At the June 2014 meeting of APsaA two historic joint sessions of the Board on Professional Standards and the Executive Council were held. Credit for this gathering is fully due to Jan Van Schaik who proposed such a meeting during the meeting of the Board on Professional Standards in January 2012. His motion was passed unanimously and, on the following day, was passed by the Executive Council. The planning for these meetings was later delegated to APsaA Executive Director Dean Stein, Treasurer William Myerson, later assisted by President-Elect Harriet Wolfe. The Board on Professional Standards and the Executive Council agreed that in the June 2014 meeting they would conduct their business on the morning of their usual full-day meeting so their afternoon meeting times could be devoted to these joint sessions. A facilitator, Jeffrey Kerr, was selected in advance to help these discussions move forward.
Importantly, our advance agreement was that no action item was to be produced by these joint sessions. While this agreement reinforced for some a cynicism that nothing could come of these meetings, it also protected the joint sessions from being distorted into political jockeying for an end purpose. Rather, a space was created for the councilors of the Executive Council and the fellows of the Board on Professional Standards to sit together and discuss our history and the challenges we face. Each group's usual U-shaped seating arrangement was replaced by tables of 10 that allowed for the mixing of groups and much more intimate discussions. Seats were not assigned and participants were encouraged to not fall back to their usual clusters of like-minded colleagues that reinforced “preaching to the choir.” Rather, participants were encouraged to sit with colleagues with whom they do not usually sit and to relocate for appropriate segments of the discussions, creating a constructive fluidity to the seating arrangements. Despite no shortage of jokes about the wedding arrangements, this format seemed to work in the interest of the purpose of these meetings: communication. These small group discussions were intermittently punctuated by large group discussions. These large group discussions were often structured around summaries of discussions by spokespersons from each table, but there were additional large group discussions facilitated by Kerr.
While important aspects of our difficult history were reviewed, most discussions focused on our difficult present and the challenges in our future. Despite the political divisions among the participants, common interests were identified and common emotions were experienced. Everyone who spoke shared a deep concern for the future of psychoanalysis based on an appreciation of the unique treatment psychoanalysts provide in a world increasingly dominated by a premium on speed, intrusions on privacy, and, what seem to many, more superficial treatments that are less respectful of the deeply personal world of the individual. Almost all voiced the shared wish that psychoanalysis and psychoanalytically informed treatments of quality remain available and accessible to future generations.
Our differences became more evident when discussions moved to understanding how we got to our present situation and how we need to respond to the challenges we face. There is no shortage of blame for our woes, with the most common object of blame being each other. Stereotypes of the past were heard, and those dated in time were often corrected. Relaxing educational standards, raising educational standards, redefining psychoanalysis, and preserving our definitions of psychoanalysis were all solutions passionately offered as actions critical to our survival. There was recognition of dramatic changes in our external world and how this might impact on practice, recruitment of candidates, and esteem. Questions about what might explain differences among practices and institute health were also raised, but not clearly answered.
Certain themes emerged from discussions that highlighted common emotions identified by participants. Distrust based on past grievances and competing histories was readily identifiable. Fear for what will be faced in the future was also identified as a palpable force influencing discussions. This included fear based on distrust, with expectations that the discussions would lead to future betrayal, and fear that outcomes would arise that participants would find difficult to accept. There was also a tremendous undercurrent of loss, with increasing recognition that our organization had already changed significantly, and that future changes would threaten further loss. The greatest sense of threat seemed to be that the shared sense of cohesion among colleagues and sense of “family” among colleagues could be lost in any reorganization of the Association as we have known it. And with this, there was recognition of an already emerging grief for a past, perhaps idealized, that was more calm, cohesive, coherent, comforting, and secure.
This past January, a plan was presented to the Board on Professional Standards that seems to address our institutes' longing for local autonomy while preserving options for certification and accreditation for those who want it. Most importantly, this plan would preserve APsaA as a membership organization composed of colleagues with the shared professional identities that have made APsaA a home and have provided a sense of intellectual stimulation and family to its members.
