One of the interesting themes that emerged from the Open Line's discussion of certification was proposals for alternatives: alternative ways to evaluate, alternative objects of evaluation, alternative credentials, alternative ways to spend our professional time and attention. TAP asked three members who advocated alternatives for certification to give us a brief summary of their ideas.
Here, in their own words, are the proposals of Bill Gottdiener, Arthur Nielsen, and Joseph Schachter. Gottdiener proposes substituting a case study method analogous to defense of a doctoral dissertation. Nielsen suggests we are over-emphasizing evaluating each other; he proposes some better uses of our time. Like Gottdiener's, Schachter's proposal takes off on the Ph.D. model, but he has devised a method that would maximize autonomy and innovation in the analyst's professional development.
Instead of testing an applicant's knowledge of psychoanalytic process, certification should demonstrate the applicant's knowledge of case study methodology. The case study is a respected, valuable scientific enterprise. The certification process would serve a useful purpose if it were viewed as a way of helping recently graduated psychoanalysts demonstrate their mastery of the case study method. Their treatments during training have all been extensive case studies, whether they thought of them that way or not.
Demonstration of case study methodology would get around the minimal clinical competence problem, and the certification process would then be the natural culmination of an educational process that new psychoanalysts have undergone.
I liken this process to the completion of the dissertation in clinical psychology and clinical social work. To complete the dissertation, the student goes through a three-stage process. First, the student must develop a study topic and design, which is usually done with a mentor. Second, the student defends this proposal orally to his or her dissertation committee. Ideally, the committee and the student work collegially to craft the best study for the student. As the dissertation progresses, the student and mentor meet periodically to monitor its progress. Third, once the dissertation is thought to be completed, the student defends the final work to the committee.
“Instead of testing an applicant's knowledge of psychoanalytic process, certification should demonstrate the applicant's knowledge of case study methodology.”
It is a rule of thumb that no student goes to a dissertation defense with the anticipation that he or she will fail (this of course doesn't mean students don't fear failing). Although failure can occur, it's a poor dissertation mentor who allows an unprepared student to defend a poorly executed dissertation. A student might be asked to make minor changes after having passed the defense, but they are reasonably small changes.
Having passed the dissertation doesn't mean that the new graduate will be maximally competent to conduct research. It means that he or she was competent with that project and is prepared to continue learning how to do research using increasingly sophisticated methods.
Certification might be improved if it followed a similar process. An applicant could have a mentor or advisor going into the process, perhaps someone from his or her training institute. The applicant and mentor could meet to discuss the case or cases the applicant wants to present for certification and craft a proposal based on these discussions.
The proposal of the case writeup would, like a dissertation proposal, be presented to a committee. This could be an APsaA committee, but at least one member of the committee would be the applicant's mentor/advisor. Thus the applicant would have a friendly face on the committee, someone who knew the applicant's point of view.
The committee's disagreements on definitions of analytic process and other matters could be hashed out in a collegial meeting that would have an educational purpose. The applicant would walk away from the meeting knowing exactly what has to be done to “pass” the case writeup defense.
When the case writeup had been completed, the applicant could schedule a defense, just like a dissertation defense. The applicant would have received feedback from the committee and the mentor/advisor prior to the defense, so that the defense would be a final discussion of the merits of the case and the writeup, what was learned, and limitations of that particular case study. Most importantly, the applicant would know that he or she would pass.
If certification were conducted in this way, then the whole process would be an educational experience rather than a test of what appears to be highly questionable validity. I write this as a candidate in psychoanalytic training with a Ph.D. and base it on my experience in graduate school.
We should stop assessing the competence of already thoroughly evaluated graduate psychoanalysts and spend our limited resources elsewhere. We ought to spend our scarce nonclinical time doing other things, like raising our kids, participating in the community, and doing research. These ought to take precedence over “certification,” a process that is unnecessary (it protects no one), anti-creative (it encourages undue conformity and untruthfulness), and devitalizing (it has been too much of a roadblock and a hazing and has deterred many from further involvement in our organizational life).
Nonetheless, this important debate over certification encourages us to evaluate our actual organizational weaknesses — specifically our excessive evaluative focus on ourselves internally, which distracts us from glaring external problems. We might compare ourselves to a father whose constant worry over his son's imperfect grades distracts the family from his own failure to advance at work.
William H. Gottdiener, Ph.D., is a research psychologist at Beth Israel Medical Center in New York City and a psychoanalytic candidate at the New York Psychoanalytic Institute. Arthur C. Nielsen, M.D., is a faculty member of the Chicago Institute for Psychoanalysis, a clinical associate professor of psychiatry at Northwestern University Medical School, a faculty member at Northwestem's Family Institute, and a founding member of the Chicago Center for the Study of Groups and Organizations of the A.K. Rice Institute. Joseph Schachter, M.D., Ph.D., is a former training and supervising analyst of the Pittsburgh Psychoanalytic Institute, now retired. Janice Lieberman of the TAP editorial board conceived of this article and solicited the authors' contributions.
