Feature Story

Division 39 practice survey: A roundtable

Five psychoanalysts discuss their views on the current state of the field based upon the results of a recent Division 39 practice survey and suggest what should be done to maintain the vitality of the profession

By Bob Prince, Ricardo Ainslie, Nancy McWilliams, Nina K. Thomas, PhD, and Steven D. Axelrod

Bob Prince  (BP):
If the survey respondents  are a representative sample of American psychoanalysts: we fall into two groups, one fairly satisfied and secure, the other moderately dissatisfied and anxious; we’re mature [60ish], over two-thirds women, in practice 20 to 24 years. In other words, we began training around the time the psychoanalytic fall from grace was underway but was still being significantly denied by our mentors, from whom we have a different social and gendered sensibility, but to whom we are still heir. One way to contextualize the crisis of psychoanalysis is as a crisis of generations, augmented by our own long apprenticeships and consequent maturational lags, occurring in the midst of a wider cultural shift that privileges change over tradition. While our forbears needed us for their vitality, we face a poverty of legatees. The critical population of psychoanalytic patients having been psychoanalytic candidates, psychoanalysis has some resemblances to a pyramid scheme nearing the end of a long run.

Two unambiguous findings initially seem paradoxical. First, respondents give most credit to their psychoanalytic training for the success of their practices. Second, we overwhelmingly see patients once a week. How can we explain that in our intellectual activity we overwhelmingly promote theories of therapeutic action that require significantly greater frequency than our actual practice and are thus dissociated from quotidian clinical reality, and thus make us suspect other dissociations of dearly held theory and practice? [John Gedo’s similar report of the absolute dominance of once-weekly sessions in practices of members of the American Psychoanalytic Association over 25 years ago, just at the time our respondents were beginning their careers, suggests a long-term denial of a split between the reality of practice and emotionally invested clinical theory.]

Ricardo  Ainslie (RA):
It  is impossible to  miss the  obvious. The Division is aging and the division is almost exclusively white. These two facts alone do not augur well for the  future of the Division or the future of psychoanalysis. No matter how intellectually interesting, vibrant, and engaging our work is, and no matter how adroit our insights, we will not survive unless this changes.

I teach in a doctoral program in coun- seling psychology. We  have top-notch students from all over the country. Almost none has read Freud as an undergraduate or in their master’s programs (and these students come  from excellent schools). When they are exposed to psychoanalytic ideas and formulations they are quite taken and amazed, and they are  surprised by the richness of psychoanalysis  and  its  utility for working with a broad variety of patients in different contexts. But they do not come looking for psychoanalysis, far from it. Their preconceptions are that the theory is dated, not a “best practice,” not “empirically validated,” and therefore of dubious validity. They have to be shown. They have to be exposed to these concepts and see them deployed. The other reality we are not adequately engaging is the changing demographics of the nation. Only 4 percent of our members are Latino, Asian, or African American (combined), yet the country is almost 30% nonwhite. Very few of us have participated in the annual APA Multicultural Summit (our board has contributed fi nancially to it, but, unlike other APA practice-related divisions where the Summit is a signifi cant event, for most of us it is off the radar). And there are very few presentations at our division meetings or local chapter meetings that speak to these issues on a theoretical and/or clinical level. Yet, across the nation, many clinical and counseling trainees as well as social workers and master’s-level psychologists view the psychology of race and culture as central, cutting-edge topics. We’re on the sidelines, or a step or two behind on the issues that are engaging the imagination of trainees and early career professionals, and that is refl ected in our membership and in our meetings.

