The Corporate Shrink

Our new group is pushing hard to turn the business around, but our corporate parent seems to block our every initiative. Requisitions for even the smallest expenses take weeks, and every new idea faces a battle. This rigidity may somehow be in the company’s best interest – but it’s clearly not in ours. (issue 75, page 56)

Whenever you encounter a system that seems so irrational, you should ponder what’s going on beneath the surface. One possibility: This is a simple display of power. Those unaccommodating managers may be trying to show your new team just who’s in charge.

Waging outright war with the minders of bureaucracy will only provoke them to dig their heels in deeper. So before trying the Terminatorapproach, understand that, in the long run, establishing a good relationship with these folks is clearly in your best interest.

Think creatively about the situation. Who in the corporate hierarchy has ultimate responsibility for these senseless decisions? And which top executive put your new group in place? Approach these people to seek their “guidance” on dealing with your predicament. A bit of guilt and empathy can be powerful motivators. Put these people in your frustrated group’s heels or wingtips, and they may soften their stance.

If reasoned appeals fail, then carefully turn up the heat. Don’t resort to name-calling – although I’m sure that as weeks and months pass with your purchase order still in limbo, your potential vocabulary knows no bounds. Instead, make the case that the bureaucrats are blocking your ability to do business effectively. Put some of the responsibility on their shoulders. Do they really want your group to fail?

By the way, why wasn’t this sorted out before now? Could it be that your group’s leaders made faulty assumptions about existing corporate practices or inadvertently communicated that you’d do things their way? Just wondering.

People always talk about changing the corporate culture. Well, our company needs a culture transplant. It’s cutthroat and punitive. Poor performers are routinely berated in public, and the rest of us are afraid to speak up. Can a culture like this really be changed?

A culture can be changed. But to borrow from the old joke about how many psychiatrists it takes to change a lightbulb, it has to want to change. And change has to start at the top.

Like an individual’s personality, corporate culture is constant and predictable over time. Formed early in the life of an organization, culture is determined by the personalities and behavior of its founders or key leaders, by the company’s strategy and practices, and by its position in the marketplace. Culture is embedded in the fabric of the company, and it tends to live on long after even top executives depart.

Changing culture usually starts with leadership. In your company, I have to wonder what hidden purpose is served by maintaining the status quo. Are leaders “identifying with the aggressor,” doing unto everyone else what was done to them by leaders past? To break this vicious circle, leaders need to model a different way of treating others. They also need to make it clear that abusive behavior – and silence – will no longer fly.

Dr. Kerry J. Sulkowicz, a psychiatrist, psychoanalyst, and founder of The Boswell Group LLC, advises executives on leadership, management, and governance. Send him your questions about the psychology of business (shrink@fastcompany.com).

Chairman’s Style Governs Board Dynamics

Audit committees occupy center stage in the wake of corporate scandals and the resulting reforms brought on by Sarbanes-Oxley. With significantly increased responsibility to oversee the accuracy of corporate financial reporting, audit committees are understandably nervous these days. Although they have always been critically important in corporate governance, these committees are now feeling the glare of governmental and public scrutiny like never before. This newly intensified public role is resulting in new organizational as well as psychological challenges that need to be understood and addressed.

As a consultant to CEO’s and directors on issues involving boardroom dynamics and relations between boards and senior management, I’ve seen close up the organizational and psychological stresses confronting the audit committee. These stresses can result in a wide range of potential dangers that the audit committee and the full board needs to be sensitive to in order for the audit committee to effectively meet its charter mandate.

One danger is the possibility that audit committees will become paralyzed by this increased scrutiny, fearful that any move they make will be watched and criticized. In the name of accountability, they run the risk of becoming overly conservative in their oversight role, and even inhibiting the management team from taking reasonable risks and being creative — albeit in a legal way.

The newly mandated role of the “audit committee financial expert” is also fraught with psychological pitfalls. While some audit committees have sorely needed a dose of rigor and expertise, they now might invest undue power in the person who holds this role. The “audit committee financial expert” is in danger of becoming viewed as the ultimate authority who will keep the company honest, despite the fact that this unenviable expectation far exceeds what any one individual can do. Will the expert acquire so much authority that he becomes cast in an unfortunate power struggle with the CFO or the CEO? And could the “audit committee financial expert” become the object of envy and competition from other board members, or diminish the role of the chairman?

Various factors might account for the apparent laxity of some audit committees in the past. Members of audit committees are human, and subject to all the natural forces of group dynamics that can be expected under these circumstances. When you have a personal stake in believing that something you are overseeing is being done right, there is an expectable pull either to be extremely cautious and scrupulous, or to not look very deeply at all. We may veer towards the latter in circumstances where the prevailing culture is one that rewards conformity and cohesiveness rather than open debate and dissent. Reports provided by management, internal audit and the external auditors may be accepted a bit too much on faith, and there might be an unspoken peer pressure to gloss over questions they might otherwise be pursued. Retaining membership in an “exclusive club” by not making waves, can become more important than doing what is right.

Audit committees are like the chaperone on the high school trip: they’re supposed to keep an eye on the occasionally unruly kids, but they also know that it’s a perennial struggle to get a close enough, real-time view. Neither Sarbanes-Oxley, nor any other rule-based approach, can guarantee that audit committees will catch every misdeed.

