Three alternative models for nonmedical training presented to the Board and Council at the April 1983 meetings by Dr. Vann Spruiell, Chairman of the Joint Ad Hoc Committee on Training for Non-Medical Candidates, provided the springboard for continued and at times intense discussion on this major issue.
The first model would only require a change in Association bylaws to permit such training and would impose an overall quota for nonmedical trainees, requiring no separate committee for administration. The second, similar to child analytic training programs, would entail a committee to monitor institute programs but would not be involved in selection of individuals. The third would require a committee both to monitor institute programs and to grant individual waivers, similar to the actions of the Committee on Research and Special Training (CORST). A fourth model was proposed from the floor, wherein CORST, itself, would assume these functions, selecting only “outstanding” nonmedical applicants. In all models, a change in bylaws would be required, and the nonmedical candidates would be eligible for eventual certification with full voting membership.
Although the first model was presented as entailing an explicit quota, it was maintained by some that it could exist without a quota. Conversely, the other two models could include an explicit quota. Considerable doubt was expressed in both meetings regarding the legal viability of any quota system, as well as its possible negative effect on the image of the Association. Using a CORST model to select outstanding applicants, it was contended, would obviate the need for a quota.
It was pointed out, however, that CORST does not select outstanding individuals — it reviews the special credentials of applicants already selected. Nonmedical applicants under any of the proposed models would not necessarily be any more outstanding than regular applicants. Without any criteria by which to determine who is “outstanding,” an indeterminate number of applicants would then be eligible.
In both Board and Council, the discussion veered from consideration of the proposed mechanisms to the underlying issues of what the consequences of nonmedical training would be to the Association, to its members, and to the field of psychoanalysis itself. Although previous committees have already reported on the prerequisites, on the feasibility, and on the desirability of such training, the crucial questions, according to some discussants, was whether the Association wanted nonmedical training.
A major expressed concern was over the possible loss of the Association's medical identity. For some, this overriding concern would lead them to vote only for a model or mechanism that would preserve this identity. The related question of the effect on psychiatric residents was raised — would the implication that a medical education was unnecessary discourage them from pursuing a psychoanalytic career?
Some maintained that the expansion of the available pool of applicants would lead to an improvement in the overall quality of candidates and eventual practitioners of psychoanalysis. It was asserted that nonmedical training especially offered an opportunity to thus “improve the breed,” because the eccentricities needed for our profession were unevenly distributed among medical and nonmedical individuals. Others claimed that the expectation of obtaining a new kind of special candidate was illusory, and that there is no greater frequency of outstanding potential in the nonmedical pool than in the medical group.
Issues of competition and economics were only transiently and indirectly addressed. One speaker wondered about unspoken issues that might currently influence the deliberations, e.g., whether there was currently a significant decrease in the number of adequate applicants to institutes. It was also noted that the survey of the Committee on Psychoanalytic Practice found no particular need for more practitioners in the field.
It was made clear in both the Board and Council that no quick resolution of the issues was desired and that further discussion was expected at the December 1983 meetings after the component institutes and societies again debated and considered the questions. President Reiser, who had characterized the question as a socio-political one that required a “judgment call”, pledged that the topic would be high on the next Council meeting's agenda to permit more extensive discussion.