Nancy McWilliams (NM):
I have long felt that I am watching the slow destruction of my beloved profession, and the survey offers few grounds for revising that view…My experience teaching graduate students parallels Rico Ainslie’s. People come to our Rutgers program having been exposed to remarkable misunderstandings and disparagements of the psychoanalytic tradition, purveyed by undergraduate teachers at prestigious colleges who know little about psychoanalysis or even clinical practice generally. Once these students are exposed to psychoanalytic ideas, they are as likely to fall in love with them as we were, and to see their therapeutic potential, yet they fear they cannot make a living as one of us and had better specialize in niche practices or specific CBT treatments. One bright spot is that those who do follow a psychoanalytic path seem to be surviving professionally, often in the context of having learned to comply with insurance company rules and assumptions— a notably corrupting but virtually unavoidable fact of contemporary professional life, especially for newer practitioners.

Interestingly, it is often my international and minority students who are most excited by psychoanalysis, as their sense of marginality may attune them to dynamics that are not so visible to their more mainstream peers. This phenomenon might augur a welcome infusion into our field of nonwhite, nonprivileged colleagues. But even enthusiastic students, those who have seen through claims that analytic treatments have been “empirically discredited” or are “not evidence-based,” know that insurance companies have drunk that Kool-Aid and will ignore entreaties that their clients need more time or intensity to reduce their suffering in meaningful, enduring ways.

I have spent my career trying to show the value of an analytic sensibility to people outside psychoanalytic ingroups, and I am not about to give that up, or to stop speaking truth to power. It is clear that we help people and they appreciate that. But I do not see much basis for optimism in the survey results.

Nina K. Thomas (NT):
To read the survey results and our discussion is disheartening indeed. Ours is an aging profession; in large measure bifurcated, as Robert Prince points out, between those who are “fairly satisfied and secure” and those who are “moderately dissatisfied and anxious.”

In a separate survey conducted in 2010 by three members of the Division 39 committee I chair, the Committee on Public Relations for Psychoanalysis, Daniel Hsu, Sean Murphy, and Susan Parlow performed powerful qualitative and quantitative analyses of the data of participants’ responses and rankings of words that to them best characterize psychoanalysis. Very [briefly], our survey [of approximately 200 respondents] demonstrated several distinct differences in the ways in which men and women identify the field.

  • Women are signifi cantly more likely to mention the “Analyst Patient Relationship” in their responses than are men [p = .013]

  • Women are more likely to mention “Exploration of the UCS” in their responses than men [p = .046].

  • Women are more likely to mention “Promotes a Better Quality of Life” in their responses than men [p = .021]. In similar fashion, the distinctions between how early career practitioners as compared with senior psychoanalysts think about the field are revealed in the following data:

  • Early career respondents were more likely to mention that “Change is Transformative” in their responses than either senior practitioners or graduate students [p = .005].

  • Early career respondents were more likely to mention that psychoanalysis is “Research Based” in their responses than the other two groups [p = .014].

D/R: Thank you all for getting it started. I think we have all been struck by a certain discouraging picture represented by the results, discouraging in a number of ways that each of you have identified. I wonder if there is anecdotal or other evidence for a contrasting picture regarding the wider field, or do you think that the depiction that emerges in the data regarding Division 39 membership is true in general of the field of psychoanalysis?

BP: Our editor, David Lichtenstein, seems taken aback by the pessimism in our original statements and queries optimism among us. Regarding Nancy’s reference to Kool-Aid, it’s not the insurance companies who drank it; we served it to ourselves. To be absolutely clear, I believe that the most grievous of our wounds are and continue to be selfinflicted, including a profligate squandering of the resources of wisdom our profession offered us. First, a combination of our relation to the generation before and our narcissism, grandiose and wounded, led to failures in our relation to reality.

I think there is Kool-Aid in confusing the necessity and desirability of adapting to change with bemoaning the diminished image we see in the mirror. The result is a self-devaluation where we might otherwise have an appreciation of our worth, our maturity, and, yes, our real successes in enhancing the legacy left us. In fact, I think the psychoanalysis we do today is much better therapeutically than the psychoanalysis we were taught, but this is another discussion.