A real danger is the potential view of these committees as saviors. But just as audit committees are at risk of being blamed, they are also at risk for being seen as knights on white horses. This view may lead to some members acquiring an exaggerated sense of their own importance. What about the relationship between the audit committee and the larger board? Will audit committees now acquire more influence and power, and inadvertently disempower the board as a whole? Will members of the audit committee be envied for their power, or pitied for the weight of their increased responsibility? Will board members be reluctant to serve on audit committees? And what about the prospects for tension between the “audit committee financial expert” and other members of the audit committee, the board or management?

While there are no easy answers to these questions, the best way for audit committees to avoid the pitfalls is to be alert to their possibility in the first place, and to frequently examine and reflect on their performance as individuals and as a group. This might include a formal self-evaluation, an approach now being adopted by many companies based on proposals from the NYSE, seeking more constructive feedback from management and the board, or the use of external consultants on organizational dynamics.

Audit Committees are facing a time of tremendous change with increased pressures to meet ever higher expectations; and with increased responsibility comes the opportunity to make a difference. There is no formula for audit committee success, but ongoing vigilance and heightened awareness to the organizational dynamics and psychological dimensions of their roles can strengthen an audit committees functioning and help insure that they continue upholding the highest standards of accountability.

Kerry J. Sulkowicz, M.D., founder of The Boswell Group LLC in New York City, advises senior executives and boards of directors on psychological aspects of management and governance. He also writes the “Corporate Shrink” column for Fast Company magazine, and can be reached at 1-212-737-1542 orkjs@boswellgroup.com.

New Organizational and Psychological Challenges of the Audit Committee

Audit committees occupy center stage in the wake of corporate scandals and the resulting reforms brought on by Sarbanes-Oxley. With significantly increased responsibility to oversee the accuracy of corporate financial reporting, audit committees are understandably nervous these days. Although they have always been critically important in corporate governance, these committees are now feeling the glare of governmental and public scrutiny like never before. This newly intensified public role is resulting in new organizational as well as psychological challenges that need to be understood and addressed.

As a consultant to CEO’s and directors on issues involving boardroom dynamics and relations between boards and senior management, I’ve seen close up the organizational and psychological stresses confronting the audit committee. These stresses can result in a wide range of potential dangers that the audit committee and the full board needs to be sensitive to in order for the audit committee to effectively meet its charter mandate.

One danger is the possibility that audit committees will become paralyzed by this increased scrutiny, fearful that any move they make will be watched and criticized. In the name of accountability, they run the risk of becoming overly conservative in their oversight role, and even inhibiting the management team from taking reasonable risks and being creative — albeit in a legal way.

The newly mandated role of the “audit committee financial expert” is also fraught with psychological pitfalls. While some audit committees have sorely needed a dose of rigor and expertise, they now might invest undue power in the person who holds this role. The “audit committee financial expert” is in danger of becoming viewed as the ultimate authority who will keep the company honest, despite the fact that this unenviable expectation far exceeds what any one individual can do. Will the expert acquire so much authority that he becomes cast in an unfortunate power struggle with the CFO or the CEO? And could the “audit committee financial expert” become the object of envy and competition from other board members, or diminish the role of the chairman?

Various factors might account for the apparent laxity of some audit committees in the past. Members of audit committees are human, and subject to all the natural forces of group dynamics that can be expected under these circumstances. When you have a personal stake in believing that something you are overseeing is being done right, there is an expectable pull either to be extremely cautious and scrupulous, or to not look very deeply at all. We may veer towards the latter in circumstances where the prevailing culture is one that rewards conformity and cohesiveness rather than open debate and dissent. Reports provided by management, internal audit and the external auditors may be accepted a bit too much on faith, and there might be an unspoken peer pressure to gloss over questions they might otherwise be pursued. Retaining membership in an “exclusive club” by not making waves, can become more important than doing what is right.

Audit committees are like the chaperone on the high school trip: they’re supposed to keep an eye on the occasionally unruly kids, but they also know that it’s a perennial struggle to get a close enough, real-time view. Neither Sarbanes-Oxley, nor any other rule-based approach, can guarantee that audit committees will catch every misdeed.

A real danger is the potential view of these committees as saviors. But just as audit committees are at risk of being blamed, they are also at risk for being seen as knights on white horses. This view may lead to some members acquiring an exaggerated sense of their own importance. What about the relationship between the audit committee and the larger board? Will audit committees now acquire more influence and power, and inadvertently disempower the board as a whole? Will members of the audit committee be envied for their power, or pitied for the weight of their increased responsibility? Will board members be reluctant to serve on audit committees? And what about the prospects for tension between the “audit committee financial expert” and other members of the audit committee, the board or management?

While there are no easy answers to these questions, the best way for audit committees to avoid the pitfalls is to be alert to their possibility in the first place, and to frequently examine and reflect on their performance as individuals and as a group. This might include a formal self-evaluation, an approach now being adopted by many companies based on proposals from the NYSE, seeking more constructive feedback from management and the board, or the use of external consultants on organizational dynamics.

