Although The American has intermittently considered some external credentialing action since 1939, interest in the issue was restimulated in 1990, when we were again faced with the attempts of the National Association for the Advancement of Psychoanalysis (NAAP), and its subsidiary, the American Board for Accreditation in Psychoanalysis (ABAP), to obtain recognition as the official national accrediting body for psychoanalytic training centers.
George Allison, then president of The American, and Marvin Margolis, then chair of BOPS, appointed the Ad Hoc Joint Committee on External Credentialing. It was given the dual charge to: oppose NAAP and to “study and recommend measures the Association can take to promote psychoanalytic practice through seeking credentialing of our members by outside organizations.” The latter goal was considered to be desirable independent of the issue of NAAP applications.
Credentialing is the umbrella term used to encompass both accreditation and certification. Educational bodies, such as psychoanalytic institutes, are accredited when their training programs meet established standards; individuals are certified as having passed examinations and authenticated their expert status in a field.
Accrediting and certifying agencies must be kept separate because, according to the United States Department of Education, an inherent conflict of interest exists when a single agency is responsible for both. A single agency may, for example, be influenced to make accreditation easier to justify its certification standards, or vice versa. The two are related, however, since certification requires training standards to determine that an applicant's training makes him or her eligible to take a certification exam.
Official recognition of a national accrediting body is awarded by two agencies, the Committee on Recognition of Post-Secondary Accreditation (CORPA) and the Department of Education. Accreditation by a CORPA- recognized accrediting body becomes a major consideration in many formal actions, e.g., by governmental funding agencies, state licensing boards, and scholarship commissions. In addition, accreditation of a training program by an accrediting body that is approved by the Department of Education permits students in that program to be eligible for low-cost loans up to $25,000 per student.
In the last five years, the Ad Hoc Joint Committee on External Credentialing has explored five possible alternative routes to establish an accrediting body that fulfill the department's requirement to be “separate and independent” from any related membership organization. The committee has been guided by three major considerations: (1) an overriding concern to protect the internal standards of The American for its own institutes from any erosion; (2) a need to establish an external credentialing organization to set a national floor of minimum standards that would be generally acceptable to the mainstream psychoanalytic community, and that would prevent the eventual success of NAAP or any NAAP-like organization with grossly inferior standards from obtaining recognition; and (3) a need to formulate a design for an external credentialing body to conform to Department of Education standards, enabling students of our institutes to be eligible for low-cost loans.
The ad hoc committee has been advised by competent and knowledgable Washington observers that, unless a reasonable alternative is offered to CORPA and the Department of Education for a generally accepted national floor for psychanalytic training standards, repeated applications of NAAP, with the accompanying threats of suits, will eventually force the agencies to grant them recognition. Such an official accrediting body would redefine psychoanalysis in the eyes of the public, official agencies, and health care marketers as a weekly procedure conducted by individuals with no mental health background and little, if any, clinical or academic training.
Even if other accrediting agencies were subsequently recognized with higher standards (as is possible with the Department of Education), the committee believes public and official perception will inevitably focus on the lowest common denominator as characterizing psychoanalysis, identifying it as a once weekly therapy by those with little training.
Thus inaction did not seem to be a viable alternative, even though NAAP's latest application was defeated.
The Committee narrowed down the viable options to two: (1) The American could go it alone (or possibly with the IPA-accredited institutes, if they are willing to meet our standards) to develop an independent accrediting agency with our current standards of training. The expense would be borne by The American in a ratio of about four to one. (2) We could engage in a joint effort with the other three members of the Psychoanalytic Consortium to set up an agency with standards generally equivalent to our current ones, except that it would require psychoanalysis three times per week, rather than four; and three, rather than two, supervised cases (The IPA currently requires only two). In such a joint effort, any institute that is a member of a parent organization (such as The American) would be required to meet the training standards of that organization to be eligible for accreditation. Our institutes would thus be protected from any danger of eroding our standards.
In the fall of 1994, as part of its referral duties to prepare for a Council discussion the Committee on Societies, at the direction of the Executive Committee, surveyed the societies on their views about external credentialing. Of the thirty societies that reported a position, 24 (80 percent) were in favor of exploring external credentialing as a joint effort with the Consortium members.
In the fall of 1995, our committee decided to survey the institutes to gather more information. The committee had not been placed on the agenda of the previous three consecutive Board meetings, and because it is a joint committee it was felt that the Fellows and institutes should be allowed to participate in an informed discussion. Opposition to this by the chair of BOPS was followed by the resignation of the four Board committee members. Of the seventeen institutes that reported a position,
Allan D. Rosenblatt is chair of the External Credentialing Committee.
thirteen were in favor of pursuing the exploration of external credentialing as a joint effort with the Consortium organizations.
The committee believes that although setting up an independent agency with the standards of The American would be feasible, it would not solve the problem of setting a national, generally accepted floor for training standards. (At last count, there are fifty-eight self-designated psychoanalytic institutes in New York State alone.) An agency using standards of The American would be vigorously opposed by the other members of the Consortium as representing only a minority of psychoanalysts in the nation, and it would likely provoke significant disruption in the Consortium. The other members of the Consortium have shown increasing distress in recent meetings about their perception that The American is stalling on external credentialing.
Even if we prevailed over opposition from the other Consortium members and set up an agency with the standards of The American, competing accrediting agencies would likely be set up by the other Consortium members, with somewhat lower standards. Then, the NAAP or a similar organization could have a rationale to obtain recognition for yet another agency with completely inferior standards. They could convincingly claim that there is no commonly accepted set of standards and that their own standards are entitled to recognition. Thus going it alone would likely increase the probability that NAAP would gain recognition.
At the December 1995 meeting of the Council, the BOPS recommendation that our committee be discharged was rejected by the Council. Our committee was instead charged with developing a model plan for an external credentialing organization, including governance and finances, to be presented to the Council at its December 1996 meeting. The committee is in the process of preparing this report, which will be distributed in the fall.