Last December I attended a portion of the Executive Council's meeting devoted to discussing certification. This was after reading a number of e-mails posted to the Open Line e-mail list about certification, our by-laws, and the history of the Association. The debate is rich and interesting and has been continued by delegates to the Affiliate Council in our own e-mail discussion. As voting members of the APsaA, affiliates across the country are deeply concerned about the certification debate.
To certify or not to certify, that is the question. Or is it? Why has certification become such a lightning rod?
As I thought about the number of tests and examinations most of us have had in our careers, I began to wonder what is really concerning us. I had no interest in questioning whether or not I would take national board examinations during my medical training. Without this depth of debate I took my general psychiatry board exam so that I could certify in my specialty. I will have to recertify in my specialty periodically, in order to demonstrate competency. I had to take the special section of the Graduate Record Examination to gain entrance to the next level of training between undergraduate and graduate school.
I do very clearly recall not liking that I had to take these tests. I didn't like having to spend hours preparing, studying, self-testing, all with the possibility that I would do poorly and not get to advance to the next step in my training. I remember getting envelopes with the results and hardly daring to open them because I thought I'd done poorly. At each step I did well enough to move on to the next level in training, but at each step I had to deal with fears before I took the exam, even more fears when the scores came in, and then even more complicated feelings about the results themselves.
With these feelings and fears in mind, I would like to address an obvious point that I haven't seen taken up in the debate thus far. We don't like to prepare for and take difficult examinations. We don't like the possibility of doing poorly or unacceptably, or not moving on to the next level, particularly when the next level is seen by some as more desirable or lucrative. It's threatening to have your work scrutinized, and it's threatening for your peers and colleagues to know if you haven't certified.
“One of the things psychoanalysis has to offer is that within it we can celebrate subjectivity and not feel threatened by it.”
We mobilize arguments the way we mobilize defenses. One of these arguments is that psychoanalysis is too subjective an activity to measure by our current certification procedure. Another is that the certification procedure isn't objective enough. Yet another is that competent graduate analysts are kept from analyzing candidates because they have not been certified (and then gone on to meet the further rigorous requirements that the Board on Professional Standards has established for becoming a training analyst).
I'd like to focus for a bit upon the idea that the analytic process is too subjective to be looked at via the certification procedure. I think we have gotten entangled in an argument about subjectivity as a way of defensively dealing with narcissistic wounds (real and potential) that the certification procedure stirs up.
In analysis, my experience is that two people are doing their best to work together in a way that has both objective and subjective aspects. One person is necessarily conducting the analysis, and therefore is required to rely at times on a more objective stance so that the other person can experience the benefit. During certification, the committee is functioning in a relatively more objective role by carefully examining one person's material and attempting to determine whether or not a subjective psychoanalytic process has been established.
Both analysis and the certification procedure involve subjectivity and objectivity. Somehow we are bothered more by certification's subjectivity. I think this relates to our fears about succeeding and failing, scrutiny, and the presence of levels of training. It's particularly difficult that the level of training one achieves can be determined by a process that has many subjective aspects, so we react defensively about those aspects.
Psychoanalysts need not be troubled that we are engaging in activities with inherently subjective aspects and measuring with techniques that also have many subjective aspects. Of course we are measuring in this way. Measuring competency is necessary. We know that graduating from a local institute does not and cannot guarantee that an analyst has developed clinical competency, any more than graduating from medical school or graduate school guarantees competency. One of the things psychoanalysis has to offer is that within it we can celebrate subjectivity and not feel threatened by it. We have perhaps the only professional arena besides the arts in which this is so highly valued. I want the Committee on Certification to make sure the process is as clear and fair to applicants as possible.
Finally, I want the opportunity to certify. I'd like to be fluent in the clinical application of multiple theoretical perspectives: to think about what a classical analyst might say or do, and what a self psychologist might be thinking, and what an intersubjectivist might be considering. Anticipating the opportunity to certify helps candidates to bear in mind the importance of being able to translate their clinical work between theories. Because of this, candidates will be more likely to learn and use multiple theoretical stances. I don't want to be measured by some rigidly objective set of criteria determined by someone's idea of statistical validity and reliability. I don't believe that's possible or desirable with such highly subjective work. I want to be able to fluidly, fluently communicate what I feel and know. That's why psychoanalysis as a profession and as a personal experience is at once so challenging, attractive, and meaningful.
Sheri A. Hunt, M.D., is a candidate at the Seattle Psychoanalytic Society and Institute in both the adult and child training programs. She is in private practice in Seattle and chairs the Committee on Candidates Organizations, a committee of the Affiliate Council.