In this column we continue our discussion of a proposal, now called “Institute Autonomy,” that addresses our institutes' longing for local autonomy while preserving options for certification and accreditation for those institutes that want it. It would also preserve APsaA as a membership organization whose scientific meetings and publications would continue, providing the professional home we have all enjoyed. Below you will find responses to a number of questions we have received about this proposal. We have also attempted to distinguish the Institute Autonomy proposal from what many have come to call “Live and Let Live.”
This proposal is not Live and Let Live. It is so revolutionary it has even been deemed too radical by some of the very proponents of Live and Let Live. This proposal endorses the dissolution of the Board on Professional Standards as a regulatory body within APsaA. The externalization of certification has already moved forward in planning. What is now proposed is the externalization of functions of key Board on Professional Standards committees: the Committee on Institutes (COI), the Committee on New Training Facilities (CNTF), and the Committee on Child and Adolescent Analysis (COCAA).
These externalized entities will provide voluntary standards for psychoanalytic education while continuing to provide consultative services as requested to any institute or center, including those that may not adopt their recommended standards. Every institute would decide whether they want to voluntarily adhere to these standards. The Accreditation Council for Psychoanalytic Education Inc. (ACPE, Inc.) would remain the exclusive body that accredits North American institutes. ACPE, Inc. accreditation has always been voluntary for those institutes and centers that wish to have this accreditation.
APsaA would no longer have a role in approving or regulating institutes. Our institutes would then have the same freedom as all other institutes in the U.S. Each institute's relationship with the International Psychoanalytical Association (IPA) would be voluntary and direct, as is the case for all other IPA institutes across the world. Each institute could also seek approval (not accreditation) from the newly externalized bodies previously functioning as COI and COCAA, but only if they wanted to do so. Similarly, with certification externalized, any institute that wanted to promote certification could do so, but no institute would be forced to do so. Any individual who wanted to seek certification could do so whether or not her or his institute encouraged it.
Below you will find responses to common questions about this proposal.
Isn't the Board on Professional Standards just saying if they can't control standards, they will leave?
No. The leaders of the Board on Professional Standards recognize that our many institutes have increasingly differing cultures, circumstances and priorities. To give our institutes the ultimate freedom to choose their way, APsaA must disengage from attempting to enforce uniformity. This is Institute Autonomy.
Why remove the educational body and focus from APsaA? Don't our institutes need a home?
This proposal does not remove a collective home for institutes to discuss educational issues. It removes from that entity a regulatory role. The body that will be the heir to the Board on Professional Standards can remain in APsaA as a creative forum to discuss education, exchanging ideas and solutions to challenges. In this way, APsaA will be like the European Psychoanalytic Federation (EPF) and the Federacion Psicoanalitica de America Latina (FEPAL).
Why not Live and Let Live? Why can't our institutes remain within APsaA with multiple sets of standards using IPA requirements as the minimum floorboard for all institutes?
While at first glance the Live and Let Live proposal seems like the ultimate compromise, it has several serious flaws and unintended consequences. In Live and Let Live, APsaA, through its Board on Professional Standards, maintains its role as the regulator of our institutes, attesting to the IPA that all our member institutes follow IPA expectations, and imposing sanctions on those that do not conform. This perpetuates APsaA's Board on Professional Standards as the regulatory middleman between the IPA and the institutes, diluting direct communication between the institutes and the IPA. Live and Let Live also mandates that all institutes are bound by the rules and regulations of one of the three IPA models. Many of our institutes and members do not have sufficient knowledge of the expectations of these models and may find them no less encumbering or disagreeable than our existing standards. In Live and Let Live the Board on Professional Standards remains the policeman for APsaA institutes, which must adopt a sanctioned model, as a whole, whether or not the model fits their circumstances. Ironically Institute Autonomy provides far more tolerance of institute differences than Live and Let Live, which demands conformity.
Our proposal, Institute Autonomy, would give our institutes full and true choice. Any institute could choose to follow all IPA requirements for one of the three IPA models or they could elect to become a freestanding institute whose educational policies reflect their circumstances and local needs. Their members could remain full participants in APsaA. Live and Let Live perpetuates the Board on Professional Standards' regulatory power and unwieldy task of overseeing their definition of acceptable standards. Lastly, by keeping the educational standard-setting body within the membership organization, the Live and Let Live proposal would maintain an organizational structure contrary to modern best practice. All other modern professional organizations have moved to
Lee I. Ascherman, M.D., is chair of the Board on Professional Standards, and Elizabeth Brett, Ph.D., is secretary.
externalize these functions so that the membership organization is truly a membership organization. By doing so, these modern organizations are also in accord with Department of Education requirements for the separation of standard-setting bodies from membership organizations in orderto ensure their autonomy and protection from undue influence outside the public interest.
