It is time to recognize that our organization is fundamentally flawed in its governance. We have a fault line in the structure of our organization that must be addressed. The fault line is appears around our effort to coordinate the professional practice aims of our organization, which includes its scientific, social, cultural, economic, and political dimensions with our educational and professional standards aims.
It is time to ask the question: What if we were designing an American Psychoanalytic Association from scratch? We should — I believe we must — collectively answer this question and have the courage to implement change, however radical.
Each of us must participate in this review of our organizational structure and governance. We must not deflect difficult and subversive questions into actions that appear to be solutions but do not serve our long-term interests. We have the potential to find true solutions that will further all of our goals and commitments. If we respond to the opportunities before us within the larger context of our common commitment to our patients, our practices, and our educational and professional standards, we will have truly learned from our past and be optimally positioned to face the future.
Over the past year, committees of BOPS and the Executive Council have been reevaluating the relationship between certification and membership rights. The newest signs of the fault line are emerging around the consideration of this relationship. The underlying issue involves the nature of the governance we want our educational institutions to have. Do we wish to have a body such as BOPS, in which educators, representing a diverse national constituency of certified and non-certified faculty, develop a consensus on national educational standards and procedures, in a manner insulated from political influence? Or do we want a different structure, such as one in which these educational institutions are governed by the entire membership? We currently have neither fish nor fowl.
There are three different versions of what the American Psychoanalytic Association can be. We must actively decide which version we want.
We can choose to retain the current hybrid organization, with either stabilization or greater functional separation between the two organizational components, BOPS and Council. Adherents of this position would point to the historical accomplishments and pre-eminence of our organization and to the enrichment from the dialectic between our professional practice and education/professional standards components. Greater functional separation would require a re-examination of the relationship between BOPS and Executive Council and a re-examination of our board of directors structure. The “Kris-Pyles” recommendations, which detailed an approach involving a small board of directors with representatives from both Executive Council and BOPS, provided an excellent model of such governance.
We can choose a holistic organization, with unitary governance of all aspects of the organization. When our organization is viewed that way, it makes little sense (and is even offensive), for one organizational component to control prerogatives that are associated with membership.
With a holistic organization, we would abandon the concept of a functionally autonomous national educational body, comprising educators who are democratically chosen by the component educational programs, that determines the national educational standards, policies, and related professional standards. BOPS could either be completely dissolved or become an advisory and service committee.
We can achieve a holistic organization in one of two ways. The first could be to choose this option openly. The second could be to achieve it covertly, i.e., by moving in the current evolutionary direction involving a gradual shift of governance and a dismantling of BOPS activities and authority.
We can choose a division into two fully separated entities: a membership organization of individuals and a membership organization of institutes. This option is sometimes known as “externalizing BOPS.” Adherents of this position believe there has been an intolerable cost associated with the noble attempt to coordinate membership functions (professional practice) and educational/professional standards functions (particularly accrediting and certifying). They also believe that our current mode of governance, in which an educational/professional standards board exists within the governance of a professional practice organization, is not acceptable by any reasonable standard. Some advocates of this option believe that the de-linkage compromise of 1992, which delinked pieces of the BOPS standards from certain membership prerogatives, created new imbalances, divisions, and inequities; they are reluctant to repeat this mistake with a new round of de-linking of standards and membership prerogatives. They would argue that a far better solution is to de-link BOPS as a whole in one thoughtful, well-planned action.
In this option, the American Psychoanalytic Association would become a member organization of BOPS. It would be free to establish any membership criteria that it wished, including accepting members other than graduates of our institutes or members of IPA societies. The “American Board on Psychoanalytic Education” would incorporate as a fully separate organization of member institutes. Institutes of the American would decide whether they wished to join this independent board. The board would continue to set national standards of the highest quality and participate in other activities as it determined. Its funding might derive partly from the equivalent of the current institute dues, and perhaps partly from endowment funds deriving from an equitable division of the parent association's reserve between its two successor organizations.
There was a time when things were different than they are now. The APsaA was, in effect, a fellowship organization. It comprised graduates of our institutes who had “passed” a second level of review, which came to be known as certification. BOPS, which conducted this review, was the major center of the organization. The interests and activities of the organization were largely (although never completely) congruent with the Board's scope. The Executive Council had a secondary role in organizational life. The major tension, or fault line, was between the members of the Association who wanted to keep the existing system of membership and those members who objected to the existing system (joined by many non-member graduates).
