, 2010, Arietta Slade, Ph.D., a Professor of Clinical and Developmental Psychology at the City University of New York, and a visiting Research Scientist at the Yale Child Study Center, will speak about applying attachment theory and research on mother-infant interaction to clinical work.

On April 17th, 2010, Brian Johnson, M.D., an Associate Professor of Psychiatry at State University of New York, Upstate, and a co-chair of the American Psychoanalytic Association's annual Study Group on "The Substance Abusing Patient in Psychoanalysis and Psychotherapy", will be discussing neuroscience, addictions, and relatedness.

  For our Sunday Symposium Brunches we have also scheduled some wonderful programs. On September 13th, 2009, Antonio Virsida, Ph.D., A.B.P.P. will present and discuss the movie “Stranger than Fiction”: OCD Conflicts and Disavowal of the Beauty of Actuality. Scott Winfield, L.C.S.W., will present on The Body in Psychotherapy on November 8th, 2009; January 10th, 2010, Frederic J. Levine, Ph.D. will present Magic and Reality: Unconscious Quests for an Omnipotent Protector and on June 13, 2010 Richard Steinberg, Ph.D., and Marshall Fenster, Psy.D. will present Psychotherapy with an Aging Population.

  Of course we will also have our annual Members Brunch on March 14th and our annual Freud Amongst the Arts fundraiser on May 8th.

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 Special Report: Veteran’s Project of South Florida Update - Frederic J. Levine, Ph.D.

 Since the first Newsletter in April, our voluntary project for offering mental health services to that very underserved, and very deserving group – troops serving in the Iraq and Afghan wars and their families – has had a number of major achievements, and continues to struggle to “get the word out” to those who need our help.

 Highlights

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Steering Committee Members:

  Your Steering Committee consists of Frederic J. Levine, Ph.D and Richard Steinberg, Ph.D. as Co-Chairs, Ana Eriksen, M.D., Emily Krestow, Ph.D., Cathy Stamm-Kaufman, LCSW, John McCauley, Ph.D., Antonio Virsida, Ph.D. and Karen Dainer-Best, Ph.D.  We welcome your participation.  Contact us at flavetsofar@gmail.com or via phone at 877-783-2748 for more information.

 Overview

  We are expanding our beachheads in reaching out to troops, veterans and their families. We have gotten some recognition and help from outside agencies, and may receive more. But until the major National Guard deployment, things will remain slow – after that, they may get hectic for us.

  We again urge all volunteers to send credentials to:

Cristina Virsida, SEFAPP

831 SE 2nd Terrace

Pompano Beach, FL  33060

  Send a CV, a copy of your insurance (malpractice) face sheet, and the Attestation Form, attesting that you are volunteering in this project and will accept no fees from your work with or related to it, and will not advocate political positions about the wars as a volunteer in this project.   Please also let us know about whether you can do outreach, and whether you have child/family expertise.

  As we said in the first Newsletter, we know – and the other organizations that we deal with also know – that psychoanalysts and psychoanalytic psychotherapists can make unique contributions in working with veterans and their families.

  The authors of the recent RAND Corporation report on services to troops – a typical, and highly respected establishment organization – complained that not enough soldiers are receiving the care that they thought necessary – i.e., 8 sessions of psychotherapy!!! That’s the standard that’s in force “out there”.

  Psychoanalysts know the absolutely urgent need for long-term, intimate, thorough psychotherapy, and we can provide it as no one else can. Psychoanalytically-trained professionals also know that families suffer along with soldiers, and that children are our most vulnerable citizens, and among our least well-served.   We know that children must be served, if generational transmission of trauma is to be minimized. We know it cannot be avoided.

  PLEASE LET US KNOW IF YOU WOULD LIKE TO JOIN THE STEERING COMMITTEE, IF YOU WISH TO MEET OCCASIONALLY WITH FAMILY SUPPORT NETWORKS OF DEPLOYED TROOPS, TO ASSIST THEM WITH THE MANY ADJUSTMENT PROBLEMS THEY ENCOUNTER; OR IF YOU HAVE CONTACTS WITH VETERANS GROUPS OR OTHER IDEAS THAT WILL HELP “GET THE WORD OUT” ABOUT OUR PROJECT. 

