Two significant proposals emerged at the December 14 meeting of the Board on Professional Standards. After prolonged deliberation and debate, BOPS voted to recommend joining the Psychoanalytic Consortium, but with provisos that would exclude any involvement in joint external credentialing. BOPS also approved a proposal recommending major modifications in the administrative structure of The American.
Lawrence Chalfin, chair of BOPS, opened the afternoon session with his assessment of Consortium issues. (A brief history of the Psychoanalytic Consortium appears on page 4.) The Consortium, then organized as an informal group, had drafted a set of proposed bylaws, and The American was being asked to become an official member. Chalfin cautioned that there was much uncertainty surrounding the question. Some felt that not joining might mean lost opportunities for collaboration on issues vital to the profession. Others felt that joining might mean the erosion of The American's practice standards. Many were torn between the two sides.
The major concern voiced in the ensuing discussion involved the issue of “entwining”—that is, whether membership in the Consortium was covertly tied to external credentialing with Consortium members. Some speakers opposed external accrediting in general. Others opposed joint accrediting with members of the Consortium whose standards of training are less rigorous than those of The American. A related apprehension was that the Consortium might become a superordinate organization that could exert power over The American.
Norman Clemens, immediate past chair of the Committee on Government Relations and Insurance, sought to allay fears that the proposed Consortium bylaws were ominous. They in fact protect Consortium members, he noted, as they state that no action or policy can be undertaken without the unanimous approval of all member organizations. President Judith Schachter spoke to the same point, reporting that The American's lawyer had read the proposed bylaws and found nothing in them that would require participation in joint accreditation.
Another objection involved the “strange bedfellow” issue. Some, perhaps recalling the painful lawsuit of several years ago, cautioned that if The American moved to become its own external accrediting agency, other members of the Consortium would oppose the effort and perhaps bring legal action. Others questioned whether The American, by formally joining the Consortium, would tacitly be approving the standards of its partners.
President-elect Marvin Margolis underscored the need for The American to cultivate a broad base of allies. He warned that the fight over health care has not ended; the next round will be fought on the state level. Any decision on external credentialing, he argued, should be made only after considerably longer reflection. Allan Rosenblatt, chair of the Committee on External Credentialing, worried that facts were being distorted, perhaps indicating a lack of trust in the committee. He noted that his committee has made no recommendation; the possibility of joining Consortium members in external credentialing is but one of a range of options. Several Fellows and speakers from the floor questioned the sense of urgency. They called for further discussion of a complicated situation and cautioned that members needed time to be reassured. However, other Fellows reported that they were well informed (as were their institutes) and were prepared to vote.
Finally, after two hours, discussion slackened and Chalfin asked for a motion. In response, BOPS secretary Donald Rosenblitt presented a three-part proposal.
Point one of the motion was that The American “join the alliance for the purpose of advocating in the public domain for psychoanalysis and psychotherapy, and of furthering scientific interchanges among colleagues in the organizations of the Psychoanalytic Consortium.” Proscribed would be any involvement in setting “standards of psychoanalytic education or standards of psychoanalytic practice, including joint external accreditation.”
The second point called for The American to form a Committee on Alliances. This would be a joint committee of Board and Council consisting of the president of The American, the chair of BOPS, and the chairs of relevant committees.
The final point of Rosenblitt's motion was a reaffirmation that joining would not “involve a position on the part of The American about the training and practice standards of other component organizations in the Psychoanalytic Consortium.” Rosenblitt then spoke to the advantages of this compromise. Citing the concerns of previous speakers, he sought to convince them that his proposal should answer their objections and put their fears to rest.
Daniel Greenson proposed an amendment that point three be dropped, as he felt it might be insulting to other Consortium members. The amendment was defeated by a large majority. Robert Michels then proposed an amendment, approved by a large majority, that BOPS “recommend” the proposal, a more appropriate wording meant to clarify the role of BOPS. Michels also proposed an amendment to eliminate Rosenblitt's second point, arguing that if the Consortium were indeed not involved in training issues, there was no reason for BOPS to be directly involved in its affairs. This amendment was defeated by a large majority.
Shortly thereafter, a motion to accept the proposal as amended was carried by an overwhelming majority. Many felt that the proposal was a good compromise and that BOPS had reached common ground, though some were upset that the motion had appeared late in the afternoon session.
The next day, however, a proposal to join the Consortium, with no restrictions placed on external credentialing, was introduced at the meeting of the Executive Council. After much debate, the motion passed. An attempt was then made at
the Meeting of Members to vote down the Council proposal, but the effort fell short.
