In this monthly column, the Div. 39 president shares his thoughts with division members.

June 2017
This past week, division Secretary Dana Charatan posted the abstract of an article called “Psychodynamic Therapy: As Efficacious as Other Empirically Supported Treatments? A Meta-Analysis Testing Equivalence of Outcomes,” from the American Journal of Psychiatry by Christiane Steinert, Thomas Munder, Sven Rabung, Jürgen Hoyer and Falk Leichsenring, DSc. As the title suggests, these authors conclude that, “Results suggest equivalence of psychodynamic therapy to treatments established in efficacy. Further research should examine who benefits most from which treatment.”
 
A division member expressed her enthusiasm by posting a happy, laughing emoticon in response to this post and other members enjoyed this.  Someone else suggested that, while these results are encouraging, they suggest only that psychodynamic therapy, CBT and medication are equally efficacious.  I agree with this observer and look forward to more research that demonstrates how the efficacy of psychodynamic treatments is superior, especially after treatment ends, as newer research is suggesting.
 
When I first read Dana’s post, I was reminded what I felt when I read division member Jonathan Shedler’s article in the American Psychologist in 2010 entitled “The Efficacy of Psychodynamic Therapy.” I felt a huge sense of validation and relief that gave way to elation.  This reaction led me to reflect on how the anti-psychoanalytic prevailing cultural narrative had slowly but insidiously gotten under my skin and had started to erode my professional and personal self-esteem. 
 
This weekend, at a conference about the newly published Psychodynamic Diagnostic Manual, Second Edition (PDM-2), Nancy McWilliams made the point that most psychodynamic clinicians are not aware of the large amount of research that supports psychodynamic treatments.  I think that this lack of knowledge may contribute to some psychodynamic clinicians’ vulnerability to the propaganda that insists that the ways in which they work are not supported by research. 
 
As someone who teaches doctoral students in a clinical psychology graduate program, I see the struggles that students interested in psychodynamic therapies have as they are simultaneously drawn to working psychoanalytically with their clients or are seeking psychodynamic supervisors, but feel sheepish about doing so, or worry that they will be evaluated in a biased way in classes and on examinations if they present cases from a psychodynamic perspective. 
 
Although I think that all of us are vulnerable to the negative impact of anti-psychoanalytic narratives that predominate in our culture right now, graduate students and early career professionals may be most vulnerable to this.  Luckily, Div. 39 members like Philadelphia psychologist and educator Barbara Goldsmith, who heads the mentoring program of the Philadelphia Society for Psychoanalytic Psychology, a local chapter of Div. 39, hosted a program last month at her home to discuss this.  The event was called, “Am I Even Doing Psychotherapy? Battling Internalized ‘Psychodynamic Phobia’ in Training Environments Promoting Evidence-Based Treatments.”
 
I will conclude this month’s column with some of the reflections on this issue that Barbara Goldsmith offered at the start of this event.  I think that many of us will appreciate Barbara’s perspective.
 
The Prevailing Myths, Misconceptions and Negative Stereotypes about Psychoanalysis and Psychodynamic Psychotherapy: The impact on teaching and supervising graduate students
 
Graduate students and teaching faculty in many clinical psychology programs know that myths about psychodynamic treatment continue to prevail despite evidence to the contrary.  Some of the more common misconceptions are that psychodynamic therapies are obsolete and antiquated treatments that are “slow” to work, if at all, and are based only on insight which does not change behavior. The public perception (fueled by the health insurance industry) is that only CBT or other manualized treatments work, and only those treatments are “evidenced based.”
 
Faculty and students alike continue to believe that psychodynamic treatment is not supported by empirical research, that psychoanalysis, regarded as an elite treatment suitable only for rich and high-functioning clients, has not changed since Freud.  Graduate students training in this climate can easily feel criticized and become defensive about wanting to learn and practice psychodynamic therapy. The disparagement of psychodynamic practice is particularly difficult for students who are currently in psychoanalysis or in treatment with psychodynamic practitioners.  Students worry that presenting a clinical case from a psychodynamic perspective might cause them not to pass their oral exams. Students from non-psychodynamic programs worry that someone in their program might find out if they request meetings with a psychodynamic mentor or supervisor. What’s more, students are often led to believe that they will not find a job after graduate school if they practice psychodynamic therapy.
 
