Culminating several years of debate on external accreditation, the Board on Professional Standards voted on December 17 to accept the report of the Ad Hoc Joint Committee on External Credentialing. BOPS agreed that The American will work within the Psychoanalytic Consortium to develop plans for a national board to accredit psychoanalytic institutes. The approval included the proviso that the Independent Psychoanalytic Societies (the four IPA-approved institutes in the United States) would be included in deliberations. The following day, the committee's report was accepted by the Executive Council.
The report engendered much debate — unlike at the May meeting of BOPS, where Calvern Narcisi and Leon Hoffman, co-chairs of the external credentialing committee, presented its preliminary report to a generally positive response with minimal discussion. The focus of contention was less on the report itself than on an addendum: the latest draft of provisional standards for analytic training developed by the Consortium Committee on Accreditation.
Donald Rosenblitt, chair of BOPS, called for a full and complete discussion, and more than 25 Fellows commented during a discourse lasting most of the Board's morning session. Rosenblitt explained that The American would only work with the Consortium if the IPS were included and said he believed that the other Consortium members would agree. He added that if The American worked with the Consortium, BOPS and the Executive Council would be continually informed of progress on the topic of standards.
In introducing the external credentialing committee's report, Hoffman said that its acceptance would mean approval for The American to work with the Consortium to develop standards, not approval to adopt any current provisional standards. The provisional standards document, he said, was a working draft that would undergo further revisions. Hoffman noted that The American already belongs to an organization with differing standards — the IPA.
Ironically, an item in the provisional standards that members of the Committee on External Credentialing viewed as positive became a focus of criticism. The proposal recommended training analysis “conducted at four or five sessions per week on separate days, with a minimal requirement of three sessions per week.” Committee members felt this demonstrated the Consortium's seriousness and willingness to move toward standards approaching those of The American. However, several Fellows of BOPS argued vigorously that a minimal standard of three times a week was inadequate. They criticized several other specific recommendations, including (1) that that three training cases be required, but two would be acceptable as a minimum; and (2) that two training cases be supervised for two years and one case for one year, but again that one case for two years and one case for one year would be an acceptable minimum. Sam Rubin commented that one can't negotiate educational standards; it was a question of integrity, he said.
Narcisi thanked the Board for its comments, again emphasizing that the provisional standards were a work in progress and that suggestions were welcome.
Those speaking against joining the Consortium cautioned against working with an organization that included Division 39, which has sued The American in the past. They feared another lawsuit if The American decided to leave the Consortium. Others voiced concern that institutes would take the easy way out and opt for the minimal, not the recommended standards. Finally, the necessity of the whole enterprise was questioned.
Marvin Margolis, president of The American, said it could take several years to develop the provisional standards to a point where they could be voted upon. The agreement among members of the Consortium was that any component, including The American, could withdraw at any time, Margolis pointed out; therefore he did not see the possibility of a lawsuit. He noted that some provisional Consortium standards were higher than the standards of The American. For example, the document calls for an ethics committee in each institute, which is not currently the case. Margolis said that The American would not lower its own standards and that therefore all institutes of The American would continue to meet The American's standards. Ronald Benson, chair of the Committee on Institutes, added that any Consortium standards would not be a substitute for COI site visits.
Robert Pyles, APsaA president-elect, observed that members of the Consortium Committee had moved from acrimonious exchanges to a good working relationship with each other. The overall plan is to preserve the standards of The American while dealing with the outside world. A national floor of standards for analytic training would be extremely beneficial. Having national standards might eliminate the myriad of groups that call themselves analytic training institutes but have substantially lower standards.
Lawrence Chalfin underlined the importance of IPS participation because IPS institutes have considerable experience in analytic education.
Toward the end of the discussion, Ronald Fleischmann moved that a positive vote would not indicate approval of the standards. The Board was reassured that the purpose of a vote was not to approve any standards. Any proposed standards would require approval by both BOPS and the Council; if approved, they would then require a vote by certified members.
