New Orleans-Birmingham
Site Visit Report
2014
Site Visit Chair:
Sam Robertson
Site Visit Representatives:
Steve Clarke
Allan Compton
Sybil Ginsberg
Rex Moody
Adam Libow, COCCA representative
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Before the site visit:
In initial phone contacts and when we met in NYC at the January meetings in 2013, you
immediately brought forward your primary concern, too many of your center’s members were
little involved in the institute. Later, and more gradually, you let us know a natural consequence
of that, those involved were overworked and exhausted. You made it clear the survival of the
institute depended on solving this problem and you wanted our help. You had an idea, to invite
and encourage everyone in the institute to speak with site visitors in private meetings. You hoped
they would say things so far unspoken. The promise of confidentiality would be enhanced by
greater numbers talking to us. Presenting a composite of opinions gained, we could lessen any
idea being tied to a particular individual. Ultimately, we added another element to this plan; rather
than directly reporting what we had been told, we most frequently utilized the ideas gained as a
heads up which allowed us to look for and see instances where what we were told privately
showed up publically. Informed by the private meetings, we undoubtedly saw things we might
not have and by discussing them with you at the time or in close retrospection, we were able to
get them on the table. We thank you for raising our observational I. Q. and admire you for
allowing us this open and productive exploration.
Looking at your program, we realized by the time we arrived in the fall of 2014, your candidates
would be in their third year and no longer, as in the first two years, jointly attending classes with
students in your psychotherapy program. To learn more about the first two years we decided to,
electronically, join a week of your second year classes in the spring. Attending electronically also
provided the advantage of giving us a feel for how you system actually works. This increased our
ability to appreciate the road your candidates are traveling and provided more solid grounding
for us to hear discussions which occurred during our fall visit, especially the effects of mixing
candidates with those in the psychotherapy program.
Both before and during the site visit, we are grateful for the way you welcomed us and for
giving us a taste of southern hospitality. We would to express our appreciation to everyone one
who contributed to our experience. Foremost among there were Denise Dorsey, Elsa Pool, and
Marilyn Skinner from your faculty and your very able administrator, Jana Hathaway, who lived
up to her reputation as a skilled and efficient administrator. Using your excellent Drop Box
system we were able, both before we joined classes in the Spring and before our visit in the
fall, to easily access and review the necessary policies, minutes and reports.
Your last site visit report left you with 37 recommendations. We have less than 10 and the most
important of these are guided by your request to help you consider how to avoid exhaustion
and better engage and more efficiently use your faculty.
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History, Structure, Bylaws, Policies and Procedures, Board of Directors,
Administrator
History
The New Orleans Psychoanalytic Institute was incorporated in 1952.
Ten years ago, the New Orleans Psychoanalytic Institute was making plans to re-organize into a
psychoanalytic center model. The reasoning behind this re-organization included wanting to
make the organization less vertical, less likely to be experienced as being exclusive, and to make
it more inclusive and inviting in its’ membership while allowing fuller participation in the
governance and functioning of all aspects of the Center to the members.
Nine years ago, hurricane Katrina devastated the city of New Orleans and the region and
dramatically disrupted the lives of its’ people. Katrina’s devastation disrupted the lives of the
members of the Society and Institute. Some members stayed in New Orleans but some moved
away, often with the generous help of friends or colleagues in other cities. A few moved to
Birmingham and some of them stayed. The Society and Institute, assisted by outside funding,
reached out early and effectively to help the therapeutic community work with residents of New
Orleans in the aftermath of Katrina. The trauma and loss from Katrina seems still a very present
part of the lives of the people who experienced it, and the loss of some significant members of
the analytic group around this time added to the experience of loss.
Eight years ago, the analytic groups in New Orleans and Birmingham were forming a
psychoanalytic center encompassing both groups, now the New Orleans-Birmingham
Psychoanalytic Center (NOBPC).
Seven years ago the new Center had a Committee on Institutes (COI) site visit and here we are
today with the next site visit.
Structure
The organization chart of the Center shows a Board of Directors comprised of officers, chairs of
the Psychoanalytic Education Committee (PEC) and the Outreach/Continuing Education Chair,
and two members at large; the Board currently has ten members. Beneath each of the two
committees referred to above is a cascade of sub-committees.
The sub-committees of the PEC are common institute committees charged with
administering educational programs, i.e. Psychotherapy Program, Curriculum, Selection,
Progress, and Child Analysis.
The sub-committees of the Outreach Committee will be considered in detail later in this
report.
There are several other committees of the Board enumerated in the Bylaws, including
Executive, Membership, Faculty, Nominating, Ethics, Clinician Assistance, Finance, and
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Information; we do not recall having heard any reference during our visit to the Executive
Committee.
Further reference to the policies and procedures of specific committees may be included later in
this report.
The Foundation is a subsidiary corporation of the Center.
Jana Hathaway is widely appreciated for her capability as Administrator. Our experience of her
during our interaction with the Center has confirmed this assessment. We think the Center
members, particularly Board members and committee chairs, need to be careful so as not to allow
Jana’s effectiveness in managing things to take the place of following policies and procedures and
lines of communication between themselves and with the membership.
Bylaws
The Bylaws of the Center appears quite complete and we expect it to be adequately functional in
the workings of the Center. In addition to this assessment of the Bylaws, the goal of inclusiveness
as noted above is represented in two statements in the Membership article: “Any person with a
bona-fide interest in psychoanalysis may apply for membership in the Center;” and “Each member
shall be entitled to vote on each matter submitted to a vote of the Membership….”
A clear statement of the authority and responsibility of the Board of Directors in the functioning
of the Center is in Article VI: “If there is a question of interpretation of a policy, that question
shall be referred to the Board.” This statement may help clarify a situation wherein such a
difference in interpretation occurs.