The de-linkage compromise, passed in 1992, created a new system of virtually automatic membership in the APsaA for graduates of our institutes. Because the compromise was also intended to protect the endorsement, value, and meaning of certification in organizational life, certain organizational rights were restricted to certified members. Certification conferred eligibility to serve as a member of a BOPS committee, a BOPS Fellow, an Executive Councilor, or an Association officer, and to vote on by-law amendments.
Most observers agree that the major shifts in our organization in the last eight years are strongly related to the shift in membership that followed the de-linkage compromise as well as to the opening of psychoanalytic education to mental health professionals other than physicians. These shifts in our organization include the Executive Council functioning in a more meaningful way as a board of directors and expanding into areas of professional practice. With these professional practice interests becoming increasingly high priorities in the context of the massive cultural and political threats to the practice climate, the major fault line has been shifted to incompatibilities between achieving professional practice and educational/professional standard goals. This tension has been manifested in waves of BOPS-Council tensions, since each has different constituencies and responsibilities. This tension will return repeatedly, despite the continued efforts of our officers and many other members to work together and heal divisiveness, because they are working within a system that is ambivalent and ambiguous about the governance status of a national body that establishes national educational and professional standards.
We are burdened with a long and contradictory organizational tradition that both gives BOPS autonomy and places it under the governance of an Executive Council. Our problem is with a system that creates a de facto conflict of interest by charging our Executive Council with the duty to be even-handed with regard to both professional practice and education/professional standards issues while emphasizing the Councilors' extra-educational role and allegiances by selecting them from societies and imbuing the actual work of the Council with professional practice concerns.
I was a Fellow of the Board in 1992 when the de-linkage issue came before BOPS. I voted against the compromise that limited the rights for uncertified members. I believed that a national organization should have an egalitarian membership structure, and I was concerned about implementing an unstable, inequitable situation. Also, at that time, I did not understand what BOPS was, and that the de-linkage debate was about much more than eligibility for membership and membership prerogatives.
One way in which the fault line manifests is through the perceived or actual ability of a membership organization to politicize and inappropriately influence educational and professional practice standards. For example, the legitimacy of certification is lessened when it is embedded in a membership organization and is
therefore susceptible to being controlled and influenced by membership agendas. A description of this kind of interference is provided in the final report (1998) of the BOPS Ad Hoc Task Force on Board Structure and Function:
Our review suggests that on occasion, senior leaders of our Association, operating out of sincerely held beliefs about what would best serve the Association, have directly expressed views or preferences about specific cases involving certification, of waivers, and about situations involving New Training Facilities. In view of the prestige of the Council and the Association's Officers, their control of the budget, and their capacity via Executive Committee or Executive Council actions to effect the ability of BOPS to carry out its work as it deems most appropriate, such expressions of views and preferences can be experienced as an influence. This should alert the Association that we require more certain structures than now exist to safeguard the integrity of the accreditation, certification, and educational mandate that is the responsibility of the Board on Professional Standards.
Another manifestation of the fault line is the ambiguous role of the Executive Council in determining educational/professional standards. The problem represented by this ambiguity transcends any “legal” opinion concerning the relationship between BOPS and Executive Council, because determining this matter on “legal” technicalities is simply avoiding an organization's commitment to be what it wants to be. In fact, the viewpoint is promulgated by some that the Executive Council, in its role as board of directors, has the power to override any decision of BOPS. Such a view can be, and in my view has been, an incentive for BOPS to accept positions with which the Fellows are uncomfortable to avoid provoking an organizational crisis. The danger to the varied goals of our organization is not the power of BOPS, as it is sometimes perceived, but BOPS's overall organizational weakness caused by our current structures. Indeed, our current structure assures continued internal strife, which diverts both BOPS and Executive Council away from the more crucial tasks of each.
The fault line equally affects our professional practice agendas. For example, many wish to expand our membership to individuals trained in institutes that do not follow the training models endorsed by BOPS. The current limitations on membership deprive our Association of talented people, fresh scientific viewpoints, and economic and political resources. In addition, certification and the training analyst system, however worthwhile, stir lingering reactions that have profound effects upon organizational life.
Over the nearly six years that I have been involved in recruitment for BOPS committees (I was secretary of BOPS before becoming chair), I have noted increasing reluctance of members to assume the duties of certain BOPS committees. I believe that the major reason is the increasing difficulty of making economic sacrifices. However, I have come to recognize that certain organizational attitudes have affected members' willingness to serve. The situation with the Committee on Certification is perhaps the clearest illustration.
Most know and many have followed the e-mail discussion of certification over the past year. In that discussion, some of our colleagues have described personal experiences with certification, including quoting and naming members of the Committee on Certification, sometimes in appreciation and sometimes critically.