After this clarification, the focus of discussion shifted to the External Credentialing Committee's report. Many Fellows expressed favorable opinions about working with the Consortium. Drew Clemens mentioned that the American Psychiatric Association would not include certification in psychoanalysis in its list of members because of lack of a national standard.
Rosenblitt, who along with Marvin Margolis is an official representative to the Consortium Subcommittee on External Accreditation, said the current document was the best compromise, rather than a consensus. He thought that other Consortium members may have reached their limit on setting higher standards.
The first order of business following lunch was the vote. In spite of the extent of criticism in the morning session, the Committee's report was easily passed 47 to 6, with 3 abstentions.
The proposal of the Committee on Preparedness and Progress (COPAP) to allow institutes greater autonomy in selecting candidates without a doctorate came up for discussion once again. The proposal has been debated and revised for several years, and at the May meeting BOPS voted approval. At the time, it was considered a procedural change involving waivers.
However, because of complexities in The American's by-laws involving eligibility for membership, the Executive Committee decided that an amendment to the by-laws should be voted upon by the certified members. The COPAP proposal would allow an institute to accept for training certain candidates with master's degrees. However, upon graduation the same individuals would not be eligible for automatic membership in The American because the by-laws only allow automatic membership for graduates with doctorates. The aim of the proposed by-law change was to prevent a two-tier membership.
Robert Michels questioned the legality of BOPS's May vote, feeling that it went beyond the scope of its authority. Even Phyllis Tyson, chair of COPAP, who had patiently shepherded the proposal over the years, said she was uncertain about these current complexities. The Board was reassured by a stated policy that those institutes that did not wish to train master's-level candidates were not obligated to do so.
Tyson advised institutes to obtain waivers before allowing candidates who require waivers to begin classes. In a few instances, avoidable problems have occurred. She proposed three applicants for waivers, and they were passed.
Donald Rosenblitt announced the formation of Project 2000, a study chaired by past BOPS Chair Lawrence Chalfin, to evaluate the current status of psychoanalytic education and to make recommendations for its future. (See Rosenblitt's article on page 8.) Chalfin commented that much had changed since the last comprehensive study in 1974. Now candidates do not have a homogeneous background and have been exposed to many models of treatment. A greater diversity of psychoanalytic models now exists. There is now decreased possibility for full analytic practice and clinical immersion, resulting in less opportunity to maintain analytic skills.
Ronald Benson, Chair of the Committee on Institutes, reported that work was progressing on updating the Standards of Training, which were last revised in 1980. A draft will be distributed to institutes for discussion prior to the May meeting. Benson announced that the institutes to be visited by COI in 1998 are Baltimore-Washington, Chicago, St. Louis, and UNC-Duke.
Sam Robertson from Cincinnati, Karen Gilmore from Columbia, Gail F. Anderson and Salley S. Jessee from Emory, and Gregory D. Graham and James W. Lomax from Houston-Galveston were appointed training and supervising analysts. Also appointed were Sterrett Mayson and Melvin Singer of the Institute of the Philadelphia Association, Nicholas Kouretas and Ira Lable from PINE, and Joanne E. Callan, Nadine A. Levinson, and Stephen R. Silk from San Diego. Additional appointments were Raymond Poggi from San Francisco, Richard L. Munich from Topeka, and Cecile R. Bassen from Washington. Appointed geographic rule supervising analysts were Robert S. Wallerstein for St. Louis and Kenneth D. Cohen for Western New England. Richard A. Frank (Chicago) and Michael K. Harty (Topeka) were appointed geographic rule training analysts, and Marianne Goldberger (Florida) was appointed geographic rule supervising analyst. Appointed child and adolescent supervising analysts were Allen Palmer from Boston, Karen Gilmore from Columbia, and Landrum S. Tucker from UNC-Duke.