My concern is that the certification system serves less to “certify” graduate analysts than to reassure us that all is well in our discipline. As we know from our obsessional patients, just because something can be tested and checked doesn't mean the effort is justified. We need to face the myth of unlimited resources and time and realize that our obsessional focus on evaluating our students and graduates derives from our daily uncertainty over our method, our results, and our public reception. Our certification system supports the illusions that there is a known way to proceed and that our patients all do great once we get our technique and theory straight.
Instead of continuing this obsessive internal focus, we should spend our non-patient time on things that will make a real difference rather than an illusory one. Our glaring deficiencies as an organization are on our external boundaries: our anemic interest and involvement in formal research and our difficulty bridging the gap to other academic disciplines and to the lay public.
Why not push for national, coordinated studies, more standardized recordings, before-and-after ratings, etc.? Why not confront the amazing lack of interest in such studies as truly dangerous to our profession? Why not look more closely at our resistances to joining in research projects, rather than seeking to perfect certification? The same goes for addressing public attitudes about psychoanalysis. Why not have more discussion online and at meetings about community outreach?
I think the Board would serve us better by supervising a national graduation requirement that all candidates participate in a national research/learning project. They could complete standardized questionnaires on a case and discuss the unvarnished truth about what seemed to help and what seemed not to work, where changes were made, and where the analytic pair remained disappointed in the outcome. This would have a far more salutary effect on the intellectual curiosity of graduates and possibly on the advancement of our science.
I would like to offer a different concept of certification, one dedicated neither to the assessment of analytic competence nor to the enhancement of a traditional view of analytic identity.
The current certification goals, unfortunately, tend to enhance the human inclination toward conformity and identification with revered teachers. These roots in medicine, from which psychoanalysis developed, are described by Nobel laureate D. W. Richards, Jr., as developing a “tradition-bound medical priesthood.” This is fostered within the tripartite system of analytic training, where there is a chilling effect on candidates' innovative ideas, dissent, disagreement, and lifestyle choices — since they may put the candidate's progression at risk.
Mark Poster provided me with Jacob Arlow's eloquent statement about this attitude in relation to the training analyst:
With the effulgence of omnipotence and omniscience surrounding the training analyst, it is not difficult to understand how he may be identified unconsciously in the collective fantasy of the institute with the primal progenitor, the source of power and knowledge. … For many individuals there is a lingering sense of inferiority and incompletion which can be terminated only when they have achieved actualization of their unconscious fantasies of omnipotence in the form of an appointment as training analyst. … Pedagogically, the process of identification contributes to an overly strong clinging to the past.
What would help the analytic graduate to reduce this tendency toward “clinging to the past?” What will foster a “disidentification,” a healthy individuation? Such development must be institutionally valued, and the graduate must be able to conceive that he or she is capable of such individuation, capable of developing nonconforming, original, creative points of view.
My proposed certification is designed to facilitate and reward such an expanded identity, which would foster the productive development of both the graduate and our field. This new conception of certification is solely educational. It serves no gatekeeping function; that is, it is not proposed as a prerequisite for training analyst appointment. The model for this new conception is the usual Ph.D. program in which an applicant tries to demonstrate the capacity to conduct individual research.
Implementing this concept of certification would require the analytic applicant to develop and submit a brief prospectus outlining some work that he or she is interested in pursuing. The proposed project would have to distinguish itself from a more routine graduation paper by its ability to pursue and explore ideas, concepts, and hypotheses, as well as to be creatively innovative. A certification committee comprising analysts with widely diverse points of view, selected to broaden the applicant's point of view, would review the prospectus and seek consultation with relevant outside experts, including non-analysts. The applicant's meetings with the committee to discuss the prospectus would be framed by educational goals. The initial prospectus might be accepted without change, or modified, or rejected, always with full, constructive explication of what is questionable or unacceptable.
The prospectus should not focus on received wisdom but should engage with something “outside the box,” yet with clear relevance to psychoanalytic theory, practice, or research. Projects might include new concepts, either of analytic theory or technique; problems in analytic theory, in analytic technique, or in analytic training; a history of the training analyst concept; the impact on technique of supervision by an analyst from a different school; the impact on technique of participating in a study group; a report of analytic treatment failures; video or telephone analyses; participation of analytic patients in couples treatment or group therapy; issues of patients who are parents; or a clinical research project.
Once the prospectus was approved, the applicant, in consultation with the Committee on Certification, would select a mentor to assist him or her with the project. The committee would later assess the completed report to determine whether the applicant had followed through and demonstrated the capacity for independent, individual thought. The applicant who fulfilled this expectation would be awarded a certification certificate attesting to those qualities portending future growth and development as a psychoanalyst and a contributor to our profession.