Certification, its implementation, and its uses have often held center stage on the APsaA agenda for more than forty years. At one time or another, certification has served as a passport to membership, a requirement for voting rights, a requisite to stand for election and to serve as a representative from a local institute or society, and a prerequisite for appointment as a training analyst.
In addition to being a highly debated topic, the certification process has been the subject of task force studies, surveys, and reappraisals. We have attempted to make it more accessible, user-friendly, and collegial. In spite of these efforts, it has failed to achieve the status that certification has in other fields, either within the profession or with the public.
Although it no longer serves the other purposes it once did in the Association, certification remains a prerequisite for appointment as a “training analyst,” a title that represents a special status in the profession. In the minds of some, “training analyst” status has come to represent a two-tiered ranking of psychoanalysts, and some of the dissatisfaction with this two-class structure in our profession has fallen on certification.
Certification also carries the burden of past abuses associated with the process — such as policing local institutes or maintaining theoretical orthodoxy. In addition, the certification examination continues to be experienced by some as biased, lacking validity or objectivity, and at times conducted in an insensitive or even cruel fashion.
In the face of ongoing criticism, the Committee on Certification has continued to work over the years to improve the process. The certification examination as currently conducted is a far cry from that of ten or fifteen years ago. Unfortunately, harm had already been done and is not easily forgotten. Potential applicants may be negatively prejudiced in their expectations. Occasionally, mistakes of the past are repeated, perpetuating these negative expectations.
There are some inherent obstacles to developing an acceptable measure of clinical competence in psychoanalysis. Any examination can be a challenging and potentially embarrassing experience, but a certification exam in psychoanalysis carries added personal difficulty.
For those who do not pass, it may seem to negate the completion of years of training at one of our accredited institutes. The deeply personal nature of analytic work complicates evaluation of the applicant's presentation. The applicant exposes much more of himself or herself in presenting in-depth psychoanalytic work than does the surgeon or the internist in seeking certification in these specialties. A critical appraisal can be felt much more acutely as a judgment of the person of the presenter than simply of his or her technique. Such personal exposure occurs in the context of a highly charged relationship between examiner and applicant; when this occurs in the absence of genuine rapport, the results can be hurtful. My impression is that many certification casualties occur in the context of a relationship mismatch. Examiners need to be sensitive to the problem of such a possibility and take steps to correct it, such as recommending a change in examiners.
As to my personal opinion on certification, I would hope that we are able to develop a credible national certification process that is open, reliable, and as non-traumatic as possible and that we are able to elevate it to the status that certification holds in other professions. Certification should not simply be an affirmation of graduation but rather a reflection of post-graduate psychoanalytic maturation. We really only begin to acquire our own unique personal psychoanalytic technique after we have completed supervision and begin to work on our own. Certification should attest to this post-graduate growth.
There is a need in psychoanalysis for a certifying process that reflects both national standards and analytic maturation, recognized nationally by some such status as Diplomat or Fellow in Psychoanalysis.
Dick Fox, M.D., is president of the APsaA.