Contact us via phone at 877-783-2748 or via email at veteransprojectfl@gmail.com.

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Special Report: The Southeast Florida Institute for Psychoanalysis & Psychotherapy (SEFIPP) Status and Update -

By Antonio R. Virsida, Ph.D., ABPP, President 

With renewed vigor, definition and purpose, SEFIPP’s board has recruited new faculty members, new visiting faculty members, is revising the curriculum, training requirements and is offering a wider range of training and educational programs. We have recruited Daniel Schwartz, Lynne Harkless, Luly Caseres, Kirsten Kupferman, Debra Stein, Stefan Pasternak, Raymond Roitman (from Sarasota) and Arnold Schneider (from Clearwater).  Helen Banta, Sonia Ionnides and Fred Levine are rejoining us.

  SEFIPP’s visiting faculty members now include prominent and some internationally known psychoanalysts; Donnel  Stern,  Joseph Lichtenberg,  James  Fosshage, Darlene Eherenbeg, Frank Summers, Paul Lippmann, Ghislaine Boulanger,  Todd Essig, Susan Kolod, Steven Tublin,  Glenn Good, Brian Johnson,  Alan Sugarman and Dorie Sorter, Neil Altman, John Auerbach, Marilyn Charles, Jack Novick and Kerry Kelly Novick .  We will be extending invitations to several other psychoanalysts in the future.  

  Visiting faculty members may teach all, or parts of, courses by way of teleconference, and in the future by way of video conference.  Currently candidates may choose one of their two analytic case supervisors from among the visiting faculty members.

SEFIPP will be offering a variety of training and educational programs in an attempt to accommodate differing interests and time requirements. 

In January, we launched a new educational program, the Contemporary Psychodynamic Case Seminars (CPCS), a series of nine, monthly two hour Saturday morning classes.  This series taught by three faculty members (Richard Steinberg, me and Donna Bentolila) who teach three classes each, has been very well received.  Twelve mental health professionals from Broward, Dade and Palm Beach counties enrolled and by all accounts are learning, enhancing their clinical skills and enjoying the experience. 

  The curriculum of the four year, Training Program in Psychoanalysis (TPIP) is being revised to include neuroscience, infant research and more focus on comparative study of the ever expanding theoretical and clinical perspectives.  We are reviving and revising the two year, Training Program in Psychoanalytic Psychotherapy (TPIPP) and the two year Academic Program in Psychoanalytic Psychotherapy (APIPP).  The TPIPP is a clinical training program with requirements of two supervised psychotherapy patients and personal therapy, while the APIPP program is an educational program with no requirements of supervision and personal therapy.

  The SEFIPP board is excited about the all the changes and the renewed vitality of our institute   We have received several inquires regarding our training programs and are hopeful that we will continue to grow, thrive and offer richly diverse and quality training and education.

   If you would like information about SEFIPP, please contact me at arvirsida@aol.com

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Special Report: Division of Psychoanalysis (39) Section Membership Information -

By William A. MacGillivray, Ph.D., ABPP

Division of Psychoanalysis

Section Membership Information 2008

One important way to participate in Division 39 is to belong to one or more of the sections that the division has established. Section membership allows a more informal and personal entrée into division activities, including participation in writing and presenting papers, participating in email discussions and online continuing education activities, and so on. The sections also contribute to the vitality of the division through the development of projects, especially graduate student awards and stipends, that help ensure the continued growth of the division and psychoanalysis.

Section I: Psychologist Psychoanalyst Practitioners 

Section I fulfills Freud's historic testimony in the 1927 trial that tested the legitimacy of psychologists to practice psychoanalysis. He said then, "Psychoanalysis falls under the head of psychology; not of medical psychology in the old sense, nor the psychology of morbid processes, but simply of psychology." Now in its second decade of life, the idea of Section I was fleshed out ten years ago when a special group of psychologist psychoanalysts met for several days to articulate goals and purposes for the Section. A set of standards governing admission was submitted and later approved. Section I members have since distinguished themselves for their contributions to the advancement of psychoanalysis in theory, in practice and in research. The Section offers its members a rich program of study groups, workshops, and seminars. Currently the Section plans to support and subsidize fledgling training institutes throughout the country, not only with funds but with a panel of distinguished members who are prepared to travel to centers of training to advise and consult in the establishment of functioning training institutes. The Round Robin, the Sections' official publication, reports Section news and publishes submissions from its members which are unfailingly bright, animated essays that vary from a provocative film review to the nature of practice in faraway places. Membership in Division 39 is a prerequisite for membership in the Section.