Robert Cummings brought to the attention of BOPS the difficulties involving the American Psychiatric Association Practice Guidelines project. The APA has written the third draft of practice guidelines for panic disorder and related anxiety disorders. He emphasized the importance of these guidelines and noted that they tend to become standards of care. Cummings mentioned an alarming trend in the APA guidelines to move away from the biopsychosocial viewpoint toward double-blind research studies. Moreover, the guidelines fail to cite dynamic psychotherapy research. Most surprising, the document states that a side effect of an analytic approach was the risk of exacerbating panic symptoms and developing psychological dependency. Margolis and Pyles have written a very strong letter to the APA, and the problem will be closely monitored by The American. Cummings praised the work of Sheila Hafter Gray in examining and criticizing the extensive APA drafts.
Cummings briefly explained his recommendation that The American work to have CPT code 90845 (psychoanalysis and modified psychoanalytic treatment) removed from the covered services of Medicare (see TAP 31/4, page 24.) Warren Procci, chair of CGRI, said the committee was opposed to this approach (see page 10 of this issue).
The American has met informally and unofficially with representatives of the William Alanson White Institute, a free-standing institute in New York City, at “a most preliminary level” to discuss the feasibility of this institute's joining The American. BOPS requested ongoing reports of these meetings.
Deanna Holtzman will have completed six years as chair of the Committee on Research and Special Training when Peter Loewenberg becomes chair in May. At the time Holtzman took office, the committee was viewed with much ambivalence by academics. Now The American's ties with academia are improved and strengthened. Holtzman said CORST had come a long way since 1957, when it was for the benefit of “outstanding research men [sic].” With the support of the American Psychoanalytic Foundation, the first APsaA grant was given to a CORST candidate. Holtzman also announced the first CORST essay prize, awarded to Janice M. Coco, who presented her paper “Exploring
the Frontier From the Inside Out in John Sloan's Nude Studies“ at the Fall Meeting. Holtzman proposed a waiver for Ellen R. Sachs, which was approved by an unanimous vote. The GORST research training grant went to James Anderson of the Chicago Institute.
As chair of the Committee on IPA Membership, Robert Cummings proposed five individuals for membership, and the board unanimously approved. They were Leonard Corte from the Los Angeles Institute and Society for Psychoanalytic Studies; Pasquale DeBlasi, Jr., from the New York Freudian Society; Andrew B. Druck from the Institute for Psychoanalytic Training and Research in New York City; Ruth F. Lax from both The New York Freudian Society and the Institute for Psychoanalytic Training and Research; and Carol Ann Munschauer from The Canadian Psychoanalytic Society.
BOPS voted to have the Joint Ad Hoc Committee on Homosexuality become a permanent joint committee. Ralph Roughton will leave as chair in May, and Susan Vaughan will replace him. Roughton mentioned that the committee will visit and consult with institutes at the institutes' request. Recently in Cleveland he presented a paper, attended a reception, participated in a case seminar, provided individual consultation, discussed institute curriculum, and attended an open house for the gay and lesbian community sponsored by the institute.
Sander Abend mentioned that the report by the COPE study group on the impaired training and teaching analyst will be disseminated to the membership.
Ellen Rowntree, chair of the Committee on New Training Facilities, reported steady progress in the four provisional institutes and one study group. She recommended that BOPS consider a proposal suggested by Jon Meyer to seat non-voting representatives of each new training facility and to extend the vote to provisional institutes. The Board was receptive and will vote on these issues in May.
Harvey Rich reported that the Psychoanalytic Foundation has received increased requests for funding.
Ralph Engle, chair of the Committee on Ethics, reported that the committee is developing an ethics casebook that will illustrate principles and guidelines. The committee plans to send vignettes of ethics problems to institutes for feedback.
Myron Hurwitz, chair of the Committee on Certification, reported 25 initial applications and 10 continued applications for certification since May 1997. Of these, 17 were certified. He reported high registration for the certification discussion group and workshop. The committee plans to produce a videotape of the certification process to inform prospective applicants of the procedure. Hurwitz said the most common difficulties with case reports were gross enactments, poor choice of patients, intellectualized theory-driven reports, and opaque writing style.
Dorothy Holmes gave the report on the Committee on Ethnic and Racial Diversity. She commented on the increased commitment of The American to diversity and the availability of the Visiting Professor for Racial and Ethnic Diversity to visit institutes.