As long as we measure our value by the fee we’re paid, not only will we be very unhappy, we will severely limit our vitality. We need to distinguish psychoanalysis as a way of making a living and psychoanalysis as a way of life. It will be necessary to adjust our expectations of remuneration and perhaps status and to be eager to integrate new observations and ideas into our way of thinking while maintaining what is essential and defi ning. Confusing transformations that are inevitable, some of which may even be salutary, with a surrender of the essentials that defi ne us to the point of losing our identity is truly drinking the Kool-Aid.

If pessimism is an expectation that practice will not be the same as it was for the generation that inspired mine, well then I am very pessimistic. On the other hand, I’m absolutely fi ne, maybe even better, when frequency and fee are on the table, perhaps the structure of the psychoanalytic encounter and certainly our connection to the health care system. Rico and Nina bring changing demographics into the discussion. In my understanding of history, outsiders started psychoanalysis, and I suspect that outsider status is a requirement for success at it. Yet, how have we failed to communicate the enthusiasm and commitment we once had and which Nancy so beautifully describes?

Steve Axelrod (SA):
he roundtable participants rightly point to the demographics of the survey participants (and division membership) as the basis for their pessimism about the field. Any profession that cannot replicate itself, that does not recruit new members from across the social spectrum, is in serious trouble. We need to ask more rigorously what keeps young people from entering our profession. In the most general sense I believe our fi eld has lost status over the course of our professional lives, which is ironic given the widespread acceptance of psychotherapy in our culture. That loss of status has two major interlocking components— economics and reputation.

On a purely economic basis, our profession does not look like a particularly good bet to young people embarking on a career—not vital, exciting, or lucrative. It may well be that people think more narrowly about career options than in the past, but even the recession hasn’t changed the belief that the real payday lies in getting a degree in business, law, accounting, and maybe medicine. Psychology and psychoanalysis isn’t a top choice, especially for ambitious men who value financial reward.

But as Bob Prince pointed out, we bear some responsibility for our diminished reputation. I agree that we developed a set of expectations about psychoanalysis and its practice based on conditions at a particular point in time, and have not adapted well to the changes around us. Even though many of us have done quite well fi nancially and are relatively satisfied with our practices, we also feel besieged and unappreciated.

It is not wrong to talk about our sense of entitlement and defensiveness, but I prefer to see the problem as one of insularity. When I talk to people who are informed nonpsychoanalysts, they typically describe the fi eld as “insular,” often adding that while we offer something of enormous value we don’t communicate this well to the wider world.

The insularity of our profession was evident in survey participants’ responses to some of the questions concerning practice development. The respondents typically strive to “grow their reputations” as the key to professional growth, and look to methods “internal to the profession” to do so. That is, the respondents favor activities such as teaching and supervising, networking with colleagues, and attending study and supervision groups over methods such as advertising, noncolleague networking, and developing specialized clinical or applied psychoanalytic skills. Even more significantly, the respondents don’t seem to have much conviction that any particular method is helpful in expanding their private practices other than obtaining psychoanalytic training.

So I would conclude that as a group we have become highly aware of and attuned to the external threats to our professional lives but have been quite unsuccessful in formulating effective responses to those threats.

I do think we have some very talented people within the Division who have helped counter its insularity. Two of them, Rico and Nancy, are participating in this discussion. We need more, and should actively encourage those who have interest and talent in explaining psychoanalysis and making its ideas and methods accessible to the broader population. I hope more of our senior members will take up the mantle of “public intellectual” by applying psychoanalytic understanding to everyday problems.

Finally, Nancy observed that psychoanalysis is most exciting to her international and minority students, perhaps because they have a broader view of careers beyond finance, business, law, and medicine. In a similar vein, I think we need to know more about who our prospective patients are most likely to be and what messages and methods we use to reach them. This requires skills outside our profession and I think we would do well, perhaps in concert with other groups of psychoanalysts, in searching for and hiring the right consultants to do an in-depth marketing study.