Membership Fees: $100 ($25 candidates)

Information:  William K Fried, PhD: billfried@hotmail.com

Application: Division Web site - www.division39.org

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Section II: Childhood & Adolescence

Members are child clinicians who practice psychoanalysis and psychoanalytic psychotherapy and who conduct research in the area of child psychoanalysis. A major goal is to increase, through the development of study groups, communications among Section members .

Membership Fees: $40 for members ($30 for affiliates; $20 for students)

Information: Jill Bellinson, PhD: bellinsonj@nyc.rr.com

Application: Division Web site - www.division39.org

Section III: Women, Gender & Psychoanalysis

The purposes of Section III include pursuing the following goals for women and men in a gendered society; to support scholarship and professional development; to develop leadership skills; to promote networking opportunities; and to deepen understanding of contemporary, gender-related concerns involving work, play, and family. Section III applies psychoanalytic theory, research, clinical experience, and mentoring to these issues and others in which gender is a significant factor. The Section offers both scholarly and clinically oriented programs at the Division’s meetings, actively encourages its members in their political ambitions, and maintains liaisons with other groups that share its concerns. Membership is open to all members of the Division of Psychoanalysis. Graduate student members are particularly encouraged to join in order to take advantage of the Section’s interest in supporting professionals in the early stages of their careers.

Membership Fees: $20. ($10 for associate members, and $10 for students)

Information: Maurine Kelly: maurinekelly@comcast.net

Application: Division Web site - www.division39.org

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Section IV: Local Chapters

The Division 39 Bylaws permit the establishment of local chapters in various areas around the country. Section IV is that Section of the Division which enables local chapters to come together in a forum to discuss local chapter development, share programs and plans; sponsor programs for the Division's Annual Meeting and APA Annual Convention, assist the development of new local chapters, and foster the development of educational programs and psychoanalytic training programs around the country. Currently there are twenty-seven local chapters, with two chapters in formation.
Although local chapters are formed by Division 39 members and are part of Division 39, psychoanalytic clinicians from other disciplines and other psychologist who are not members of the Division may join a local chapter depending upon the bylaws of the local chapter. Individuals who would like assistance in establishing local chapter in their area should contact one of the Section IV officers:

Membership Fees: Local chapters pay $4.00 for each division member in the chapter.

Information: Bill MacGillivray: DrMacG@comcast.net

Section V: Psychologist Psychoanalyst Clinicians

Section V was established within Division 39 to represent and foster diversity and pluralism in psychoanalysis through a varied program of professional activities. We think that psychotherapy practice which recognizes the unconscious (that is, meaning and motivation which are outside of awareness), honors the importance of the developmental history of the individual, and makes use of an exploration of the relationship between the therapist and the patient is psychoanalytic. We think that psychoanalysis should be a discipline of inquiry not an orthodoxy of belief. That is, that our work, on both the theoretical and the clinical level, is distinguished by the questions being asked and not by the answers which may seem to have been found. We believe that answers are inevitably provisional. Our programs, essay contests, website discussions, CE program, panels and lectures are informed by this worldview. We see psychoanalytically informed practice as a vital protection against the assaults on inner life and individual spirit that have come as a consequence of the industrialization of health care and of psychotherapy in particular. We think that being a psychoanalyst is a matter less of curriculum vitae than of worldview. It is our mission to both defend and extend this worldview.

Membership Fees: $60 for members ($30 for students

Information: David Lichtenstein: davidlichtenstein@att.net

Application: Section V website: http://www.sectionfive.org/

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Section VI: Psychoanalytic Research Society

The overall purpose of this section is to promote psychoanalytic research of an empirical, theoretical and clinical nature. Section VI administers The Psychoanalytic Research Fund which aims to advance our field by supporting empirical doctoral dissertation research related to psychoanalytic theory and technique. The section stimulates and supports communication among researchers by the use of professional meeting and publications. In addition, Section VI aims to facilitate (1) the continual development and training of psychoanalytically oriented researchers; and, (2) the broadening of the role that psychoanalytic research plays in general psychology, with other related professional disciplines, and to the public.

