The Certification Process: Opinion

I support certification and view it as a significant contributor to the maintenance of high quality psychoanalytic education. I believe, however, that its present procedural format is unsatisfactory and should be improved by providing a more collegial and, in many instances, a less traumatic experience for applicants. With this in mind, I would like to propose some alterations in the guidelines.

My thinking on certification became focused in October 1988, when Irwin Solomon, who was at the time chair of the Certification Committee, appeared at the Los Angeles Psychoanalytic Institute. I was impressed both by the intensity of the resentment expressed toward the certification process and by the reasoned and patient response of Dr. Solomon to this barrage. I had read the report of a LAPSI ad hoc committee on certification, chaired by Richard P. Fox, that had been prepared for this occasion. This report, based on an in-depth study of the certification process as it affected LAPSI and its applicants, presented the disturbing information that only 19% (9 of 48) of recent LAPSI graduates were certified. As a result, the greater part of its junior faculty were uncertified and ineligible to become training analysts.

In recent years I have heard numerous reports of graduates not applying out of the expectation of a hurtful experience, and of others, who had submitted themselves to the process, nursing wounds and nourishing grievances. One can scarcely underemphasize the untoward effects of this process when repeated deferrals extend over many years, casting a cloud over analytic careers.

According to the 1988 LAPSI survey, only 42% of applicants are certified on the first try; according to the Central Office, only 59% eventually realize their goal. This indicates that a large number of those turned down the first time are so discouraged and traumatized that they do not reapply. These statistics are particularly heartrending in light of the estimate made by Dr. Solomon that 90-95% of those who persist are eventually certified. This suggests that a great majority of graduates are qualified but that the certification process fails to grant them recognition soon enough to forestall disillusion. Thus, insofar as the process unduly discourages applicants, many of whom are viewed as talented and capable, it is perceived as depriving institutes and their members from developing future practitioners and furthering progress in the field.

I am aware that the Certification Committee is made up of dedicated and highly qualified practitioners who should be given credit not only for hard work but also for recent efforts to improve and reform its guidelines. Not having been a member of this committee, some might regard me as presumptuous for assuming that I am qualified to advise the committee on its workings. However, having served the past four years as a member of the Committee on Institutes and having become increasingly respectful of its procedures, which are characterized by considerable communication and collegiality in its assessment procedure, I have wondered whether the spirit informing this highly popular committee might usefully be emulated by a committee that has become the target of unremitting criticism—most recently by Arnold Goldberg (see TAP 26/2), who recounts a number of horror stories with reference to unsuccessful applicants from his institute.

First of all, I suggest that there be an oral as well as a written component to the exam. As it is now, assessment commences with written case presentations, and examiners are given the task of evaluating capability using this single modality of communication. This seems a risky proposition, in that psychoanalysts vary greatly in their writing ability, and a talent for writing does not necessarily coincide with clinical ability. Under the best of circumstances, evaluating the quality of personal relationships on the basis of such a denatured procedure is perilous; when, in addition, the applicant is extensively coached, an advantage has been created over those who pursue a more independent course.

During an oral interview applicants have an opportunity to clarify the implications of their work with patients. In addition, the examiners are much better able to evaluate an applicant's work when they can engage in dialogue and focus on such subtleties as choice of phraseology, quality of affect, omission of significant issues, attitudes toward patients, etc.

The certification process provides an opportunity to examine the entire course of an analytic experience. If in every case applicants are given the opportunity to discuss in depth certain portions' of their reports, as they have done previously with their local supervisors, wouldn't this add another dimension to their understanding? And wouldn't this be a much more lively, meaningful, and informative process for all concerned? In addition, the interview would afford applicants the opportunity of exposure to the example of dedicated service by leading members of The American.

What I am advocating is a more personal relationship between examiners and applicants for the purpose of improving communication and reducing misunderstanding and grievance. Again, I have in mind as a model the procedures of COI, which conducts its site visits in the spirit of cooperative interaction, friendly and collegial interchange of views, and constructive criticism. For weeks prior to a visit, there is useful communication between the committee and representatives of the host institute, both by phone and in person. Were such an ambience to characterize the certification process, not only would the criticism abate, but the process would become a much richer and more worthwhile encounter.

Suppose that the three committee members assigned to read an applicant's case reports compared notes well before the next meeting date of the committee. Omissions, obscurities, incompleteness, etc., could be tallied and one of the examiners be assigned to communicate these deficiencies to the applicant by telephone, perhaps followed by a letter. The applicant would be allowed a reasonable time to clarify, make changes, etc., and there might be one or more further communications prior to the face-to-face meeting. This would obviate many deferrals, which in the past have occasioned applicants so much pain and discouragement. In some instances, applicants' preparedness might be deemed so preliminary that postponement is recommended, thus providing more time for preparation and sparing them almost certain rejection.

Moreover, a personal encounter at exam time provides an occasion for examiners to spell out deficiencies and, where it is necessary to defer acceptance, to demystify the certification process. The applicant can be made aware of, and also acknowledge, where he/she has not satisfied the requirements of the committee. This will do much, of course, to reduce grievances and discouragement, and will provide a stimulus to self-improvement. Meanwhile the examiner assigned to the applicant would be available to answer questions, etc., prior to the applicant's next appearance before the committee.

We analysts are noteworthy for the extraordinary efforts we make to attend to the vital needs of our patients in order to facilitate their growth and development. Might we not demonstrate a similar degree of sensitivity and care in alleviating this vexing and dispiriting aspect of our organizational functioning?