By externalizing certification and the functions of the COI and COCAA, aren't you just recreating the Board on Professional Standards outside of APsaA where members will not be able to control it?
No. The credibility to the public of externalized credentialing and accreditation demands autonomy and protection from undue influence by any organization or group. It is standard practice that externalized entities have a board of directors composed of members of the field and the public. Individuals and training programs use what is offered on an entirely voluntary basis. An inherent principle of Institute Autonomy is the voluntary basis of certification and the use of COI/CNTF and COCAA functions, without demands to adhere to suggested standards. This is analogous to ACPE, Inc. accreditation being entirely elective. Each institute would choose what is useful to it. Individuals would also choose whether certification is a credential they sufficiently value to pursue.
Some IPA institutes no longer require four times a week analyses or a training analyst system. The Live and Let Live proposal to use IPA requirements as the floorboard for minimum standards should be sufficient to give those institutes who want greater flexibility regarding educational standards the freedom to do so. Why should our institutes be required to hold to any higher standards?
The IPA expects each of its institutes to select one of three educational models and adhere to it, not mix and match. These models are the Eitingon, French, and Uruguayan. APsaA institutes are presently Eitingon, requiring four times a week analyses and a training analyst system. As long as the IPA requirements serve as the minimum floorboard for APsaA institutes, every APsaA institute would be required to fully adhere to one of the three models. Models that do not require fourtimes a week analyses or a training analyst system have other requirements that may not be appealing but are expected. For example, the French model expects candidates to complete their analyses before matriculating, and a potential candidate does not have a guarantee of acceptance upon completing that analysis. The Uruguayan model has similar requirements.
Institute Autonomy offers institutes real and complete choice without sanctions. Institutes will have the right to decide if they accept and choose to adhere to one of the three IPA models. If the requirements of these models are objectionable or threaten the survival of an institute, that, institute can choose to be freestanding. Their decision need not have any bearing as to whether their members can remain members of APsaA. Every APsaA member could continue to remain an APsaA member because APsaA will be a true membership organization free of enforcing or imposing standards on any institute.
Won't the loss of uniform standards return us to the days of local politics and undue influence related to faculty and career progression?
Moving from a national system to one of greater local autonomy does create risk for a return to undue and unchecked influence on analytic careers based on local politics. It is a cost and risk of relinquishing agreed upon and enforceable standards. However, those institutes using ACPE Inc. accreditation or participating in an elective commitment to other standards may find some opportunities to balance unchecked local influence.
Doesn't APsaA need to define membership by training standards?
Ironically, this question has been voiced most loudly by some who insist that APsaA is and should only be a membership organization. They remind us that institutes are not members although each institute pays a substantial annual fee to APsaA. Any membership organization can set membership criteria however its members choose. Membership does not need to be defined by one training model or its “substantial equivalent.” We already include candidates and psychotherapy associates among our colleagues. Would we now exclude them because of differing backgrounds or because they have not yet graduated? Those who now oppose the dissolution of the Board on Professional Standards and who want to keep regulation within APsaA using the Live and Let Live model may themselves be reluctant to relinquish the belief that one group can determine and enforce standards for all and control these standards.
We all have deep connections to APsaA as a professional home. Why would we support a proposal that diminishes APsaA?
Institute Autonomy will not diminish APsaA. To the contrary, it will allow APsaA to thrive. Freed from the acrimonious infighting over standards that has drained our members' energy and morale for decades, we can return to a focus on the intellectual, professional and educational interests that brought us to the organization. APsaA will then become a true membership organization.
Won't APsaA be diminished in its capacity to advocate and lobby for the profession if the institutes are more independent?
Not at all. As a membership organization APsaA's power to advocate and lobby comes from the vitality of its membership. Freed from our internal acrimony, our membership will grow, our finances will be more secure, and our energies can be directed to the critical policy issues around which we can unite.
We appreciate that the proposal for Institute Autonomy touches deep emotions. It is difficult for many to trust that autonomy will not diminish our professional bonds and friendships or the sense of APsaA as our professional home. Most of us have wanted to believe that, like a good parent, APsaA would take care of us, protect us, and keep us uniform despite our anger and infighting. It is a difficult idea to relinquish. However, growth always occurs when the dissolution of an existing structure catalyzes movement to a new structure and improved adaptation. Increased autonomy of our institutes will not diminish professional bonds and friendships. Nor should it in any way diminish APsaA as our professional home. Freed from acrimony over the enforcement of a particular educational model, it will become a much better home. We are confident that with the autonomy inherent to the Institute Autonomy proposal, our institutes and APsaA can thrive.