Membership Fees: $20 ($10 for students)

Information: William Gottdiener, PhD:  wgottdiener@jjay.cuny.edu

Application:  Section VI Web site: http://www.columbia.edu/~hc137/prs/ and Division Web site - www.division39.org

Section VII: Psychoanalysis and Groups

The Section of Psychoanalysis and Groups provides a forum for studying the application of psychoanalytic thinking to the theory and practice of psychoanalytic group therapy, and for understanding phenomena endemic to institutional and societal groups. Members of the Section are encouraged to present their ideas regarding the interrelationships between psychoanalysis and groups in the official programs of Division 39 and of the American Psychological Association. In addition, the Section sponsors its own annual scientific meeting on critical issues relating to psychoanalysis and groups.

Membership Fees:  $25, ($15 for students).

Information:  Christine Kieffer, PhD: CCKPHD@aol.com

Application: Division Web site - www.division39.org

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Section VIII: Couple and Family Therapy and Psychoanalysis

Section VIII is dedicated to promoting the understanding and treatment of the psychological needs of couples and families. At both theoretical and clinical levels, we are exploring how multiple perspectives within psychoanalysis, and within other relevant models, can inform and enrich one another, expanding the horizons of psychoanalysis to include couples and families. We are also committed to increasing the discourse within
the Division 39 community around issues at the interface of the individual and the broader relational context in which he/she is embedded. This includes an emphasis on supporting and building on the strengths of family and social relationships as a source of healing.

Membership Fees: $35 ($10 for students)

Information: Gerald Stechler, PhD: Stechler@BU.edu

Application: Section VIII Web site: http://www.psychoanalysis.net/SectionVIII/How%20to%20Join

Section IX: Psychoanalysts for Social Responsibility

Section IX is open to those interested in both social issues and psychoanalytic ideas. We sponsor events and activities in which a psychoanalytic perspective is brought to bear on contemporary social issues such as human rights, race relations, education, poverty, and violence. We work to promote the accessibility of psychoanalytically oriented clinical services to under served groups of people, and to expand the cultural and socio-economic usefulness of psychoanalytic treatment.

Membership Fees: $40 for full members ($20 for students)

Information: Karen Rosica, PsyD: Krosica@aol.com

To learn more about the sections, please visit the Division 39 website at www.division39.org and follow the links to the various sections. As noted above, some of the sections also have their own websites, but these can also be accessed through the division site. A better way is to attend Division 39 Spring Meeting or visit the Division 39 Hospitality Suite during the APA Annual Convention to meet section members, attend section panels and begin to learn about this important part of the division.

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Special Report: The National Coalition of Mental Health Professionals and Consumers, Inc. - White Paper and Enrollment Form

By William A. MacGillivray, Ph.D., A.B.P.P., President 

 As professionals and consumers we are enmeshed in a context of many dysfunctional US health care payment plans. These plans require major changes to allow services and financing that meet human and economic need without over-regulation, waste, fraud, or excessive profit-taking. Proposals to change U.S. healthcare economics must include specific elements that protect access, choice, privacy and quality in the area of mental health and substance abuse services. The changes must be both pro-consumer and pro-clinician while being mindful of costs.

This white paper has been prepared by the National Coalition in service of policy makers at all levels of the health care change process.

Access

There must be no discrimination between availability of physical and mental health care. Availability and continuity of services should not be contingent on people’s place of employment. Any barrier or process that denies people access to mental health and substance abuse services drives up medical care spending, destroys lives, hurts families, damages workplace productivity and increases crime.

Proposals for improvement in health care must assure that mental health and substance abuse services include:

·   Consumer choice of professionals, treatment settings, types of treatment.

·   Wide range of services for all populations.

·   High quality, coordinated care for vulnerable populations via integrated community networks, and local community control of these networks.