Audit Committees are facing a time of tremendous change with increased pressures to meet ever higher expectations; and with increased responsibility comes the opportunity to make a difference. There is no formula for audit committee success, but ongoing vigilance and heightened awareness to the organizational dynamics and psychological dimensions of their roles can strengthen an audit committees functioning and help insure that they continue upholding the highest standards of accountability.

The Corporate Shrink

I’m stuck in a great job with a bad boss. I’ve got a senior marketing position in a consumer products company, where I’ve been for 15 years. I’m highly skilled and well paid. But my immediate boss gets in the way of every good idea I have. He can’t seem to tolerate my wanting to be creative or successful. (issue 74, page 50)

Before blaming your boss – and yes, you might wind up doing that anyway – I’d advise investing in a good mirror.

Perhaps you’re actually sabotaging your own efforts, while attributing the obstruction to your boss. Psychoanalysts call that “projection.” Or the problem may lie in the dynamics of your relationship. You may be unwittingly inviting him to meddle, either by coming across as threateningly competitive or by trying too hard to please him.

That said, you could well be right about your boss. Are other of his direct reports having the same problem? That’s a telling indicator. Even if this is about him, though, you’re not off the hook. It’s clear your current approach to solving your relationship problems isn’t working, and you need to do things differently.

One option: Try giving your boss some feedback in a way that’s direct but not self-destructive or provocative. Do this alone or with a group of colleagues who share your sinking boat. Tact is of the essence. If your boss can’t hear what you’re saying, don’t respond by yelling louder.

You’ve tried to patch things up and failed? Then consider one more possibility: Maybe this is about more than your boss. Perhaps your company’s culture rewards conformity and compliance over innovation and individual achievement. If so, then it’s back to the mirror – to ask what you’re doing there in the first place.

The favorite sport at our young firm is trying to figure out our CEO. He’s constantly pitching our services, but he always swings for the home run and whiffs, leaving it to lower-level salespeople to bring in the business that keeps us afloat. He loves to talk, rarely listens, and seems more of a dreamer than a real leader. Everybody always talks about him behind his back. I’m no shrink, but I think he’s insecure and out of touch.

Well, I am a shrink – and while I encourage amateur shrinking in the workplace (it’s a form of empathy), don’t put too much stock in your conclusions. Treat your speculations like Kleenex: Use them liberally, but throw them out when they’ve outlived their usefulness.

Why do you think that shrinking your CEO is such popular sport? Is it because the guy really is such an enigma, or does it reflect a general reluctance to challenge him directly? Is it because he is unapproachable, or is everyone colluding to avoid bursting his bubble? Since you’ve taken the initiative to write me, perhaps you’re the logical person to speak for all of those gathered around the watercooler. Find a way to tell your CEO that you need him to return to earth.

Presumably, your boss wouldn’t be where he is without some measure of ability and accomplishment. I bet that he was once a grounded entrepreneur and his dreamer quality came off as visionary leadership. Now that he’s been at it for a while, he’s uncomfortable with running a more structured company. Rather than confront the mundane work of a CEO, he shoots for the stars. It may be time for him to move on to a new challenge. At least, that’s my Kleenex.

 Dr. Kerry J. Sulkowicz, a psychiatrist, psychoanalyst, and founder of The Boswell Group LLC, advises executives on leadership, management, and governance. Send him your questions about the psychology of business (shrink@fastcompany.com).

The Id, The Ego, and The Office

It’s the corner office, of course. It belongs to the founder and owner of the firm, a man who has long indulged a reputation for running his engineering supply business with unyielding authority–at least until now. Now he’s yielded his authority, all right: He suffered a stroke that has cost him his speech and possibly his mind. Knowingly or not, he has left his three daughters in charge of the family business. Just how difficult their task is going to be becomes clear to one visitor after he examines the adornments on the office wall and sees three telling pieces of evidence: the daughters’ high school diplomas.

“He treated his daughters as these possessions ,” says Kerry J. Sulkowicz, MD, the New York corporate consultant the family hired to help them through this transition. “He always thought more about how they would grow up to serve him, rather than helping them develop into independent, free women.”

Where others might see a sentimental gesture–a father’s pride in his daughters’ accomplishments– Sulkowicz senses something more sinister. And if his interpretation seems somewhat Freudian, that’s because it is. Sulkowicz is a psychoanalyst.

The situation in this case is literally a family matter, but Sulkowicz has found in his corporate practice that business conflicts always carry a certain primal association. And so they should, he argues, since a business setting is simply the breakfast table writ large: the over- (or under-) demanding patriarch, the under- (or over-) rewarding maternal figure, and, always, the minions who can’t help but regard the authority figures in the corner office with the same sort of ambivalence they still associate with the all-powerful parents of their own childhood–and who therefore, well, act out.

Sulkowicz isn’t the only psychoanalyst to take the lessons of the couch and apply them to the boardroom or cubicle. As psychopharmacology and managed care began costing them clients in the 1990s, some analysts sought an alternative way to ply their trade. They found it at the heart–or in the psyche, anyway–of the economic boom. In 1996, about 10 members of the American Psychoanalytic Association formed what became the Committee on Corporate and Organizational Consulting. Today that committee has tripled in size.

