Most contributors to the recent e-mail discussion of certification have emphasized the effects on applicants for good or ill: Some applicants have suffered professional traumatization or felt forced to toe the current party line, while others have experienced the process as educational and identity-consolidating. Representatives of BOPS have tried to make the process more educational and less traumatic.
But there are better ways to further post-institute education and to consolidate analytic identities. Peer study groups, for instance, are much more likely to foster honest assessment of analytic work. The chief impediment to consolidating analytic identity today is insufficient numbers of analytic patients — a situation better remedied by spending our scarce time and energy on public relations and community outreach than by squandering them on further evaluations of mostly middle-aged graduate analysts.
However, both critics and advocates of certification tend to forget that the main rationale for certification is neither education nor identity enhancement, but gatekeeping, a function akin to peer review of journal submissions. While it is true that the certification process will have an impact on the morale, education, and identities of those undergoing it, such gatekeeping is unnecessary, and our scarce professional time would be better spent on other activities.
Certification might attest to two different statuses:
It might independently attest that practicing analysts already certified by their institutes by having met graduation requirements have indeed been competently trained.
It might attest to some higher level of competence within the profession beyond mere graduation.
The assumption underlying the first kind of certification is that our analytic institutes can't be trusted and will allow substantial numbers of sub-standard candidates to graduate. Lacking actual data on the percentages of such candidates, it is difficult to know whether certification is important or unnecessary. The ultimately high pass rates of the BOPS certification process ironically argue against the need for such quality control.
Lacking hard statistical data, we can only go by impressions. Of the candidates whom I would have hesitated to graduate from the Chicago Institute, few made it. In Chicago, at least, the biggest differentiation appears to be between those who did not graduate and those who did, not between graduates who are competent and those who are not.
Such impressions aside, screening for validation of graduation is irrelevant. Certification is often assumed to protect the public, which would otherwise be vulnerable to charlatanism and incompetent care by people who falsely represent themselves as qualified analysts. In actual practice, the public does not consult this sort of credentialing, and neither do we. Certification is not required to hold oneself out as a psychoanalyst, and no one is saying that our institute graduates should not do so. Further, the public is just not that sophisticated. Aside from analytic candidates who know about training analyst status, no one asks whether a graduate analyst has been certified. This state of affairs renders the graduation-validating function of certification moot.
Even if certification were relevant, its validity remains uncertain. Although relying on external raters seems an advantage, these raters are limited in their access to data. They review case write-ups produced for the purpose of convincing them of the writer's competence. Such data can hardly compare in breadth, depth, and honesty to the years of data presented to supervisors and teachers at the candidate's institute. While institutes might prove biased and let some of their inferior candidates through, it seems equally likely that reviewers of a few written case reports will not be sufficiently informed and may have biases of their own toward passing or failing applicants.
For these reasons, organized psychoanalysis should more fully authorize its institutes and their faculties by accepting, without additional review, the conclusions they have drawn after years of experience with their students. We simply do not need the double checking.
The rationale here is that graduation is not a tough enough selector for identifying the really top practitioners in our field. The problem with this thinking is that in practice, the actual goal of credentialing by BOPS is not to make things really tough on those submitting their cases. The bar in certification is actually pretty low: The applicant need show only that he or she was able to establish a psychoanalytic process and demonstrate understanding of such basics as transference, resistance, dream analysis, countertransference, etc. Again, recall that most everyone who stays the course passes.
What about the analysts who dropped out of the race after graduation? Perhaps these are the lesser analysts winnowed out by the certification process that they decline to undertake? We might equally argue that those who don't go for certification are less masochistic, more fearful, less in need of external validation, or more involved elsewhere. Since we have no hard data on this point, we really can't say. We can note impressionistically that there seem many, especially among those under age sixty, who appear competent and uncertified, and others who are certified who don't seem to be our “best and brightest.”
Local institutes should exercise a gatekeeping function in selecting training analysts, but I think there are better ways to do this than via case write-ups submitted to the American.
As we know from treating obsessionals, just because something can be measured, checked, or quality-controlled shouldn't distract us from asking whether this is worthwhile and what else we might better be doing. We've considered the uncertain benefits of certification; what about the costs?
First, certification demands too much of our free time, not just from applicants (who routinely sacrifice six months of extracurricular time to write up their cases) but from reviewers as well.
Arthur Nielsen, M.D., is a faculty member of the Chicago Institute for Psychoanalysis, clinical associate professor of psychiatry at Northwestern University Medical School, a faculty member at Northwestern's Family Institute, and a founding member of the Chicago Center for the Study of Groups and Organizations of the A.K. Rice Institute.
Psychoanalysis is currently in trouble, not because of insufficiently screened practitioners (as was true for pre-Flexner American medicine), but because of lack of public awareness, good PR, and supporting research. We would do better to devote our limited extracurricular time to these pursuits.
Second, we should acknowledge the emotional damage that certification sometimes inflicts. Our certification system may have uncertain validity, but it predictably causes considerable pain. We should stop alienating our friends.
Third, the current certification system may function as a self-destructive social defense typical of our history and group dynamics. Psychoanalysis has perennially suffered when some members accused others of being insufficiently loyal, analyzed, mature, or informed. Such internal criticism attempts to reduce anxiety within a field under attack from the outside and uncomfortable with real diversity on the inside. Let's not allow this to continue in the venue of certification. It is prevalent enough in our institutes, journals, and conferences.
The presumed benefits of certification are not great and do not hold up to critical scrutiny. Certification, which is extremely time-consuming, achieves relatively little toward the goals of furthering education, singling out the best to be our training analysts, or authenticating quality for consumers. Our energies would be better spent elsewhere.