In 1991, APsaA president George Allison and BOPS chair Marvin Margolis appointed the Ad Hoc Joint Committee on External Credentialing. It was given a dual charge:
To oppose efforts by the National Association for the Advancement of Psychoanalysis (NAAP) to win recognition as the official accrediting body for psychoanalysis.
To “study and recommend measures the Association can take to promote psychoanalytic practice through seeking credentialing of our members by outside organizations.”
It was made clear then that pursuit of external credentialing was considered not merely a defense against NAAP efforts but also a desirable goal in itself. During the subsequent eleven years, the Executive Council has repeatedly expressed its wish to explore and pursue the development of an independent external certification agency.
Credentialing is the umbrella term used to encompass both accreditation and certification. Educational bodies are accredited when their training programs meet established standards. Individuals are certified by examination, thereby establishing their expert status in a field. The U.S. Department of Education stipulates that accrediting and certifying agencies must be kept separate; an inherent conflict of interest exists when a single agency is responsible for both. The two are related, however, since certification requires training standards to determine that an applicant is eligible to take a certification exam, by virtue of having completed training at an accredited psychoanalytic training center.
Certification as a warrant of clinical expertise can be valuable, conferring prestige on the practitioner and providing greater assurance of competence to the consumer. However, the procedure must be perceived as reliably testing the clinical expertise that it purports to warrant, and it must also be perceived as awarded by a disinterested third party.
Our current certification procedure fails in both respects. Its validity, reliability, and freedom from bias are suspect, evoking dissension and cynicism rather than respect. Moreover, as an in-house function, it cannot possibly gain the significance to the public that an independent external procedure could. Rarely indeed does a patient know or care whether a psychoanalyst is certified by our procedure.
Last August, the Psychoanalytic Consortium established the new Accreditation Council for Psychoanalytic Education (ACPE), a national accrediting board with its set of core standards of training. These standards provide the necessary criteria to determine eligibility to take a certifying examination — a first step toward establishing another separate and independent agency that would offer certification of individuals in psychoanalysis.
Under the aegis of such an independent agency, examination procedures could be developed, free of ideology or bias, to reliably test an individual's competence in the mastery of core psychoanalytic concepts and clinical procedures. Although examinations in such a complex field as ours must of necessity have a subjective aspect, subjectivity in itself is not fatal to any examination, so long as reliability and validity are established by well-known procedures.
Video simulations of analytic sessions could be stopped at significant times to ask questions: how the applicant integrated the session; what, if any, intervention would be indicated; and the like. Given the current theoretical pluralism of our field, knowledge of the various theoretical positions and resultant clinical approaches could be tested without requiring the applicant to declare adherence to any one. Similar tests have been devised in Continuing Medical Education examinations, where a clinical condition admits of a variety of equally acceptable treatment approaches. More than fifteen years ago, Herbert Schlesinger (with Emily Mumford) demonstrated in NIMH-funded research the reliability of using videotapes of actors trained to simulate patients in assessing clinical skills. Unfortunately, the APsaA administration rejected his proposal to use this work as a basis for developing more reliable certification procedures.
Private conversations with members of two of the Consortium organizations lead me to believe that once the ACPE is fully formed and operational, it will be feasible to begin work on an external certification organization. An umbrella organization could be structured with a uniform examination.
If we are sincere about our declarations of collegiality with all appropriately trained psychoanalysts, regardless of their professional affiliation, it makes little sense to have differing certification procedures and differing certification standards for each discipline. Such a state of affairs ill serves the public as a measure of quality assurance.
With a national certification board, we would have a certification process and designation that is both meaningful to the public interest and prestigious for the individual practitioner.
Allan D. Rosenblatt, M.D., is a training and supervising psychoanalyst at the San Diego Psychoanalytic Institute. He is clinical professor of psychiatry at the University of California at San Diego.