NT: hank you, Steve, for your excellent “pulling together” of our discussion and, in particular, thank you for calling for an in-depth marketing study. While we tell others that they should seek professional assistance when needed, we take an opposite view when it comes to developing our own businesses.

Whether we are talking about advancing our profession or just maintaining it, we do need to make the case for what we do beyond the consulting rooms of likeminded professionals. We need powerful materials that speak to “thought leaders” in business, government, and social policy. To do that in any meaningful way requires expertise beyond what we can beg or borrow from our members, their spouses, neighbors, or cousins. So I thoroughly agree with you about funding an in-depth marketing plan and hope we can educate others in our Division about the necessity for such an effort. We could consider undertaking such an effort in concert with other psychoanalytically oriented groups, the APsaA, for instance.

BP: Who, no matter how insularly oriented, would be so (stereotypically psychoanalytic) obstructionist as to cavil with your proposals, particularly since they reflect thoughtful attention to boundary issues? So, let’s just say I’m very cautious.

Steve, thanks for highlighting my position that “we bear some responsibility” for our status, but my position is more extreme than that. Over the years there have been countless [public relations] efforts. 20 years ago I proposed and co-chaired a committee for the April Meeting in New York. We engaged a professional publicist who got to the New York Times behavioral science writer. The column that appeared in that Tuesday’s Science section was titled, “When a Lot of Therapy Goes a Little Way.” A recent New Yorker cartoon shows a group of sad-faced clowns around a computer screen. The caption asks, “What do you do when you have a dying profession?” and is answered “Start a new website.” Yes, in the face of threat there is a laudable impulse to do something, but there is real danger in making things worse. It’s ludicrous to think that we would ever have access to a budget that is even an infi nitesimal fraction of Big Pharma’s. More importantly, their marketing has also undermined the integrity of psychiatrists, respect for psychiatry, the credibility of science and research, and has contributed to the distrust and cynicism that is the bane of our times. For me, marketing is the antithesis of what makes psychoanalysis essential and crucial and marketing changes it into something else that can’t compete because it really is inferior.

If, on the other hand, by marketing you mean education, then you have my enthusiastic support. We need voices. I’d support, for example, asking our clearest writers to express the range of our best ideas for a lay audience and develop and pay to promote, yes, a website with their contributions. I’d also reorient our writing awards toward the best books written for those lay audiences. The fact is there is no more popular major than psychology, not enough places in graduate programs for really talented students, and yet psychoanalysis is out in the cold. They are starving for what we have to offer but not looking twice at us. For about 80 years psychoanalysis addressed both a yearning to alleviate emotional suffering and a tremendous curiosity about the mind, and then was found wanting. Why? It’s easy enough to blame others, but what are we doing wrong? Because we live in a borderland between ideas and earning, it’s hard to figure out. My fear of marketing is that it creates a false reality and our imperative is to move out of the castles in the air that we have built and, as the nuanced saying goes, “get real.”

NM: In my previous comment I was feeling particularly discouraged about our profession, partly because of the disparity between what my students wish they could do as therapists and what they are increasingly required to do by hospitals, agencies, insurance companies, and graduate programs. This has very little to do with their wanting to make the big bucks that were possible at one point in psychoanalytic history; it has much moreto do with their wanting to have authentic, curious, engaged, devoted  relationships with  the people they are trying to help. It’s hard to do that under the rushed, one- size-fits-all formulations that now pass for “best practices.”

I have also been distressed by the recent news that an official NIMH brochure on treatments for borderline personality disorder makes no mention of psychodynamic treatments, despite the fact that the colleagues of analysts  such as Kernberg and Fonagy have published utterly kosher randomized  controlled studies of psychodynamic therapies for BPD. The politics of analytic scholars getting funding and getting their work cited is formidable; this is not just a matter of not having done the science in a timely way. I do think Bob is right about who drank the Kool-Aid, but we need to be careful not to be overly self-critical when what is needed now includes some pretty aggressive fighting back and the correcting of omissions, misconceptions, and lies. I will try to mention a few of the more positive features of the current psychoanalytic scene, however, in what follows.

