Sometimes fundamental shifts occur with little fanfare. This was the case in San Diego when the Board on Professional Standards ratified the Revision of Selection Criteria, which has been developed by the Committee on Preparedness and Progress (COPAP). This revision is far-reaching and farsighted because it addresses core issues not only of selection, but also of progression, graduation, and the nature of the relationship between institutes and the Board.
This extraordinary COPAP document integrates multiple directions and multiple aims. The revision fulfills the original vision of the Gaskill proposal and brings the waiver process to a mature plateau. According to this “revision,” institutes will have the autonomy to select candidates that meet the modified eligibility criteria without the need for a national waiver. It represents another major step in the Board's multiyear project to review and revise standards to insure their vitality, contemporary relevance, and continuing service to our patients, our institutes, our membership, the profession, and the public at large.
The document describes the criteria for eligibility and readiness thus:
The most fundamental requirement is a solid identity as a professional whose principles of ethical conduct mandate a firm, enduring, and uncompromising commitment to patient responsibility and a genuine concern for the welfare and optimal mental health of the patient. … While psychoanalysis may be the most effective treatment for properly selected patients suffering from certain mental disorders, it is a highly specialized procedure. Many mental disorders require supplementary or even other modalities of treatment. It is therefore essential that every psychoanalyst have a professional level of knowledge, clinical experience and expertise, and a professional identity that will assure appropriate care being given to every patient seen. Psychoanalytic education does not include all the theoretical background knowledge or clinical experience that optimally prepares the future psychoanalyst for [generalized] competence. Rather, competence should already be achieved [or be in the process of being achieved]. It has been the experience of the Committee on Preparedness and Progress that preparedness for psychoanalytic education can be achieved by pursuing any one of a variety of diverse pathways, and that success in psychoanalytic education cannot be predicted simply on the basis of education degree category, or years of clinical experience. COPAP has further found that readiness for psychoanalytic education and clinical training does not automatically follow completion of a mental health professional education; rather further dynamically oriented didactic and/or clinical training may be necessary or advantageous. These experiences have led COPAP to recommend [an] objective yet universally applicable approach to eligibility by establishing, in addition to professional degree categories, explicit didactic and clinical prerequisites. [I]t is essential that all applicants, regardless of degree category, be judged equally according to the criteria [specified in the document].
Having established its philosophical basis, the document specifies a variety of specific educational prerequisites for psychoanalytic training, including the following:
[The applicant shall have graduated] from a post-baccalaureate degree-based mental health educational program. This must be either a doctoral-level degree or a clinical masters degree recognized as the highest clinical degree generally obtained within a specific mental health profession, supplemented with additional didactic and clinical training.
The document specifies many aspects of this training, including the following:
Courses in psychopathology such that the applicant has a theoretical and clinical understanding of neurotic, characterological, borderline, and psychotic disorders and disorders caused by substance abuse. In addition, the applicant should have some familiarity with central nervous system-determined psychopathology, with those medical disorders presenting symptoms likely to be regarded as psychiatric or behavior problems, and with those psychiatric disorders which might present symptoms likely to be regarded as medical disorders.
At least 60 hours' participation in psychodynamically oriented courses and clinical seminars.
A minimum of 3000 hours or the equivalent of two years [of] full-time mental-health clinical experience under weekly supervision.
A minimum of 60 hours in individual supervision in the practice of psychodynamic psychotherapy such that the applicant can demonstrate a capacity to establish a clinical process, and demonstrate the potential for psychoanalytic clinical competence.
Concerning degrees, the revision states: An individual whose mental health education and clinical experience included the above and who possesses the degree of Doctor of Medicine or Doctor of Osteopathic Medicine, and is enrolled in or has completed a psychiatric residency training program, is eligible to apply for psychoanalytic education and clinical training. An individual who possesses a doctoral-level mental health degree, such as a Doctor of Philosophy in Psychology, Doctor of Philosophy in Counseling Psychology, Doctor of Psychology, Doctor of Education [when it represents the equivalent of a degree in clinical psychology], Doctor of Philosophy in Social Work, Doctor of Social Work, or Doctor of Mental Health, is eligible to apply for psychoanalytic education and clinical training. An individual whose mental health education and clinical experience included the [other prerequisites in the document] and who possesses the highest clinical degree generally obtained within a specific mental health profession, such as a Masters of Social Work or Masters of Marriage, Family, and Child Counseling, is eligible to apply if (1) this education is supplemented with at least two years of additional post-graduate didactic and clinical training, or (2) the individual, who already has an M.S.W. or M.F.C.C., is enrolled in and has completed at least two years of a doctoral-level mental health educational program.
