At the annual May meeting of The American, the Executive Council proposed that a bylaw amendment be drawn up to extend eligibility for clinical training without the requirement of a waiver to “qualified nonmedical applicants in the following professional categories: (1) Doctors of Clinical Psychology (PhD and PsyD), (2) Doctors of Mental Health (DMH), and (3) Doctors of Clinical Social Work (PhD and DSW).” The task force to design the amendment is headed by Homer Curtis and includes Allan D. Rosenblatt, Leo Sadow, Paula Bernstein, Dan H. Buie, Jr., Carl Lewis Davis, and Helen Rosen.
The task force plans to submit its proposal to the Executive Committee in time for discussion by the Board on Professional Standards and the Executive Council at the December meeting in Miami. Dr. Curtis indicated that the BOPS and the Council may want the proposal to be circulated to the institutes and societies of The American for their feedback. After the final report of the Board on Professional Standards and the Council, the amendment would go out in a form recommended by legal counsel and would become a by-law as amended if approved by two-thirds of the membership.
Dr. Curtis stated that the basic principle for the change in by-laws would be to protect the standards of The American. He emphasized that applicants must qualify on the basis of their clinical, as well as their academic, background. “Our emphasis is on preparedness, readiness, and quality,” he said. Dr. Curtis believes that the CNMCT should continue to function in the area of eligibility so that individuals who do not qualify for training without a waiver under the expanded eligibility by-law would still be eligible for training.
George Allison, President of The American, indicated that a vote of the membership could occur as early as late May or June of 1991, a timetable that Marvin Margolis, Chair of the BOPS, anticipates as well. “The leadership has been in favor of the evolutionary process toward clinical nonmedical training,” Allison commented, adding that he believes the by-law will receive the necessary two-thirds vote in order to pass.
Dr. Margolis commented that during the past three years, “the CNMCT (under the dedicated leadership of John A. MacLeod) has served The American well by facilitating the waivering of 130 nonmedical applicants. This figure represents a pass rate of approximately 85% of all the applicants forwarded by local institutes to the CNMCT. The remainder have largely been deferred until such time as their applications can again be considered after additional preparatory clinical and didactic work.”
During these three years, the CNMCT, together with admission committees of local institutes, have accumulated sufficient experience in processing nonmedical applicants possessing doctoral degrees in psychology or social work to allow this function to be assumed now by local institutes. This important evolutionary step has also gained support from the report of Dan Buie and Jack Ross, who surveyed the local institutes about their experience with the waivered nonmedical applicants. They report good progress by these candidates in class work and clinical work.
With the passage of the by-law amendment, the CNMCT would continue to assess the eligibility of potential candidates who do not qualify under the new, expanded criteria of
eligibility. Under the Ross (Topeka) proposal, voted on by the BOPS at the December 1989 meeting, the CNMCT is charged with monitoring eligibility on the basis of criteria set by the Board for academic and professional achievement. Primary responsibility for selection, based on judgments of character, analyzability, educability, and clinical competence, would lie with the institutes.
Nonetheless, there remains within the Board a lack of resolve about the precise admissions criteria for nonmedical candidates, and the function and charge of the CNMCT remains an issue of controversy. Last February, after the passage of the Ross proposal, John A. MacLeod, Chair of the CNMCT, sent letters to Chairs of Education Committees and Directors of Institutes suggesting an outline for waiver applications. Certain of the suggestions—for example that “a copy of the entire application form submitted to the institute be forwarded to the CNMCT”; that “a professional autobiography showing how the professional development of the applicant occurred and how the interest in psychoanalysis developed” be included; and that “two case summaries be submitted of continuing work with patients, one of work with a female and one of work with a male”—seemed to be at variance with the Ross proposal's specific empowering of individual institutes to assess suitability.
To make more explicit the charge of the CNMCT, a motion was presented to the BOPS at the May meeting to instruct the Committee on Nonmedical Clinical Training that the written clinical material documenting clinical competence submitted to the institute by the applicant not be forwarded to the CNMCT with the waiver application. The waiver application would contain the detailed information that confirms the procedures undertaken to evaluate the quality of the clinical work and the competence of the applicant. Because of time constraints, this proposal was tabled until the December meeting. The significance of this motion lies in its refinement of the Ross proposal's intent to separate issues of eligibility from issues of suitability for psychoanalytic training.