I think Steve is right that we are ambivalent about money, and that we kid ourselves about the extent to which it is important to us. The  survey results suggest that we wish we could have practiced at a time when standard  fees were high. Because it was simply the way things were, we could regard ourselves as generous and flexible (which was easier when we were earning more) and not particularly interested  in financial issues. There is also a gender difference here, with women’s self-esteem being (in general) less tied to money than that of men. As our field becomes less “stale, pale, and male” there may also be less drive to keep ourselves in steak and caviar, and I’m not sure how to view that probability.

The  relational movement has inspired a new generation of psychoanalytic  practitioners. One seldom-noted upside of analysts not being as highly valued as we once were is that the people who are attracted to our work come to us because they have the passion for it, not  because it will increase their status. It seems to me that a clear benefit of the relational turn, which applies irrespective of whether a given practitioner identifies with  that  orientation or not, is its effect on case presentations throughout the field. Both verbally and in writing, case descriptions are no longer one-dimensional depictions of the patient’s pathology and the therapist’s ingenuity in detecting and overcoming it. Instead, therapists are telling more of the truth of how they thought  and felt and what they said and how the two parties struggled with painful change.

Although I am  intellectually a pessimist, I am temperamentally an optimist. I can notice that  Rome is burning way out of control and still try to organize a bucket brigade. So I hope my pessimistic observations are not equated with defeatism. The positive things we can build on are not trivial. We help  people  in profound, permanent ways. Contemporary research, not just our anecdotal experience as patients and therapists, increasingly attests to this. Our sometimes lamented marginality is, as Bob notes, part of our strength; as the culture becomes increasingly controlled by a corporate culture  accountable to almost no one, we are still trying to interrogate together what is not being seen and valued in such a world. I agree that we tend to do better outside the mainstream, and the flip side of no longer being so central and conventional is that we may be even freer to critique the self-deceptions of our time and place, insofar as we can see them. But we do need to get out of our offices to do that.

RA:  I just returned  from the  Association for Psychoanalysis, Culture, and Society meetings at Rutgers where I participated in two panels, each with two different sets of graduate students. For three of them, it was their first conference where psychoanalytic ideas were discussed. They found the expe- rience enlightening and very motivating—it galvanized their interest in psychoanalysis. As a division we should  make our graduate student and early career professional ef- forts a priority: get people to the meetings, create forums where graduate students and early career colleagues present their work, and where  our collective norm is that  we attend such presentations, not  just  when we happen  to be chairing the event. Some division chapters  have an award in which they underwrite the travel of one or two graduate students to the division meetings every year. Several of the students here in Austin who have been the beneficiaries of such awards have in turn become young professionals with an active engagement in psychoanalysis. That investment, in other words, often translates into a strong identification with psychoanalytic ideas. That’s something that all of our chapters could take on as a major effort and perhaps the Division could help underwrite such costs at the chapter level: an investment in our future. Those graduate students and early career professionals come home and talk to their fellow students and colleagues.

I agree with Steve Axelrod’s point that we need more “public intellectuals” writing about and otherwise “performing” psychoanalysis and psychoanalytic ideas in the public sphere. We are the best ambassadors for these ideas. If not us, who? The Division should find ways of encouraging, acknowledging, and rewarding such efforts. I also share Nancy’s frustration regarding the ways in which psychoanalytic ideas and concepts have been “appropriated” and relabeled. I don’t see an alternative here but to step into the discussions and debates within APA, which is where we have the greatest potential of influencing in the short-term, and becoming activists for what we believe (and, especially, the data and research that, in fact, support the work we do as psychoanalysts, no matter how many times a week we see a patient).