Stalin to Saddam: So Much for the Madman Theory

”BY his word he could kill them, have them tortured, have them rescued again, have them rewarded. Life and death depended on his whim.”

The psychoanalyst Erich Fromm used these words to describe the ”refined sadism” of Josef Stalin, who took delight in playing with the minds of his victims before he ordered the destruction of their bodies.

But the revelations of recent weeks suggest that they might as easily be applied to another former dictator, Saddam Hussein.

The objects unearthed at Iraqi prisons, palaces and safe houses speak of brutality and indulgence. A gold machine gun. A cable used to deliver electric shocks to ears and genitals. Fantasy paintings of snakes, monsters and unclad women. A red wire cage with a cement channel in the floor for human excrement.

The stories behind the objects tell of paranoia and caprice — arbitrary imprisonment and equally arbitrary release, opulently furnished rooms never inhabited. And behind it all is a man who acted out his fantasies of omnipotence using a nation as his theater and its citizens as his props.

Psychoanalyzing political leaders is a dicey business, and psychiatrists are quick to caution that without extensive research or personal contact with Mr. Hussein, nothing can be said with certainty about his psychological makeup. But what is already known about Mr. Hussein is suggestive, the psychiatrists say.

Like Stalin and Hitler, Mr. Hussein has sometimes been referred to as a madman, in part because people are reluctant to accept such ruthlessness and cruelty as the product of anything but insanity.

But bad does not equal mad. Most historical analysts have rejected the notion that mental illness could explain the actions of either Stalin or Hitler. Experts familiar with Mr. Hussein’s upbringing and years in power said that there was no evidence that he suffered from psychosis or any severe mental illness. The very fact that he was able to stay in charge for so long and exert such complete control argues against insanity, the experts said.

Two researchers, Jerrold M. Post and Amatzia Baram, concluded in a psychological profile of Mr. Hussein that he was more accurately described as a malignant narcissist, a label that has also been applied to Stalin and Hitler. Dr. Post, a psychiatrist at George Washington University, and Dr. Baram, an expert on Iraq at the University of Haifa in Israel, wrote the profile for the United States Air Force Counterproliferation Center. Dr. Post was also the founding director of the Central Intelligence Agency’s political profiling program.

Malignant narcissism, as defined by psychiatrists, is a severe form of narcissistic personality disorder. Like classic narcissists, malignant narcissists are grandiose, self-centered, oversensitive to criticism and unable to feel empathy for others. They cover over deep insecurities with an inflated self-image.

But malignant narcissists also tend to paranoia and aggression, and share some features of the antisocial personality, including the absence of moral or ethical judgment, said Dr. Otto Kernberg, a psychiatry professor at Cornell University and an expert on personality disorders.

Far from being psychotic, malignant narcissists are adept at charming and manipulating those around them. Political leaders with this personality, Dr. Kernberg said, are able to take control ”because their inordinate narcissism is expressed in grandiosity, a confidence in themselves and the assurance that they know what the world needs.”

At the same time, he said, ”They express their aggression in cruel and sadistic behavior against their enemies: whoever does not submit to them or love them.”

Dr. Kernberg added that while he had studied Hitler and Stalin, and would categorize them as malignant narcissists, he knew little about Mr. Hussein and could not comment directly about him.

Dr. Post, however, said that the concept of malignant narcissism fit Mr. Hussein quite nicely.

”The overarching theme is the centrality of the self — that he is Iraq,” Dr. Post said. This self-glorification, he said, was combined with ”a deep-seated need to reassure himself through public adulation of how magnificent he is.”

Dr. Post added that the bunker built beneath one of Mr. Hussein’s palaces was a perfect metaphor for his personality. ”Here, under this grandiose palace with its inlaid woods and fine marbles, is this underground bunker with reinforced concrete and steel,” Dr. Post said. ”That’s his psychology: a grandiose facade and under it a siege state, ready to be betrayed, to be attacked, to strike back.”

In their profile of Mr. Hussein, compiled from news accounts and interviews, Dr. Post and Dr. Baram attributed much of the Iraqi leader’s psychopathology to his early childhood.

They described how Mr. Hussein’s mother suffered the death of both her husband and an elder son while she was pregnant with him. She tried to commit suicide and to abort her son, but was prevented in each case by members of a Jewish family who became her benefactors. When Saddam Hussein was born, the researchers wrote, his mother refused to look at him or take him in her arms.

Saddam went to live with a maternal uncle, Khairallah Tulfah, who imbued him with dreams of becoming a great Arab leader, like Saladin and Gamal Abdel Nasser. At 3, he returned to live with his mother for several years, but was psychologically and physically abused by her new husband, according to the profile.

”One course in the face of such traumatizing experiences is to sink into despair, passivity and hopelessness,” Dr. Post and Dr. Baram wrote. ”But another is to etch a psychological template of compensatory grandiosity, as if to vow, ‘Never again, never again shall I submit to superior force.’ This was the developmental path Saddam followed.”

