Dr. Snyder: I think people are really very curious about the Board on Professional Standards and how it works. I don't know (and probably a lot of our readers don't know) how one becomes the Chairman of the Board.
Dr. Orgel: The Chairman is elected by the members of the BOPS for a three year term and names his own Secretary. At the first Annual Meeting of the Association following his taking office—in other words, after a year—the Chairman names three persons to a new Nominating Committee. At the following Fall Meeting the Fellows of the Board nominate and elect two additional members. From these five, the Chairman of the Board appoints a chairman of the committee which will select two nominees over the next few months. One of these is elected by the Board a year before assuming office.
Dr. Snyder: We have your C.V. on file, but I'd prefer that you tell me some facts about yourself.
Dr. Orgel: I was once Editor of this Newsletter. It was fun to learn from David Kairys how to cut and paste together a newspaper in what was pretty much a one-person operation. Making the copy “fit” in columns and pages was a constantly frantic and hilarious challenge. I also appreciate how much effort goes into creating a well-written, interesting, and fair Newsletter.
I went to medical school at N.Y.U. I graduated in 1961 from what used to be called the Downstate Institute in Brooklyn and became an Active Member of the American in 1962. I've worked for the Board since 1968; as a member of the Committee on Institutes from 1968-1975, then as Secretary of the Board from 1976-1978, and was appointed Chairman of the Committee on Institutes in 1978. I've also done editorial work on the Psychoanalytic Quarterly and the International Journal. I'm now Associate Director of the N.Y.U. Institute. Fortunately, the responsibilities of this position in my institute allow me to be fully engaged in the work of the BOPS.
Dr. Snyder: What do you see as the Board's most pressing concerns at this time?
Dr. Orgel: The institutes today must cope with unusual external pressures. Their responses to these also have an impact on the Board. The Board must understand the facts of institute life and help where it can, while also keeping clear the reason for its existence: maintaining high national standards for analytic education. Such things as threats of lawsuits could impinge on admissions policies, graduation decisions—virtually every educational principle and activity could be compromised. Also, the difficulties candidates experience in getting analytic cases can prolong training and distort its tripartite aspect. Different sorts of pressures and impacts come from wide shifts in the potential candidate population—a dearth of good candidates in some places and in others, a plethora.
Many kinds of circumstances cause strains in institute functioning. In particular, I've thought about the impact the present lawsuit might have on the Board—and how to limit it. What we need to do is to go about our business, conduct our workshops, and discuss educational matters in our committees and at the Board—in our usual ways. I feel very strongly that the Board be free of all political pressures if it is to function in an atmosphere conducive to full, unhampered consideration of educational concerns. The Board is a vital part of the Association, but it needs to keep some distance from the crises which these days can so easily embroil us if it is to function under the Association's By-laws as the standards setting and
maintaining part of the organization.
Dr. Snyder: How would you go about keeping the Board clear of these pressures?
Dr. Orgel: I think it will take hard work and leadership to keep the Board mindful of its positive goals and not be caught in reactive or defensive positions which can waste its energies and time. We need to steer a course that doesn't confound our basic organizational aims with the hope of avoiding legal entanglements. I'll give an example of that. There were a number of analysts, myself among them, who for some time have favored a Board monitored plan to train a number of carefully selected, clinically promising nonmedical people. For many years we realized that this was a potentially divisive issue in the American.
Until recently, we were not prepared to support such a proposal because we felt it could lead to a destructive polarization of the Board, Council, and membership of the American. As you know, the Gaskill Proposal was enthusiastically endorsed by the Executive Committee in May and was passed at the Board by a very wide margin, and by the Council unanimously. There may be people who will say that this proposal was so widely supported because of the lawsuit. I hope this argument will be considered irrelevant. When we consider this proposal in the next months, we must focus as clearly as possible on its merits and realize that we will be living with its consequences long after today's legal pressures have passed. We need to consider whether we believe it is the right thing for our Association to do—in moral terms—as well as in terms of its effects on our organizational structure and functioning.