Clinicians vs. technicians seem to be the new binary in therapy praxis. Quick symptom reduction seems to be the ultimate goal of the manualized treatments, which students and practitioners can practice from manuals–with a concomitant decline in interest in self-reflection, curiosity and insight. 
 
In light of the above issues, a program was presented by the local Philadelphia chapter (PSPP) at its annual graduate student brunch on April 23, 2017.  The panel consisted of three psychologists: a graduate student; a post-doctoral fellow; and an adjunct teaching faculty. The discussion focused on the status of psychodynamic psychotherapy in graduate clinical psychology programs–examining it from three perspectives: training; supervision; and teaching. Students from a variety of PsyD and PhD programs in the Philadelphia area attended. They voiced concerns about the scarcity of psychodynamic supervisors and about how psychodynamic ideas are often devalued. In some programs, psychodynamic courses are not taught. In other programs, there is a focus only on “integrating” psychodynamic practice with other treatment approaches.
 
These negative views about psychodynamic work affect teaching and supervising and make it difficult to engage students to read and learn about psychodynamic theory.  Students often complain that constructs (like transference, intersubjectivity, transitional objects and projective identification) seem too abstract and inaccessible in comparison to the more concrete “cookbook” approaches to psychotherapy, which lend themselves to much simpler concrete didactic description.  For novice therapists, the concrete techniques associated with CBT, IPT and ACT are way easier to grasp and more user-friendly than the conceptually abstract and theoretically-based psychodynamic interventions that rely heavily on clinical judgment and use of the therapist’s countertransference and understanding of enactments.
 
Terms like “clinical judgment” can be hard to grasp and seem irrelevant for clinicians who will learn by following manuals.  It is difficult for students to accept that there are no “general” techniques that are applicable to all patients and that what you say and do is on a case-by-case basis.  This absence of broadly-applicable general techniques is anxiety-provoking for the student and felt not to be helpful.  Instructing students on listening and being curious, on asking questions, and to sit with their anxiety without resort to action doesn’t help the student know what to say or do.  The well-known saying, “don’t just do something, sit there,” is difficult for anxious students to follow.     
 
Many programs either choose or fail to offer courses in psychodynamic research and, as a result, students gain little or no exposure to it in their didactic courses, case conferences and supervision.  The long-time lag in research on psychodynamic therapies has contributed to the decreasing emphasis of teaching this form of psychotherapy in many graduate training programs.  Right here in Philadelphia, at the University of Pennsylvania, Lester Luborsky began his research on the treatment alliance in 1976 and later in 1984 developed the core conflictual relationship theme (CCRT) as a way to operationalize transference.  Now, in 2017, Zilcha-Mano revisits and continues to investigate the positive outcomes of strong alliances between patients and therapists in her article “Is the Alliance really therapeutic? Revisiting this question in light of recent Methodological Advances.” American Psychologist (2017) vol. 72, #4.
 
Current research shows that psychodynamic psychotherapy is equal or superior to CBT. And, although researchers have debunked the myth that psychodynamic psychotherapy is not evidence-based and is ineffective in alleviating symptoms, the myth nevertheless persists.  This is puzzling. 
 
What can be done about this? Some suggestions: 
  • Make teaching psychotherapy research a part of case conferences and didactic course in order to help enhance the value of psychodynamic approaches.
  • Support students who are interested in becoming psychodynamic practitioners by helping them: 
    • Find psychodynamic supervisors and mentors
    • Network with other psychodynamic clinicians
    • Find referrals for their personal therapy/analysis
  • Graduate training programs need to provide programming for students to have exposure to cutting-edge psychoanalytic thinkers and writers.
  • For both students and faculty, there needs to be a stronger emphasis on educating and correcting misinformation about psychodynamic treatment effectiveness within training programs.
  • This is no time to retreat or be insular–or to be fighting over which psychodynamic theoretical orientation is better.
  • There needs to be more education of the public that there are additional and effective forms of psychotherapy other than CBT.  It is overly simplistic to believe that one form of treatment can be the best for all patients.
Dennis M. Debiak, PsyD
May 2017