We have found what appears to be an inconsistency in the election of officers of the Board of
Directors: Article V states “The Officers of the Center shall be elected from and by the Board of
the Center…” and Article VII, section Nominating Committee, states “… the Nominating
Committee shall submit to the Membership a single slate of candidates for the Officers…to be
filled.” We think we know what this means and how you do things, but it might be useful to
clarify this apparent discrepancy in this document.
Finances and Foundation:
The NO-BPC and NO-BP Foundation finances were reviewed for the fiscal year ending July 31,
2014. The Center reported a total income of $66,286.27 and expenses of $66,135.56 for a net
income of $150.71. This income / expense picture was described as relatively consistent with
recent prior fiscal years. The Center also reports a fixed asset of the Center building valued at
$325,000 and library, $30,245. There is no debt reported. In addition, the NO-BP Foundation
reports total assets of $274,887.87, which includes $232,783.40 in a conservative Foundation
investment and $42,104.47 in a money market fund. The Foundation received a contribution of
$29,150 from the Polchow Foundation, which is consistent with recent prior year contributions.
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The Foundation also reported a combined income of $4,324.30 on its investment, representing
approximately a 1.5% annual yield.
These figures were reviewed with the Center administrator as well as the Board Treasurer.
It was observed that theCenter and Foundation have no debt and have a growing endowment
base over the last several years, largely due to a single contribution source. It was also noted
that the investment yield of 1.5% was very conservative and that the Center might consider
engaging a financial advisor who might be able to help find slightly higher yet still conservative
returns in the 4-5% range so as to help the Center further build a longer term equity and asset
base.
It was also observed that there does not appear to be an active strategic plan for either
growing the Foundation's resources or potentially spending some of its yield on strategic initiatives
that could help promote the Center’s interests as well as secure its future. Examples would be
to consider whether soliciting funding through private philanthropy or federal grants to support
community outreach and training programs could further improve the equity base. Additionally,
the Center might consider whether a portion of annual income could be used toward creating
partial scholarships for all or select analytic and psychotherapy candidates so as to further
enhance training opportunities and offset both the perception and real cost burden of prospective
and future trainees.
Ethics Committee
Ron Fleischman is the Chair of the Ethics Committee. He constructed the Ethics policies and
procedures document for the Dallas institute in 1998. The Ethics Committee here has not
received any complaints over the past year during his chairmanship.
The Ethics document appears to be carefully constructed, with well thought out approach to
responding to a complaint. It includes informal and formal procedures for considering a
complaint and for the hearing and the disposition of a complaint, and any resultant actions by
the Center, including sending a report of the committee process and recommendations to the
Board of Directors, the American Psychoanalytic Association, and to the proper licensing board.
We discussed changing the part of the procedures that a complaint may be expressed to any
member of the Center to having a complaint of ethical issue be directed in writing to the Chair
of the Ethics Committee by the complainant for it to be considered by the committee.
The committee may also consider whether or not it should conduct an investigation of an ethics
complaint in parallel before or after or concurrent with such an investigation by the relevant
licensing board.
Clinical Assistance Committee
The Clinician Assistance Committee, chaired by Denise Newman, is evaluating the policies and
procedures document for the committee. They would like to clarify the purview and functions
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of the committee particularly relative to the Ethics Committee purview and functions. We agree
that this is the necessary step for this committee, and these aspects of the Assistance
Committee need to be differentiated from, as well as related to, these aspects of the Ethics
committee. That is, an ethics complaint sent to the Ethics Committee may be determined by
that committee to not be an ethical issue and they may forward the complaint to the Assistance
Committee for an attempt at resolution of the problem by discussion and mediation.
Conversely, the Assistance Committee may determine that a concern about a member’s
functioning is an ethical issue and recommend the concerned party send an ethics complaint to
the Ethics Committee.
We very much support the ideas voiced by the Assistance Committee that the committee’s
existence and purview and methods should be promoted to the membership of the Center and
to the broader community as being available for assistance. We agree as well that assistance
and ethics considerations and functions could constructively be promoted to both the Center
and broader community, including through outreach and educational programs.
Records:
In review of your candidate records, we were again impressed about how complete,
systematically approached and thorough they are. The progress summaries and supervisors
reports are well written with good case observations about the progress of the supervisees. The
very advanced candidates’ files were missing some 6 month reports about cases, though for the
most part there was documentation about having requested these from the candidates. The
records for confidential candidate material were stored under lock and key.
Center records were stored digitally on a local computer and were reported to not contain
confidential information; however there does not appear to be a regular systematic backup in
place for these digital records. Distribution of non-confidential material only was done via remote
commercial computer systems, which was experienced by the site visit committee as a boon to
our work. We can see this is probably very helpful to the candidate’s and Center’s work.
We suggest the Center establish a systematic, regular backup system for material stored
electronically.
Most of candidates training records are destroyed after graduation, with a summary saved of the
graduates’ years of training. The candidates have access to their own record should they request
it. The admission applications and documents continue to be kept with the candidates institute
progress reports.
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Faculty Committee:
Structure and Functions: The Faculty committee, composed of two training analyst and two
non-training analyst are nominated by the nominating committee (or potentially from the floor
of the membership) and elected by a vote of the membership of the center. The committee
members then choose one of their own to chair. The committee’s responsibilities include
creating written criteria for evaluating members or potential members and for Training Analyst
appointments. The committee is also responsible for deliberating and processing applications,
both for faculty and for training analyst, and for presenting these to the PEC.
The meeting we observed focused on considering an application to become faculty and on the
resignation of two faculty members. We were told that, while procedures for faculty
appointment were being precisely followed in the present case, these procedures had often not
been followed, including for the two faculty members who resigned and that there are
established policies or plans for handling resignations.