How well will our institutes be able to integrate this new group into its candidate and graduate body? We must consider the effects of even a small change in the composition of classes on both medical and nonmedical candidates and the entire educational program. We must ask whether it will be good for the future of the profession. I emphasize the future. I believe the Board must work deliberately because it is concerned not only with today or tomorrow but with the future of psychoanalysis, the discipline.
Dr. Snyder: I know that some analysts feel that the Board moves too slowly.
Dr. Orgel: I don't take that position. I think that organizational changes have to be taken slowly. The Board seems to make its biggest mistakes when it acts too quickly in response to crises. Actions taken to resolve crises set precedents with which the Board has to live. Changes do occur. For example, in the last ten years there have been vast changes in the Board's relationship to institutes.
Previously when site visits occurred once every ten years, they were often perceived as visits from the Inspector General or police actions. Too often, the aim was to get through them with minimal damage or criticism by the visitors. The Board imposed regulations and the institutes went along with them but didn't understand them or identify them as their regulations. Nowadays, site visiting is one form of various ongoing collegial interchanges in the Committee on Institutes' work with each institute. The site visit subcommittee meets with institute representatives well in advance of site visits, and then for a year or two afterward in a kind of collaborative process which is one excellent model for the Board's functioning.
Dr. Snyder: I've heard it said that there is something about the structure of the Board which keeps it from operating as well as it should. The members of Board committees stay on long enough to know their traditions and to function well, but the members of the Board itself, depending upon how their particular institutes nominate or propose people for it, may not be on the Board long enough really to function well. Many important decisions may be taken in committee rather than in the Board.
Dr. Orgel: I think that there may be something to that, but I don't think it can change quickly or easily. Institutes must consider the way they appoint Fellows as a basic responsibility to their Board. If the people appointed balance their local problems and conflicts with the need, when acting as Fellows, to identify themselves primarily as Fellows rather than as delegates from institutes, then the Board functions as it should, as a Board. But having said that, I also realize that the struggles and lurches and eventual resolutions (sometimes) of even bitter controversies are essential to the evolution and even the wisdom of the Board's activity. So smooth functioning is not only a virtue.
Dr. Snyder: But how do you achieve that group identification as a national body?
Dr. Orgel: Sometimes it happens. Sometimes, in the national interest, so to speak, the Board rises up and transcends the parochial interests of its individual
parts. It is moved by a kind of idealism and concern about what is really best for the national organization. There will always be some tension between the institutes and the Board. Conflicts within institutes can be displaced onto the Board. These tensions between institutes and Board are basically constructive, but must never be so great that they impair effective action.
I think that the Chairman must gauge the degree of tension and set a course aimed at eventual consensus. For example, in December, 1984, at the end of a long day's meeting of the Board a proposal was made that a committee be appointed to look into the composition of Board committees and chairmanships. It was passed by a very small majority after about one-third of the Fellows had already left the meeting. I very much agreed with Homer Curtis who decided that even though the vote was “legalistically” questionable, such a committee should be appointed anyway. It was important to reduce a tension, to respond positively to a sensed need for airing this data.
However one interprets the compiled figures, I believe there was a message to me in it. Although there was no challenge to the Chairman's authority to appoint committees and their chairmen, the Fellows were reminding me and future Chairmen of the Board not to neglect the distribution of committee appointments. I have now contacted the Directors and Chairmen of Education Committees of all the Institutes. I have tried to get some better idea of their concerns, their needs, and their feelings about the Board. I have asked for their suggestions for people to appoint to Board committees and will consider these seriously over the next years.
Dr. Snyder: Are there geographic issues dividing the institutes and their concerns?
Dr. Orgel: I don't think so. I think that a more meaningful division may be between large and small institutes. There seems to be some feeling that the Board does not pay enough attention to the problems of small institutes. Rather than compromise their standards, many small institutes have chosen not to have classes every year. They now have faculties and graduates who are frustrated in their wishes and expectations to teach, to analyze candidates, and so on. There is the possibility of discontent and disaffection. It is not possible to go into it here, but large institutes have other kinds of stresses and potential conflicts which are of great concern.