"The Times, They Are A-Changin’ How About Us?" is the question posed to the Division of Psychoanalysis by the Steering Committee of last week’s 37th Annual Spring Meeting in New York City. My sense of the answer to this question is a resounding, “yes.” People had very different experiences at this year’s meeting, as is always the case, but a large and diverse group of people shared with me that the division is changing is important ways. Clearly, we are talking more about identities and the ways these dimensions of who we are impact our clinical work, our worldview and our lives.

The co-chairs of the excellent 2017 spring meeting were Maria Lechich and Barry Cohen. The committee members were Eugenio Duarte, Jonathan Eger, Tom Johnson, Alan Kintzer, Steven Kuchuck, Emily Kuriloff, Kevin Meehan, Liat Tsuman and Cleonie White. The keynote speakers, Allan Schore and Cleonie White, presented compelling and moving addresses that focused on neuropsychoanalysis and race, respectively. I was brought to tears by the music, visual art and literature that White used in her fascinating and comprehensive discussion of skin color and oppression.

Colin Ennis, the chair of the division’s Program Committee, did a beautiful job advising the Steering Committee and acting as a liaison between these committees and Natalie P. Shear Associates, our professional conference planner for almost 25 years. The division has conflicting goals for the spring meeting: we want creative, high-quality programs and program formats, special events and opportunities to for socialization AND we also want to respect tried-and-true procedures and not lose money. Colin, like our former Program Committee chairs, is at the epicenter of this conflict and negotiates it with aplomb.

Of course, there are difficult realities we must acknowledge about the ways in which our nation and our division are not equally protective of all of us. While many felt more welcome at our spring meeting than before, microaggressions and macroagressions related to ability status, race, class, culture, age and generational influences, religion, political affiliation and national origin happened. The board of directors, sections, committees and task forces of the division are in the process of reflecting on the meeting and how we talk to each other so that we can continue to work toward making the division as welcoming and respectful of all of our members and guests. As Past President Marilyn Charles said to me, “we have been actively working at listening to what goes wrong sufficiently that we can continue to build towards greater inclusiveness, which will allow us to increasingly enjoy the benefits or our plurality and many voices.”

In this regard, attendees of the meeting will be receiving a survey about their experience of the meeting. I know that we all get too many requests for us to fill out surveys and give feedback, but I implore those of who were in attendance in NYC will take the time to complete the survey and help us to continue to improve our spring meetings.

Thanks to all of you who worked so hard for so long to make this such a successful meeting in so many ways. I will remember this meeting for years to come and I know that many attendees will also. In the context of global sociopolitical unrest and serious threats to our health and safety, I want the Division of Psychoanalysis to continue to evolve as a strong community that works toward recognizing the complexity and difference among us. Thank you.

Dennis M. Debiak, PsyD

January 2016

Dear members,

As we begin 2016, we are afforded the opportunity of taking stock of where we are in relation to where we would like to be. As we know, crisis and opportunity are tightly woven with one another, making it important for each of us to come forward and seize whatever opportunities we find in our various communities to make a difference in the lives and well-being of those around us. The recent events that have arisen in relation to the Hoffman Report remind us that, as psychologists, we have a mandate to be mindful of and attentive to the well-being of others. I hope that you will take the opportunity afforded by this new year to strengthen your efforts at constructive engagement in your personal and professional lives, both within and outside of the division, to build a better future for us all.

For those of you with aspirations for public service who have had trouble finding a direction, there are many committees within the division where you might find colleagues with similar interests.