There was an excellent discussion regarding the analyst being considered for Faculty
appointment and a decision to recommend appointment. However, the site visitors noted that
the two required letters of recommendation to the committee were actually written by two
members of the committee. Despite your manpower shortage, especially with this well qualified
applicant who everyone seemed to favor, this seemed unnecessarily expedient.
A very different but equally thoughtful discussion about the two resignations followed. We
learned there are no written guidelines or procedures to handle resignations and also that a
series of very difficult interactions had preceded the resignations. Both site visitors and
committee members wondered if earlier and more concerted thoughtful interventions with
elements of potential or relatively minor discord might have been helpful. Also, most of the
final series of communications were by e mail and we wondered if this might have contributed
to escalating discord.
We recommend establishing and following written procedures and especially intervening earlier
in difficult situations and without e mail. But we recognize your limited manpower makes the
planning, the doing and the follow through a real challenge
Admission:
A new class begins every 4 years. The Center is currently beginning year 3. The Selection
Committee meets on an ad hoc basis and met now because of the site visit. As there were no
current applicants to discuss for admission, we focused on the last class, which had had 2
psychotherapy candidates drop out. The committee thought that the candidates for that class
had not been properly vetted in the first place and that the people who had dropped out should
probably have not been admitted. The committee stated that several applications had been
submitted after the June deadline and they felt under great pressure to accept them. It is unclear
whether all the applicants had been interviewed at all. The Policies and Procedures, that we
reviewed, stated that psychotherapy and academic applicants for candidacy are supposed to have
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one interview and analytic candidates are supposed to have 3. During the Sunday wrap-up
session, the Selection Committee clarified that the Policies and Procedures have been changed,
so that every applicant is required to have 3 in-depth interviews. And their impression was that
some of the applicants for the last class had not been interviewed at all.
At the wrap-up meeting we discussed the complexities of having such a mixed group of analytic,
psychotherapy and academic candidates.
There is a tension between not being able to begin
a class at all, even every 4 years, and properly vetting the potential candidates. At this point, the
committee, as well as the faculty in general, is very concerned as to whether they will have
applicants for a new class within 2 years; in particular, whether there will be any potential analytic
candidates.
Another point of tension is between the 2 cities: Birmingham and New Orleans. The Selection
Committee meets in New Orleans and the applicants who were not interviewed were in
Birmingham.
We suggest that the Selection Committee and the PEC keep frequent
communication, both by Skype and at least some times, in person. That way they can discuss
ideas to find candidates in a creative and timely manner and share knowledge about potential
applicants. At the PEC meeting, we learned that there is indeed one completed application that
had come in from Birmingham and a second potential applicant. It should not have to wait for
the next 6 month meeting to have a dialogue about potential applicants. We suggest more
frequent meetings, with participants representing both cities. There are other possibilities, such
as offering very limited, introductory, extension division type seminars to clinicians that could help
find candidates. They could be given during the in-between years.
Candidates:
In the most recent class the psychoanalytic psychotherapy program was combined with the
psychoanalytic program. The classes meet together in the first 2 years of the psychoanalytic
training program. Psychotherapy participants are able to apply to become psychoanalytic
candidates, and recently you have had one ask to do so. We had the opportunity to meet with
the 1 psychoanalytic candidate and 3 academic candidates in the 3rd year class, and observe
them in several classes. The psychoanalytic candidate was a recent conversion from your
psychotherapy program, and 2 of the academic candidates were clinical psychotherapists who
had been psychoanalytic candidates but who converted to academic candidates. One of the
academic candidates was a non-clinically licensed individual who is seeking a means to see
patients and convert to be a full psychoanalytic candidate. There is also one advanced
candidate.
The candidates seem to have a high morale and seem to have a good rapport with each other.
They participated in a quite engaging manner in the classes that were observed, and were had
debates and mutual discussions of the articles that were presented. They were eager,
enthusiastic and energized. They thought the faculty was extremely helpful, motivated and had
a high morale as well. They were impressed at the dedication the faculty showed to teaching.
The one clinical candidate did not currently have an analytic case, though only recently
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converted to the analytic track. The clinicians seemed to benefit from the discussion with their
academic colleagues.
In reviewing the decisions about the candidates changing from psychotherapy to psychoanalysis
and to academic candidates, the faculty seemed to have made thoughtful and careful
considerations of each individual’s particular circumstances, and that each change in status
made sense. The apparent fluidity of movement between categories of student was concerning
as a trend, though. The committee felt that this has the potential of disrupting the tripartite
model for each of the candidates and disrupting growth in becoming analysts. Also, some of
the recent psychotherapy students observed in psychoanalytic classes seemed neither
sufficiently prepared nor sufficiently motivated for participation with psychoanalytic candidates.
We raise the question of whether it might be worth considering 2 types of initial applicants:
1.) A student with good motivation and preparation to be a psychoanalytic psychotherapy
student but not particularly prepared for or interested in the intense training involved in
becoming a psychoanalytic candidate. Such a person might be a star in a class for
psychoanalytic psychotherapists, but unmotivated and discouraged to perform in a class
designed for a greater commitment, mixed in with people who have a great deal of
motivation and knowledge for this intense work. Being a star in such a psychoanalytic
psychotherapy course is a great motivator and may over time get these people to want to
further develop their psychoanalytic skills. In such a setting they would likely be
appreciative of and respectful toward the psychoanalytic community that taught them.
2.) An individual who is qualified to become a candidate, well motivated and interested in
psychoanalysis who understands the commitment, but because of time, money or other
personal constraints may not be able to or willing to commit to a full psychoanalytic training.