Dr. Snyder: I know that the Board is mandated to concern itself with training standards, but it seems to me that those graduate analysts who are not (and who in most places probably never will be) training analysts, are in even greater danger of becoming disaffected. Do you have any thoughts about that group?
Dr. Orgel: A certain number of people have always felt left out. In recent years, as the possibility of maintaining a gratifying analytic practice has diminished in some places, a training analyst appointment may be even more prized than before. And a substantial number of analysts are ineligible for approval as training analysts because they are unable to meet the clinical psychoanalytic case requirement. There is much that institutes, societies and the American can do to use the abilities and potential interest of many who feel and often are overlooked. And we should forever strike from our vocabularies the terrible term, “non-training analyst.”
I think that some disaffection and some complaint (not all of it, of course) derives from conflicts about being an analyst. I also realize this is an emphasis some people would not share.
But, I think, too, that some part of a colleague's disaffection and professional disappointment may have as much to do with that person's identity as a psychoanalyst and his or her desire to do analysis as with the availability of analytic cases and opportunities to become training analysts. When certain internal conflicts are resolved, people tend to find and keep more patients in analysis. Those analysts who are able to delineate clearly between psychoanalysis and psychotherapy are also more likely to make appropriate recommendations for analysis among patients who come to them. It's very hard to remain an analyst over many years. There's a resistance in all of us to doing analysis. I think that some disaffection and some complaint (not all of it, of course) derives from conflicts about being an analyst. I also realize this is an emphasis some people would not share.
Dr. Snyder: That's a very interesting view.
Dr. Orgel: I believe that if we train people well, a large proportion of them will become certified. Achieving this form of recognition of one's clinical competence helps to consolidate one's identity as an analyst in addition to providing the rewards of Active Membership in the American. I consider certification extremely important and I'm prepared to talk about this at length because I do believe in it. As you know, there were years of discussion and debate and argument (some of it heated) over the issue of permanent associate membership. Some wondered whether a category of membership comprised of uncertified graduates might, in time, become confused by the public as well as by Active Members of the American with the certified members, and whether the value and meaning of certification would therefore be diminished.
I was generally opposed to permanent associate membership. Ultimately I voted for the compromise that finally passed. Because there was a consensus for proposals which had limits and safeguards, it seemed right to make some changes in the interest of the health and general functioning of the American. In the new By-laws, sufficient distinctions were made between the associate membership and the certified membership, so that there would not be too much blurring.
Dr. Snyder: It's still too early to tell, isn't it?
Dr. Orgel: It's early, and I am still concerned that the internal pressure and motivation to be certified will be diminished. I think, too, that the certification process and its outcomes in individual instances send important messages to institutes about the quality of their training. When institutes fail to train clinically competent graduates, the feeling may arise that the Certification Committee is too tough; that it's biased; that it doesn't really test for competence in clinical work; that some young analysts may do very good work, but don't know how to write up their cases.
The bases for such complaints need to be explored and discussed, but I also think we need to protect the autonomy of the Certification Committee. At the same time, the Committee on Certification has the responsibility of being sensitive to communications from the institutes and to work steadily to be open and informative about its standards, and about how it operates. The workshops that the Certification Committee has recently held with representatives of institutes will continue. I think that the Certification Committee should also
communicate more with graduates who have not applied for certification; to explain its procedures, to answer questions, and to encourage application.
Dr. Snyder: You mean they should actually go and seek out the uncertified graduates?
Dr. Orgel: Why not? I think there are false ideas about what the certification process entails, how difficult it is to be certified and how the Committee works. Virtually everyone who has sat in on the Committee as a member or guest has observed that almost always, the Committee members as well as nonmember observers independently arrive at the same conclusion about each applicant. Those who come from so-called “easier” institutes and those who might be “stricter” or who have definite views of the “true best analysis,” all, when faced with the clinical records arrive at very similar assessments.
