Legal, Ethical, and Professional Issues in Psychoanalysis and Psychotherapy
"The Narrowing Scope of Psychoanalysis":
New Section Formed Within MSPP
Patrick B. Kavanaugh, Ph.D.
Premised in a paradigm of biology, medicine and the natural sciences, psychology and psychoanalysis have developed in the United States as empirically based health care professions concerned with repairing and normalizing pathological structures, states of mind, behaviors, and ways of thinking. Infused with a medical ideology, psychoanalytic psychology has become a medical psychology. The scope of psychoanalysis increasingly narrows as the analytic practitioner and educator are subsumed by the changing rules and regulations of the health care professions. A new section is proposed in the Michigan Society for Psychoanalytic Psychology with the scholarly objective of participating in the rethinking of psychoanalytic theory, practice, education, and ethics situated in philosophy, the humanities and the arts. And with the political objective of actively advancing this rethinking in the marketplace of ideas.
Since its beginnings in the early '80s, the Michigan Society for Psychoanalytic Psychology (MSPP) has provided a philosophical and professional home for those in Michigan interested in psychoanalytic psychology. In the mid '90s, the MSPP has provided the opportunity, through the formation of a new section, to begin to develop a different conceptual and philosophical home for psychoanalysis and psychoanalytic psychotherapy. This "home" was suggested in the observation made in 1927 that "Psychoanalysis falls under the head of psychology; not of medical psychology in the old sense, nor of psychology of morbid processes, but simply of psychology." (italics added) (Freud, 1927).
Powerful institutional forces, cultural, political, social, and economic, have combined during this, "The Decade of the Brain," to functionally reshape and redefine:
(1) educational programs of study at the graduate school level so as to prepare future generations of practitioners to practice from within the "Managed Care Model" of service delivery;
(2) conceptual understandings of human behavior based upon a biologized-medicalized-chemicalized pathologized reductive metaphysical position;
(3) "appropriate" and "necessary" types of treatment for individuals through the establishment of treatment guidelines for particular diagnostic conditions; and
(4) the health care professions in terms of duties, functions, responsibilities, and the parameters for professional judgment for all health care professionals, including the mental health professional.
The "industrialization of the health care professions" currently has enveloped these professions and has come to define for the practitioner how to conceptualize and practice. Responding to the more immediate impact and aftermath of the ongoing health care reform, a small group of MSPP members met in early January and formed a new section within the MSPP, called the Academy for the Study of the Psychoanalytic Arts.
The formation of the Academy has been based upon the growing concern that these powerful sociopolitical economic forces have operationally defined psychoanalysis and psychoanalytic psychotherapy as being a function of the health care professions, and as having restrictively defined psychoanalysis and psychoanalytic psychotherapy as being "appropriate" for only certain diagnostic conditions through the development of treatment guidelines. Conceptual parameters for the directions and future advancements in theory, research, and practice are being defined and established. The history of the development, teaching, and practice of psychoanalysis in this country has been closely interwoven with the history of the development of the health care professions. The understanding of mental phenomena, functioning, and process has been conceptualized and taught from within the contextual metaphor of "mental health," "mental disease," and "diagnostic classification." This metaphor of medicalization extends to practice organized around various theories of treatment," "cure," and "curative factors." Within the history of the development of the health care professions, other professions, such as clinical psychology, have identified themselves as being members of the same family of health care providers. So too have medicine, nursing, neurology, and the "natural sciences," such as biology and chemistry. Clinical psychology has sought to achieve the status and recognition of being seated as a "full member" at the table of health care professions with the status and recognition of an independent health care profession. This recognition is to be accomplished through a broadened scope of practice as a health care profession: The power to hospitalize on an involuntary basis as well as to practice and treat within the hospital setting; the authorization to diagnose and to prescribe medications; to assume training and education responsibilities; and lastly, to achieve economic parity with other health care professionals, particularly through reimbursement from various health insurance plans for diagnostic and treatment services rendered.
Psychoanalysis and psychoanalytic psychotherapy, the talking therapies, have been functionally defined as a "health care profession" or a function thereof. "Psychoanalytic psychology" now appears to be understood and functionally defined, de facto, as a "medical psychology," a clinical psychology concerned with the further specification and elaboration of causative and/or correlative factors involved in human behavior through scientific research, the findings of which are understood and evaluated from within the medicalized contextual metaphor of "symptomatology-pathology-disease treatment." It had long been customary for many psychoanalytic educators and practitioners to maintain the position that "disease and cure" were to be understood as a contextual metaphor: a convenient, prestructured, and sometimes helpful way of thinking about the human condition. Something quite profound, however, has happened: the changing sociopolitical economic times of this current cultural epoch, as embodied in health care reform, have reified this traditional and prevalent contextual metaphor of "health" and "disease." For many legislators, professionals, regulatory, and accrediting groups, the reification of this contextual metaphor for psychoanalysis and psychoanalytic psychotherapy is now subject to further regulation and definition. Psychoanalytic practitioners who prefer to believe and maintain that, as professionals, they can continue to conceptualize alternative understandings of mental phenomena, function, and process and, thus, proceed to practice according to these conceptualizations appear to have not realized the full impact of the health care reform. Among the many consequences of the reform, there is the ongoing redefinition of various "standards" e.g., "standards of care," "ethical standards," "educational and training standards," and "standards of practice." The developing definitions of these new "standards" derive from the prominent underlying conceptualizations guiding the health care reform and are being established through the maze of rules, regulations, and procedures being bureaucratically generated and encoded in various health care regulations, standards, and laws that have already impacted quite directly upon each psychoanalytic practitioner.