Such a person will likely greatly benefit from a shorter, less intensive program of training
mixed with full psychoanalytic candidates. This group will likely have very positive feelings
about such a training experience, be able to benefit a great deal from it, and may find the
resources to go on further in their training.
We certainly understand that one of the great difficulties the NOBC has is limited numbers but
we think that in the long term what we are recommending is more likely to produce more
analytic candidates. There is also a benefit to the Psychoanalytic Education Center of short
term seminars or workshops designed to educated clinical providers, giving them some
exposure to psychoanalytic concepts and an introduction to the psychoanalytic community.
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Curriculum:
The curriculum is in flux for several reasons. The recent change combining courses of
instruction for candidates with courses for psychotherapy students is serving very well to
produce large enough classes. The psychotherapy students tend strongly to continue in the
psychotherapy track: they are learning and have a community. As in several other institutes:
Why graduate?
“Modernization”, that is, how much Freud to teach, if any, and if taught, just what and exactly
when is unsettling in New Orleans as it is in many of our other institutes at this point. Finally,
responsibility for construction and maintenance seems to have been placed too exclusively in
the hands of someone who has now resigned from the organization, leaving a large vacuum. .
Except for the last item these are not unusual problems.
Classes and Teaching:
The teaching we observed was good to excellent. The teachers seemed to be well versed in their
subjects and very lively in their manner. The enthusiastic participation of the students
certainly confirms this observation.
There are six to eight students in each class, only one of whom is a candidate in psychoanalytic
training and also an excellent candidate. A solution to the problem of putting together classes of
adequate size and composition appears to be well beyond the resources the New OrleansBirmingham institute or any other single institute. It seems, at least to this observer, to rest upon
on the ability of our profession as a whole to find ways to train candidates who are younger,
probably by reducing their dollar costs while increasing their earning potential. The NO-B Center
shows abundant enthusiasm and willingness to work and no lack of skill or intelligence.
Supervision:
We observed 2 supervisions. In both cases there was excellent rapport between supervisor and
supervisee and both seemed comfortable being observed. One case was in psychotherapy with
a candidate who had recently switched to full candidacy. The candidate was self-reflective and
working toward deepening the process as much as was feasible. In the other case, there was a
long-term psychoanalysis and after about 200 supervisory hours the supervisions had been
decreased to bi-weekly sessions. This was a widening scope patient and the first and only case
of the candidate; yet, an analytic process had been achieved, with a deepening transference. It
is doubtful that this case will go to termination; however, the patient is being helped by this
candidate who appears to be gifted in treating this type of patient, with the advantage of
supervision from an empathic supervisor.
It is of concern that there were only these supervisions to observe. There is no analysis of higher
functioning patients currently happening in NOBPC. That fact has to influence learning. They
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cannot present such cases and cannot draw from their experience if recently graduates or faculty
present to them. The faculty at NOBPC recognizes this; but they must put creative energy and
perhaps funds into identifying more applicants for candidacy and perhaps more potential patient
referrals.
Progression
The Progression Committee evaluates the progress of all the candidates: analytic,
psychotherapy and academic. There are currently 10 candidates, 2 of whom are analytic
candidates. Analytic candidates follow the usual procedures recommended by APsaA.
Academic candidates are in classes only, although they are encouraged to be in analysis or
therapy. Psychotherapy candidates take 2 years of classes, during which they must be in
therapy or analysis. They must have 2 cases, in at least once weekly treatment, consecutively,
for at least a year. Each case must be supervised by a different supervisor.
The Progression Committee meets twice a year. The last meeting was in June 2014, so the
September meeting we attended was being held early. During the meeting, each of the 10
candidates is discussed at length. Advisory and supervisory reports are read. Special requests
for change in status are discussed as are individual problems.
We were told that common problems are the infractions of not handing in write-ups and of
being delinquent in paying tuition. Both issues often occur with respect to the same candidate.
In some instances, a given candidate has handed in almost no reports over a prolonged period
of time and has accumulated several thousand dollars in owed payments. It has been left to
the supervisors to remind candidates when reports are due. Another infraction is that of
supervisors not handing in reports. We suggested that the reminders be sent directly to the
candidates (and also to the supervisors). During the ensuing discussion, it was noted that there
used to be a writing course. It was suggested that writing once again be made part of the
curriculum. One of the TA’s volunteered to contact the delinquent candidates and offer a
writing tutorial.
A contributing factor, to the lack of confrontation of the above noted concerns, is that six
months may go by without the issues being brought to the attention of the Progression
Committee. The site visitors suggested that a follow-though would be facilitated by having
more frequent progression meetings. The Progression Committee then discussed that the
meetings, at the end of the calendar year and in June, might be timelier if they were changed
to be held at the beginning of the academic year and the middle of the academic year. They
thought there could also be interim focused meetings once a problem candidate is identified.
One of the academic candidates, hopes to become a full (CORST) candidate and the committee
discussed how to provide her with clinical training. Two of the psychotherapy candidates had
misunderstood that they needed to have 2 cases with different supervisors. Those candidates
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not find themselves in a position where they have finished classes but cannot yet get the
Certificate of Completion of the program. Three people owe large sums. Several have not
handed in write-ups.
We recommend more timely interventions for infractions. This might be achieved by more
frequent meetings to flag at risk candidates, followed by individual help with and pressure to
get in write-ups and pay tuition. At times, a candidate might need to be suspended or dropped.
At other times, tuition relief or scholarship might be necessary. An active, timely stance toward
these issues is essential.
