In day-long sessions at the 2001 Fall Meeting, both Board and Council dealt in depth with the current controversy regarding certification policies, procedures, and scientific validity. The two governing groups' focus on certification followed a months-long debate on the legitimacy and value of certification that appeared on the APsaA's Open Line e-mail list.
The certification procedure is conducted by the Board's Committee on Certification. Although certification is an optional additional credential, not required to practice psychoanalysis, members must be certified in order to serve on BOPS and on BOPS committees and to achieve training analyst status.
The Board's discussion began with the customary presentation of the current applications. Mike Singer, chair of the Committee on Certification, reported that twenty-one first-time applicants for certification and ten continued applications were evaluated at the Fall Meeting. (See the box on page 25 for names of newly certified members.) Of these thirty-one individuals, twenty-four were certified; of these, four were certified in child/adolescent psychoanalysis and one in combined adult and child/adolescent analysis.
Singer then addressed the Board about the background of certification and the current status of the debate. Members were last surveyed about certification in 1992. At that time, 19 percent opposed certification, 66 percent approved certification but felt there needed to be modifications in the procedure, and 15 percent approved certification as it stood at that time. Surveys of candidates yielded similar numbers.
In the decade following this survey, numerous changes have been made in the procedure; however, complaints persist about the process. Singer believes that doubts will always persist. Most members, at any given time, will support certification but want changes; changes will be implemented, and people will be satisfied for a while, but eventually the clamor of opposition will return. For Singer, this raises some deeper questions: Do we really want credentialing of our members in any form? Or are we fundamentally uncomfortable with it? What should such a process accomplish? Is it a test, or educational? Should it be linked to training analyst status? Would another system be better, such as designating clinical fellows? Can we measure competence by any procedure? Should individual credentialing be externalized?
Photo by Mervin Stewart
Singer cautioned that the constant need for the Committee on Certification to defend itself against criticism of its methods and calls to abolish certification were terrible for committee morale.
Ronald Benson stated that he favors a policy of continual reassessment. He supports the Open Line discussion because it guarantees minority rights and gives voice to individuals outside official organizational roles at a given moment. The e-mail forum, he went on to say, cannot replace the representative structures of the Association, which has vested its welfare in BOPS and the Executive Council by democratic process.
Discussion from the floor was wide-ranging and long. Numerous members of the Board acknowledged that questions of reliability, validity, and subjectivity were serious. The San Francisco Education Committee had instructed its representative to inform the Board that it was unanimously against the certification system, primarily because of concerns over validity and reliability. The practice of “bringing the pass rate up to 100 percent with repeated returns” suggests for some that the applicant learns to be compliant. Some speakers brought up the contention that the process is painful and traumatic for applicants.
Jeffrey Nason noted that “certification is a stalking horse for other hierarchical issues, especially the training analyst issue.” He believes we should look at the larger issue of hierarchy, rather than separating certification from the training analyst system. Howard Benensohn pointed out that doing away with certification could cause real professional harm to some analysts who use certification in psychoanalysis to get privileges in hospitals or work with national managed care groups.
Some fellows offered ideas toward solutions, including regionalization. Bob Michels argued for recertification and suggested more communication with the community of certifiers at large in other professions and bringing experts in as consultants.
After the general discussion, Benson said he would appoint a BOPS ad hoc committee to look at certification as now implemented and review the history of the changes that have been made. The committee will review the costs and benefits, study its rationale and role in our educational system, evaluate the experience of recent applicants, survey the view of the general membership (in concert with the Council), and assess the implications of certification for our relations with other psychoanalytic organizations and the general public. The committee will make a status report to the Board at the May meeting and present its final report with recommendations by January 2003. The proposal for the ad hoc committee was approved.
The Council began its discussion of certification the morning after the Board meeting.
Elise Snyder said the effect of the certification process on member morale is significant. People who have passed are often cynical, and those who have “flunked” have often left the Association and sometimes even their local group. Bob Gordon echoed Snyder, citing an “atmosphere of cynicism — people change things to get it right for the committee.” He
believes that a large number of members feel the certification process is intellectually corrupt. Allan Rosenblatt said that the process can be constructive, offering prestige and providing some consumer confidence. However, the procedure must have validity and freedom from bias. Rosenblatt believes that an in-house function cannot gain confidence from the public. Bob Pyles said that the Board will continue to be a target until we have external credentialing.
Early in the Council discussion, the entire Affiliate Council filed in, having adjourned its own meeting in order to hear the Council discussion. Amid standing room only, the discussion continued.
Mel Bornstein spoke up strongly in favor of certification, arguing that it represents what psychoanalysis is all about — humiliation and exposure, courage and integrity. Warren Procci reported that the Education Committee of Southern California was unanimously against certification as currently organized. Jane Walvoord, president of the Affiliate Council, said she valued some kind of national certification. She argued that recruitment would be more difficult without certification. She specifically praised the certification workshop.
Henry Friedman decried the negative impact on applicants who are “continued.” No change in their work is possible, only a change in how it is described, leading to compliance but not to growth. Joe Schachter agreed, saying our current procedure awards conformity, which is deleterious to innovative thought in our field.
Mike Singer said that one of the most common misunderstandings is about the rigidity of the Committee on Certification. In fact, the committee has responded to the widening scope of patients, practice, and theory. He predicted that two-thirds of respondents in a new survey would come out in favor of certification with some modifications, just as in the 1992 survey.
In the afternoon, the Council began a second session on certification, this time to consider proposals for action. Ralph Fishkin presented a motion for a non-binding referendum on certification. He felt the Association would benefit from knowing the current opinions of the membership. The specifics of the motion for the referendum had been discussed and refined previously on the Open Line.
A number of members spoke up against the motion. They were concerned that it would re-establish old splits between Board and Council, that the language was pre-emptive rather than consultative, and that the effort was unilateral rather than bilateral. BOPS secretary Eric Nuetzel said that the Board was “in favor of a poll but not the referendum.”
All together, about two dozen speakers addressed the certification issue in the Council's afternoon session; three dozen spoke in the morning.
The motion for the referendum was defeated by a vote of 23 to 16, with four abstentions. Leon Hoffman then proposed a new motion:
In order to execute the Executive Committee's responsibility to serve in an advisory role to the Board on Professional Standards, and to insure that a collaborative process is achieved, the EC and the BOPS should jointly develop a poll of our members on the issue of certification. The group putting together the poll will be jointly appointed by the President of the APsaA and the Chair of the BOPS.
This motion was approved by a vote of 39 to 4, concluding the two-day marathon on certification. The atmosphere in the Jade Room at the Waldorf where both Board and Council meetings took place was one of exhaustion, relief for many, and disappointment for the sponsors of the referendum.
The meeting closed with a standing ovation for president Dick Fox, whose even-handed and skillful leadership had created a civil meeting where a wide range of opinions were considered.