I wish you a new year that brings peace and goodwill to all,

Marilyn

December 2015

Dear members,

We are living in trying times. More clearly than ever, the safety and well-being of each of us depends on the safety and well-being of all. Our hearts go out to the people of Syria, where living conditions are so impossible as to have forced this mass migration and displacement of home, heart and family. Our hearts go out to the people of France, whose well-being has been shattered by the recent attacks that have brought war into the heart of their daily life. The widespread unrest and instability across the globe reminds us of the price of paying insufficient attention and respect to the needs of any group that is suffering. How we bring peace and love rather than war and hatred to this planet remains to be seen. 

In the midst of this chaos and unrest, APA offered their first Psychology in the Public Interest Leadership Conference in Washington, D.C. Although difficulties within APA have been highlighted recently, this, too, is APA, an organization that focuses substantial energy and resources on trying to better understand the causes of distress and to better advocate for social change and social justice. 

The purpose of this event was to offer information to APA leaders that might assist them in being more effective in advocating for issues of importance to them. This was a working conference, offering an interplay of didactic information and working sessions to help members to integrate the information being offered and to apply that information to their own particular concerns regarding social issues. 

The preconference evening began with introductions to leaders in the Directorate of Public Interest and of the Board for the Advancement of Psychology in the Public Interest, along with information as to resources available within those agencies to support the efforts of APA members and divisions. The first full day consisted of presentations about how to most effectively communicate findings from science, and about interventions that have been effective in producing social change. Break-out sessions were offered to allow participants to work together to discuss and integrate the information offered and to consider how we might apply that information to our own concerns. The final presentation that day was by Lynn Davey, whose talk focused on “Utilizing Psychology to Effect Social Change.” She offered clear, practical information regarding how best to have an impact on public understanding through social media. I trust that we can make use of the information she offered to help division members who are working on social welfare and social justice issues to be more effective in achieving their aims. 

The second day, participants divided into three tracks. The first focused on dissemination for public messages, the second for legislative audiences and the third for executive branch audiences. Much of the material will be accessible to me online and I hope to make use of it within the division so that we can more effectively advocate for the values we cherish and provide solutions for the issues of pressing concern. 

Given the extent of the suffering here and abroad, it becomes even more important to be able to make use of whatever resources are available, at all levels, to bring the tools afforded by a psychoanalytic lens to bear on the problems of our day. 

I wish you all a joyful and peaceful holiday season, 

Marilyn Charles, PhD
President of Div. 39

November 2015

Dear members,

In this month's column, I would like to report on just two of the many offerings through which members can find and build support for their efforts.

On Oct. 14-15 Austen Riggs hosted the second working conference focusing on training issues at the graduate student level. Through both large and small group formats, we considered ways in which we might be more proactive in supporting efforts to find a more effective and constructive interface between APA requirements and psychodynamic clinical values. Jackie Wall, the new director for consultation and accreditation at APA joined us to consider difficulties attendees were encountering and to offer suggestions regarding how we might more effectively utilize resources at APA and also have an impact on training and practice guidelines. There was an atmosphere of collegiality and mutual respect that was heartening and generative.

Attendees focused on concerns that arise in teaching, pleased to be able to share problems and possible solutions with one another. An area of particular concern was the diversity course, and several attendees agreed to propose a roundtable discussion for APA 2016 in Denver, to further discuss these issues.

On Oct. 24-25, I attended the annual conference of the Association for the Psychoanalysis of Culture and Society (APCS) at Rutgers University in New Brunswick. Many Div. 39 members attended. This is a forum in which each participant can find a place at the table, and it was heartening to see so many young people presenting their work in ways that enlarged and deepened the conversations. APCS is a group where psychoanalysis and social justice are at the heart of the mission, which makes for a sense of community and collaboration. Conversations occur across disciplines, which helps to broaden and enlarge those conversations in ways that create alternative possibilities and avenues for exploration and for finding possible solutions to some of the social and clinical problems we face.

I bring up these two experiences because I found them so energizing. Each event helped me to feel part of a broader community of individuals also working towards the greater good. Through these communities, my own efforts are refined and strengthened and new ideas can be considered. Div. 39 meets once yearly and yet we need support throughout the year. Finding ways of recognizing common needs and possibilities for support and assistance strengthens us all.

Warm regards to you all,

Marilyn Charles, PhD 
President of Div. 39