Child program:
The New Orleans-Birmingham Psychoanalytic Center has a very strong child psychoanalytic
tradition. A decade ago the New Orleans Institute counted six child analysts on its faculty,
many of whom played an integral role in the training, development and administration of the
then New Orleans Psychoanalytic Institute. Child analysts were heavily involved in both the
adult and child curriculum, were sought-after training analysts and had successful practices that
were sources of cross-referrals with adult colleagues. Child candidates were also relatively
common. Over the past decade the shape and form of the Child Program has shifted as the
Institute (now Center) evolved in response to a variety of factors intrinsic and extrinsic to its
organization. Several analysts retired or passed away shortly before and after the catastrophic
hurricane Katrina, which lead to the displacement of additional faculty to Birmingham. At
current count, there are six training analysts in Birmingham, three of whom are child analysts.
While there are two local child analysts who remain in New Orleans, it does not appear that
they have an active ongoing role in either the child or adult curriculum.
The reorganization of the New Orleans Psychoanalytic Center into the New Orleans Birmingham Psychoanalytic Center in 2007 was an effort to help distribute and share faculty
and administrative resources over a geographic range that could both address the devastation
and loss suffered by New Orleans as well as support and give foundation to the burgeoning
Birmingham group. Around the time of this New Orleans-Birmingham geographic link child
analysts in the Birmingham group, in conjunction with colleagues at the Cincinnati Institute,
launched the Southeast Child Psychoanalytic Consortium, a model designed to strengthen and
centralize several local programs that did not seem to have sufficient resources, faculty and
students to continue to operate independent child psychoanalytic training programs. Currently,
the consortium is administratively organized through New Orleans - Birmingham Psychoanalytic
Center as well as the Cincinnati Psychoanalytic Institute, with candidates able to choose an
administrative home at either organization.
At present, there are four Child Consortium candidates residing in St. Louis, Pittsburgh, Miami,
Atlanta, some of whom are administered through NO-BPC. There are two additional candidates
in the Consortium who are primarily affiliated with NO-BPC and began their child training at NO11
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BPC more than a decade ago. Both are active teachers in the adult training program. It also
appears that there are as many as eight prospective candidates considering upcoming child
training through the Consortium residing in diverse locations that include Miami, Houston,
Dallas and Pittsburgh. There are not any prospective candidates that have been identified in
New Orleans or Birmingham.
The primary faculty of the Consortium are also from diverse locations, including Birmingham,
Cincinnati, Houston and Dallas. It is clear from observing a supervision, a child case
conference, and a faculty meeting as well as from conducting individual discussions with faculty
and candidates that the Consortium is an active, ambitious and highly motivated group that are
seeking to address a profound gap in child training and education in many areas of the country.
Institutes and cities that have never had a child training program or those who have had very
weakened child training (i.e. New Orleans) are now able to offer a pathway toward child
analytic training through the Consortium that was not available even a handful of years ago.
The faculty and candidates of the Consortium seem to share a sense of enthusiasm,
collaboration and pioneering spirit that is infectious and quite inspiring, especially in this era of
often more resigned prognostications about the future of child psychoanalysis.
Perhaps one of the unintended consequences of developing such a geographically diverse yet
centralized child training apparatus is the impact that this structure has on local groups. Since
much of the function and training of the Consortium occurs remotely and over video conference
the strong sense of partnership and collaboration felt within the Consortium among its faculty
and candidates is experienced - at least in New Orleans - as absence, loss and, at times,
exclusion. The presence of the child faculty within the adult curriculum has been tempered
over the last several years due to a number of factors including geographic distance and
training analyst conflicts that have left some of the most experienced, recognizable and vibrant
instructors out of the adult analytic curriculum in its current form.
There appears to be a willingness within the Consortium to work more actively with New
Orleans to reintegrate within the adult curriculum by participating more in the teaching of
courses and perhaps identifying alternative ways of managing issues such as training analyst
teaching conflicts through the use of tutorials.
An additional issue facing the New Orleans group is how to reinvigorate interest in child analysis
locally, both within the Center as well as the larger New Orleans community. Historically in
New Orleans, outreach and consultation by child analysts to local schools and nurseries
appeared to be an effective way of generating referrals as well as establishing the presence of
child analysis within the school and larger community. It appears that before this could occur
the recruitment and development of new child candidates would need to occur locally. It would
appear that in this regard the Consortium could be a major asset as it provides a ready avenue
for potential candidates to immediately participate in child training once they express interest.
In addition to the presence of Consortium child analysts within the adult curriculum it might
also be helpful if the Consortium were to select New Orleans as a site for one of its upcoming
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annual fall conferences. This would bring a major influx of child analysts and analytically
interested child practitioners to the meeting, potentially developing further awareness within the
New Orleans community of the potential to train within the Consortium through NO-BPC. An
additional outreach and development option might be to see if the adult group in New Orleans
would be interested in sponsoring a local conference or lecture in which a Consortium child
faculty was invited to talk about the impact of child analysis on adult work. This could be a
lecture designed both for the purpose of building bridges with the New Orleans adult faculty
The Education Committee
The chair is an elected officer of the Board. The Board selects the chairs of the, curriculum,
selection, progression, child analysis and psychotherapy and adds essential others to constitute
the EC Committee.
Discussions included:
Selection: The chair began the meeting emphasizing the need for timely applications. Last
minute applicants contributed to problems in the current class. Tension was evident.
Curriculum: Containing more contemporary ideas, the current curriculum was adopted, in toto,
from Houston. A member of the faculty is reading each paper and will help the new Chair of
Curriculum who intends to cull these papers and insert treasured classical articles and attitudes
from the old curriculum.
Child Consortium: A successful conference just occurred in Cincinnati. New candidates are being
recruited in several cities including Miami and Houston.
Faculty Committee: An applicant for faculty was approved to be recommended to the board.
