Psychoanalysts are professionals. That means they are committed to using their knowledge and skills to help people. This is, of course, the goal of clinical psychoanalysis, and it is further reflected in the ethical codes of psychoanalytic organizations. However, in order to provide society with the kind of help it wants, deserves, and expects, the profession must be more than a number of individual practitioners who do good clinical work and avoid evil. There must also be some arrangement to train new psychoanalysts, develop new and better methods of treatment, and assure the quality of analysts available to the community while identifying and removing poor practitioners.
Over the years psychoanalysis has been only partially successful at these tasks—recently it has felt so challenged and endangered by economic threats to its survival that it hasn't had much energy left to focus on them. However, in the long run its economic success and its very survival will depend on accomplishing these aims, which are essential to maintain and increase public confidence in the profession.
Credentialing is one strategy to assure the quality of practitioners and to identify those who are unqualified. This involves evaluating training programs (accreditation) and individual practitioners (certification). The American Psychoanalytic Association devotes a great deal of time and effort to both of these functions. Over the years, and particularly recently, there has been discussion and concern regarding how The American does this, and whether it might do it better. This includes questions such as:
Who should be responsible for credentialing—The American itself, or some other organization, and if some other, should it include members of the psychoanalytic community who are not members of The American, or even individuals who are not analysts?
What is the optimal relationship between certification and accreditation? Should they be carried out by the same or different organizations? What role should The American play in each?
What should the standards be? What if they are too low, too high?
How should we prioritize the goals?
assuring the quality of certified psychoanalysts;
identifying substandard practitioners to protect the public;
generating public trust and confidence.
Is there a relationship between the level of the standards and their efficacy in achieving these goals?
The recent concern has been fueled by the threat that another organization, one with lower standards, would be recognized as a certifying body, and that the many years of hard work by The American would be threatened. Our longstanding internal process has led to high standards, but also to an aura of cronyism, to a large number of uncertified colleagues viewed by themselves and others as psychoanalysts, and to the charge of placing the interests of members above those of the public. In fact we have done a rather poor job of protecting the public from substandard practitioners who call themselves psychoanalysts. Some have argued that an “external” group that included The American as well as others who are generally regarded as analysts might be able to establish a credentialing system that would protect the public from substandard practitioners. Others believe that any such group would itself have standards that were too low, and would endanger the profession. Some see external credentialing as recognizing the social mission of professions to serve the public, avoiding the taint of trade unionism, and building valuable bridges to our professional colleagues. Others fear extending this most vital professional function, the definition of who we are, to nonmembers of The American who may not share our values.
These questions and concerns are not unique to psychoanalysis—they are found in every profession. In the United States (and typical of medical specialties) psychiatric certification and accreditation are conducted by separate but related organizations: The American Board of Psychiatry and Neurology (ABPN) and the Residency Review Committee (RRC). Each of these is, in turn, separate from but related to the membership organization, The American Psychiatric Association (APA). The APA is concerned with members who are not certified as well as those who are. The APA is interested in standards and certification procedures, as well as developing a program for mandatory periodic recertification and considering applications for subspecialty certification. (There has been a series of dialogues over the years regarding the possibility of the ABPN offering subspecialty recognition for psychoanalysts, but the growth of analysis outside of psychiatry makes this increasingly unlikely.) The RRC is the least visible of the three entities; it evaluates and accredits training programs, and from time to time discredits them as well. Both the ABPN and the RRC have a lower percentage of applicants who “pass” than do the corresponding committees of The American Psychoanalytic Association.
Thus the psychiatric profession has developed two separate “external” credentialing organizations, one for certification and other for accreditation, while the psychoanalytic profession has, until now, carried out both functions internally, and with close links between them. The vast majority of psychoanalytic institutes that seek accreditation or graduates who seek certification eventually receive it. The profession is now entering a healthy period of self-examination and dialogue about this process. Is the way we have done it in the past the way we should do it in the future? Do we have something to learn from other professions? Would external credentialing and separation of certification from accreditation lead to greater objectivity, better relations with colleagues, or greater credibility when a program or practitioner is deemed unqualified? Would a change in minimal standards endanger the profession or
Robert Michels, M.D., is the Walsh McDermott University Professor of Medicine and professor of psychiatry at Cornell University Medical College, and a training and supervising analyst at Columbia University Center for Psychoanalytic Training and Research.
assist the public in selecting practitioners?
Should more training programs lose accreditation; should more candidates fail certification? Can we devise a system that will lead to a greater public confidence in the psychoanalytic profession and in good psychoanalysts, and, equally important, less public confidence in poorer ones?
It is vital that, in spite of the current stresses on our profession, we conduct this dialogue with a primary focus on our long-term professional responsibility to serve the public interest rather than short-term administrative, economic, or political considerations.