BP: The institution of psychoanalysis embodies a confl ict between the needs for organization, best reflected historically by Freud’s and the IPA’s tight reins on orthodoxy (civilization) and the inherent ethos of nonconformity (discontent) . . . While our animus is directed at insurance companies, we all are concerned with the cost of our own medical care and insurance. I’m guessing many of us recognize that cost containment is an absolute priority but don’t reconcile our needs as consumers of health care with our needs as “providers,” i.e., to make a living. We support mental health parity in the abstract, yet are either naïve or dissociated about the impossibility of maintaining a psychoanalytic practice in the context of a model we would desire for our own medical treatment. Further, I do not think sufficient thought has been given to where in the medical arena—if at all— psychoanalysis belongs. I don’t doubt for a second that it results in the amelioration of “medical disorders,” but I believe such benefi ts are actually secondary to its essential nature as something sui generis. Could anything that pretends to be a medical practice survive being nondirective and symptom tolerant? Much more thought has to go into our model of practice and being assertive, not apologetic, about it.

SA: I appreciate the lively exchange that has taken place among the participants. Let me return one more time to the survey results in order to offer an observation and suggest some future steps.

Our discussion has focused mostly on the “macro” of how and why our fi eld has evolved the way it has. The participants have offered a number of suggestions for how we might counter our insularity, whether by educating the public, recasting our message, or by more strongly and confi dently connecting with different constituencies. In this fi nal comment I would like to shift to a more “micro” view of today’s psychoanalytic clinician.

I suspect that the paradigm for practice development has shifted since the attitudes of our 60-ish survey respondents were formed. That model emphasized technical excellence, professional reputation, and colleague referral networks as the key to developing a vital clinical practice. Adherence to that model is evident in the attitudinal data of the practice survey.

But the world has changed, and I wonder if continued adherence to the old model puts us at a disadvantage and unwittingly ignores the needs of our early career colleagues. As practitioners we are certainly not alone (i.e., lawyers, physicians, accountants) in feeling the increased exigencies of commerce and marketing, though I think we are particularly adept at self-righteous protest and political complaint. Today’s practitioner needs to add to the old model of practice development by being more outwardly focused, more attentive to the boundary between professional identity and the universe of potential referral sources, patients, and especially competitors. I would argue that marketing in this sense is not in opposition to the self-knowledge and identity development that we so cherish. It starts with self-refl ection and self-discovery— what aspects of practice (settings, activities, patient types) are most energizing, most linked to mastery, self-confi dence, and joy? What aspects of our practice activity are unique and differentiating? These are the points of departure for developing a personal brand, a personal mission statement, and long-term career goals. Specifi c tools for marketing and advertising then come into play.

NM: Even if the psychoanalytic profession is not a ticket to the high life, it has enormous staying power in ways that cannot really be counted. It is meaningful. It reduces suffering in profound ways. Part of my worry about the future of our profession is my sense of how much more difficult it is now, for the reasons we have all talked about, to have a psychoanalytic practice in which these rewards can accrue.

I agree with Bob that there is something inherently outsider-like and even subversive about psychoanalysis. All the more reason that, in an era in which promising psychology students are no longer being steered in our direction, we need to reach out and welcome those in the next generation who have a feel for the unconscious into the fellowship of the deliberately and even joyously marginal.

NT: I suggest that mine is a position shared by many in our fi eld, as we prefer to do what we have habitually done—teach, write, give presentations—and hope for the best. Ours is a profession in which we speak primarily to one another and even disdain the necessity of speaking to a wider “lay” public. Yet, not to do so imperils our field. I suspect that some of our tendency to speak to like-minded initiates lies in the personality dynamics that lead us to choose a profession in which our primary communication is with one, or less often, only a handful of others. I applaud Bob’s suggestion as a potential remedy that we develop an award to honor the publication of a book that presents psychoanalytic thinking in a way that could reach a nonpsychoanalytic public. But more than that, I do think each of us who is temperamentally suited to doing so consider the ways we may undertake to speak about the essential components of psychoanalytic process and thinking to the many different publics we encounter regularly. Recently, I attended an international law conference on restorative justice. Several presenters spoke from what they described as a theoretical perspective of “relational theory.” I asked what they meant in describing their thinking in that way. The response I received was that the “relational theory” referred to emerged out of feminist theory of the Jean Baker Miller school and, further, that intersubjectivity was an essential dimension to be included in thinking about restorative justice processes. While none I spoke with specifically articulated psychoanalysis as contributing to their thinking, the roots are clearly there.

