The American Psychoanalytic Association is conspicuous among professional organizations not only because it embraces professional standards and ideals, but also because it is involved with implementing and maintaining standards and ideals. The APsaA is both a professional organization and an accrediting and certifying body. This dual function has been the source of considerable controversy since the inception of the APsaA in 1911. The current discussion on certification reflects this controversy.
One of the reasons for the persistence of the dual function lies within the nature of psychoanalysis itself. Psychoanalysis is not only a body of knowledge that involves the study and research of the mind; it is also a treatment between two people that involves development, values, ideals, and relatedness. These aspects cannot be readily separated from psychoanalysis and psychoanalytic organizations as it can from other professional organizations. The APsaA has embraced psychoanalytic development, values, ideals, and relatedness partly through its Board on Professional Standards, which attests to the special qualities of psychoanalysis and a congruity between its professional and evaluative activities. The congruity reflects the considerable strength of the APsaA.
I believe that the certification process reflects the congruity of the APsaA implementing the attributes of development, ideals, values, and relatedness that are intrinsic to psychoanalysis.
My belief developed from serving on the Certification Committee for six years in the 1980s and '90s. The charge of the certification committee is to evaluate the applicant's psychoanalytic understanding of the psychoanalytic process. Psychoanalytic understanding is an intellectual and emotional understanding, reflecting what one knows and what one does with what one knows.
Psychoanalytic training has dealt with the complexity of evaluating how a candidate understands and functions within a analyst-patient interaction by using the supervisory process, wherein the candidate communicates to his or her supervisor the interaction of an ongoing, developing relationship. Rapaport, in describing the methodology of psychoanalysis, referred to psychoanalysis as based upon a relationship in which the analyst takes responsibility for the relationship progressing to its last consequence: the removal of all impediments against free-associations.
In accord with the evaluation procedure currently used by institutes, the Certification Committee asks applicants to communicate their understanding of their participation in an analysis through writing and interviews. By asking the applicants to organize their ideas, put them together, and communicate them in writing and in interviews, the committee asks them to enter into a developmental, ethical experience that demonstrates their understanding and activity within a psychoanalytic process. The applicants must use their theoretical understanding and communicate what they did, how they understood what they did, and what happened to the patient. The applicant's success in communicating these aspects of the interaction concretely reflects the applicant's intellectual, emotional, and professional understanding of a psychoanalytic process.
A similar activity is seen in all that is necessary for an analyst to make an effective interpretation. At a given moment, the analyst must put his or her theoretical and clinical ideas together and communicate them to enhance a process that includes the analyst's vision, ideals, values, and relatedness. This is intrinsically a revealing, developmental, and ethical experience for the patient and analyst — the essence of a psychoanalysis.
The members of the Certification Committee are focused on the candidate's ability to communicate the psychoanalytic process. Theoretical orientation does not play a factor.
I first joined the Certification Committee in the late 1980s. Psychoanalysis was changing with the beginning of the development of theoretical pluralism and the spread of a diversity of ideas within its theory and clinical activities to enrich understanding of the psychoanalytic process. Many of the applicants for certification at that time were unable to communicate issues related to object relation theory, interaction, intersubjectivity, and narcissism because they simply did not have the conceptual tools. Many of the candidates' applications reflected the writings of the psychoanalytic process in the 1960s, a time when pluralism had not infused psychoanalytic thinking.
I believe it was the message that candidates were not being sufficiently trained in the use of methods and psychoanalytic perspectives that the Certification Committee communicated to the applicants and the institutes. This message played some role in the changes that have occurred in the teaching and practice of psychoanalysis in the last twenty years. In the early 1980s, our training was not in synchrony with the actual development and practice of psychoanalysis.
Responses to criticism of certification can be addressed by considering the certification process itself. The criticism is frequently voiced that the certification process cannot be empirically tested and validated. The difficulty in testing and validating the certification process, according to the canons of empirical science, reflects the current state of psychoanalytic knowledge. We are not able to use empirical methods to validate psychoanalysis, psychoanalytic training, and certification. However, in the evaluation of a two-person interactive process, we have the interview and written communication about the process, which remains an essential part of any currently used psychoanalytic evaluation.
Another commonly heard criticism is that certification does not reflect the applicant's current level of understanding and functioning because applicants are frequently coached and helped in writing their case summaries. I believe that in the certification process we are dealing with a process of conceptualizing and communicating. If applicants can be helped or coached to refine their ability to conceptualize and communicate interaction with their patients in a psychoanalytic situation, then such applicants have made progress toward being a psychoanalyst.
The criticism is made that the applicants are not authentic in their applications for
Melvin Bomstein, M.D., is an APsaA councilor-at-large and a training and supervising analyst at the Michigan Psychoanalytic Institute, of which he is president.
certification. They write and say what they believe the members of the Certification Committee want to read and hear. I believe that the certification process does not validate this criticism. It does not take great skill to know when a person is being inauthentic in his or her communications. There is no hiding when one is describes oneself interacting in an evolving relationship.
The certification process promotes standards of practice and education reflecting the state of psychoanalytic knowledge. It is a source of growth and strength for psychoanalysis and the APsaA.