The process that determines eligibility for analytic education is ripe for review, according to those who are studying the issue, including the Board of Professional Standards.
The Board began to discuss the important question of eligibility for analytic education at its last two meetings. In debating eligibility we will engage many of the issues that have shaped our history, and our resolution of these questions will have far-reaching implications for our future.
The Committee on Preparedness and Progress (COPAP) (formerly Committee on Non-Medical Clinical Training), in reviewing waivered applicants' former educational experience and success in our programs, and the urgings and experiences of many institutes, bring these questions to our attention. COPAP has now had ten years of experience with institutes seeking waivers to educate psychologists with doctorates other than clinical psychology and social workers with MSWs. COPAP reports that the care given to the quality and standards of the admissions process is generally very high. Waivered applicants appear to be learning at levels comparable to those achieved by candidates from the nonwaivered backgrounds.
COPAP Chair Phyllis Tyson, the committee members, as well as many institute educators, are looking into how the process that determines eligibility should evolve. Change could take various forms: It could involve eliminating the need for waiver for applicants with MSWs, while retaining the waiver procedure for applicants from other backgrounds that currently require a waiver. This solution would, however, raise other issues. There is a diverse collection of degree programs relating to mental health. Our knowledge of many of these programs and how they vary is often limited. Acquiring in-depth knowledge about each program on a national level and judging the adequacy of individual programs would be formidable tasks.
Another option would be to require a degree in a mental-health discipline but rely on local institutes, which would likely have a better understanding of them, to assess the degrees. Of course, this also creates complications. For example, many students who wish to become analysts are no longer attracted to psychiatric residencies and are entering family medicine or pediatrics because they view them to be closer to their humanistic interests.
To some, such a change in the requirement of a mental-health degree seems a bold and refreshing initiative that would create a more hopeful future for our profession; but others see it as a risk to standards they feel the level of educational experience now required for eligiblity is necessary for developing capacities for patient care. These members also are concerned about our identity in the professional community and the potential impact on our future candidate population.
Some argue that reliance on the degree as a primary criterion for admission has never been adequate, and that an applicant's potential to become an analyst is our central concern. A deemphasis on the specific degree could, if implemented with great care, stimulate further thought about:
what an applicant should be able to do and know before acceptance
what qualities and skills are indications of potential and how we assess them
what experiences other than the degree should be prerequisites for eligibility.
For example, probably everyone would agree that a psychoanalyst should be able to recognize when symptoms are caused by processes that are unlikely to respond to analysis, such as genetic, organic, or psychotic disease. So knowledge of psychopathology, including diagnostic skills, would be required either before or during training.
We must consider how we can assess an applicant's identity as a human caretaker—their concern, motivation, and skills and their sense of professional responsibility to care for people in our profession and to work creatively with the full range of human experiences and feelings.
If we are focusing more on the readiness of an applicant, rather than on the degree attained, we may be able to be more flexible about when applicants are admitted, (e.g., while they are still in medical school.)
These are just some of the questions to be decided. The answers will be critical in defining our place in the future. If we move away from primary reliance on a prerequisite degree to determine eligibility, psychoanalysis may become more of a primary profession, rather than as an additional qualification, with all the implications that may have.
We will need to work hard to reach a consensus about functional prerequisites. If we can achieve this, the task of other Board committees would need to be widened. For example, COPAP and the Committee on Institutes would probably have to more closely evaluate the general progression of students from nondoctoral degree programs.
There are related issues at a more institutional level. Our times give us the opportunity to use the issue of eligibility to confront and define fundamental issues of psychoanalytic education. We are, of course, responding partly to current realities, but also to the clear maturation of our institutes, which are the heart of analytic education. I hope we can respond in ways that lead us not to reluctant compromise, but toward even higher educational achievement.