Other psychiatrists, however, cautioned that it was difficult to draw conclusions about psychological development from sketchy information about a leader’s childhood, particularly when another culture was involved. ”Certainly, childhood experiences are very important,” Dr. Kernberg said, ”but very often that’s what we know least about, and what is most easily distorted by fancy speculation.”

What is not speculative is the adult that Mr. Hussein became, a man obsessed with molding the world into a reflection of his own power.

Malignant narcissism is not the exclusive province of dictators. In another country, at another time, with a different set of dice, some psychiatrists say, Mr. Hussein might instead have become a corporate executive, a lawyer, a cult leader or a politician. His ambition, paranoia and violence might then have been modulated by legal codes and tempered by the checks and balances of a free society.

Unfortunately, this was not the case. ”The best way to understand this,” said Dr. Kerry J. Sulkowicz, a psychoanalyst in private practice in Manhattan, ”is that occasionally in history there is a confluence of events, in which the severe psychopathology of a leader is allowed to flourish.’

Written by Erica Goode

Science Desk: Even in the Age of Prozac, Some Still Prefer the Couch

Four days a week, Rachel H. takes the subway uptown, waves to the doorman in the large prewar apartment building where her psychoanalyst keeps his office, lies down on a burgundy leather couch and begins to talk. 

Ms. H., a 33-year-old graduate student, has heard all the jokes. She has listened patiently to friends who tell her she would be better off taking Prozac or trying yoga or leaving New York altogether to escape her obvious ”dependency” on her analyst. She has endured teasing and incredulity. ”Don’t you think that’s so last century?” asked one woman. 

Yet Ms. H. is not bothered by this lack of enthusiasm. 

After spending six years and about $60,000 on analysis, she says, she is less self-destructive, more responsible, more productive and more successful in her work. She has more compassion for others. She understands, in ways that have grown more layered and complex, her own strengths and limits and those of the people close to her. 

In the last quarter century, psychoanalysis has been declared dead many times over. Psychoanalysts, once dominant in psychiatry, now stand on the sidelines of a field where drug treatments and brief forms of talk therapy are the rule. Thanks in large part to Woody Allen, Freud’s talking cure has become shorthand for costly self-indulgence with no obvious benefit. And many psychiatrists barely hide their disdain for what they regard as an outmoded approach to treating mental disorders. 

Yet thousands of Americans – it is not known exactly how many – continue to seek out psychoanalysis. Like Ms. H., they believe that the arduous, uncertain and often emotionally painful dissection of mental life such treatment entails offers something they can find nowhere else. 

”Obviously I think it’s an incredibly valuable thing that I’m doing. Otherwise, why would I do it?” said Ms. H., who spoke on the condition that her last name not be used out of concerns for her privacy. 

”You have to see things for what they are, and I think that’s essentially all that it’s about,” she said. ”It’s about lifting the veil, seeing relationships and seeing yourself, so that you can begin to make choices that will not lock you into an unhappy future and an unhappy life.” 

In its heyday in the 1950’s and 1960’s, psychoanalysis attracted a wide swath of the intellectual elite, along with many middle class patients who, backed by generous health insurance plans, were referred to psychoanalytic treatment as the best psychiatry had to offer. 

Experiences on the couch, good or bad, provided routine fodder for dinner parties. And the language of classical psychoanalytic theory – the unconscious, the Oedipus complex, the superego and the id – became firmly embedded in the culture. 

Yet most psychoanalysts now acknowledge that analysis was practiced far too broadly and that its effectiveness, particularly as a treatment for severe mental illnesses like schizophrenia and manic depression, was greatly oversold. 

”Many analysts thought that psychoanalysis was the treatment of choice for virtually every mental disorder,” said Dr. Kerry J. Sulkowicz, the chairman of the public information committee for the American Psychoanalytic Association, which held its winter meeting in New York last week. ”We’ve learned that that’s not the case.” 

Today, pharmacology and focused, short-term psychotherapies predominate in the treatment of mental illness. Psychoanalysts are more cautious about whom they will treat on the couch. And those who seek their help represent a far smaller and more select group. 

According to a survey conducted in 2001 by the psychoanalytic association, analytic patients in the United States are typically well educated, well-off financially, white and 30 to 50 years old. Some are mental health professionals, trying to understand themselves better in order to better help their patients. But business people, artists, writers, academics and others also find their way into analysis. 

Many have tried other forms of talk therapy and have been dissatisfied with the results. Some have taken, or continue to take, antidepressants or other psychiatric drugs and have found that while helpful, the medications have not solved their problems in forming intimate relationships or in avoiding destructive behavior patterns. Still others remain stubbornly committed to the notion that their emotional difficulties are rooted in the unconscious rather than in the ebb and flow of brain chemicals. 

”I had this really strong conviction that my problems were psychological, and I wanted to deal with them psychologically,” said Patrick Cody, 40, a communications consultant in Washington who spent 10 years in analysis, which he sought out after experiencing depression and severe panic attacks. 

In an era of managed care, most patients pay out of their own pockets for their treatment, which typically involves three to five sessions a week, at fees varying from $10 a session at a psychoanalytic training clinic to more than $200 a session at a Park Avenue practice. 

But time is often a bigger issue than money. 

