Recently there has been a flurry of activity within the analytic community over the issue of certification of analysts. In part, this has been created by the attempt on the part of NAAP to receive official status through the U.S. Office of Education as the national certifying body for all of psychoanalysis.
The discussions over the “Chicago proposal” relate in some way to the issues of certification but appear to be directed more broadly at the appropriate definition of a member of the American Psychoanalytic Association.
There appears to be an attitudinal problem among analysts about both the nature and the value of certification. The current method of certification used by the Association is so insular that it appears to be ludicrous and self-serving to observers from outside of our organization. The American Psychoanalytic Association sets the standards for becoming an analyst, accredits the training institutions, dictates, for the most part, the curriculum and criteria for
graduation, reviews applications for membership in the Association, and serves as the certifying body for ultimate “certification” as an analyst. Furthermore, this certification process is only open to those who have graduated from accredited institutes and is ultimately tied to membership in the American Psychoanalytic Association.
The potential criticisms of such a system are enormous. Even if the system were in the hands of honest, forthright and “totally” unbiased analysts, the opportunities for real or imagined abuse are extraordinary. Furthermore, in all other certifying situations, the system which provides the educational input is totally separate from the system which evaluates the product.
Are there criteria which clearly define the process of becoming an analyst and the average expectable product of that process? If so, then an outside, independent group of certifiers should be able to separate the competent from the incompetent trainees. I am not pressing for such a situation totally. Rather, I am asking the Association to recognize the untenable nature of this current process. When the NAAP first applied, I recommended to the Officers of the Association that they join with the Academy and present a counter application to become the national psychoanalytic accrediting body. I felt that if the two organizations joined forces to create a separate, bona fide and higher entity, the threat presented by the NAAP could be successfully dissipated and we could avoid the criticisms which are inherent in our current system. This suggestion was greeted with a variety of responses which seemed to beg the question of the dangers posed by the insistence of the NAAP. Comments about the adulteration of analysis and the unacceptability of any joint venture with the Academy seemed much more important than the issue of appropriate, recognized, external review, evaluation and certification.
I would like to alert members of the American to the imminent dangers generated by the combination of external threats posed by such spurious and unacceptable organizations as NAAP and the internal threats posed by an unanalytic and unrealistic approach to the issues of analytic education and certification. The NAAP may well succeed in its attempt to persuade the Office of Education that it should be the single, national, certifying group for all analysts. It is now unopposed in its application to the government reviewers, who have no personal knowledge or interest in psychoanalysis, and have no way of knowing if they are the “correct” group. The letters and testimony in opposition to the NAAP have slowed down the process, but we should not be lulled into a sense of false security. Furthermore, each time they reapply, they get more advice and acquire greater expertise in preparing and submitting the application. All of our protests could be interpreted as petty bickering among competing organizations, and since theirs is still the only application which the Office of Education has received, our opposition can easily be misunderstood.
Should the NAAP be successful, their accredited institutes and their students will be eligible for subsidized loans and their standards would be the ones recognized by the academic and therapeutic communities. Eventually, those certified by the NAAP might be eligible for third party reimbursement, etc.
My concern is echoed in the following excerpt from President Cooper's comments in the Newsletter of June, 1980: “I am cautiously optimistic that we will prevail, but NAAP has been energetic and extremely well organized and this has required that our response be equally intense. We must write letters, organize our institutes and societies to provide information on the care they provide and so on. It is not easy to begin to adapt to the idea that our involvement with issues of governmental regulation is a part of our clinical responsibility to our patients to assure that they will receive the best clinical psychoanalytic care.”
To my mind, the greater problem is the lack of understanding among leaders of our Association that we cannot preserve psychoanalysis as a “pure” profession in an alien world where attacks on the sanctity of psychoanalysis make greater sense to a majority of professionals and consumers alike. Instead of applying analytic scrutiny to the strong beliefs which play such a large role in the policy discussions of the Association, we seem to persist in acting like ostriches and ignoring increasingly serious encroachments on the practice of our profession.
Paul J. Fink, M.D.
Philadelphia