Trailblazing Local Option: One Institute's Experience

RT : How does it feel to be at the forefront of change at APsaA, having co-authored the first working localized system for certifying members and appointing TAs at the same time?

JP: I believe the New Center for Psychoanalysis (NCP) has found a way, with the cooperation of the national organization, to move forward without promoting divisiveness at the local institute level. We succeeded in creating an APsaA-approved set of procedures, known as the “Expedited Pathway,” which “localizes” certification and appointment of training and supervising analysts. The kind of change NCP has pioneered—with the approval of the Committee on Institutes (COI)—came about by our institute working to develop a set of procedures that were acceptable to NCP members. Only then did we seek approval from and obtain agreement from our national organization. Ours was a “bottom up” approach.

The Expedited Pathway procedures I'm about to describe provide a working model that can help extricate us from the impasse that's plagued not only the Association and individual members' relation to it, but also, and perhaps more important, the divisions that exist between members of local institutes. This set of procedures does not require local institutes to decide between those who prefer local option—a kind of secessionist impulse—and those who believe there is a role for the national organization in the healthy functioning of local institutes.

RT: When and how did the Expedited Pathway come about?

JP: One result of our 2010 site visit from COI was its recommendation that we affirmatively respond to an impending crisis in our institute. Our TA system was strained by two factors: 1) an aging population of TAs (The average age of our TAs was 73) and 2) a total lack of interest on the part of NCP analysts in pursuing certification from the Association. Otherwise, our institute was doing quite well and, at the time, we had just admitted a first-year class of seven incoming candidates. It was clear that unless we responded through some exceptional mechanism, we would not be able to provide a sufficient pool of training and supervising analysts for our trainees. That was COI's concern, which quickly became ours as well.

NCP's plan was the result of a long and arduous process. At the time, I was co-dean, along with Martha Slagerman, and together we discussed with NCP members our plan to provide an Expedited Pathway in response to the recommendation of the Site Visit Committee. We described this as “expedited” to indicate that NCP would revisit these procedures once our developmental pathway curriculum was fully in place. After receiving faculty endorsement, we appointed an ad hoc committee to draft a plan we hoped would prove acceptable to the Association. Even more important, we wanted to put into place a procedure that might entice those NCP analysts who had not pursued TA status to consider signing up and going through the Expedited Pathway. In 2012, we received the approval from our Education Committee to proceed, pending approval by the Association.

Martha and I began discussions with Betsy Brett and Dan Jacobs, at the time co-chairs of the COI, and proceeded to make minor changes here and there that would help satisfy members of COI and, ultimately, BOPS as well. Again, this was a painstaking process in which more careful language was introduced concerning the ways in which local and national members would be appointed to the examining committee, the conditions under which certification from the Association would be granted and other issues. At a breakfast meeting in January 2012 at the APsaA meeting, NCP and COI reached agreement on the final form for the Expedited Pathway. Later that day, we received approval from the co-chairs of BOPS, at the time Colleen Carney and Lee Ascherman, for our set of procedures. We were then off and running.

RT: How exactly does the Expedited Pathway work?

JP: There are several features of this plan that make it distinctive, and very attractive to our members. First, it shifts the process of evaluation, in its entirety, to our own institute and away from New York. Second, it offers simultaneously, if one is successful in his or her application, TA/SA status and certification from the Association. Certification, when it occurs, is simply ratified at the next meeting of BOPS. In this instance, COI and BOPS agreed to consolidate the procedures for certification from the national organization with application for TA/SA status at the local level.

The procedures (available for anyone to examine) provide for a two-step process, designed to take somewhere between six months and a year to complete. Assuming the applicant meets the necessary immersion criteria for psychoanalysis, he or she appoints a study group. This group consists of three or

four NCP TAs with whom one meets to discuss the ethical, legal and professional expectations of NCP and the Association to serve as a TA/SA. Various issues are expected to be covered that bear heavily on the duties and responsibilities of TA/SAs, including confidentiality, teaching while serving as a training analyst, and conditions when recusal from administrative activities are appropriate. In addition, contemporary and classical journal articles on the supervisory role for TA/SAs are read and discussed. By mutual agreement of the applicant and the committee, the work of the study group is declared complete once these issues have been taken up and sufficiently discussed.

