The purpose of my letter is to recommend a study of methods for evaluating clinical competence in order to improve the certification process.
I doubt that the present method is a satisfactory one because the case write-ups do not provide an adequate measure of the applicant's clinical competence. Though case write-ups do give an indication of the applicant's writing abilities, they do not give a clear or unambiguous indication of the applicant's clinical skills. A few years ago, after several applicants from one institute were either rejected or deferred by the Certification Committee, the members of that institute became alarmed and set about trying to rectify the situation by instituting a writing seminar. They tacitly understood that what is needed to pass the Certification Committee evaluation are writing abilities more than clinical skills. One candidate who was deferred sought the assistance of a training analyst, who then showed the candidate how to write up his cases in a way he thought would be more pleasing to the Certification Committee. Evidently this kindly training analyst was right, because the candidate's case write-ups were then accepted and the applicant was certified.
I recommend that a committee be appointed to check into the research literature on this issue and to determine what methods and tests are available for measuring clinical competence. This new committee might also check with the American Board of Psychiatry, a group facing similar issues. Perhaps they have knowledge of the relevant literature. I suspect that such an investigation would reveal that the evaluation process could profitably use a variety of different methods, including oral and written examinations as well as write-ups of control cases. My hunch is that no one method is sufficient.
In my clinical and supervisory experience, the best way to evaluate a candidate's or graduate analyst's clinical competence is to have him or her present process notes of analytic sessions on a regular basis. Sometimes such an evaluation must extend for months before I attain some conviction regarding the individual's clinical skills. Perhaps this method of evaluation could be used by the certification committee.
The American Psychoanalytic Association should take a searching look at different methods of evaluation because, in my opinion, the present case write-up method is inadequate.
Theodore L. Dorpat
Seattle, Wash.