A certain number of people graduate after fulfilling the requirements only marginally. After graduation, they often do not develop analytic practices. When something like a “compassionate” graduation has occurred, the buck is easily passed to the Certification Committee. When such an individual is not certified, some institutes will be quietly relieved. Others are, of course, righteously indignant. They blame the Board for being too picky or for being elitist or for not taking account of their problems. That is one of the sources of tension between institutes and the Board.
Recently, the Certification Committee has been using personal interviews with applicants more and more to try
to resolve its questions. In time, it may be that deferral will be seen less as failure and more as a vicissitude in the maturation of an analyst. I recall that in the sixties, site visitors—always to other people's institutes—were sometimes critical or even scornful when they discovered some candidates who were in their twelfth or thirteenth year or beyond. Today, in all institutes, the educational process and training analysis take much longer for most candidates.
We better realize that people develop at different rates. And personal circumstances may make a temporary intermission of training desirable. A candidate whose analysis or personal maturation is progressing according to its own patterns, or who hasn't had enough clinical experience to benefit optimally from a planned curriculum should not advance in lock-step fashion. Such individuals may require temporary interruptions in their educations.
There is much we do not know about how someone becomes an analyst. Some candidates have appeared unlikely to succeed. Then, maybe at year ten or eleven something happens —a corner is turned, and everyone notices they have started to think and act like analysts, and enjoy the work! While there are obviously training failures and compassionate graduations, my point is that among graduates too there are people who have not been certified for a variety of reasons who are capable of further development. I don't think we—and here I mean the American, the Board—should neglect them. We have much to offer them, and they us—humanly and professionally. Perhaps we can help them to remain motivated to work toward the goal of being certified. Both the Board and the institutes should make this a matter of concern. There is a substantial number of these people—and they are as important to us as we can be important to them.
There are also many hard-working people of good character who, despite many years of training, cannot do analysis without supervision, cannot work independently, or for some other reason are not able to graduate. In addition to this group are those nonmedical people who have gone through a limited amount of nonclincial training. The Membership Committee has been considering ways of creating appropriate forms of affiliation for individuals in these groups.
Dr. Snyder: What has come through to me in this interview is a philosophy which has to do with concerns about consensus, with concerns about educating in order to arrive at a consensus, and with concerns that regulation not be imposed from on high. In specific, you concern yourself with the future of psychoanalysis.
Dr. Orgel: Yes. And I believe the foundation for our future growth is in our commitment to clinical psychoanalysis. I want to emphasize that what gives membership in the American its value is that it is an organization of people who have had their competence to do clinical psychoanalysis attested to by graduating from accredited institutes which meet certain standards and then who have had their analytic work further tested by being certified by a national body of their peers. In these difficult times, in our small, beleaguered profession, some people say that we give clinical psychoanalysis a position of importance which can no longer be supported.
Some question the value of psychoanalysis
as a treatment, its cost effectiveness, and assert there are too many analysts and too few patients. Some suggest that our institutes might focus more on training in psychoanalytically oriented psychotherapy, applied analysis, and research. They believe that the standards for graduation and for certification are too high and/or place too much emphasis on competence in clinical psychoanalysis. These are views with which I strongly disagree.
I think that our unique strength has been that we are the one association in the mental health field that has maintained and monitored high standards of clinical competence in our accredited programs. We have evolved good methods of evaluating the results of our training. This assurance of standards is what we owe the public. The strength of the American Psychoanalytic Association derives from our standards; from how we observe them and raise them, and from the role of the Board on Professional Standards as a kind of bulwark against pressures to lower them.
I don't think that having more duespaying members or more candidates will, by itself, make us stronger. In fact, I believe it is in the peculiar nature of clinical psychoanalysis that we will always be a small group of rather idiosyncratic people. The essence of what we have to offer others and the source of what sustains us comes from a unique endless personal struggle to be able to do this strange, wonderful thing called psychoanalysis.
Dr. Snyder: I think what you have said is very important. Thank you very much.
Dr. Orgel: Thank you.