Finally, the document describes the future role of COPAP:
During the time of transition toward increasing institute autonomy regarding the selection
Page 8of candidates for psychoanalytic education and clinical training, COPAP will remain available for consultation on matters of eligibility and about ways in which institutes might mentor, advise, and facilitate those individuals not yet eligible or ready for psychoanalytic education and clinical training. Furthermore, in collaboration with institutes and the Committee on Institutes, COPAP will be challenged (1) to study and collate institutes' experiences with extended autonomy and extended eligibility so as to continually develop and refine a more profound definition of the qualities of character, education, and experience which constitute optimal preparedness for psychoanalytic education; (2) to study the educational process. Where appropriate, COPAP shall make recommendations for curriculum development, considering the special needs of those with and those without medical education, extensive clinical experience, and so forth; and (3) to develop, in consultation with institutes, possible procedures by which to terminate a candidacy should an individual prove to be unsuitable. Extending liaison activities between BOPS and member institutes is vital for our organizational development, and expanding the educational mission of BOPS is critical to our profession. COPAP can continue to play an important role toward enhancing and supporting this effort [italics mine].“
The COPAP revision requires ratification of a new by-law provision by our certified membership. If the new by-law is passed, COPAP would continue to review waiver requests from institutes for applicants who do not meet the revision guidelines. For example, an application for training from a physician who will not be completing a psychiatric residency would still require a COPAP waiver.
The revision redefines the nature and scope of psychoanalytic training. It reflects our increasing awareness that there is a core body of information, experience, and skill that transcends degree-based prerequisite considerations. The psychoanalyst of the future must be familiar with a core of essential information in such areas as neurophysiology, psycho-pharmacology, and use of medication as part of an analysis and must possess the ability to assess the full range of psychopathology and provide appropriate recommendations for specific conditions. The psychoanalyst of the future must further be familiar with core aspects of psychodynamic theory and technique before undertaking the rigors of analytic work. Although psychoanalysts from different disciplines will have specific areas of expertise, the Revision of Selection Criteria recognizes the essential truth that psychoanalysts have a common core identity and common core range of knowledge and experience, both specifically psychoanalytic and more general.
If the by-law is approved by our certified membership, institutes will face an exciting challenge. The new guidelines encourage all institutes to pay close attention to an applicant's prerequisite experiences and to the range of experiences that each candidate will need in order to achieve excellence as a practitioner of psychoanalysis in the broadest sense. In many cases, applicants would be evaluated against a more sophisticated — indeed, a more rigorous — set of criteria than is currently the practice. The Revision of Selection Criteria says, in effect, “Candidates come with different experiences and will require different educational programs.” Along with a maturing of institute-BOPS relationships in the direction of greater institute autonomy has come an increased understanding of institutes' responsibility to their candidates.
True partnerships are based on mutual autonomy. The path is now open for a new level of relationship between COPAP and institutes. In a non-hierarchical way, COPAP would be available to function as a think tank and clearinghouse, collating and distilling experience and advising institutes. The work has just begun. This development is another major step in the ongoing reformulation of the relationship between our institutes and the Board of Professional Standards. This reformulation is leading to processes that will more effectively promote psychoanalytic educational excellence.
On behalf of the Board, our institutes, and our Association, I thank Phyllis Tyson and Larry Chalfin for their dedicated leadership. Over the past six years as chair of COPAP, Phyllis Tyson has consistently sought and responded to the input of individuals and institutes and has guided her talented committee through innumerable drafts of the revision. Larry Chalfin has assisted with the document and consulted responsively with institutes to help achieve our current high level of consensus. As the new Chair of the Board, I am fortunate to benefit from this major progressive step in our preparation of candidates for their careers as psychoanalysts.