In the last few years the Board on Professional Standards (BOPS) has made profound contributions to the development and advancement of our institutes. Development has proceeded in so many directions that many of our members are not aware of some far-reaching productive changes. Adding to the value of these changes is that they have been effected by building on the collegial, peer interchange that has become the model for our site-visiting and accreditation processes, and that principles of education have replaced the imposition of rigid rules. I would like to review some illustrative developments of the last three years.
A major achievement has been the development of new eligibility standards for training. Building on the experience of the former Committee on Non-Medical Training and the current Committee on Preparation and Progress, and on the experience of our institutes, Phyllis Tyson, chair, and her committee have developed these changes, which allow for institute autonomy in most instances that had previously required a waiver from BOPS. This proposal thus significantly eases the burden of institutes and diminishes the stigma of second-class status that could be associated with the formerly waivered degrees. The committee and the institutes will jointly continue to evaluate this new experience. This change will likely be voted on in San Diego.
Perhaps even more importantly, the new proposal contains a statement for prerequisites for psychoanalytic training regardless of the prior mental health degree, while still acknowledging the requirement of those professional degrees. These prerequisites are based on the understanding that professional competence as a psychoanalyst requires the ability to diagnose and recommend treatment for all patients, including the many who are unsuitable for psychoanalytic treatment. It provides a statement of quality preparation that can enhance the status of the profession and serve as a quality assurance for the public and patients, as well as health-care providers.
Defining prerequisites better defines the many educational roles that analysts can and need to play in psychiatry, psychology, social work, and academic programs. I can testify from personal experience to the rewards of fostering development of skills in talented mental-health professionals drawn to psychotherapy programs, and to our invaluable contribution as role models in demonstrating an approach to patients and to thinking about clinical data in relation to the pressing tasks of psychiatric residency like supportive therapy or interviewing techniques. Joint Board/Council committees have been formed to further enhance these educational outreach efforts. A joint committee on the study of psychotherapy education within our institutes and societies, chaired by Carl Brotman, has been formed and has already developed an initial survey. This committee's efforts now will complement the well-established work of the Joint Committee on University and Medical Education, chaired by Steve Levy, and the new outreach emphasis of the Committee on Research and Special Training. The Committee on Research and Special Training, under the leadership of Deanna Holtzman, has moved toward a model of seeking and encouraging younger academics who have not yet reached their full potential as researchers and whose research and teaching could benefit from clinical training. The significance of this for the future of our Association and our profession cannot be overestimated and should not be measured at this point by the success of any “recruitment” efforts, although they are beginning such outreach efforts. Psychoanalysis has a significant academic and humanities aspect, and researchers and teachers who have such an interest need to be encouraged about our openness to their participation as candidates and faculty. We have to acknowledge these roots as an important part of the psychoanalytic contribution. The American is the largest psychoanalytic organization open to such backgrounds as potential candidates and members.
The Membership Committee, chaired by Richard Fox, is in the process of evolving its charge in the direction of understanding, encouraging, and recommending ways to provide for the continuing education of our graduates, recognizing the central importance of the post-graduation period in the life-cycle of the analyst. This becomes even more urgent in these times when diminished practice makes it harder to maintain a psychoanalytic identity. The American, in conjunction with institutes and societies, needs to help our members with this.
Much time and energy has been devoted to this issue, the outcome of which can shape the future of our Association and our profession. As much as the specific details of any of the options are vitally important, the major part of the effort has been to create a situation in which members are fully informed of all the facts and complexities of the issue, since this is a decision in which we must all participate to determine our future. It is important that we can see beyond the specific agendas of individual leaders toward what is in the best interest of our Association, its members, and the profession. It is an issue with possibilities and pitfalls. The history and structure of our organization does not favor such a truly democratic approach to such a vital question. Thus far we have achieved the greater participation of the Board and Council, societies and institutes, and many members. The issue is now in the hands of a new ad hoc joint committee, which will make its final report in December. The issue has more clearly emerged as one in which we either immediately build on our sophisticated organizational structure and its values, and build on a our thirty-four-year history of accreditation through seeking recognition for our Association, while continuing to work with other groups that wish to develop accreditation possibilities for themselves or follow the lengthy, uncertain, and not truly explored and evaluated path of seeking to develop a new accreditation board with other members of the Consortium. Unfortunately, this is a question that has been heavily politicized, and the struggle to maintain creative potential on it is seriously encumbered.
This is an area for the immediate future. In recent years the Board and the Association have become more fully cognizant of the problems facing child analysis. The Committee on Child and Adolescent Analysis, chaired by Sam Rubin, and the Task Force on Child Analysis have brought to bear our wealth of talent and
experience on the questions troubling its survival. Both will bring to the Board various options in training and eligibility, and in demonstrating our organization's full commitment to its future, for the Fellows to consider.
This remains our most serious and pressing concern. It is an educational and an economic issue. There is no certain prescription for improving it. However, I believe three approaches can be of significant help. These relate to the diminished image of the analyst and of the field, in these times dominated by biological thinking, the “fast cure,” and managed care. The first approach lies in outreach efforts within the mental-health community, particularly at the level of education of future mental health professionals. By outreach I do not mean simple recruitment, but rather our educational presence in these programs in order to demonstrate the usefulness of analytic thinking to the questions they struggle with. It is important to recognize, acknowledge, and respond to the many often well-justified criticisms about psychoanalysis and to convey that we aspire to be fully informed practitioners who recognize and respect the therapeutic modalities available to the mental-health professional. We also need to convey our sense of common causes, whether on issues such as managed-care abuses, parity, or private contracting and confidentiality. Second, I believe our public relations and information effort should not only respond to our critics but be a proactive one that demonstrates who analysts are, what psychoanalysis can or cannot achieve, and our place in the spectrum of helpful modalities. Last, but intertwined with the first two approaches, is the importance of regaining status as a respected and independent profession. I think this can best be achieved by seeking appropriate recognition for the accreditation and credentialing activities of The American and its requirement of a rigorous psychoanalytic education as a prerequisite for professional standing as a competent psychoanalyst.
Donald Rosenblitt, incoming chair of BOPS, and Robert Cummings, incoming secretary, both represent a new generation of leaders who are clearly identified with and able to identify the issues that most concern our members. Both come from institutes that have not represented the leadership of the Board or the Association. Don, a child analyst and vitally involved in the relationship of psychoanalysis to the public and to the community, and Bob, with his deep knowledge of issues related to confidentiality and managed care, bring a specialized knowledge and awareness to the issues confronting the Association and the Board. I hope you will give them your full confidence.