Despite the movement for change, some concerns within The American remain. Two institutes, Southern California and Columbia, are in disagreement with the CNMCT. Southern California Psychoanalytic Institute (SCPI) began training three nonmedical candidates in the fall of 1989, although the CNMCT had not yet granted them waivers. The American informed the SCPI early this year that it was in violation of the by-laws of The American. It urged the SCPI to accept the help of a consultative committee from The American with the aim of resolving the noncompliance, as well as to help defuse tensions that had emerged within the Institute partly as a result of the training of the three nonmedical candidates.
Last May, members of the Education Committee met with the SCPI's Committee to Work with The American. Both sides agreed that The American would invite the SCPI to request the formation of a consultative committee without policing power and consisting of mutually acceptable individuals. A consultative committee, chaired by John Boswell, Jr. and comprising Dan H. Buie, Jr., Dexter M. Bullard, Jr., David M. Hurst, Lester Schwartz, and Stephen Morgenstern, visited the SCPI from September 30 through October 2, 1990. During that time, they met with many members of the Institute. Richard Rosenstein, Chair of the Education Committee, stated afterwards that, although there had been some distrust prior to the site visit, he believed that the visit had succeeded in reducing the tension between the SCPI and The American, and within the Institute itself.
The issue with Columbia concerns their counsel's advice that it would violate Columbia University's principle of academic freedom for the CNMCT to rule on the admissibility of Columbia's nonmedical candidates. The University does not permit outside agencies to determine whether individual applicants satisfy the University's academic standards for admission. The Institute, as part of Columbia, is bound by its rules. Indeed, at the time the lawsuit was settled, Columbia signed a separate agreement with the plaintiffs that states this policy. It cannot submit the applications of its nonmedical candidates to the CNMCT unless so requested by the applicants, in which case Columbia will assist with the waiver. In an interview, Ethel Person, Director of the Institute, indicated that Columbia supports a by-law change, which would resolve the Center's problem with The American, one that both sides hope to resolve.
Even with the passage of the by-law amendment, some concern from outside The American would remain regarding the eligibility of MSWs. In a letter dated May 9, 1990, to then President of The American, Homer Curtis, the National Federation of Societies for Clinical Social Work pointed out that the by-law amendment, if developed as proposed, would allow Doctors of Clinical Social work to be accepted for training without a waiver, whereas individuals holding the MSW degree would still be required to obtain a waiver. The letter continued that the settlement stipulates that nonmedical applicants should have achieved the highest clinical degree in their field. The highest clinical degree in social work is an MSW (a DSW or a PhD in Social Work is rarely a clinical degree); yet individuals who hold that degree would still be required to obtain a waiver before being allowed to enter training, whereas their colleagues with nonclinical degrees would not.
The letter to Curtis went on to suggest that one way of developing objective criteria by which clinical social workers could be evaluated, short of a waiver application, might be through using Board Certification in clinical social work, which is offered by the American Board of Examiners. The National Federation of Societies for Clinical Social Work made the following recommendation: “We are not opposed to approval of the present recommendation, as we do not want to impede the liberalization of the waiver process. … If the Executive Committee recommendation is adopted in its present form, we will work to persuade The American to take the next step at its next meeting and to adjust the criteria for defining which clinical social workers do not require waivers in order to be considered for admission to institute training.”
Dr. Margolis indicated that many psychoanalysts in The American's membership wish to make psychoanalytic training available to all eligible nonmedical applicants, including social workers. However, many feel that it is premature not to require waivers of MSWs. “Therefore,” he said, “local institutes must continue to apply for waivers for social workers with the MSW degree through the CNMCT, which has already granted waivers to a
significant number of applicants.”
The general problem facing The American and local institutes is that applicants with MSW, MD,PhD, or PsyD degrees have variable clinical and didactic experiences. All applicants must have a fairly equivalent and extensive clinical didactic grounding in diagnostic and treatment skills, as well as in psychiatry, psychology, and the behavioral sciences. Applicants holding MSW degrees, therefore, would need additional supervised clinical experiences, as well as significant formal course work, before they are ready for psychoanalytic training.
Dr. Margolis stated, “Our institutes will increasingly be prepared to aid and advise those individuals from social work about necessary postdoctoral work experience.”
The Board on Professional Standards, through such committees as CNMCT and COI, will be directing its attention and energy to providing guidelines for local institutes to help such applicants prepare for psychoanalytic training. Psychoanalysts will, through extension courses and supervision, aid interested individuals while they are in their training programs. “We hope to develop additional methods of preanalytic training. The task is complex and difficult,” said Dr. Margolis, “but the rewards of adding talented, highly motivated students to our candidate body and profession are potentially of great value.”
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