Discussion of the third year candidates: The first two years of their training, classes included
students in the psychotherapy program. Readings alternated focus between psychotherapy and
analysis. Opinions varied including these: 1) Alternating papers seemed workable helping
candidates learn psychotherapy; 2)The psychotherapy students read less, attended less and
were little involved in class; 3) Since they were not disruptive and candidates didn’t mind as
much as did faculty; 4) Three, or even two qualified candidates would be better than the mixed
group. 5) Because selection process was faulty, it was not a true test. Tension rose as the chair
described the selection problem. Several residents, after several false starts, were pressed
forward by those in Birmingham just as classes were beginning leaving no time for interviews.
Those from Birmingham gave a brief explanation which did not defuse tension.
The discussion moved to engaging more faculty members and possibly acquiring faculty from
other institutes to lessen the teaching burden. One of the site visitors interrupted and pointed
out significant tension had been bypassed with no resolution of the underlying problems and no
policy formed. Committee members agreed and a meaningful and emotional series of
interactions expressed previously sequestered feelings including that analyst in Birmingham
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had courted talent from New Orleans, and putting most of their energy into the child
consortium, “stolen our child program “ and were less supportive of N. O. than N. O. was of
them. This heartfelt and healthy discussion showed affection as deep as the hurt, especially
including those most involved. It was wonderful and hopeful. But a number of people told the
site visitors it wouldn’t have happened without our presence and input. So, despite seeing
major and impressive steps towards repprochement we strongly recommend an outside
facilitator help you better sweep the chimney to create more lasting cohesion and coordination.
Outreach and Continuing Education:
The Chair of Outreach and Continuing Education, a member of the Board of Directors, is elected
by the membership. There are eight sub-committees listed: Extension, Scientific Meetings,
Evaluation and Referral, Endowment Fund Meetings, Film Series, Honorary Fellowship
Programs, CME, and Residency Teaching. Chairs of these are chosen by the Board of Directors
and, together, the chairs constitute the Outreach Committee.
We learned about a number of good connections in the community and creative work by the
committee. A remarkable project followed Katrina. Kathy Nathan applied for and the institute
received a grant from the Farr Fund to study therapist and patient who have shared trauma.
Between 2008 and 2012, the institute received $40,000 a year for this study. Numerous local
therapists were interviewed, a documentary was produced, there were two national panels, one
at the American, the other at Division 39, the work was published and ideas developed in the
project were adopted by the Red Cross. This was really quite an achievement.
You have many ongoing activities. You are involved in teaching residents at LSU and Tulane
and present at Grand Rounds. A candidate is instrumental in the training of Psychology
graduate students at LSU. Classes for the residents are held at the institute to increase your
profile. A number of faculty supervise residents but without any formal institute connection. You
provide an honorary fellowship for 7 or 8 residents a year. The fellows meet with a mentor
monthly, are brought together at the beginning and the end of the year and each are asked to
come to three events at the institute during the year. We wonder if having the fellows meet in a
group, for example each month to hear clinical material, would create more of a group process,
synergy and perhaps lead to deeper involvement with the ideas with each other and the
institute.
You have presentations of films but said attendance was low at these. However your scientific
meetings, where a faculty member presents ideas that are of current interest to her, seem well
attended by the community clinicians and others. We found the topics creative and very
interesting and, with you, wonder why few faculty members attend.
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RECOMMENDATONS:
Electronically back up records
We suggest the Center establish a systematic, regular backup system for material stored
electronically.
Procedures:
Flexibility is important but some there were not several examples where procedures were not
followed in areas of importance including admissions and selecting faculty. A procedure for
resignation from the faculty should be developed.
Clarifying the roles of the Ethics Committee and the Clinical Assistance Committee
The Clinician Assistance Committee, chaired by Denise Newman, is evaluating their policies and
procedures and expressed a desire to clarify the purview and functions of the committee
particularly relative to the Ethics Committee’s purview and functions. We also recommend you
consider having a policy that any complaint regarding an ethical issue be directed in writing to
the Chair of the Ethics Committee and also to determine whether an investigation of an ethics
complaint should be before or after or concurrent with such an investigation by the relevant
licensing board.
Creating a strategic plan for growing and spending the Foundations resources
As elaborated in the body of this report. See Finances and Finance on page 3.
A More Strategic Approach to Coordinate Outreach and Educational Programs
For your number, the quantity of the things that you do is really quite impressive but we believe
that there are ways to increase your effectiveness by coordinating these programs to bring
attendees into increasing involvement with analytic ideas.
Consider for the moment, outreach having four primary functions:
1.
2.
3.
4.
Simply doing a good deed, providing something of value to the community;
Crassly put, advertising and branding, making your presence and value known;
Economic, some might seek treatment;
Obtaining students, especially analytic candidates.
We suggest it is important to both distinguish these goals and create a strategy designed to clarify
the function of various offerings and their relationship to each other. What follows is but one
example of such a strategy.
Many offerings will serve one or more of the four functions. Programs designed for the general
public typically serve the first three automatically. But to serve the fourth goal, getting students,
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it is possible to present a thoughtful cascade of programs, sequentially offered, with gradually
increasing depth, sophistication and requirement of greater investment? Imagine a tiered array:





The first tier is the entry level, offerings for the general public, a supervision or teaching
at the residency or a chance encounter. Any clinician met in these ways is invited to attend
a second tier event.
The second tier, offered to clinicians, by invitation only, is more directly analytically
oriented and, importantly, is of short duration. Examples might include: a single 90 minute
case presentation; an ethics workshop with CME; the presentation of an accessible paper.
One offering does not exclude another, you could offer a 90 minute case presentation
quarterly, an ethics workshop annually etc. But anyone who attends a second tier event
gets a personal invitation to attend a third tier event. And beginning with second tier
events, there is some degree of oversight by the PEC.