At that point, the applicant appoints two TA members of an Examining Committee, the institute appoints a third member (subject to the applicant's veto), and BOPS appoints the fourth and final member. The Examining Committee meets with the applicant to discuss clinical material, case write-ups, as well as the one particular case the applicant has prepared to present for his or her final exam. All local members of the committee are expected to attend each of these meetings, and the national representative is free to join the group for these discussions, though in practice they have tended to join in only at the tail end of the process. By mutual agreement, the applicant is deemed ready and able to convene a final examination during which the national member must be in attendance. In a three-hour exam, the applicant provides a case presentation on one selected case to demonstrate psychoanalytic competency, as well as an awareness of legal and ethical issues that might have arisen in the case. Each member of the committee has a single vote. The expectation is that consensus will develop through the examining process about whether the applicant should be passed or sent back for further work. No single voting member has veto power over the final decision.

RT: How has this been working thus far?

JP: The procedures have been working remarkably well. On the issues that matter, NCP cannot be more pleased, though we are hoping more eligible members will come forth to take advantage of the opportunity. To date, we have attracted two applicants who have successfully completed the process and have accordingly been certified and appointed as TA/SAs. Several more seem to be in the pipeline. As we had hoped, the decision-making process by which the committee renders its opinion, thus far, has produced a consensus that the applicant had met the requirements being assessed. There have been no split votes. And while the BOPS representatives to each of these committees were, at first, skeptical of the process, they have now endorsed it as adequate for establishing the competency of the applicant. We are very encouraged.

RT: You were recently reassessed by the chairs of COI. How did that go? What was their reaction to how the Expedited Pathway has been operating?

JP: As stipulated in the final agreement, the approval for the Expedited Pathway was contingent on the preparation of a report to the COI in January 2014. Martha and I met with the new co-chairs of COI, Jack Solomon and Ingrid Pisetsky and reported on the implementation of the program and the experiences of those who've completed it. They were both very impressed by the procedures and, in fact, asked if we would be willing to circulate the procedures to other institutes faced with similar problems as our own.

RT: With all this talk about local option, what do you make of the fact that the Expedited Pathway isn't better known? It appears that some institutes are leaning in favor of local option—and here is a BOPS-approved program that's been up and running for two years. What do you make of that?

JP: In the preamble to our procedures, we indicate that we were seeking COI and BOPS approval of this plan for NCP only. We explicitly stated that the procedures were not drafted to be precedent setting and necessarily applicable to other institutes. We thought this explicit statement was needed at the time to reassure both the leadership of COI and BOPS that our interest was simply the survival of NCP and responsive to the specific request of our site visitors.

RT: Granted, the Expedited Pathway was developed by a specific institute facing a particular problem. But from what you are saying, I wonder whether it might be something other institutes might want to consider adopting.

JP: I happen to think this set of procedures, working to the satisfaction of our local institute and to COI, offers a way to preserve the advantage of some national oversight in the function of local institutes while respecting the capacity of local institute members to evaluate the competency of their own members. However, we do not see these procedures as necessarily applicable to each and every institute. Similar kinds of procedures might be adopted, bearing in mind the specific challenges faced by the particular institute and the specific attitudes of the local membership. We tailor-made these procedures to be responsive to our own institute and its membership. Other institutes, I believe, ought to do the same.

RT: Thanks for filling us in on the details. I hope this clarifies the many questions that have arisen around the country at institutes that have become curious about what the Expedited Pathway is and how it works. And congratulations for having crafted such a useful and elegant solution to your institute's problem.