Lee I. Ascherman, M.D., is chair of the Board on Professional Standards and Elizabeth Brett, Ph.D., is secretary.
We have already begun externalizing certification and propose externalizing the functions of key committees of the Board on Professional Standards (Committee on Institutes, Committee on New Training Facilities, Committee on Child and Adolescent Analysis) which will propose standards for psychoanalytic education and provide the consultative services that many have asked continue in our new structure. Institutes can decide whether or not to subscribe to the standards this new entity establishes and affiliate with it or not. The Accreditation Council for Psychoanalytic Education (ACPE, Inc.) will remain the body that accredits North American institutes. ACPE, Inc. accredits on the basis of its own core requirements and additional educational standards each institute states they follow. Hence, ACPE, Inc. maintains basic expectations but does not accredit by a single set of educational standards.
What is being proposed is true institute choice. There would no longer be an institute approving relationship between institutes and APsaA, nor would APsaA continue to be the representative of the IPA, guaranteeing that institutes meet IPA standards. Institutes would be in the same position as all other institutes in the U.S. Each institute's relationship with the IPA would be direct, which is how all other IPA institutes across the world function. Each institute could also seek approval from the newly externalized body, but only if it wanted it. Similarly, APsaA is presently undergoing externalization of certification. In the new proposed arrangement, any institute that wants to promote certification can, but no institute will be forced to. Any individual who would want to pursue certification could also do so, whether or not his or her institute promoted it.
Each of our institutes will therefore decide among a finite number of choices what it will be. Each will determine if it wants to remain an IPA institute, and if so, which model: Eitingon (the present model for APsaA institutes), French, or Uruguayan. Or, if all of these models appear too encumbering or regimenting, or for any other reason are unappealing, any institute can choose to be freestanding and not be affiliated with the IPA. This proposal is entirely consistent with other proposals that state IPA requirements will be the floor-board for required expectations, but offers even greater freedom. Institutes can choose whether the IPA requirements are also too encumbering and if so, those institutes can become freestanding if they wish to be.
With any freedom comes loss. What is being proposed is that APsaA get out of the business of certifying and approving institutes. APsaA will be a membership organization, as it is now, but without the role of certifying or approving institutes, roles that have been at the source of so much of our corrosive acrimony. No matter what any given institute chooses for its future, any present APsaA member should be able to remain an APsaA member Future criteria for APsaA membership will remain the domain of the Executive Council. Free of such regulatory responsibilities, APsaA can thrive. Its role providing excellent scientific meetings and publications and advocacy for the profession will continue, and will likely be strengthened. Membership losses in response to disgust with the politics of acrimony will stop. No longer will there be a bicameral organization that so many cite as the source of our woes.
Very real and potentially powerful loss and grief will be experienced as APsaA no longer remains what most of us have known it to be. The Board on Professional Standards as we know it will no longer exist. It can continue as an important forum for discussion of educational issues, but not for regulation. Like with the European Psychoanalytic Federation (EPF) and that of Latin America, Federacion Psicoanalitica de America Latina (FEPAL), no institute would be in a position to impose in any way on any other institute. Each institute will be faced with the challenge of determining what it is. This is a difficult maturational step for any organization, relinquishing the idea that a “parent” organization will tell it what to be, whether it agrees or not with that parent organization.
It is our belief that this difficult step will be healthy for our institutes, and healthy for APsaA. APsaA will be free of the acrimony over education and standards that has nearly consumed it. It will also be free to grow and thrive as a membership organization devoted to the promotion of psychoanalysis through stimulating scientific meetings and publications, and advocacy. Our institutes will gain the freedom to define themselves, and to see what works and what does not work for them. Perhaps as we metabolize these changes, we can also rediscover what we thought we had lost, a psychoanalytic home with a community of colleagues who feel like family, free of the rancor that has divided us.