John MacLeod, Cincinnati, new Chairman of the Committee on Non-Medical Training, requested that the Board approve waivers for affiliated institutes to train 15 new applicants for non-medical training out of the 25 applications reviewed by the committee during the May 1989 meeting in San Francisco. MacLeod noted that since its inception, the Committee has requested, and the Board has granted, 58 such waivers, and that through this total experience, regional guidelines have been devised by the Committee for reviewing CNMCT applications. These criteria include sophistication in clinical work as illustrated in two case writeups, both currently ongoing, with both genders. The writeups should demonstrate good diagnostic thinking, use of the psychoanalytic point of view, manifest capacity to establish and use a therapeutic alliance, capacity to use transference, and ability to use insight-oriented as well as supportive therapy. In addition, attention is given to the applicant's educability and analyzability.
The controversy in response to MacLeod's report centered around several issues. Some Fellows of the Board expressed confusion and concern as to who legitimately had jurisdiction over acceptance of the applicant, feeling that the local group, with its direct access over a long period of time to the applicants was more knowledgeable about the applicant than a national committee basing its assessment on written material only could possibly be. Sol Altshul, of Chicago, summarized these concerns by suggesting that he sees three alternatives: applicants might apply directly to the American, avoiding time and money spent by the local institute in assessment; the local institute could do the evaluation, with the CNMCT function restricted to advice and consent; the local institutes might select the candidates without reference to the American at all — put bluntly, “you do it; we do it with approval; or we do it without approval.”
Others expressed the view that the standards set by the CNMCT were more appropriate for graduates from institutes than for applicants to them. Question was also directed toward the nature of the post-graduate education required of the applicant; should the focus be on further academic work, or, rather, on further clinical work? Many Fellows interpreted the original Gaskill Proposal as having emphasized evidence of post-degree clinical training and excellence, rather than evidence of further, post graduate, academic attainment.
MacLeod, Carl Davis (the former Chairman of CNMCT), and Shelley Orgel (the former Chairman of the Board on Professional Standards), among others, all explained that CNMCT had been established to facilitate a broadening of the applicant category beyond that of the psychiatrist; that criteria had to be devised that would provide certainty that the difference in educational background between the psychiatrist (whose education was familiar to the organization, and insured attention to human caregiving) and those trained in other mental health professions, might be equalized. This had been the charge of the Board to CNMCT, and it was to this charge that the Committee's functioning was directed. Moreover, the Committee represented a national scope, with a consequent broadened perspective both of psychoanalysis and on the field of applicants; this increased scope might insure a more balanced and judicious selection process than the local institute could achieve alone. Finally, the point was made that the Committee focuses on and assesses the local institute's procedures in regard to selecting the individual applicant, not on that applicant per se; when the Committee has questions about an application, therefore, it is not in regard to the applicant's qualifications so much as it is in regard to the institute's capacity to represent them effectively.
The debate in the Board ended with many questions still unanswered concerning the exact role of CNMCT in relation to non-medical clinical training, and with Krent's suggestion that perhaps further discussion and consultation is in order.