I had been walking around for most of my life with a personal certification committee in my head. As I anticipated writing up my cases for certification, I knew that the case that best demonstrated my analytic work was one that I had converted from therapy to analysis. At the time, I had heard that this was frowned upon by the Committee on Certification, even though it was quite widely practiced. I wanted to be truthful about my analytic work, but I feared being seen as not “classical” enough. I had studied the process of conversion to analysis with my supervisor and found there were no ill effects. Since I could find no literature on the subject, I wrote and published a paper on conversion to analysis and cited it in the case report.
Eventually, I was certified. However, when I read the case reports and the paper now, I find them stilted and defensive; such were my contortions in order to ward off an anticipated attack by a committee that I had never met or been interviewed by and that had not rejected me.
Some years later, I took on the job of preparing the guidelines for writing case reports for the Committee on Certification. After reading hundreds of case reports, I learned that most analysts are more comfortable with the spoken word, even though written description is basic to our study, teaching, and research. Perhaps this is so because until recently, many institutes have not provided training in clinical writing.
Only through writing can we gain an overview of an analysis and transmit clinical data over time and to distant locations. Only through writing can years of analysis be condensed, integrated, stored, conveyed and, in the case of certification, assessed. But often the clinical descriptions in our case reports and our current literature hide the analyst and the analytic process behind nonspecific treatment summaries, extended samples of the patient's associations with little mention of the analyst's participation, and formulations of the patient's dynamics that omit information gained from the analyst's experience in the process.
Problems often occur in the dynamics of the certification process. Applicants are asked to reveal their most personal work and intimate responses to unknown readers and interviewers. When some interviewers respond with silence, or without providing a context for their questions, this may give rise to strong reactions in the applicant and impede the applicant's presentation. The committee reader or interviewer may feel frustrated because information needed to make an appropriate evaluation is not available. An inadvertent insensitive remark in a letter from the committee or made by an interviewer will not easily fade from an applicant's memory.
I believe in the usefulness of certification for our profession and for the analyst's growth. We learn as we re-examine, re-experience, and find perspective on our work. However, several changes in the analyst's education and in the certification committee's structure and procedure will increase our confidence in the certification process.
First, the committee should be completely open with applicants about what it looks for in case reports and in interviews. The committee could publish a newsletter of its ongoing observations about the presentation of clinical process gained from experience with hundreds of case reports and interviews.
Second, the Association should study methods for clinical writing. The Program Committee should encourage dialogue concerning these methods, and our journals should invite contributions on this issue.
Third, institutes should train candidates in clinical writing throughout their training.
Fourth, the institutes' writing curricula should be evaluated during site visits of the Committee on Institutes.
Fifth, exit interviews of applicants for certification should provide feedback to the Committee on Certification and the Board on Professional Standards.
Sixth, committee members should be selected to ensure that various theoretical viewpoints are represented, and applicants should be examined in the context of their own clinical orientation. Committee members should participate in ongoing study about reading and assessing case material and about the interviewing process.
Seventh, applicants who are distressed by their certification experience should be able to discuss this either with an ombudsperson or with members of a small ongoing committee who attend the certification committee's meetings as observers.
A certification process that encourages openness and relative comfort will also influence how candidly we can present our analytic work in our clinical presentations and in our analytic literature.
Stephen B. Bernstein, M.D., is a training and supervising analyst at the Boston Psychoanalytic Society and Institute, where he chairs the Education Committee. He is a clinical professor of psychiatry at Tufts University School of Medicine and a lecturer in psychiatry at Harvard Medical School.