This is the fifth of a series of articles designed to inform the membership of the functions of the Association's various offices, governing bodies, and committees.
The COI has a major responsibility for assuring the Board that accredited psychoanalytic institutes follow its guidelines in order to meet its standards for sound psychoanalytic education. In the most recent edition of The Standards for Training in Psychoanalysis, Dr. Stanley Goodman, former Chairman of the Board on Professional Standards stated: “The Standards includes reference to the prerequisites for admission and requirements for completion of training with the aim of encouraging the highest possible quality in the education provided and the education obtained. It is assumed that the accredited institutes will strive to maintain criteria for the admission, education, progression, and graduation of their students to the level of these Standards so that their graduates, with few exceptions, would be well qualified to achieve individual certification by application to the BOPS. Although such Board Certification is optional, it is a prerequisite for active membership in the American Psychoanalytic Association.”
The goals of the COI are: l)to make as careful, fair, and frequent evaluations of all major functions of psychoanalytic education in accredited institutes as is practical and reasonable; and 2] to make available the maximum assistance it can offer accredited institutes, consistent with its own limited resources and its belief that the mature exercise of autonomy by institutes is the best way of insuring fine psychoanalytic education.
To work toward these goals, the COI assigns subcommittees of about six members plus one member of the Committee on Child and Adolescent Analysis to make site visits to each institute about once every seven years. These visits last four or five very full working days and include many observations of all institute functions, both educational and administrative; conversations with personnel on all levels, from candidates to executive officers; and review of all recent institute records, available documents pertaining to the history and ecology of the institute, and relevant statistical data. Following such formal site visits, the Chairman of the Site Visit Subcommittee submits to the institute, a detailed report which is usually discussed in several follow-up meetings with institute representatives.
In addition, Liaison Subcommittees are established, usually consisting of two individuals who meet relatively informally with institute representatives once or twice a year. As this title implies, the continuity of communication and the availability for exchange of ideas and information are generally regarded as most important.
When it is evident that difficulties in an institute require more active outside assistance, consultative committees are set up. When indicated, they share responsibility with the institute's Education Committee for carrying out specific functions. Used infrequently, flexibly, and with the approval of an informed BOPS, such consultative committees, which may also include experienced educators who are not members of the COI, have helped some troubled institutes to regain their ability to function fully autonomously without disrupting the continuity of the education of their candidates.
The COI conducts at least two regular workshops twice yearly for representatives from all institutes on topics of mutual interest and concern. Issues discussed at workshops have often been studied in advance, and institutes may have been surveyed in a preliminary way by small subcommittees of the COI as task forces. Some topics discussed at workshops have followed study by COPE subcommittees.
Finally, the COI shares in evaluating the appropriateness, according to the criteria set by the BOPS, of appointments of Training and Supervising Analysts.
Many other written exchanges and conversations, concerning particular local problems affecting the educations of candidates, regularly take place. Often at issue is a need to discuss and agree upon an interpretation of the sometimes flexibly defined Standards for Training. The preparation and study of annual reports of statistical and other current developments of all kinds are helping to keep the COI increasingly well informed.
This regular and more intensive involvement in recent years with our component institutes has helped to maintain attitudes of greater mutual trust, has made it possible to offer more varied, appropriate, and timely assistance where needed, and has enabled each institute and the COI to make more valid observations of the strengths and deficiencies of virtually every program. As I stressed in my report to the Board in May 1982, our ability to know about the inner workings of largely autonomous individual institutes and to influence their actions in response to our observations and suggestions are necessarily and properly limited. The COI re-accredits institutes; the Committee on Certifications certifies graduates of these institutes.
It is the position of the COI that only the certification process allows the BOPS to assess individual graduates and maintain a national standard of clinical competence. Therefore, the strong incentive for almost all graduates to offer for review evidence of the quality of their clinical work in order to become certified in psychoanalysis has been and continues to be
essential for the Board to carry out its mandated functions. Further, this assessment makes it possible for committees of the Board and the individual institutes to ascertain in a continuous way how institutes are actually performing in training their candidates.
A basic assumption dictates this point of view: While all institutes strive conscientiously for excellence, the quality and approaches to training will never be uniform — nor should they be! Local policies are ingrained, and practices have long, complex histories and meanings.
In addition, the difficulties in maintaining thriving institutes in today's harsh analytic climate inevitably tempts educators to lower standards for admission to obtain more candidates. Accepting more “high-risk” candidates may be quite defensible and is at least debatable, but consequences are also observable. Even the most highly regarded institutes reach the point after years of hard work and difficult progression decisions when they must decide whether to graduate some candidates of many years standing whom they realize do not meet their usual standards of competence to do independent analytic work. Such candidates have graduated from every institute. (Of course, by no means all of them were originally accepted as “gambles.”) Can any of us be certain that we would make better decisions in such instances?
But there is, in such cases, a gap between what graduation from an accredited institute should assert about an individual's training and achievements, and what it can be assumed to mean. Only the second review of certification by a national representative body removed from local pressures, interests, and personal involvements can insure that the American Psychoanalytic Association will continue to preserve what in many people's opinions is its greatest value, the reputation for excellence of its Active Members.
The COI cannot and should not be directly responsible for the quality of work of individual graduates. We are invited to visit institutes and we are effective largely through persuasion. Our power depends on the institutes' willingness to collaborate freely with peers who respect their autonomy. We admit we share common problems and failings in our own institutes. The limitations on what the COI can accomplish demonstrate how inextricably the effectiveness of its work for the Board is intertwined with the continuing strength and stability of the Board's certification process.
Finally, it is my strong belief that all of the committees of the Board on Professional Standards work together so closely that the effectiveness of each affects the integrity of the whole. For example, the Committee of Membership has a special opportunity to review and study personal and educational problems and records and to communicate with individual candidates and graduates before they apply for certification. Thus, it provides a source of continuing information in relation to “problem” candidates and graduates, which supplements the contribution the Committee on Certification makes about the vast majority, who then properly constitute the Active Membership of Association. By serving to guard its standards for analytic training and membership, all of the Board Committees, separately and in coordination, serve the interests of all the members of the American Psychoanalytic Association.
Shelley Orgel, M.D.
Chairman, Committee on Institutes