The third tier involves a slightly longer time commitment, for example 6 weekly or 6
monthly clinical seminars, perhaps accompanied by assessable readings. To consistently
collect those at recent events on the second tier, the clinical seminar series could be
offered twice a year. Those who attend a third tier program should be invited to attend a
level four program.
The fourth tier involves more time commitment and reading, perhaps a six month weekly
course, 90 minutes a week, offered annually, )or every 2nd or third yea if there are multiple
offerings). Potential offerings include courses on child psychotherapy, or on adult
psychotherapy, or on adolescents or sexual issues or regarding dreams or anything
interesting. Those who attend a fourth tier program should be invited to other level four
programs but also invited to apply for level five programs.
Level five includes both the analytic or psychotherapy program and requires application
and acceptance. As recommended in the section of this report on candidates (pages 7-8),
we believe only those qualified to enter analytic training should admitted into the analytic
program. The psychotherapy program would then be composed of those willing and able
to do that program and might include some of those able to do the analytic program but,
as yet, unwilling. All psychotherapy graduates would be invited to apply for the analytic
program.
It was easier for clinicians to take a long step into the unknown when analysis was idealized. And
back then, when the analytic ideas were more consistently part of their earlier training, the step
from what they knew to analytic training was a shorter one. Now, with analytic ideas often little
understood or even misunderstood, it is important to prove ourselves useful. Doing so in each of
a series of steps leads more naturally into greater interest and involvement. Creating learning
cadres, small learning communities, each moving towards greater depth, is also helpful.
See Appendix A for further ideas concerning the tiered approach, the creation of learning
communities, comments on the manpower required and some examples.
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More direct feedback with a personal touch.
We learned about several situations where an intention to avoid conflict at early stages led to
later destructive interactions. We wonder if the recent trauma of Katrina, faculty loss, limited
manpower and a limited number of candidates might be contributing factors. Below are some
specific situations and suggestions.
You have problems with tardy clinical summaries and tuition payments. To ease the writing task,
we recommend adding a short writing segment to each year in the curriculum but we also
recommend a faculty member be assigned to be sure candidates are current on all financial and
educational obligations at some regular interval, for example prior to each academic year or prior
to each consideration of progression.
We also think it might be wise to synthesize feedback from candidates regarding faculty rather
than handing faculty what candidates have written. It is difficult for someone who feels they are
giving to receive, in return, coarse and primarily negative feedback without any recognition of
the teacher’s efforts and contribution. If a particularly fair minded and tactful faculty member,
having received written feedback, were to meet with the candidates for a discussion and then
with the faculty member to deliver an accurately message in a more acceptable tone to
instructors, hurt feelings and faculty loss might be avoided and perhaps a teachable moment
embraced.
And, having heard about an escalating E-motional E-mail exchange, perhaps we all might be
reminded that E mail is not your friend in emotional discussions. Sometimes, “Let’s talk about it
as soon as we can,” is the most that should be written.
There are some real problems related to the tension between faculty at your two sites,
Birmingham and New Orleans. We heard about these tensions in various ways from so many of
your members. It seemed to be a secret that everyone knew but no one seemed able to bring
into the open. In the EC meeting, we experienced you wanting and needing our help in opening
the discussion. We were impressed, both with the difficulty you had getting into the discussion
and with the genuineness of the discussion and the affection which followed. We were told by
some of your members that our presence may have been necessary to mobilize the discussion.
We think this may have been true and supports the wisdom of a suggestion from several of your
members, that a sufficiently complete resolution of the difficulties will require an outside
consultant, someone with a great deal of experience and gravitas, to work with you in an ongoing
way. We strongly recommend you consider this.
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Approaches to your biggest issue, small size:
Your Site visit organizers let us know at from the beginning that your biggest problem was the
need for more actively contributing members. They set up private interviews so we could
understand something of what people were feeling and we learned the following which we think
makes your situation particularly difficult:
1. At the turn of the century a centralized power group had, according to many we spoke
with and a previous site visit report, held power too closely leading to a number of people
feeling disenfranchised. In response a site visit recommend movement away this towards
a center model. However necessary, this event had to leave painful residue.
2. Your center model was developed. The design would work well for a large organization,
one where many people want a piece of the action. The membership, as a whole,
nominates and elects a nominating committee which nominates members for all major
offices followed by election by all the members. In a large organization, unless reasonably
satisfying a majority, no small group could hold onto power. In a small organization where
only a few vote, a small group might constitute a majority of those who attend the
membership meetings and retain power. But all this becomes less meaningful when you
have a very small group with too much work. The task then becomes finding some way
to encourage a few to take on an immense workload.
3. Katrina occurred with multiple effects: Everyone was personally affected in so many ways,
including a desire to pull together, as humans do in crisis. In a way, bad times led to good
things, a sense of being in it together, to cooperation, to less interpersonal strife but also
greater energy. The phoenix rose and things were good at the institute. We think this may
have been the situation at the time of your last site visit.
4. But then the secondary effects hit: There had been a diaspora, many left town or for other
reasons were no longer available. The child consortium attracted the attention of very
talented faculty who were less available to the main institute. Eventually, people felt
increasingly overworked, the adrenaline which led to and accompanied pulling together
was not sustainable. All of this contributed to fewer analytic candidates and now
Candidates and Faculty were in short supply but the workload not much lighter. Like other
institutes, your organizational structure requires essentially the same number of meetings
it would if you were ten 10 times your size. Basically, in economic terms, the fixed cost of
running an institute, something figured primarily in man hours rather than dollars, is pretty
much the same regardless of the size of the institute or number of students. There are
essentially the same number of committees, the same number of classes and if the
program is going to be successful, a very similar number of outreach programs.