”I don’t have a problem with patients’ affording fees,” said Dr. Henry Bachrach, a researcher and analyst at the New York Psychoanalytic Institute. ”But I can’t get to see them four times a week, because I can’t ask them to give up their livelihood.” 

Hollywood portrayals to the contrary, studies suggest that few people enter analysis for casual reasons. 

In a 2002 survey of 342 American analysts conducted by Dr. Norman Doidge, an assistant professor of psychiatry at the University of Toronto, most said that many of their patients in analysis suffered from multiple longstanding psychiatric disorders like anxiety, depression, sexual dysfunction and pervasive personality problems. 

About 80 percent of the 940 patients reported on in the survey had received other treatment before analysis. Eighteen percent were taking psychiatric medication. 

At the same time, three-quarters of the analysts’ patients were steadily employed at the start of analysis, Dr. Doidge found. And they were mentally tough enough to survive the rigors of treatment on the couch – an experience that bears some similarity to immersion in a sensory deprivation tank and that Dr. Bachrach described as ”putting you on the stove and turning up the heat.” 

Psychoanalysis itself has undergone profound changes in the last decades. 

In Argentina, France, Germany, Finland, Canada, especially in Quebec, and other countries, Freud’s legacy continues to thrive. Psychoanalysts are held in esteem and patients are plentiful. In some cases, the cost of psychoanalytic treatment is underwritten by national insurance. 

But in the United States, the scientific and economic events that have transformed psychiatry have squeezed psychoanalysts to the margins. Most analysts’ caseloads include only a few full-fledged psychoanalytic patients, the rest arriving once or twice a week for less intensive psychotherapy. The American association, the largest of the psychoanalytic organizations, counts roughly 3,500 members, 700 of them in New York. The average age of the association’s membership is 62. 

Once rulers, analysts now more often find themselves supplicants, mounting public relations campaigns to improve their image and reaching out to attract more candidates for psychoanalytic training and to forge better relationships with other psychiatric disciplines. 

This is not always an easy battle, as was evident in the focus groups assembled as part of a ”strategic marketing initiative” undertaken by the association in 2000. Asked to describe their psychoanalyst colleagues, the mental health professionals who participated in the groups used adjectives like ”arrogant,” ”elitist,” ”uninvolved,” ”cultish” and ”insular.” 

The public was no more helpful. Freud’s name still rang a bell. But the marketing effort found that the only thing most Americans knew about psychoanalysis was that it took a long time and that it involved a couch. Asked what kind of mental health professional they might look to for treatment, no one mentioned an analyst. 

Still, much of the tarnish that clings to psychoanalysis derives from an earlier time, when rigid neo-Freudian orthodoxy was the rule. 

”I think there’s been a shift in the last 15 years,” said Dr. Robert Galatzer-Levy, an analyst in Chicago. ”There was a time that if people deviated from whatever was at that point standard, they risked being thrown out of the analytic community.” 

Now, Dr. Galatzer-Levy said, ”the ideas get heard, they get discussed, they get debated, they are often integrated with one another.” 

In fact, few analysts these days adhere to a strict Freudian model, though most subscribe to the basic tenets of psychoanalytic theory, including the importance of unconscious fantasies and conflicts, the influence of childhood experiences, the centrality of the relationship with the analyst as a replaying of other important relationships in the patient’s life. 

Most talk to their patients, rather than sitting silently. Many are willing to divulge information about their personal lives: whether they are married, for example. Many exercise eclecticism in treating patients, drawing upon different theoretical perspectives. And many endorse the use of medication, in some cases prescribing it themselves. 

At one time, analysts were required to have medical degrees. But social workers, psychologists, art therapists and other mental health professionals have now joined the ranks of those who pursue the four years of training or more that becoming a psychoanalyst requires. 

At its best, Dr. Galatzer-Levy said, what analysis has to offer is change that is far deeper than what may be achieved in the 6 to 20 sessions of therapy covered by most insurance plans, change affecting ”the way people think and feel about things, the way they act in the world.” 

Some of that change may take place after the last psychoanalytic session has ended. 

In one of the first tightly controlled studies of the effectiveness of psychoanalytic treatment, Dr. Peter Fonagy, a professor of psychoanalysis at University College London, found that adult patients with borderline personality disorder, given psychoanalytic treatment in a partial hospital setting, showed significantly more improvement than a control group that received no formal psychotherapy. 

But Dr. Fonagy also found that the patients receiving psychoanalysis continued to improve in the 18 months after the treatment, progress he believes occurs ”when you face new problems and you are then able to deal with them in a superior way.” 

Patients who have had good experiences in psychoanalysis also describe substantial personal growth.

For Mr. Cody of Washington, the fruit of his treatment has been emotional maturity, he said, a lessening of fear, a greater ability to control his emotions, an ability to laugh off criticism where he once would have rankled. 

In his analysis, Mr. Cody said, there were ”periods of great stagnation but also periods of great benefits.” 

”There would suddenly be one session where things popped open,” he said. ”Every time that happened, I’d say, ‘That’s worth $3,000.’ ” 

Ms. H. said that in the course of her sessions on the couch she had examined every aspect of her life, from her fears of abandonment to her perfectionism to her repetitive dreams of running through city streets to save her brother from an attack by urban guerrillas. 

