The process of certifying psychoanalysts is at present receiving a good deal of attention. In order to lift some of the ambiguity and mystery that cloud the process, and to assist applicants in the preparation of cases to be presented for certification, I am submitting this description of my recent experience as a participant observer of the Certification Committee to TAP.
Before the committee met in May I had received the application material of eight part-one applicants and eleven part-two applicants. This, I was told was a light load, as in December there had been twenty applications for part one alone. Part one involves three case presentations of supervised analytic work with at least one man and one woman, with one case taken to a successful termination. These are minimum requirements; most of the applicants in fact had five or more cases.
Part two is for candidates whose application material left questions in the minds of the committee or who have had difficulty in writing about their work. This part may consist of an interiew with two members of the committee to discuss the issues in question, a rewrite of case material, or both an interview and a rewrite. In rare instances the committee may request an entirely new case presentation. A carefully balanced, open-minded, and supportive attitude characterized the deliberations following these interviews.
For part one, applications are read by all six to ten members of the committee and the three participant observers. One member is given primary responsibility for presenting an applicant's work, along with a detailed discussion of the material, leading to a recommendation as to whether the applicant should be certified at this time. Three members then present critiques and are given as much time as necessary to present their views. The floor is then opened for general discussion, and a vote is taken. If on further reflection, it seems that something may have been missed or misconstrued, any member may request another vote.
Following the meeting, letters are sent out to the applicants, informing them of the committee's decision. Where there are questions about an applicant's work, an attempt is made to formulate and communicate these questions as clearly as possible, including direct references to problematic case material.
In their evaluation of the case material, the committee asks the following kinds of questions:
Does the applicant choose patients who appear reasonably suitable for analysis?
How does the analyst initiate the analytic work?
What is the analyst's understanding of the presenting complaints, symptoms, and attendant character issues?
Does a process develop in which there is a deepening of the analytic material?
How does the analyst address strong affects, transference storms, countertransference storms, acting out, etc.?
Is a historical (genetic) perspective introduced?
Does the analysand develop a greater tolerance for previously warded-off feelings, thoughts, and memories? Does this lead to an increased ability to reflect on these inner experiences without resort to action either within or out of the session?
How does the analyst come to understand the patient in terms of the patient's infantile longings and conflicts (preoedipal and oedipal) as well as more advanced conflicts and desires?
How does the understanding of the patient's analytic issues unfold and change over the course of the analysis for both analyst and analysand? How does the analyst communicate his/her understanding to the patient?
How does the analyst use supervision?
How has the analyst come to see his/her own growth during the course of the analysis?
How does the issue of termination arise? How is it carried through?
Has the analyst been able to maintain a relatively nonjudgmental, nonintrusive, and neutral attitude over the course of the analysis? Was the analyst aware of times when such an attitude was not maintained? Were these instances addressed? How are they now understood?
Questions such as these are used by the committee in its attempt to determine the presence or absence of psychoanalytic process. These considerations represent widely accepted analytic concepts free of any particular theoretical bias.
In writing up their cases, applicants might keep the following questions in mind.
Who was this person at the time you were about to start the analysis? What was his/her background? What were the presenting complaints? What additional difficulties did you come to suspect?
How did you come to the decision to start the analysis?
How did the analysis go? How did it unfold? What did the patient say and do? How did he/she affect you? What are the various ways the patient experienced you, and how did you respond? What major themes developed? What went on in your supervision or your own analysis that helped you to under stand the difficulties that occurred during the course of the analysis?
How did things change? What changes were there in your understanding of the patient's issues? How did you come to corroborate your original hypotheses or to frame new ones?
How did the patient avoid unwanted experiences? What was it that these defenses attempted to avoid: wishes, impulses, perceptions, memories, fantasies? And why did the patient want to avoid them: anxiety, depression, guilt, fear of loss?
How did you and the patient come to understand the relationships that seemed to exist between early life experiences and present ones, especially the patient's experience of the analysis and of you? How did the issue of termination arise? How did it come to be understood? What took place during the termination period?
In retrospect, what issue(s) were missed or only partially worked through?
In addition to addressing these issues, the applicant in composing the narrative should step back from the material from time to time and attempt to provide an overall synthesis of the analysis to that point. The key is to communicate, as vividly, and genuinely as possible, what transpired in the analysis. It is also important to demonstrate, in the handling of the material, the use and understanding of the generally accepted principles relied on by the committee in making its evaluation.