Finally, I do want to return to the point of our field’s response to the changing demographics of our society. The United States will become a “majority minority” culture by 2030, or so some predict. Nancy has commented on the appeal of the discipline to her international and minority students, perhaps refl ecting how “their sense of marginality may attune them to dynamics that are not so visible to their more mainstream peers.” This is an interesting conjecture. Beyond such a question, however, I think we are obliged as ethical practitioners to apply a psychoanalytic perspective to power structures that, among other things, marginalize difference. Incorporating ethnic perspectives on psychoanalytic thinking is vital to remaining a living rather than dead praxis. I welcome, as do my colleagues in this discussion, the enlargement of our field in such a way.

BP: I feel privileged to have been part of this conversation. Embedded in it is one of the essential insights of psychoanalysis, the inevitability of conflict and the difficulty of its resolution. I need a vocation as well as an avocation. I also need to see my self as progressive, open to and assimilating new knowledge, cultural forms, metaphors, and models. But I also derive personal meaning from being part of a discipline that embodies the Western tradition. Just as some people feel an obligation to protect endangered species, scholars to preserve dying languages, artisans to maintain crafts, psychoanalysis, in opposition to the market and common wisdom, will strive toward leaving some measure of pure gold unalloyed. For most, much of the time, it will be an unattainable extravagance. But I also believe a very few, for some part of the time, will sustain its ethos even as they also integrate new knowledge, and that the fate of the many will be linked to the success of the few. And finally, I believe that success will require personal and institutional self-reflection, and the conversation has to be sustained, continued, and enlarged.

About the authors

Robert Prince, PhD is in private practice in New York City and Great Neck. Adjunct Clinical Associate Professor and Co-Chair, Interpersonal Track, New York University Postdoctoral Program in Psychoanalysis and an Associate Editor, American Journal of Psychoanalysis, he is the author of the Legacy of the Holocaust: Psychohistorical Themes in the Second Generation and editor of The Death of Psychoanalysis: Murder, Suicide or Rumor Greatly Exaggerated.

Nancy McWilliams teaches at Rutgers University’s Graduate School of Applied & Professional Psychology and practices in Flemington, New Jersey. Author of Psychoanalytic Diagnosis (1994, rev. ed. 2011), Psychoanalytic Case Formulation (1999), and Psychoanalytic Psychotherapy (2004), and associate editor of the Psychodynamic Diagnostic Manual (2006), she is a former president of Division 39 (Psychoanalysis) of the American Psychological Association. She is one of three psychotherapists chosen by APA Press (2011) to be videotaped for purposes of training in a comparison.

Nina K. Thomas, PhD, ABPP, served as co-chair of the relational track at the NYU Postdoctoral Program in Psychotherapy and Psychoanalysis and Chair of the Specialization in Trauma and Disaster Studies. Faculty and supervisor at NYU Postdoc and at the Center for Psychoanalytic Psychotherapy of New Jersey, she is in private practice in New York City and Morristown, New Jersey.

Steven D. Axelrod, PhD, practices psychotherapy and psychoanalysis as well as organizational consultation in New York City. He is a graduate of the NYU Postdoctoral Program in Psychotherapy and Psychoanalysis. Steve initiated the Practice Survey in 2008, has been active in a number of division-wide efforts to advance the profession, and is a Contributing Editor to DIVISION/Review.