Certification Committee members are not perfect. They are, in the aggregate, a remarkable group of people, carefully chosen and fulfilling their task with all the care and sensitivity that they can bring. The task of assessment and discussion with applicants is almost as difficult for them as it is for the applicant, because of the kind of people they are and their recognition of the weight and difficulty of their task. They frequently need to bring to the attention of applicants the very same issues about their work that were noticed and addressed in their training experiences and perhaps remain as unresolved issues. We all have such issues to varying degrees. Some people react to such a discussion of their work with a redoubling of their effort to understand and address the issue. Some react with defensiveness. One manifestation of this can be to hear and portray the positions of the Committee on Certification as if they are emanating from a prejudiced group of people, well-meaning but clueless, caught in a time warp, acting capriciously, chasing irrelevancies, and anything but compassionate and sophisticated analysts who live in the real world.
From the standpoint of a membership organization, the open forum that is provided by the members' e-mail list is a tremendous advance. But the task of the committee members is complicated and affected by the awareness that their words might appear in some misconstrued form in a public forum. Committee members cannot respond in a public forum because of their obligation to maintain the confidentiality of the committee's work. This situation illustrates the incompatibilities of coordinating membership and educational/professional standard functions within one body and the politicization, personalization, and pressuring that can and does occur in that setting.
I see two options for resolving the current set of discussions about the relationship between certification and membership.
Option one is to recognize that “solutions” to the current undesirable situation will simply shift the fault line, possibly even aggravate it. Therefore, rather than devote energy to yet another diversion from the basic issue, we would choose to focus on the more challenging, basic, and anxiety-producing problems of organizational structure. We would choose and operationalize one of the three options for organizational structure that I have described. I believe this is the preferable option.
Option two also involves an organizational dedication to choosing one of the three options for organizational structure. However, it would also include the effort to seek a temporary resolution of the certification-membership conundrum, as long as this resolution did not further aggravate the fault line. I think this option could work. However, I think it is the less desirable option, because it might divert our energies into changes that satisfied some but would not solve our larger challenges, and it might lead some to mistakenly conclude that we had made real progress.
Nevertheless, I would like to offer my view of a rational approach to a temporary resolution of the certification-membership conundrum. Viewing us through the lens of a membership organization, I believe it is unjust that we do not afford full membership rights to all members. Current policies also hinder our professional practice objectives. Some members do not join the organization, some join but are dissatisfied, and some cannot use their talents at all organizational levels. There is a deep problem here.
Possible changes in the relationship between certification and membership have equally profound implications for our education/professional standards agenda. In my view, the fault line would be accentuated if certification no longer conferred eligibility for serving as an Executive Councilor or officer elected by the membership. BOPS would be structurally set off as an elite club of the certified. The governance of BOPS would be severed from the group that has met the current requisite professional standard established by BOPS. As Jane Walvoord, president-elect of the Affiliate Council, has written, certified members have demonstrated that they know enough about the practice of psychoanalysis to make informed decisions.
Removing the qualification of certification for service as an Executive Councilor or an officer elected by the membership would be a major further step in the construction of a straightforward membership organization. The major remaining step in the completion of the transfer of governance would be to shift the governance
of education/professional policy and standards to members. If such governance were given to the full membership, BOPS, as a governing body overseeing our educational programs, would be little more than a sham, structurally a front for a membership organization. We would have institutes, with faculty picked on merit, governed by a national board, all of which would be controlled not by educators but by the members who have been graduated from those educational programs. Such a system makes no more conceptual sense than the body of all physicians determining, by vote, the standards and direction of medical education, or all doctoral psychologists making similar determinations about their graduate education. The by-laws currently specify core aspects of BOPS function such as who may serve; whether BOPS accredits, certifies, or picks its own chair; eligibility criteria for training; and fundamental aspects of the new training facility process. The by-laws could even be expanded to include details of training that are now policy, e.g., frequency of sessions in supervised and training analyses. If the full membership could make these most basic and important determinations, would there be any rationale for the current requirement that the BOPS Fellows be training analysts (and therefore certified as well)?
If, on the other hand, we limit universal eligibility for voting on by-laws to non-BOPS-related matters, we will need to be certain that we haven't merely shifted the fault line. Many, including our Association's attorney, have emphasized the ambiguities involved in determining whether a matter is BOPS-related. Most of the important issues turn out to be at least arguably BOPS-related. Who will make the decision about whether a by-law is BOPS-related? Some have suggested that the Executive Committee should decide. Rather than promoting healing, this step would provide another level of conflict of interest since four of the five voting members of the Executive Committee are national officers. They are elected by the national membership and are also officers of the Executive Council. A limited universal bylaw eligibility therefore will move the governance challenge of coordinating professional practice and educational/professional standards agendas from the membership/certification arena to the by-laws arena.