She has learned, she said, that ”the truth is mutable, the story changes.” 

”You might hold your parents responsible for some of your unhappiness and then later on that becomes incredibly unimportant,” she said. 

Yet Mr. Cody and Ms. H., like many others in analysis, have moments of doubt and disillusionment, and lingering questions that may never be fully answered: How much growth would have taken place anyway, with time and life experience? How much of what has been accomplished in 10 years could have been accomplished in 4 or even 2? 

Dr. Doidge, in his survey, found that the average length of analysis was 5.7 years. 

In an address to the psychoanalytic association last week, Dr. Owen Renik, a training analyst at the San Francisco Psychoanalytic Institute and Society, said that keeping patients in analysis ”for years or even decades” when no improvement was taking place represented an egregious – and common – ethical violation by psychoanalysts. 

”Too many analysts keep too many patients too long in treatment in the absence of any evidence that it’s helping,” Dr. Renik said later in a telephone interview. 

Analysts, he added, often rationalize why they are keeping a patient in treatment, but actually may be delaying the end of the analysis out of a desire for financial gain, an unwillingness to admit defeat or other unconscious motives. 

Those whose time on the couch has been less than positive could add other breaches to the list: Analysts so psychologically damaged themselves that they make their patients worse, not better. Analysts who allow the transference to become a pseudo love affair that replaces relationships in the real world. Analysts who are unable to admit their mistakes. 

Dr. Bachrach of the New York institute said it was no surprise that analysis could cause damage. 

”If it can do a lot of good, it can also do a lot of harm,” he said. 

Yet in a world of quick fixes and glib explanations for human behavior, analysis still symbolizes a commitment to complexity and deeper understanding. 

”It is a question of values,” Dr. Bachrach said, ”of what you want and what you expect out of life.”

Written by Erica Goode

The American Psychoanalytic Association (APSAA)

A Special Invitation to Attend

What
Part of APsaA’s Winter 2003 Meeting, one of the national biannual meetings, the Public Forum will discuss issues relevant to the current interest in the psychology of CEOs. Under the leadership of APsaA’s Committee on Corporate and Organizational Consultants, the Public Forum will also address the challenges of being a CEO in the current business climate.

Audience
Leaders and executives in the New York business community as well as APsaA members from across the country.

Admission
Free, and open to the public.

Date
Friday, January 24, 2003, noon – 1:30 p.m.

Where
Grand Ballroom, Waldorf-Astoria Hotel
301 Park Avenue, New York City

Panelists
Kenneth Eisold, Ph.D., President-Elect, International Society for the Psychoanalytic Study of Organizations (ISPSO) Carol Hymowitz, senior editor and “In the Lead” columnist, The Wall Street Journal Jeffrey Sonnenfeld, Ph.D., Associate Dean for Executive Programs, Yale School of Management; Founder and CEO, The Chief Executive Leadership Institute

Moderator
Kerry Sulkowicz, M.D., Chair, Committee on Public Information; President, The Boswell Group, LLC

Sponsor
The American Psychoanalytic Foundation

Contact
Dottie Jeffries
Director of Public Affairs
Phone: 212-752-0450, ext. 29; Fax: 212-593-0571
Email: djeffries@apsa.org

About the American Psychoanalytic Association
Founded in 1911, APsaA is a professional organization of psychoanalysts throughout the United States. The Association is composed of more than 50 Affiliate Societies and Training Institutes in many cities and has approximately 3,500 individual members. APsaA is a Regional Association of the International Psychoanalytical Association.

319 East 49th Street New York, New York 10017. Phone: 212-752-0450 Fax: 212-593-0451.
Web: 
www.apsa.org

NYC: Analyzing The Imagery Off the Couch

Not to dredge up old news, but you may recall that several weeks ago America’s most lethal psychiatric patient, Tony Soprano, walked out on his shrink, Dr. Jennifer Melfi.

Yes, yes, we realize this was a television show. But we’re not the only ones with trouble at times separating reality from illusion. Even the American Psychoanalytic Association can fuzz the line between the two. So smitten is it with Dr. Melfi that barely a year ago it gave a special award to the actress who plays her, Lorraine Bracco.

What, then, does it think about an honored colleague being treated so cavalierly by this lug?

It seems fair to ask, given that hundreds and hundreds of association members are in New York for the first time since that award. They are here for their winter gathering at the Waldorf-Astoria, a five-day affair that will stretch through the weekend.

(Note that of the association’s roughly 3,500 members, 700 live in and around the city. Metro New York’s share of the United States population is about 7.5 percent. Yet we have 20 percent of the shrinks. You be the judge of what this says about the state of our mental health.)

Back to Tony Soprano. Let’s put the question to the shrinks in terms that everyone can understand: how does what he did to his therapist make them feel?

Not bad at all, they say. Who knows? He may yet come back.

More important, ”it’s real life — patients leave us all the time,” said Dr. Leon Hoffman, a former chairman of the association’s committee on public information. His successor in that position, Dr. Kerry J. Sulkowicz, added, ”Patients don’t stay in treatment forever.”