During the morning session BOPS voted to put into bylaw form a proposal to restructure The American. A major reason for the proposal is that under existing bylaws the Executive Council, which meets only twice a year, serves as The American's board of directors. Deficiencies in this arrangement have become more glaring, especially in the light of concerns over the current health care reforms. It is felt by many that the Council is too large and unwieldy to deal effectively with rapidly changing political developments requiring swift decisions. Between meetings of the Council, the Executive Committee handles the essential day-to-day activities of The American.
The proposal for the new structure integrated two similar proposals developed by the Task Force on Board/Council Structure and Function, headed by Robert Pyles and Carl Davis, and the Committee on Bylaws, headed by Anton Kris. The two groups had met in joint session prior to the meeting of BOPS and agreed on a compromise plan. (For further details, see the article on the meeting of Council.)
Prior to the meeting, the Coordinating Committee of BOPS met to discuss the current situation of child psychoanalysis within The American. Samuel Rubin, chair of the Committee on Child and Adolescent Analysis, alluded to a general feeling that at some institutes child analysis is viewed as something of a stepchild. Rubin advised increased efforts to integrate child analytic programs into the adult training experience. One step in this direction is a plan to include training standards for child and adolescent analysis with those for adult psychoanalysis. The booklet Principles of Training and Standards in Psychoanalysis is being revised and will include both, where previously the child and adolescent standards were published separately. Also afoot are plans to better integrate the child portion of The American's site visits into the overall site visit report.
Chalfin remarked that the revision will concentrate on giving a rationale for standards, rather than simply laying them down in dogmatic fashion. Two new committees have been formed as part of an ongoing review of standards. The first, chaired by Kenneth Cohen, will study the current requirements and procedures followed by institutes in selecting and evaluating training analysts. The committee will study the response of the various institutes to the current trend toward reduced or delayed clinical immersion of graduates. A second committee, chaired by Edward Schiff, will study issues of candidate selection. It will seek to identify those qualities of character and talent, regardless of background, that institutes consider the best indicators of potential for becoming an analyst. The committees will conduct surveys and report to the Board.
Arthur Rosenbaum reported that the Committee on Certification evaluated twenty new and five continued applications. Thirteen of the new applications and four of the continued were approved (see sidebar). Rosenbaum's assessment is that the feedback to applicants is improving. However, although members of the committee contact deferred applicants by telephone, the sense of injury can still be great. No applicants have as yet availed themselves of the newly established procedure whereby members seven years past graduation need report only two cases. Of the twenty-five applicants, only three have submitted work on nonsupervised cases.
Appointed training analysts were Jay A. Phillips of Baltimore-Washington; James P. Frosch and James D. Walton of Boston; Peter Buckley, Lucy LaFarge, and Eric Marcus of Columbia; and Gary Martin of Denver. Other training analyst appointments were Anita G. Schmukler of the Philadelphia Association; Richard A. Ruzumna of Michigan; Leon Balter, Leon Hoffman, and Nathaniel P. Karush of New York; and Volney P. Gay of St. Louis. Additional appointments were James Dimon, Lee Grossman, and David A. Lake of San Francisco; Peter A. Gelker and Monique V. King of Southern California; Efrain Bleiberg of Topeka; and David I. Joseph of Washington. Harold Boverman of San Francisco was appointed geographic rule training analyst for Portland.
Phyllis Tyson proposed that the name of the committee she chairs be changed from the Committee on Nonmedical Clinical Training (CNMCT) to the Committee on Preparedness and Progress (COPAP), to reflect the committee's evolving function. The proposal was passed. Five applicants to four institutes were also granted waivers. As of May, the committee had recommended 183 of 198 waivers submitted by institutes over the years. A recent survey of institutes showed a very positive experience with these candidates. Tyson noted that the professional mixture of The American is changing: 330 of the 1,083 candidates currently in its institutes are not physicians. Tyson further remarked that many institutes have difficulty terminating candidates who lack the ability to do analysis. There is a need to develop ways of counseling these colleagues to end psychoanalytic training while preserving their dignity and assuring a continued association.
David Carlson, chair of the Committee on New Training Facilities, reported there are now five such programs, in addition to one that has been granted provisional status. Many programs, he reported, are in need of prospective training analysts.
Deanna Holtzman, speaking for the Committee on Research and Special Training, mentioned plans for an academic fellowship mentoring program. She emphasized the need to modify and foster The American's relationship to the academic world.
Stephen Morgenstern, chair of the Committee on Institutes, clarified the interim visit procedure, whereby a two-day visit by the committee may be offered to institutes between the regular site visits scheduled every seven years. The procedure enables COI to bring its wide range of experience to institutes that may be experiencing difficulty or that for other reasons desire its advice. These visits must be agreed to by the institute in question, and COI's approach will be helpful and collegial.