The Issue of Certification: Some Critical Questions and Answers

Q. What is the need for certification in psychoanalysis? Why is not certification in psychiatry sufficient in itself?

A. There are both internal reasons relating to our own Association and external reasons relating to current trends in the health professions. Though the present screening procedures carried out by our Membership Committee for the Board on Professional Standards do fulfill an implied certifying function, it is not designated as such nor generally recognized as a certification procedure. Moreover, it violates a basic principle of certification, namely that it should not be conferred only by membership in a professional organization, i.e. that membership is required as the only mode of obtaining certification.

It is clear, too, that the examinations of the American Board of Psychiatry and Neurology are not particularly revelant to competency in psychoanalysis. It appears that in the near future practitioners will be designated as primary physicians or specialists and third party payments will be made on that basis. Certification may be linked to licensure and is also essential for PSRO and Peer Review. The issue of re-certification is also on the horizon and I think that many of our members would prefer to have the opportunity to be re-certified in psychoanalysis rather than psychiatry.

Q. Why didn't the Committee pursue certification under the American Board of Psychiatry and Neurology?

A. At the present time only a special competency status would be available to us in certification under the American Board of Psychiatry and Neurology. One would first have to be certified in general psychiatry and then take another examination for special competency in psychoanalysis. Many of our members would be unwilling to undergo such a double examination. No grandfather clause would be allowed, so that some of our older and distinguished analysts would have to be examined first in general psychiatry in order to be certified as having special competency in psychoanalysis. Graduates of our institutes trained under the provisions of a waiver for research training would be ineligible for such certification because they lack a medical degree. Finally, the American Board of Psychiatry and Neurology, while willing to receive recommendations from our Association among others would maintain final authority over policies, standards and examination procedures. Our Committee felt that it would be unacceptable to our membership for the Association to relinquish all control over such important matters to an outside group unfamiliar with psychoanalytic training, eclectic in viewpoint, and conceivably even unsympathetic to analysis.

Q. In view of the objection advanced a few years ago by HEW that there may be a conflict of interest in the American being involved in training accreditation, certification, and membership, why have you abandoned the concept of a certification board that is totally independent?

A. There are two reasons. First, if we attempted to form a totally independent board, other psychoanalytic organizations could justifiably argue that we do not represent all of psychoanalysis and would claim the right to have an input in the setting of procedures and standards. The Committee realized that it would be virtually impossible to achieve agreement among these diverse groups. It would be difficult to determine the qualifications for application and no doubt there would be legal challenges. Moreover, how such an independent board could be funded is another apparently insoluble question.

A second reason is that we do not feel that the HEW suggestion is really valid. A conflict of interest would exist if local institutes were to certify their own graduates, but not when examination for certification is conducted by analysts from other accredited institutes within the American and where there is a relatively autonomous structure, the Board on Professional Standards, to review and assess the competency of graduates who apply for certification.

Q. If we establish a certifying body within the American for the graduates of institutes accredited by BOPS, isn't there the possibility that other psychoanalytic organizations or even the American Board of Psychiatry and Neurology might attempt to establish separate boards?

A. Of course there is such a possibility. Although the American Board of Psychiatry and Neurology has stated that it has the authority to establish a certification procedure in psychoanalysis on its own, its officers have assured us that it would not do so without the participation of the American. Other groups, however, may follow our example. We can have no prior certainty that our Board will be accepted completely or immediately, but we have a long tradition of establishing and maintaining high standards and this fact is generally recognized.

Q. Could you specify the principles that guided the Committee in its deliberations?

A. Summarized briefly those principles are as follows: (1) Certification should be separate from membership. (2) Certification should be a national rather than a local process. (3) The process of certification should be discharged through specific organizational structures whose functions are clearly defined and concrete. (4) Any accrediting or certifying body must be autonomous in the carrying out of its functions and reaching decisions about individual cases.

Q. Do the latest proposals of the Committee adhere to these principles?

A. In the main, I would say that they do. There is, of course, always room for improvement and there is such provision for gradual development of the certifying function as is indicated by experience.

Q. Would you clarify the relationship between the certifying body and the American Psychoanalytic Association as proposed by the Committee?

A. The certifying body would be a sub-structure, a Committee of the Board on Professional Standards. The BOPS is the ultimate authority with respect to certification within our Association, but the work of accomplishing this specific function is to be assigned to and carried out by a specifically designated standing committee of the Board. The certification committee would report to the BOPS on those recommended for certification, on general trends in the qualifications of applicants and on the development of policies and procedures. It is expected that such a sharing of experience will prove useful and constructive.

Q. Will the various institutes be represented on the certifying body?

A. To include representatives from every institute would make the certification committee of unmangeable size. However, each institute will have a chance, through the BOPS, to review developments and certainly to have a voice in influencing them. All BOPS committees have traditionally been constituted to be widely representative, although it has been felt best not to make a formal requirement for complete representation.

Q. You have indicated that not all of the details have been worked out. Shouldn't we wait until this has been done?

A. The Committee firmly believes that it is important to establish an explicit certifying function as soon as possible. To wait until there is agreement on every aspect would mean an interminable delay. Moreover, decisions would have to be made without the experience and knowledge derived from direct work with the issues and problems involved.

Q. If the proposal is approved at the December meeting, will there be a considerable delay before the certification procedure can start?

A. No. The functions of the present membership committee will be assumed by a Certification Committee which will be appointed promptly. Since there is a well established basis for its work, it can begin immediately while also attending to the reappraisal of previous policies and procedures.

Q. Under the Committee's proposal Active Members would be declared certified. Since membership will not be required for certification in the future, why shouldn't the non-member graduates receive equal treatment?

A. The present Active Members have already undergone a review and evaluation by a national body, the Membership Committee, whose functions have heretofore included an implied certification of competence within the explicit certification for membership required by the By-laws. Non-member graduates have been evaluated only by their local institutes and to accord them certification would violate an essential principle in any certification process. It would result in lowering the value of the certification already achieved by present members through a national review procedure if it were to be issued to significant numbers of graduates without requiring that review. Moreover, non-member graduates lose nothing under the proposal as they have the privilege of applying for an evaluation of their credentials by a national body whether or not they wish to become members.

Q. Would certification be open to lay analysts?

A. Individuals who have completed full training under a waiver of the medical degree by the BOPS would be eligible for certification. The lack of such a provision for research graduates was one of the reasons why the Committee rejected certification under the Board of Psychiatry and Neurology.

Q. Will it still be necessary for a training analyst to be a member of the American or will certification alone be sufficient?

A. The certification proposal makes no specifications about the requirements for a training analyst. Unless the BOPS should change the present ruling concerning membership in the American, that requirement would remain.

Q. The proposal eliminates the necessity of membership for certification. Will certification still be required for Active Membership?