·   Consumer choice of forms of payment for mental health and substance abuse services,

·   No discrimination against those who self-pay; no insurance contract, or government regulation should prohibit people from private purchase of mental health and substance abuse services.

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·   If people use insurance to help cover the cost of mental health and substance abuse services the provisions of those insurance contracts should be explicit and have full medical parity, i.e. not subject to reviewers’ definitions of “medical necessity” or any management, limitation or restriction that does not also apply to other medical benefits under that contract. To prevent discrimination between physical and mental health services, there should not be any separation in terms of annual or lifetime limits.

·   Third party payments to providers of mental health and substance abuse services should be equitable for the services rendered. Driving down payment for mental health and substance abuse services results only in limiting consumer choice when practitioners and facilities either leave third party payment systems or are driven out of business. Payments based on diagnoses without regard for their severity often lead to under-treatment. A system that does not allow for extended treatments based on severity of diagnoses hurts the consumer.

 Choice

  Effective mental health and substance abuse care requires an informed population, qualified practitioners and facilities and treatment choices that are appropriate to the individual or family seeking services.

  Proposals for improvement in health care must assure that mental health and substance abuse services include:

 • Strategies to inform consumers about mental health and substance abuse treatment alternatives; the effectiveness and limited risk of talk therapies and psychosocial interventions; effectiveness and risks of prescription medications.

 • Consumer choice over all aspects of mental health and substance abuse services including the treatment setting, the type and length of treatment and the treating practitioners and facilities.

 • Consumer choice about whether to seek mental health and substance abuse services.

Provisions that, when mental health and substance abuse services are mandates of courts, government agencies or the criminal justice system, the involuntary consumer should have as much choice as possible over the treatment setting, the type of treatment and the treating practitioners and facilities.

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 Privacy

  People own their personal health information. Proposals for improvement in health care must assure that mental health and substance abuse services include:

 • Consumers’ right to control who has access to their information, wherever and however it is kept. Exercise of the right to privacy should not effectively result in denial of services.

 • Regulation that personal details about mental health and substance abuse services which may be disclosed for purposes of payment shall not be maintained in the record or further disclosed by the payer.

 Quality

  Quality of mental health and substance abuse services is primarily based in the training of the professionals and para-professionals providing service. Adequate local and regional facilities for intensive out-patient and inpatient treatment of mental health and substance disorders are also essential.

  Proposals for improvement in health care must assure that mental health and substance abuse services include:

 • Treatment methods and processes that are informed by qualified professional education, training and research, not invasively regulated by legislators or third party payers.

 • Availability of a range of clinicians qualified by appropriate training in mental health and substance abuse specialties and sub-specialties.

 • Recognition that payment systems that are based on clinician’s degrees reward those who end formal training and punishes those who continue to improve their skills and knowledge base. A system that discourages advanced training eventually hurts the consumer. A relatively fair system to encourage clinicians to continue advanced training would set reimbursement by health plans at a fixed amount for specific services with co-pays negotiated by clinicians and patients on a sliding scale basis.

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 • No “fail-first” requirements or excessively high co-payments before consumers can use the newest or most effective medications. (This can be dangerous for people with serious mental illnesses.)

 • Availability of inpatient and intensive-outpatient settings appropriate to the care of those who cannot function safely in the community; separate units or programs for adults, children, adolescents, the elderly, and those with addictions and physical disabilities which complicate treatment. Such settings should be situated locally, to facilitate support of family and friends.

 • Availability of the full range of mental health and substance abuse treatment methods, without restriction to artificially brief, symptom-focused or problem-focused models. As with innovations in medical care, quality of mental health and substance abuse services requires respect for new understanding in human development, behavior and functioning.

 • Policies that encourage innovation and improvement of services and service delivery.

 • Recognition that claims for specific treatments as “evidence based” frequently fail meta-analytic scrutiny and may be biased by their source of funding and the limitations of the research process itself. (For decades, the brief, solution-focused therapies have gotten grants for research since those therapies fit into the most used research protocols while several forms of therapy supported by patients and the community of therapists are not given grants because they cannot be manualized or standardized and because they would require long-term studies.)

 • All funding sources for research, authors, and journals that support claims for the benefits of specific treatments must be fully disclosed.

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