By a unanimous vote, the Board on Professional Standards, at the December 1986 meeting of the American, approved the plan presented by the Committee on Non-Medical Clinical Training (CNMCT) for appropriate non-medical applicants to be admitted to affiliated institutes for full psychoanalytic training. Dr. Carl Davis, Chairman of CNMCT, made it clear in delivering his much praised report to the Board that the committee had been guided by the principles of the Gatskill proposal, which proposal had been approved through referendum by greater than two-thirds of the responding membership. Davis reiterated the committee's firm commitment to an ongoing reciprocal exchange among the Board, the Fellows, the institutes, and the committee itself as policies and procedures are developed and implemented over time. The essential responsibility for insuring that changes in the local institutes are gradual, that their medical identity is maintained, and that the excellent quality of psychoanalytic training is preserved belongs to the institutes themselves, supported as usual by the Committee on Institutes and the Board. CNMCT will concentrate its efforts on the applicants for this new training program, on their prerequisite clinical training and their already achieved clinical competence. The plan presented by Davis before the Board and Council was similar to the one that had been sent to the individual institutes at the end of October. The intention is that CNMCT will consider the first applicants at a special meeting of the committee early in April, with those recommended for the waiver presented to the Board at the May 1987 meeting. The deadline for receipt of these applications from the institutes is the end of March. Davis cautioned that institutes should present for the first round of processing only those applicants that have the clearest credentials; submission during this first year of more complicated or questionable applications might impede the workings of the committee in the initial phase of its functioning and learning. The committee will insure fairness to each institute by rotating the applications, one from each institute. Institutes that do not submit applications in the spring will be considered first in the fall. It was suggested that institutes submitting more than one application may prioritize them to insure that the most likely candidate will be considered first.
As to the candidate per se, those appropriate for acceptance must hold the highest clinical degree established in their field, and reveal demonstrable clinical excellence, not just a promise of clinical excellence. Those who have already received partial training or who have taken courses in the institutes will not be excluded from consideration, but such partial training in itself would not substantiate a waiver.
Davis stressed the importance of the institute's making an exhaustive investigation of the candidate's past educational background and clinical experience to insure the closest approximation or equivalence to the medical-psychiatric model, with its human, caretaking aspect held as prominent. He stressed as well that to be convincing to the committee, the application will have to include actual data demonstrating the candidate's clinical excellence, and not just the conclusions of the institute in this regard.
While an application form has not been developed by the committee, a “reasonable profile” of such an application is expected to include at least the following:
curriculum vitae providing the most complete details of educational and clinical experience, including an evaluation of the educational institution itself;
letters of recommendation;
summary of institute's discussion on personal attributes and motivation of the applicant;
detailed description of evaluation of applicant's clinical work, clinical talent and ability in sufficient detail to instill in the committee confidence in the applicant's capacities in this area;
current profile of candidate's activities, including clinical work, teaching, and supervision, and a list of publications.
Davis closed his remarks with an assurance that his committee wished to work as rapidly as possible, still insuring that quality is paramount. The number of applications reviewed will be small at first, but with experience, a larger number can be processed during each meeting of the American. However, even with a small number of waivers granted, a change will be felt, both at the local and the national level. For example, during 1984-85, 11 non-medical members were approved by CORST for full training. Were this level maintained, and were CNMCT now to accept just one member from each institute during the year, the number of non-medical applicants accepted to the American would be more than tripled.
Dr. Orgel, Chairman of the Board, recalled that the Gatskill proposal had been monitored repeatedly by legal counsel as it was developed with regard to its potential effects upon the currently pending law suit. The Board had been advised that the appropriate stance was to proceed in an orderly fashion with attention to our usual high standards and in accord with our usual means of operating, that this procedure was our best defense against legal challenges. Recent consultation with our current counsel, Joel Klein, affirmed this position. Orgel asserted that he knew individual institutes had their own questions and concerns regarding this matter, and to this end he will arrange a meeting between the American's counsel and institute representatives in May 1987 where questions concerning legal implications can be addressed. He requested, therefore, that the Board's discussion of the plan presented by CNMCT be limited to an open airing of educational and administrative issues.
The discussion that followed, while principally enthusiastically accepting of the CNMCT plan, did raise salient issues which clarified significant aspects of the matter. Chief among these was the attention given to the question of established reputation for clinical excellence required of the applicant. Dr. Henri Parens suggested that this might exclude applicants regarded highly for their clinical ability but who did not have extensive clinical experience. Dr. William O'Brien added that he had thought it was the institute's responsibility to promote clinical excellence; if we take that position, we could then consider applicants who might otherwise be excluded. Dr. Sol Altshul suggested that if we link the required clinical experience and excellence to that of the medical candidate, the level might not be difficult to match; the medical candidate does not have a great deal of experience. Dr. Roy Lilleskov, in essential agreement, stated that while one form of clinical excellence might be demonstrated by the vast experience of an established practitioner, another form, closer to that of the medical applicant, is of the demonstration of excellence in clinical capacity not linked to vast experience. He expressed his hope that we would accept younger people open to psychoanalytic experience that could then lead to the development of a strong analytic identity.
Another significant question raised by Parens regarded the necessity for attaining the “highest clinical degree in the field.” Davis responded that there was considerable debate as to what that meant; his committee had concluded that for psychology, both the Ph.D. and the Sci.D. were acceptable; that for social work, where only a few clinical doctoral level degree programs exist, the M.S.W. is considered the highest clinical degree in the field; and for nursing, the nurse practitioner masters degree is acceptable. Davis stressed that in all cases, considerable other documentation will be required, i.e. supervision, field placement, internship, etc., to demonstrate the required clinical ability.
In response to a question by Dr. Seymour Bird regarding the tailoring of the curriculum to meet the needs of an individual who has already taken course-work at the institute and has had a training analysis, but who might now be accepted for full training under CNMCT, Dr. Davis stated that the institute would be advised to adhere to a tripartite model of training, designing an educational program for each individual accepted. That is, the individual might have to be re-analyzed, or might have to repeat some course work, most likely the clinical seminars. The solution would be up to the institute. In any case, the committee will be interested to learn how each institute plans to adhere to the basic tripartite approach. Dr. Davis repeated that such an individual would be considered without prejudice by CNMCT.
Throughout the discussion, Dr. Davis indicated that the committee was just beginning its work, that it had much to learn, and that there would be many opportunities for institutes to consult with the committee about problem areas. For its part, the committee would readily share methods and procedures developed by individual institutes with the other institutes to facilitate the implementation of this significant program. Much appreciation was expressed to Dr. Davis and his committee members for their hard and successful work. The members of the committee include: Gerald Adler, Dale Boesky, Herbert Gaskill, Bob Gilliland, Stanley Goodman, Justin Krent, Stephan Levitan, Rhonda Shaw, and Phyllis Tyson.