“Can we survive?” is the blunt question asked by many of our institutes and members. There are many survivals in question—the survival of psychoanalysis as a profession, the survival of the Board on Professional Standards, and the survival of the American Psychoanalytic Association as we know it. We also must contend with the definition of survival. When does survival entail adaptation for preservation, and when does survival entail adaptation or evolution of an entity barely recognizable from its original meaning. These are tough questions that reflect our tough times. Our debates would be purely academic if the challenges we face were not about survival.
The International Psychoanalytical Association (IPA) has for many years recognized the problem of “graying” throughout their constituent components. Recent data suggest that in almost every IPA society there is an unmistakable shift in the average age of members and the average age of candidates from younger to older. Rare exceptions to this trend include groups from Central and Eastern Europe who experienced a resurgence of interest in psychoanalysis after the fall of the Iron Curtain. While we must still take seriously our internal debate about educational standards, the data suggest there is something more afoot contributing to the challenges our profession is facing. While some have alleged that it is our standards, the certification system, or the training analyst system that has placed a stranglehold on our survival, these cannot explain the international downturn in efforts to promote psychoanalysis.
What do the IPA components share that might explain the worldwide crisis regarding survival of psychoanalysis? We identify a number of cultural forces in the Western world that may contribute to the crisis. These include major economic and health care funding changes and vast cultural shifts emphasizing quick interventions and evidenced-based credibility; evidence that is difficult for analysts to produce easily given our emphasis on privacy and a treatment that does not conform well to standardized protocols. Our presence in professional mental health training programs has diminished, with some notable exceptions that have proven successful.
Analytic career patterns have also changed. Many contemporary analysts have multiple professional identities and commitments, affecting their level of involvement in psychoanalysis. Other cultural and generational shifts contribute to expectations of more contained work commitments balanced with time for family and avocations and less emphasis on longitudinal commitments of depth to those we treat. Significant student debt reflecting the exponential rise in tuition from earlier education dissuades some intimidated by the cost of training and insecurity about future earnings. Despite these obstacles, some younger professionals looking for depth and longitudinal experiences with those we care for find a career in psychoanalysis an attractive alternative.
The Board on Professional Standards has established the following initiatives to respond to the acute challenges faced by some of our institutes.
The immersion requirements for training analyst appointment have been adapted to include a reduction of postgraduate hours to 3000 from 3600. These hours can now include control cases' hours that continue past graduation. These adaptations continue to honor our obligations to IPA requirements.
Enabling consultation from the Committee on New Training Facilities (CNTF) to provide longitudinal, individualized guidance to institutes seeking assistance in securing their futures by reinvigorating practice environments and candidate recruitment
Establishment of the Committee on Outreach, Growth and Development as an alternative portal for consultation on reinvigorating practice environments and candidate recruitment.
Financial consultation
Leadership consultation for directors of institutes and centers
Collaboration with the Society Presidents Meeting
Consultation on practice development
Website and social meeting consultation
Regional training/long distance learning consultation modeled on successful regional child analytic programs
Initiatives to develop scholarship opportunities for candidates
Continued collaboration with ACPE, Inc. efforts to gain Department of Education recognition of analytic training programs
While all of our institutes and members face the challenges we have highlighted, at present we are not all on the same trajectory. About one-third of our institutes are reliably maintaining classes of respectable size and do not experience the acute gap in certified members and training analysts. About one-third of our institutes have mobilized with or without consultation to turn their fortunes around.
Lee I. Ascherman, M.D., is chair of the Board on Professional Standards and Elizabeth Brett, Ph.D., is secretary.
They have gone from grave states to renewed enthusiasm reflected in sizable new classes after years of drought. But of concern, about one-third of our institutes are vulnerable to very uncertain futures. Many of these have a “lost generation” of members who have not pursued certification or training analyst careers.
We have also noticed important trends. Our youngest institutes often are our smallest and tend to be among the most vulnerable. Institutes more substantially integrated into university and medical centers tend to be in the healthiest category. Institutes with internal acrimony or which have faced trauma tend to struggle, especially without assistance. Importantly, despite the challenges we are facing, the national numbers of matriculating candidates are and have been stable during the last 10 years.
In the face of threat groups tend to battle, either against the external threat or among each other. It is not coincidence that our conflicts over standards crescendo as our external threats mount. There is always a fantasy in groups that if Jonah can be found and thrown overboard, the seas will calm. In the context of clamor by some that certification, the training analyst system, and our standards are to blame and against the backdrop of serious questions about the place of educational functions in our organization, the Board on Professional Standards invited an expert on professional organization structures, Dr. Ulric Chung, to inform us on these matters. Chung is not a clinician or attorney but is nationally recognized for his knowledge of professional organizational structures. His goal was to impart information relevant to the serious questions we face and not to sway us one way or the other. He was aware that a primary objective of APsaA's Strategic Plan is to “move to a governance structure, operations, and policy and procedures consistent with model professional association best practices.” While his presentation and the discussion that followed are too lengthy to include in its entirety, we have highlighted below key points he made relevant to our professional and organizational crisis:
A certificate of graduation is not certification, and would carry no external credibility as such.
Certification is a credential that should be promoted in our representation of ourselves to the public and other professions, and we have undercut ourselves as a profession by not doing so. He knows of no profession that does not have certification.
Although accrediting agencies and credentialing bodies should have procedures for taking and considering input from practitioners and the public, federal rules and non-governmental best practices include firewalls to prevent the governing boards of professional/trade associations from having undue influence that might jeopardize the independence of accrediting agencies and credentialing bodies in making decisions in the public interest.
Modern professional organization structures demand that credentialing and accrediting bodies be firewalled for autonomy if they remain a part of the membership organization or are fully externalized into three organizations: credentialing, accrediting and membership. The latter model has been the expectation of the Department of Education since October 1991.
Multiple standards and levels of credentialing and accreditation detract from any profession's ability to credibly and effectively advocate for that profession to the public, government, licensing boards, insurance industry, and modern health care table. In a later discussion, Chung stated, “You have to know who you are to represent yourself or advocate…if you are everyone you are no one.”
After an inquiry from one of our members as to why we are bothering with these issues when our profession is in such crisis, the question was reframed to Chung as “What would happen to us if we ‘took our hands off the wheel’ and relinquished credible credentialing and accreditation functions?” His response was “You will die as a profession.” He elaborated that successful professions include a rigorous, standardized education system and a credentialing process to give a final stamp of approval on the graduate. The dilution of credentialing and accrediting becomes part of a larger process eroding the general significance of evaluation and standards of competence. The difficult work of articulating, assessing and ensuring levels of competence gives way to increasingly diffuse, unformulated and unexamined goals for professional skills, conduct and identity. Chung pointed out that while every professional group believes that it is an exception, that it does not need to demonstrate that it has high standards, when that task is ignored, the group begins to operate at lower and lower levels of functioning, and ultimately fails to distinguish itself from other treatments and professions.
Chung's words are sobering. We can destroy the messenger or listen and think carefully. If we continue to fight each other within our organization any victory will be pyrrhic. Alternatively we can work together to thoughtfully consider how in these perilous times we can adapt while still preserving the knowledge and skills that define our profession and by doing so, survive as a credible profession in the modern era.
Every group believes they are different enough for these modern expectations to not apply to them.
The reason for separating education and membership functions is for the very circumstances we find ourselves in. The pressure to lower standards in order to recruit more student and graduate members leads to a slow erosion of quality. This erosion is increasingly visible to outsiders. The profession becomes less rigorous and less credible to others.