This is the fourth of a series of articles designed to inform the membership of the functions of the Associations various offices, governing bodies, and committees.
One of the first actions of the Board on Professional Standards at its initial meeting in May 1947 was to elect an ad hoc subcommittee to determine procedures for evaluating the training credentials of graduates. Within a year the Committee on Certification of Institute-Endorsed Names for Membership initiated procedures, became a standing committee of the Board, and recommended a number of applicants for membership. This Committee soon became known as the Committee on Membership, but when certification in psychoanalysis by the BOPS was made explicit following the May 1977 meeting, it became the Committee on Certification, carrying with it 30 years of experience in evaluating training credentials.
The Committee under various names, over the now 35 years of its existence, has consistently served three functions: (1) to evaluate the analytic competence of graduates when they apply to the American; (2) to enable those who do not achieve certification at their first attempt to qualify for it at a later date; (3) to assist the BOPS in the evolution and maintenance of standards.
The material requested by the Committee has changed emphasis over the years. The initial consideration in determining the adequacy of the applicant's training was to establish whether the minimum standards had been met. Such information provided by both the institute and the applicant continues to be important in the evaluation of an application, but now the responsibility for demonstrating analytic ability rests with the applicant.
Today's Committee is interested in applicants' understanding of the theoretical and clinical aspects of analysis and especially in their ability to conduct completed psychoanalyses. The Committee follows the way applicants permit the transference to emerge and the way they react to the pressures of the transference and facilitate its resolution.
To provide this understanding, the applicant submits written reports of all supervised analytic cases, and the institute furnishes records of its view of the applicant's analytic growth during the training. The combination of the clinical and training reports provides a unique record of the development of an analyst, often continuing after the applicant's graduation. The American collects for its evaluation a portfolio of all the candidate's work — a record, in effect, of a quest for analytic mastery — with accounts of the vicissitudes encountered and the role played by the institute.
One of the charges to the Committee in 1977 was to evaluate other procedures for understanding analytic competence. The possibility of utilizing written examinations to test applicants' theoretical knowledge and their responses to particular clinical situations, instead of using the case reports to assay clinical competence, was considered. The Committee concluded that the written reports of the candidates' case experience during training, with the comments of their institutes and their supervisors, constitute a more accurate, less artificial test of an individual's ability to conduct analyses with different types of people.
The Committee, however, has increasingly augmented the written material with clinical discussions with applicants to resolve questions, and on occasion to provide the necessary verification of its assumption gathered from the written reports.
Although there have been no recent basic changes on the type of material requested from applicants, the means by which the Committee arrives at its recommendation evolves continually. The work of the committee members in preparation for a meeting is considerable, especially when the number of applicants is large, and the suggestion has often been made that if the Committee were larger, each member would have less responsibility. It is our conviction, however, that the Committee should act as a whole, relying on shared experiences of the past to evaluate reports, adhering to minimal standards and basic analytic concepts while still embracing the theoretical and geographical differences in emphasis. In order to achieve this result, every member must participate in the decisions about all applications, a requirement that would prove impossible or unwieldy if there were a large number of committee members whose experience was fragmented.
In order to make the process feasible and yet to ensure that each case is studied intensively, the Committee is usually divided into two groups, each containing about four members who together are responsible for the primary discussion of half of the applications. Group members present in rotation the cases for which they have primary responsibility. The other group has some contact with the applications not primarily assigned to it, reading at least the major case, so that the Committee can discuss and act as a whole in evaluating them. The majority of decisions are achieved by consensus, the need to resort to a vote occurring only rarely.
Those applicants who do not achieve certification after their first
application are, for the most part, deferred and given recommendations so that they may attain the standards of analytic competency necessary for certification. It may be that their case selection was poor or that they did not have adequate experience with male or female patients or that they experienced specific countertransference problems. The Committee attempts to be relatively specific, so that the applicant will have an understanding of what led to the Committee's decision and to its recommendation for additional work.
The Committee realizes that this is a traumatic experience for those who are deferred but takes heart from finding that the reapplications are often gratifyingly improved over the initial ones. Preparation for the whole certification process is viewed as a step in analytic development. The necessary review has a salutary effect in helping applicants appreciate their analytic roles and in reinforcing their analytic identities. At least this seems to be true with those applicants who reapply.
After weathering the trauma, many deferred applicants begin to work constructively to qualify for certification. If they do not understand the deferral note, they often discuss it in detail with the Chairman of the Committee or talk to some member of their own institute about the note's implications. Usually they come to understand the nature of the difficulty, and often this has a positive effect upon their subsequent analytic development.
There is no doubt that the requirement for certification and its connection with membership has a beneficial effect upon the maintenance of standards. In the experience of the Committee, once institutes learn that they have inadvertently compromised certain standards, they make the necessary changes. For example, in the past several years the case selection for candidates has improved, and applications containing cases which are flagrantly unsuited for psychoanalysis are now rarely found.
Institutes have also, for the most part, complied with maintaining a frequency of hours, five or four, throughout the termination of the analysis. Whereas in the mid-seventies many applications revealed tapering of termination to three or fewer hours a week, with some applicants believing this was the approved way to conduct a termination, candidates now almost universally have the opportunity to follow what happens in the resolution of the transference neurosis during an untapered termination.
The required review of a candidate's overall work and the realization that others outside the institute will also study the candidate's training experience are a stimulus for members of the institute to reflect upon and profit from that experience. The presence of certification induces the supervisor, just as it does the applicant, to re-explore the data.
The Committee works on its own, in relative isolation from other committees of the Board, sharing only with the Chairman of the Board on Professional Standards those issues which are paramount and of concern. When problems or questions of interpretation of standards or of training practices arise, these are brought to the attention of the Coordinating Committee as a whole, without use of the institute's name.
Certification Committee members are often asked their reaction to this considerable exposure to analytic material and training experiences. It is my impression that all members consider their tenure a privilege, a unique experience, nowhere else available. It rekindles our enthusiasm for psychoanalysis and for psychoanalytic training. From the hundreds of case reports contained in the many applications that the Committee receives, it is difficult for even the most cynical of us not to be impressed by the growth of candidates in training. There are always examples of masterful analytic work.
We are also impelled by the process to look at our own clinical work and training activities. As a consequence, most of us think that our own level of analytic work has benefited and that our own supervisory efforts and notes have improved, becoming more useful to the candidates and to the institutes.
We are more convinced of the need to uphold standards, not to compromise analytic concepts, and to be more forthright with candidates, even though this may at times be tedious or even painful.
Justin Krent, M.D.
Chairman, Committee on Certification