Is certification redundant because the institutes already perform the same evaluation? Is it an attempt by the Board on Professional Standards (BOPS) to keep institutes in line by holding their candidates “hostage”? Is it an instance of oppression of the young by the old? Or is opposition an effort to weaken the BOPS's power to establish standards and to influence training nationally? A clearer view of some of the issues might be helpful.
The American has already tried the system now advocated by those who propose delinkage. For many years, The American granted Active membership to all graduates simply upon the recommendation of their institutes. But after a fair trial, this system was found wanting, and eventually, in response to recognition of the need for promoting training standards throughout The American, a Membership Committee (the predecessor of the current Certification Committee) was established to evaluate applicants for active membership, just as we do now.
Keep in mind that there are no defined national requirements for graduation. Each institute is expected to observe the standards of training, but it alone decides when to graduate its students. This system results in a nice balance between institute autonomy and national standards, between the individual's dependence on his institute for graduation and his independent certification. Delinkage would upset this balance more than is realized. For example, most institutes graduate a candidate when at least one case seems to be firmly on its way to termination; The American requires actual termination. This difference allows graduation to occur much earlier than it would if it the stricter requirements had to be met. This policy avoids prolonging the dependence of being a student, yet allows the important observation of work done independently—after graduation and before certification. The institute graduation evaluation performed earlier does not allow for these observations. If certification is eliminated, either graduation would have to be delayed until actual termination occurred or active membership would be awarded to some who have never completed even a single analysis. Since some institutes graduate much more quickly than others, might there be a call for some national regulation of graduations? This does not seem desirable.
Can't the site visit provide all we need to know about an institute? Site visits occur only every six years or so. They offer an excellent, but mainly “horizontal” view of an institute. A certification review of an institute's applicants, with a focus on the analytic case reports, provides an in-depth, longitudinal review of both the individual and the institute. The review notes the problems that arose during training and the institute's evaluation of them. It shows the applicant's growth and what the institute did to help or hinder. Like the review of an analysis after it is ended, it allows for understanding not possible earlier; it offers a new perspective. Importantly, it samples the independent posttraining work. It provides a view of outcome of training and can recognize ways that an institute, without realizing it, may not be following its own policies, or ways in which institute policies produce unintended effects. Many of these things are not easily observable in a site visit. The certification review and site visits supplement each other. Certification adds valuable information that The American and the institute need. Conclusions of general educational interest are reported to the institutes, to other Board committees, and, when of wide interest or importance, to the entire BOPS. This is the real power of the Certification Committee—to communicate to the institutes how their policies are actually working. The Committee needs no “hostages” to accomplish this; it simply needs the data. It tries, with admirable effort and ingenuity, to work out ways by which applicants can become certified.
“If certification is eliminated, either graduation would have to be delayed until actual termination occurred or active membership would be awarded to some who have never completed even a single analysis.”
What about those analysts who never applied, or who abandoned the effort? I know of some excellent people who have problems becoming certified or who choose not to be. Some greater effort by The American and the institutes and societies is needed. A certification review of an institute's applicants, with a focus on the analytic case report, provides an in-depth longitudinal review of both the individual and the institute. Each institute and society should review its graduates who have not been certified with the aim of sponsoring steps to lead to certification. Perhaps the Certification Committee should join in this task. Since not all people write equally well, there might be greater reliance on the personal interviews. Not all cases need to be reported in the same detail. And, since some good applicants have difficulty in presenting additional suitable cases, a system for discussing clinical material, perhaps provided by the Committee itself, might supplement the application in special cases. These are only tentative suggestions, but with mutual effort some solutions should be found.
The American has achieved a position of preeminence in the analytic world. Our reputation is based on the excellence of the work done by our graduates, the excellence of our Journal the quality of our training programs, and our high training standards. We are the only organization that establishes such standards, monitors their fulfillment in the institutes, and reviews their attainment by certifying its individual members. We can state without equivocation that every Active member of The American has demonstrated independent competence as a psychoanalyst.
These are features unique to our organization. We, and the public, risk being deluged by ever-growing numbers of programs of questionable merit. Does it not seem shortsighted to discard certification, which contributes so much to our excellence, to our standards, and to our uniqueness? A designation as Active member in our directory should continue to serve as an assurance of competence for any potential patient or referral source. Ending certification may further tranquility and may gain new members, but it will surely diminish our ability to confront important educational issues.