5. Somehow, a few incredibly invested faculty kept things going, but inevitably it was like
paddling seven ten man canoes with 6 people and five paddles. Power struggles no doubt
remained but, now you mostly have exhausted power. Many of your hardest workers
desire a more balanced life.
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Facing the reality of the situation is hard enough, finding a solution may be even harder. But
fortunately, we are a species which, compared to others, is designed for adaptation. The site
visitors were not unanimous regarding a suggested solution and recognize, with thought, you
may have better ideas. But here are several to consider:




Everyone can pull together evenly. Working together, and with a great deal of sustainable
energy by all, you can make it happen.
Outside faculty could be recruited. The advantage would be more and varied faculty and
a lessened academic load for your faculty. The disadvantage is that the administrative
load would be no less, and perhaps more.
A consortium could be formed, similar to the child program. The advantage would be
shared coordinated teaching and perhaps shared curriculum which would lead to some
savings but much of the fixed administrative cost (various committees included) in each
institute would remain.
A consortium (confederation is probably the more accurate term) could be formed
designed to share the administrative load. Many committees, perhaps curriculum, ethics,
progression, selection and other committees could be joint committees with the chairs
rotating in some fashion to create balance and equal representation from each institute
which would allow members to serve on only one or two committees. One curriculum
could be developed for all. Using electronic means, the teaching load would be less and
the range of ideas, of faculty talents and probably the courses themselves would be
expanded. Classes could then be started more often. Local institutes could focus more
energy on tiered recruitment courses. The disadvantages would include less local
autonomy and, probably, with more competition for roles, power struggles.
The first solution is the one you have been hoping for and it is possible everyone in your institute
could come back into the fold, chip in and create viability. Some of us feel this idea may be wish
driven (Freud’s definition of an Illusion) and that no shell game or fantasy can remedy the reality
of a critical mass problem. If this is possibly true, would it be wise to begin looking at the other
possibilities even if considered as contingency planning? If most in your community want to
remain entirely autonomous, considering the alternative may awaken the energy you are hoping
for.
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Appendix A,
Further comments and suggestions for Outreach:
More on the organization of the tiers: As noted above, the distance between most clinicians’
previous training and analytic training is much larger than in the past, a time when analysis was
also more idealized. A series of small steps with minimal incremental investment is both more
rational and more likely than a large leap into the unknown. Of course, proving ourselves useful
at each step is essential and this usefullness is what makes the taking of the next step logical.
Being accompanied by a cadre of interested others who confirm this impression helps. A
combination of these goals is what the tiers intend; Clinicians from different backgrounds gather
and coalesce lower tiers. When invited to the next level they may move as a cadre. Who wants
to be left behind, especially, when the last step was useful and the next one is small? The tiered
invitations help solve another problem by creating a natural and automatic filter; invited to the
next tier, the less interested, the less coalesced, will choose not to move along. This limits the
number feeling rejected because not invited to be a candidate because it could be clarified there
should be no expectation to be pursued to be a candidate unless you completed the fourth tier.
And those who filter themselves out could remain affiliated and much closer to analytic thinking
than if they had taken no steps at all. Those who complete the fourth tier are invited to apply to
the fifth tier, but the selection committee would decide who better fits the psychotherapy course,
who analytic training. Here some would feel a sense of rejection but this is a more manageable
problem than no applicants at all.
Manpower: Where would the manpower come from, a problem at every level in your institute?
The number of people needed for the lower levels is not so onerous and you are doing much of
it anyway, certainly at the first level. At the second level, anyone could lead one shot clinical
conferences without strain. The third tier could involve two people, each teaching six 90 minute
periods a year, not a major strain. The fourth tier would require more investment but, assuming
several people each developed a different topic, the load could be split, no one need teach in
successive years. But a separate Psychotherapy Program and an Analytic Program do require
concerted planning and manpower, an issue that will be addressed in another section of this
report.
Two examples of how programs might be layered:
Your Katrina project led to multiple contacts with multiple therapists. Each of these might have
been and still could be invited to one or several level two events. Or, to draw them together, an
exhibit of art resulting from and about Katrina might be combined with a presentation/discussion
related to your study results and/or follow up. Whoever attends might be invited to other level
one events but any professional could be invited to a level two event.
Another example grew out of our private interview with Kim Vaz. She has given us permission to
discuss it with you. Kim Vaz trained to be an analyst at institute which is not part of the APA. She
is the associate Dean at Xavier University of Louisiana, a traditional African American University
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which is located about a 20 minute walk from the institute. The University’s mission and focus is
science and their student body includes many pre-medical students. They also beginning a
masters level program in counselling and, of course they also have their own therapist and
counselors for students. Students are from a range of backgrounds but many have traumatic
backgrounds, whether from Katrina or from other causes. Kim is enthusiastically interesting in
the following possibilities involving the members of your center:

Talks to the students including joining a class to talk about development, therapy or some
other topic.

Working with the masters level counselors, the ones they have working with their
students, for example supervision or classes. Once a relationship was developed they
would be able to come to the institute or for supervision during their work day.

Helping to developing an educational program for the new masters level program.

A project in the local community.
There are federal funds set aside for Traditional Black colleges and the university would be willing
to write for a grant if a good idea was developed.
The first step, which she is ready to make, would be for several people from her university,
including her, to meet with several people from the institute to discuss a next step.
To us it seemed a marvelous opportunity which would provide something of value to everyone
involved. Dr. Vaz seemed to us to be an ideal facilitator and partner who could provide efficient
access to an African American university and community, to clinicians ready to learn, and
potentially some support from Federal money.
And, perhaps, this could generate an Analytic Candidate or two. While some work might occur
solely in relationship to the University, their counselors could also be invited to join the ladder of
tiered programs for clinicians, expanding both their world and ours.
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