Does this mean that we are stuck with an awkward de-linkage compromise that few liked at the time, and which has gained few adherents in the interim? No, but it does mean that we cannot make changes under the cover of sound bites about democracy, trusting our membership, and power and elitism, or with covert threats. If we decide to proceed with addressing the certification and membership issues at this time, our solution must strengthen our Executive Council and our BOPS. We must strengthen our entire membership; we must strengthen our professional practice and our education/professional standards agendas. We must do this mindful that we are not really addressing the fault line, and we must not delude ourselves that we are significantly better off than we were before we made any such narrow and temporizing changes.
If we choose to make interim changes, we should remove the certification requirement for service as an Executive Councilor and as an officer elected by the full membership. But we must accept the implications. A non-certified national officer should not be eligible to serve on BOPS. Democracy and eligibility can and must co-exist. We absolutely cannot have the education/professional standards by-laws determined by the entire membership. And, if we attempt universal voting rights only for non-BOPS-related by-laws, we must also have procedures that allow for a genuine assurance, in perception and reality, that the educational/professional processes will be protected. If that tilts toward BOPS control over the decision of whether a by-law is related to educational/professional standards, then this is the appropriate tilt for the protection of the interests of an entire organization such as ours.
Shifts of the current relationship between certification and membership prerogatives would bring BOPS functioning under greater perceived or real control by the membership. For the good of our educational system and membership, and for retaining legitimacy with the public, we would need to compensate with concurrent changes more strongly protecting BOPS from influence. After all, despite the real and perceived problems over the years, our pre-eminence and leadership as an association is a direct consequence of the educational and professional standards we have maintained. As is the case with our memories of our childhood, we tend to highlight the problems that our history has brought about while accepting the benefits with insufficient acknowledgement.
What changes would provide greater assurance of the integrity of the BOPS processes? Separating the BOPS budgetary process from membership control is a particularly critical way to address the greater imbalances that would accrue from changes in the certification-membership relationship. For example, the BOPS budget could be set as a percentage of the organization's expenditures, with further allocations made by BOPS itself. The Executive Council could continue to execute its fiduciary responsibility through overseeing that BOPS used its funds for its by-law-determined functions.
Some have made the important observation that a board of directors routinely governs educational institutions. However, such a board usually does not determine educational policy or procedure. Furthermore, a board of directors whose sole responsibility is to an educational institution or body is quite different from a board of directors that derives from a membership organization and has the overall responsibility for all of the functions of that organization. If we think about BOPS as a national educational policy-setting board, which describes its function more accurately than that of an educational institution, the more appropriate model of governance would be one in which qualifications are established that specify which members of the profession are qualified to participate in and govern education.
Is certification the optimal eligibility criterion for qualifying one to govern psychoanalytic education? On the one hand, there is some intuitive appeal to an educational and standard-setting body being governed by a group that has demonstrated a post-graduate level of clinical competency as defined by the body itself. However, certified members may or may not be involved in education; indeed, many of our experienced educators are not certified. It may be an inexact criterion, necessary but not sufficient. Because certification and eligibility for governance of an educational/professional standard-setting body are not fully linked, some contemplate throwing the baby out with the bath water. We need more refined and detailed criteria for eligibility to govern BOPS. Clearly, a certain amount of educational experience must be at least part of these eligibility criteria. After all, one has to be a training analyst to serve as a Fellow, i.e., govern BOPS at the microscopic level of policymaking. The macroscopic governance of BOPS at the by-law level should also presume substantial, some would say even equivalent, educational experience.
We are a different organization than we were when our current structure was established in 1948, and than we were even ten years ago. Institutes and societies are in transition and ferment. We struggle to keep our center as we respond to the political, cultural, and social forces around us. We are all deeply devoted to psychoanalysis, to our patients, to the science, and to education.
It is time to stop wasting our energies on fights, on Board vs. Council, on certified vs. non-certified, on TAs vs. non-TAs, on who votes for what in our organization. We must choose our governance. It is time to make a decision about the role of education and professional standards within our organization. What do we believe in? What do we want our organization to do, to work for? What role should our national organization have? We must make active choices about the real issues. It is time to talk and reach a new commitment. Let us determine the ways in which we can decide these questions together, regroup together, and move on together.