The history of external credentialing as an issue dates to 1939, when The American first expressed interest in certification for psychoanalysts to the American Board of Psychiatry and Neurology. No action was taken on the matter, and it was dropped until 1948, when it was reintroduced and again dropped. In 1955, The American renewed exploratory talks, which in 1959 issued in a formal proposal by ABPN for the establishment of a subspecialty certification in psychoanalysis. After intense discussion and debate, the proposal was rejected by a vote of the membership. Though assurances were apparently given that five of seven original members of the subspecialty board would have been leaders of The American, fears over loss of autonomy prevailed.
Brief efforts at reopening the question were made in 1964, 1975, and 1986. Each time, the talks were discontinued when officials of The American concluded that the disadvantages of external credentialing would outweigh its advantages.
Interest in the issue has recently been renewed in consequence of repeated applications by the National Association for the Advancement of Psychoanalysis (NAAP) for official recognition, from the Council on Postsecondary Accreditation (COPA), as the sole national accrediting body for psychoanalytic training. Faced with the prospect that an organization with inadequate standards might be recognized as the official arbiter of psychoanalytic training, George Allison, then President of The American, appointed an ad hoc joint committee to oppose the NAAP application and to explore the possibility of establishing nationally recognized procedures for accreditation and certification that would maintain appropriate standards.
Donald Burnham was named to chair the committee and at the 1991 meeting of Council delivered a comprehensive report that outlined the various alternatives. The report concluded that the most promising route would be to explore the establishment of autonomous accrediting and certifying agencies outside The American and ABPN.
National accreditation of training programs and the certification of individuals as competent in their specialty must be kept separate, as there exists an inherent conflict of interest when a single agency is responsible for both. It was for this reason that in 1975, when The American sought recognition by the United States Department of Education as the accrediting body for educational programs in psychoanalysis, recognition was refused.
However, the two credentialing procedures are related, in that any certification procedure must establish criteria for eligibility, and these must include a determination of what training programs are acceptable. For example, ABPN, which certifies psychiatrists, requires an applicant to have completed an approved psychiatry residency program. Such programs are accredited, however, by a separate body, the Psychiatric Residency Review Committee.
In exploring alternative routes to accreditation and certification, it remained the hope of some that an arrangement might be made with ABPN to establish psychoanalysis as a certifiable subspecialty of psychiatry. This hope was given new life by the discovery that there were some precedents for medical specialty boards credentialing nonmedical practitioners. Nonetheless, while such an arrangement would have the advantage of preserving ties with organized psychiatry, there are formidable obstacles to its implementation. One is that ABPN requires applicants to have completed an approved residency program, and the Psychiatric Residency Review Committee does not accredit programs for non-M.D.'s. Some hitherto unprecedented arrangement would have to be devised, perhaps with the American Psychological Association, regarding which training programs in psychology might so be accredited. But even this arrangement would exclude analysts with neither an M.D. nor a Ph.D. in psychology, e.g., graduates of social work programs.
ABPN has a policy of setting up subspecialty accreditation, as for instance in geriatric psychiatry, only when the field in question shows sufficient interest and a formal request is made. This request would have to come from the American Psychiatric Association's Committee on Subspecialization. However, the APA is currently on record as opposing the creation of new subspecialty categories, instead supporting the issuance of certificates for “added qualifications.” Moreover, these qualifications are currently recognized in fields defined more by the population served (e.g., geriatric psychiatry or adolescent psychiatry) than by a specific treatment modality. Certification of a subspecialty such as psychoanalysis might be resisted for fear that it would provoke demands that practitioners of other modalities, such as behavioral modification or psychopharmacology, be certified in their domain, further fragmenting the field of psychiatry.
Even were a certificate in psychoanalysis to be established by ABPN as an added qualification, all applicants (at least all M.D.'s) would have first to be certified in psychiatry. The many members of The American who are not so certified might well object to such a prerequisite for certification in psychoanalysis. Yet despite these apparent obstacles, the route via ABPN is still being explored by the External Credentialing Committee, which intends to exhaust all possibilities.
As an alternative route to external credentialing, contact has been initiated with the four IPA-accredited institutes in the U.S. The Committee's short-term goal is to initiate a dialogue to explore the issues involved in developing acceptable autonomous accrediting and certification bodies. It should be emphasized that the establishment of such independent bodies to accredit training programs and certify individuals would in no way require The American to relinquish its in-house training standards and certification procedures. Just as in psychiatric residency programs, where minimum standards are set externally but some residencies are considered of higher quality than others, so The American could maintain its more rigorous training standards. Similarly, its certification procedures could remain independent of any national certification and represent a still higher standard of expertise. However, there would be a national “floor” of minimal standards for training and certification, an arrangement that would both protect the public from unqualified practitioners and preserve the distinction between psychoanalyst and psychotherapist, a distinction increasingly in danger of becoming blurred.
The American, in particular the Board on Professional Standards, is especially qualified to take the lead in establishing national standards of accreditation and certification. The Board, with its decades of experience in setting and maintaining educational standards, should play a central role in designing and implementing such procedures, thereby extending its influence well beyond The American.
Meanwhile, NAAP has again applied for COPA recognition. Unfortunately, as there is no provision for any final rejection, it may through its subsidiary, the American Board for Accreditation in Psychoanalysis (ABAP), repeatedly apply. NAAPs standards of training are far below what The American considers to
Allan D. Rosenblatt, M.D., chairs the Joint Committee on External Credentialing.
be in the public's interest. For example, only a baccalaureate degree “or its equivalent” is required, and training analyses may be conducted at a frequency of once weekly. However, unless a viable alternative is eventually presented to COPA, it is likely that NAAP or some equally unqualified group will successfully apply, with unfortunate results for the practice of psychoanalysis in this country. Not only would inadequately trained individuals put the public at risk by being designated as trained psychoanalysts, but consequences would be felt also by bona fide psychoanalysts.
Thus, for both the public and the practitioner, the issue of external credentialing is timely and important. It is vital that The American have a significant voice in any external procedures for accreditation or certification.