These guys must have missed a lot of Woody Allen movies if they believe that.

In fairness, they have bigger concerns than Dr. Melfi’s patient load. One is their own public image. It isn’t good, they say, and in part they have themselves to blame.

”We’ve probably isolated ourselves too much from the rest of the mental-health community,” Dr. Sulkowicz said. With the general public, he said, not enough has been done to ”articulate some of our ideas in plain language and to be useful to the world outside the consulting room.”

Dr. Newell Fischer, the association’s president, is even more blunt about the problem. The image of psychoanalysts is ”dismal,” he wrote in the organization’s newsletter. They are viewed as ”aloof, uncaring, too intellectual and arrogant.”

Thank goodness, he threw in ”too intellectual” with the other adjectives. Otherwise, we might have thought he was talking about journalists.

OF course, defining positive and negative when it comes to image is a tricky business.

The Melfi character was praised by Dr. Hoffman for having established ”professional boundaries” with Tony. She doesn’t hop into the sack with him, as the Barbra Streisand shrink does with Nick Nolte in the film ”The Prince of Tides.”

But they can be full of surprises, these psychoanalysts.

You would think they’d like warm and cuddly film shrinks like Judd Hirsch in ”Ordinary People” or Robin Williams in ”Good Will Hunting.” No way, Dr. Sulkowicz said. ”The characters create totally unreasonable expectations of what an analyst can do,” he said. They give you the idea that ”once you get connected up with a long-forgotten memory, you’re fixed.”

”While on the surface it sounds great,” he said, ”this ultimately does a disservice.”

Want to hear Dr. Sulkowicz’s idea of good shrink characters?

Hold onto your couches. He likes the chomping Hannibal Lecter in ”The Silence of the Lambs” and the bumbling Billy Crystal in ”Analyze This.” They may be outlandish, he said, but they ”touch on some fairly ubiquitous fears that patients have about being in therapy.” One fear for patients is that they may be sharing their innermost thoughts with someone who is in as bad shape as they are.

It’s almost enough to make you reach for a drink.

Some psychoanalysts at the Waldorf did just that yesterday, while listening to Toby Williams, a singer with a group called Cocktail Angst. She sang numbers with titles like ”Shrinker Man” and ”I Can’t Get Adjusted to the You Who Got Adjusted to Me.” There was also a Rodgers and Hart song called ”To Keep My Love Alive.” Sounds sweet, no? It’s about a woman who marries one man after another, killing each before the romance can wear off.

With so many Freudians on hand, Ms. Williams steered clear of that Sinatra standard, ”You Make Me Feel So Jung.”

Written by Clyde Haberman

War Talk May Cause Anxiety, Panic

Questions about war, terrorism, and the economy confront us every time we turn on the television or pick up a newspaper. And for certain individuals, these external crises can  and will  trigger internal crises, say leading psychoanalysts.

“We are bombarded with news about crises in business, government, and religion and it’s over-stimulating,” Kerry J, Sulkowicz, MD, New York-based psychoanalyst, tells WebMD. “And it leaves us with the feeling that some of the basic pillars of our society are disintegrating and we are seeing some huge cracks or threats in the foundations of [these pillars]. That is deeply unsettling and for some it may precipitate profound personal anxiety,” he says.

The American Psychoanalytic Association is holding its Winter 2003 meeting this week in New York.

“There is a heightened public awareness about dreadful events and that dovetails with individual anxiety in people who are predisposed to having anxious, phobic, or fearful reactions,” says Sulkowicz, also chair of the American Psychoanalytic Association’s committee on public information.

Such simple strategies as turning off the television may help, he says.

But “if you experience continuous symptoms of anxiety such as sleeplessness, loss of appetite, difficulty concentrating, and irritability, and if it isn’t going away when you turn off the television, talk to someone who can explore your reactions and what it is about these external situations that can trigger internal crises,” Sulkowicz says.

There are many different types of therapists that you could turn to, but psychoanalysts say they may be able to offer a different perspective.

Psychoanalysis prides itself on getting at the deeper, underlying issues that plaque the unconscious mind. It is based on the observation that individuals are often unaware of many of the factors that determine their emotions and behavior.

What makes now so different from past crises?

While other periods in history have been marked by feelings of intense fear, the availability and proliferation of instant communications have literally removed borders, Sulkowicz says. “A crisis is no longer delineated to one area or one country any more,” he explains. News is disseminated rapidly and within minutes, people in the U.S. can know about something that happened or may happen in Afghanistan, Iraq, or anywhere else in the world.

“When it comes to viewing current events, most people have a normal level of denial, but the more anxious you are  for whatever reason  [the more prone you are] to respond anxiously to any stimuli,” says Leon Hoffman, MD, New York-based child psychoanalyst.

“People who experience an overabundance of anxiety over social events need to turn the television off and stop reading newspapers and magazine articles about subjects that make you worry,” Hoffman stresses. “”If talking to your friends and family does not work, talk to a professional.”

“Reducing stimuli can help but it’s not the only part,” Sulkowicz agrees. “The internal part is to allow yourself to recognize the need for and getting help,” he says.

Written by Denise Mann
Reviewed by Michael Smith, MD