Psychoanalysis 1980: An Interview with the Chairman of the Board on Professional Standards

Newsletter: You have been serving as Chairman of the Board for one year. To look back for a moment, what were the major concerns you had as you took over a year ago?

Hall: Two come to mind immediately. The first has to do with some of the perceptions of the Board and its work, among the membership at large and sometimes even within the Board itself. Some of its functions are seen to the exclusion of others. On the one hand, its seeming helplessness in relation to “splits” in institutes is better remembered than its less dramatic, often unnoticed efforts along consultative and conciliative lines; the Board seems too weak. On the other hand, the efforts to maintain and to improve standards of practice of training inevitably acquire in the minds of those unacquainted with the Board an aura of exclusiveness, perfectionism, righteousness and even arrogance; then the Board looks too strong.

In fact, the Board represents the collective will of the institutes. Perhaps even more important is the fact that the Fellows of the Board (two elected from each institute) and the members of the Board Committees are engaged in an ongoing process of helping each other—that is us—to do our jobs better. There is no institute without problems; and some of these problems are universal. Some are accentuated by local circumstances of history, ecology, and the exciting consequences of man's infinite variety. Fortunately, the collaboration of institutes and their combined representation on the Board has been more effective over the years. I want this progress to continue.

A second concern has to do with the decrease in the number of applicants to our institutes and with the apparent decrease in the number of good analytic cases for our candidates and our graduates. We are all vitally interested in these facts (although there is some evidence that applications to institutes are again beginning to increase). I am also, and perhaps even more, concerned that our response to these facts of psychoanalytic life in the 1980's might lead to an unwarranted and dangerous dilution of the basic principles of our enterprise. The appreciation of the unconscious, of resistance, of transference, of infantile sexuality and aggression, and of internal conflict, to mention a few, which for me seem fundamental, is as we know difficult to acquire and regrettably easy to lose. Their loss to us as individuals and to society can be prevented by our devotion to the best of psychoanalytic work. That is where conviction grows out of experience and that is where a humanistic scientific adventure becomes more than a system of belief.

Newsletter: Some might say that in view of the diminished number of applicants to institutes, we should extend (no one wants to lower) our admission standards. Do we have good criteria for selection and are the institutes willing and able to apply them?

Hall: Our criteria are getting better and so is our capacity to identify the presence or absence of necessary qualifications in clinical interviews along with other techniques of evaluation. COPE is at work on a detailed follow-up study of selection process and procedures, and by its continuing workshops institutes are pooling their experiences and learning from each other more about this important area.

The process is not perfect and it is not likely to become so, but we continue to try to improve it. Every institute has made mistakes, and there is sadness and distress about what we did or failed to do for an unknown number of fine people who were inappropriately selected for psychoanalytic training. I suspect that every Selection Committee also harbors misgivings about decisions not to admit for training some people whose potential talent may not have been identified.

The worst and unkindest thing we could do would be to select applicants in order to fill classes. Another mistake would be to select people for whom psychoanalysis is from the outset a subordinate interest.

Newsletter: Do you feel that the issue of membership now before the Association has anything to do with the selection process?

Hall: It is hard to generalize about that. The proposal currently before the Council, if passed by Council and if ratified by the members, would extend the Associate Membership beyond the present six years. I think it is improper without more information (which we are now collecting) to make general observations about those graduates who have not pursued certification and full membership. It is not surprising that after several years of training, some individuals are going to encounter shifts of scientific and therapeutic interests, sometimes leading in quite unexpected directions. To the extent that they are still involved with psychoanalytic ideas and their various applications, they will want, and we want them to be, affiliated with us in one scientific community.

Newsletter: You bring up the issue of certification. Would you be willing to respond to the argument that membership should be separate from the issue of certification?

Hall: Sure. The reasoning is, “These people have graduated from our institutes and they want to become members of our Association.” But there is more to be considered here. For example, we have not been able to explain why a large number of candidates have not accepted the invitation to become Affiliate Members, nor do we yet know why an important number of our graduates have made no move to accept the offer of Associate Membership. We need the answers to these questions for many reasons, quite apart from the current debate.

Another important part of the argument continues, “They will

be more motivated to pursue certification once their Associate Membership is solidly established and they find themselves involved in the scientific programs of the Association.“ This suggestion has to be viewed against the background that our present procedure has induced a very large number of applications for certification. Certification is becoming an increasingly important objective in the minds of candidates as they pursue their training, and more institutes are integrating into their handbooks, curricula, and supervisory experiences information about the Association, its purposes and its programs, as well as its certification requirements.

