After two years of study and deliberation, the Joint Ad Hoc Committee on Certification reported its conclusions to the Board and Council at the Annual Meeting of the Association. This Newsletter is printing a full report in order to help institutes, societies, and members to discuss the proposals knowledgeably. All groups and individuals are invited to communicate their reactions to the Committee before final recommendations are made.
On January 22, 1975, representatives of the Committee appeared at a hearing before the Advisory Committee on Accreditation and Institutional Eligibility of the Office of Education of the Department of Health, Education, and Welfare in regard to the Association's application for listing as the Accrediting Association for Psychoanalysis. Our application was rejected on several bases, some valid and others totally inapplicable. Significantly, however, the Advisory Committee noted that our Board on Professional Standards “functions to oversee the development of new programs, approves the programs, and certifies the graduates of the programs for membership in the American Psychoanalytic Association. The placement of these three functions under the aegis of one body raises a serious conflict of interest issue.”
The Advisory Committee's statement gives some indication of how governmental agencies and other professional groups view the complexity of our organization. The Association has been attempting to discharge not only the usual functions of a scientific and professional organization, but also the functions of accreditation of institutes and the certification of the professional competency
of individuals. For other educational and training institutions, including those related to medicine, these functions are separated and carried out by different agencies. Although there are historical reasons for the inclusion of all these functions within our organization, membership in the Association has been at best a quasi-certification. It has been the only national form available, but one not recognized by outside parties, and not accepted as such by some of our members and by some graduates of institutes. The Committee on Certification was appointed to seek a more adequate and acceptable form of certification in view of national trends that will inevitably require certification for third party payments, professional liability insurance, and in some states, even licensure and relicensure.
The Committee felt that it was necessary to clarify the distinction between terms that are often used interchangeably and confusingly. It is generally accepted that accreditation is a process by which educational and training programs of a specific institution are officially approved or disapproved by an independent agency made up of representatives from various professional groups within a given field. Although the institution applying for accreditation cooperates in the process, evaluation is made by respected educators unconnected with the institution in order to avoid the conflict of interest mentioned by the Office of Education. Certification, on the other hand, is the process by which the professional competency of individual graduates of training programs is evaluated and affirmed by an independent board which has national rather than local significance.
The Committee concluded that there are four possible means of achieving certification in psychoanalysis in an acceptable manner.
One, Continuation of the same system, we now have. Because of its disadvantages, this was thought to be acceptable only if no substitute can be found that meets with the approval of a majority of the societies, institutes, and the membership.
Two, Certification through the American Board of Psychiatry and Neurology. This board is subject to the regulations of the American Board of Medical Specialties, which has taken a firm position that no more separate Boards will be established for additional specialties, presumably to avoid further fragmentation of medicine. Additionally, no more sub-specialty Boards will be approved. Therefore, the only possibility open to us would be to seek Certification in Psychiatry, with Special Competency in Psychoanalysis, by means of a special examination following the certifying examination in general psychiatry. About 75% of our members already have certification in psychiatry, but the Board would not allow any grandfather clause because of the current trend toward recertification. Non-medical graduates of our institutes would not be eligible to apply for certification. Moreover, the Board of Psychiatry and Neurology would have absolute authority. The APsaA would be consulted concerning the composition of the Examining Board, but other unspecified groups would be consulted as well, and the Association would have no assurance of even a majority on the Examining Board. This lack of control, or even assurance of predominant influence, is the issue on which previous attempts at certification through the Board of Psychiatry and Neurology were rejected by the membership. In the opinion of the members of the Committee, the composition of the Board of Psychiatry and Neurology is even more unfavorable to the interest of psychoanalysis at this time than in the past. It was the judgment of the Committee, therefore, that this possibility is unlikely to be acceptable to our membership, although the fact that it is within the framework of organized medicine offered some advantages.
Three, an independent board might be established in liaison with other groups. The Board would consist entirely of psychoanalysts, but with representatives designated by more than one professional organization. Other organizations considered included the AMA, the APA, the Academy of Psychoanalysis, and the American Psychological Association, in various combinations. It was the opinion of the Committee that this alternative also would not be acceptable to our membership.
An advantage of this fourth alternative would be that high standards could be maintained. In the beginning it would be open only to graduates of our own institutes, but at a later date it might be opened to graduates of other institutes, provided those institutes meet our standards for accreditation. How such accreditation might be achieved remains an unresolved question. It was pointed out that the Office of Education had stated “that the review program conducted by the Association can best be characterized as a developmental and consultative service, rather than accreditation” in the generally accepted sense. For this reason the possibility of separating the Association into four independent structures was discussed: 1) a scientific and professional organization on an individual membership basis; 2) an Association of Training Institutes in Psychoanalysis; 3) an organization to accredit training institutes; and 4) a Board for Certification in Psychoanalysis. The Accrediting organization and the Certifying Board might be composed of representatives designated by the scientific and professional membership organization and the Association of Training Institutes. The Committee felt that there would be serious problems in dividing the responsibilities of the present Board on Professional Standards between the Association of Training Institutes and the Accrediting Board. Although such a division of the Association might have some advantages and might ultimately be desirable, it is a radical step, with many complicated questions yet to be answered, including funding. Moreover, it goes beyond the charge of this Committee, which
was assigned to make limited recommendations. The Committee therefore decided to confine its recommendations to those concerning a Certification Board.
We are tentatively recommending that the present functions of the Membership Committee be assigned to an autonomous, and perhaps ultimately independent group, to be known as The American Board of Psychoanalysis. Graduates of Approved Institutes would be eligible to apply for such certification regardless of whether or not they want to become members of the Association. A Membership Committee would then be established under the aegis of the Executive Council to consider the qualifications of applicants for various categories of membership in the Association. We would suggest that all present full members, who have been screened by the current membership process, and therefore have achieved a status hitherto considered equivalent to certification, should be declared certified in psychoanalysis and be designated as Fellows in a new membership category. Only Fellows would be eligible 1) for Training and Supervising Analyst status, 2) to represent institutes on the Board on Professional Standards, 3) for chairmanship of important committees, 4) and for officership in the Association.
All graduates of institutes would be automatically eligible for membership, with full voting rights and without a time limit on their memberships. The present category of Affiliate Members could be retained without necessary change. New members could become Fellows only by going through the process of certification. We believe that this system might accomplish two purposes: the establishment of an independent Board on Certification, and the ingathering of graduates of institutes who heretofore could not be given full membership status because of its quasi-certification meaning.
This is not a final recommendation. But the Committee believes that it is a sufficiently promising solution to warrant widespread dissemination of the proposal and discussion of the issues within the institutes and societies as well as in Board and Council.