The Academy for the Study of the Psychoanalytic Arts has been organized to undertake a long-term project. This is the collective redefinition of psychoanalysis as being "other than" a health care profession and psychoanalytic psychology as being "other than"" a medical psychology. Stated in the affirmative: Through the collective efforts of the members of the section to define psychoanalysis and psychoanalytic psychotherapy from within a psychological framework; to define a psychological way of understanding and working with people through a conceptual reconsideration and emphasis upon the influences and contributions from philosophy, poetry, and the arts in psychoanalytic theory, research, education, and practice. The purpose of the Academy is not to arrive at a consensus definition by its members as to what constitutes psychoanalysis, nor to arrive at a consensus agreement as to a new and comprehensive contextual metaphor for psychoanalysis. To the contrary, the purpose of the Academy is to acknowledge and encourage the development of the rich diversity of current thinking and conceptualization from within a philosophical-psychological framework. Membership in the Academy signifies consensus as to what psychoanalysis is not, i.e., a health care profession. Membership in the Academy provides the opportunity for like-minded colleagues to reconsider, reexamine, rethink, and reconceptualize their definition and understanding of psychoanalysis and psychoanalytic psychotherapy as would be constituted, for example, by one of the psychologies of psychoanalysis of the Modern Era such as drive, ego, object, or self or, for that matter, of the more radicalized versions and visions of the Postmodern Era. Membership in the Academy serves to further legitimize and authorize the practice of psychoanalysis and/or psychoanalytic psychotherapy as being quite fundamentally "other than" a health care profession.
The Academy's "project of redefinition" is understood to have a four-fold "definition of redefinition":
I. The "redefinition of psychoanalysis" through the intellectually ambitious and scholarly effort of reconsidering, reexamining, and rethinking the philosophical-theoretical underpinnings of psychoanalysis within a contextual metaphor other than that of "health care" and from within a psychological understanding of the human condition more closely allied with philosophy and the arts than with biology and medicine, i.e., narrative story, linguistics, semiotics, amsufism, etc. As currently envisioned, this project of "redefinition and definition" would include an ongoing series of forums and symposia for debate and discussion, beginning with the question "Is psychoanalysis a health care profession?" Individuals from other disciplines such as semiotics, linguistics, philosophy, theatre, anthropology, and so on would be invited to participate in the debate and deliberation.
2. The "redefinition of psychoanalysis" to the professional community through presentations of new and different ways of thinking about psychoanalysis as theory, as research, as education, and/or as practice in the form of publications, paper presentations at MSPP monthly meetings, and/or presentations at conferences.
3. The "redefinition of psychoanalysis" in the immensely practical sense of presenting to the community at large a systematic, ongoing, highly visible program of information that there is a confidential alternative available that does not require quasi-public declarations of sickness/illness/diagnosis for purposes of self discovery and self determination in addressing one's "quality of life," and in which the length, duration, and objectives of the endeavor are based upon a mutual agreement between the participants.
4. Lastly, the "redefinition of psychoanalysis" can provide through the Center for Psychoanalytic Studies the opportunity for individuals interested in programs of study that represent alternatives to education and training in psychoanalysis as a health care profession, i.e., the study of the many modern and postmodern versions and visions of psychoanalysis as theory, research, education, and practice. The Academy's "project of redefinition" is conceptualized as being long-term, multiphased, multifaceted, multilevelled, and multidimensional. Indeed, towards this end, the section has adopted "The Decade of the Mind" as the theme and context for this "project of redefinition."
The Michigan Academy believes that the time has arrived for those who are likeminded as to the vision, the project, and the direction of the Academy to have a national focus and voice. If you are interested in forming a new section within the Division and/or would like more information regarding the Academy, please forward your name, address, and telephone number to:
Patrick B. Kavanaugh, Ph.D.
Academy for the Study of the Psychoanalytic
Hearthside Office Park: 31805 Middlebelt Rd., Suite #305
Farmington Hills, Michigan 48334-2367
This paper was originally published in the February 1995 newsletter of the Michigan Society for Psychoanalytic Psychology (MSPP). It is reprinted here with permission. Copyright 1995, Patrick B. Kavanaugh.
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