Newsletter: Some seem to feel that the membership issue is a symptom of something more fundamental, “some malaise” of the system. There is an implication that there is some conservative set of rules, a tradition of a closed system.

Hall: This brings us back to the first concern that I mentioned—there is some confusion about how the Board works. Let me start with a bit of history. At the time of the reorganization of the Association and the establishment in 1948 of the Board, there was at first a move to declare all graduates of institutes as automatic members of the Association. A second position was that all training analysts appointed by the institutes (remember there were only a few institutes at that time) would automatically be approved by the American. This must have taken place under the influence of some very strong and understandable “grand-fatherly” impulses. A year later, however, both of these positions were reversed. I think they were reversed because the Association was clearly going to get bigger with more institutes. Each institute, perhaps particularly the new and developing ones, looked more and more to the American, not just for rule-making and the setting up of external standards but also for consultation and help. Very often institutes ask the Board for positions to be stated that would help them in local situations.

The consequence of this—and this is greatly to condense everything—is that we have developed a process which I think is unique among professional organizations. There is a working principle in all of these matters—appointment of training analysts, selection of candidates, the didactic curriculum, the criteria for graduation, etc.—that it is essential for the welfare of candidates and candidates-to-be that the educational philosophy and policies are both developed and maintained by all of the institutes working together. So what has resulted is a “system” in which these standards represent the result, not of the thoughts of the Officers of the Board, but of a process consisting of dialogues and consultations, workshops, site visits, and conferences in which all of our institutes have participated. As the policies and standards have improved over the years, so has the adherence to those standards. This has not been something that has come “from the top down.” It has come from the collaboration of the representatives of the institutes working together in a setting somewhat removed from local pressures and complexities, a setting in which it has been possible for analysts to think about what is best for all of the candidates throughout the country.

This brings me to another matter, one which has always been and will continue to be a question of major importance for the Board. It has to do with the appointment of training analysts. It is agreed that the fundamental prerequisite for analytic training is the personal analysis. So we have to be sure that those who analyze our future analysts should continue to be individuals of character, technical competence, and good theoretical understanding. Those who have worked closely with the Board over the past 10 or 15 years have been very gratified to see that every institute makes this a matter of the highest priority. The impetus for this comes from the institutes, as has the request for workshops on the training, selection, and ongoing training of the training analyst. Many institutes faced with the intricacies of appointing or not appointing someone as a training analyst often ask their future training analyst to present clinical material to an analyst in one of the other institutes. The reason for this is that each institute wants to make sure that the basic analytic experience of its candidates is as good a personal analysis as can be provided.

Newsletter: We returned to the first of your concerns, that having to do with how the Board works and how the Board is perceived. We didn't have a chance to discuss your thoughts about the decrease in available analytic cases. You mention the need for cases for both candidates and our graduates.

Hall: I am glad that we have a chance to get back to that. I think this is the most crucial issue before us and I hope to introduce some discussions of this at the Board in December.

First, we need to realize that there are at least two conflicting explanations for it, and I think there is truth in each of them. The first involves the repeated observation that good (or more involved, or more committed) candidates tend to find and successfully analyze good analytic cases. Although this may be generally true, I am sure there are areas and situations in which the dearth of cases cannot be explained entirely on that basis. To the extent that it can be explained in that way, we in the institutes must be much more energetic in helping to find educational diagnoses and, when possible, solutions for those students who cannot find good cases while their colleagues do.

The second explanation is that there is a real drying up of the reservoirs from which good analytic cases might be taken. Where are these good cases? It is ironic that we do know where many of them are. For years analysts have been active as teachers, consultants and supervisors in a wide variety of settings, medical schools, residency programs, social agencies and other mental health programs. We have helped to train or inspire an enormous number of psychotherapists, good, bad, and indifferent, many of whom are now treating on a short-term basis many of the people who might otherwise have had an opportunity for analysis.

I hope this will not be misunderstood. I am not suggesting that analysts should not participate in good training programs for the development of mental health professionals of real competence. And I am certainly not arguing against the enormous personal and social value of briefer and more superficial forms of psychotherapy. I have serious questions about the participation by analysts in programs for the training of psychotherapists when the philosophy and structure of the programs does not guarantee that psychoanalytic concepts and principles can be adequately presented and appreciated. We may need to become more involved in the planning and administration of good programs, less involved at any level in poor programs, and we may need to develop programs of our own.

I am afraid we haven't been able to go very deeply into any of these points, and we have touched only a few of the issues. I shall be pleased to hear from any of our members, and I hope that many of them will be able to visit the Board meeting on December 17, in New York.