Dear colleagues, this is a personal account of my experience going through the process of certification in psychoanalysis. In my view, the debate over certification—what it means “to be or not to be” certified—has missed an essential point about the enormous personal and professional development this process can engender. If you choose to read on and get a glimpse of my viewpoint, I will warn you with a disclaimer. I am a “glass is half full” kind of person. Like many, I had put certification on the back burner. I had pursued my adult and child psychiatry board certifications without ambivalence and while I had theoretically valued certification in psychoanalysis as an important professional goal, I ran up against internal resistance to writing up my analytic cases for certification.
Like many, life demands had fueled my resistance to taking the time to write the summaries. To be sure, many external obligations and obstacles interfered including life threatening events, but still there was resistance because of my own anxiety. Older colleagues from time to time would say, “And when you write your certification summaries…” and I would think, “when I feel I know enough.” Then I went through a series of life events that led me to relocate from New York to Atlanta. At the New York Psychoanalytic Institute where I trained there were many analysts, so the institute wanted but did not need me to push myself to accomplish certification. But at Emory Psychoanalytic Institute, which is much smaller, the director called me one day and said, “Beverly, why don't you get certified.” I said, “OK.” I had some spare time since my new practice was not yet full.
I pulled out my partially written summaries and notes and decided to pursue the double certification in child and adolescent psychoanalysis, and adult psychoanalysis. When I made this decision I had six weeks to meet the deadline; I was determined. As I pushed myself to write, an amazing experience unfolded. I wrote up my cases one by one. Each one I finished helped me to write the next. I made the tricky decision of rewriting a case that had “failed,” many years before, but I realized that now, a more mature analyst, I had greater insight into why the patient had fled treatment. (I also had saved my process notes, which was a big plus.) Being a child analyst, my five cases spanned many stages of development. My youngest patient was four at the start of that analysis and my oldest was fifty. The experience of writing and discussing my cases with colleagues in preparation for the oral examination was profoundly transforming.
Never before had I realized the extent to which I had grown as an analyst and how my insight had deepened with maturity. I almost folded when I realized the summary of an eight-year analysis had been destroyed on a computer disc during my office move. But, fortunately, I discovered I had the initial impression in a paper file as well as the first-year summary and a thank you letter from the patient who wrote me months after termination explaining how analysis had changed her. With those elements I reconstructed the entire analysis from memory, now realizing what was truly important had never been forgotten; I just needed to be motivated to retrieve it. I made it to the UPS store nine minutes before the last express pickup to meet the deadline the following day.
As I told a friend afterward, you will spend a lot of your time questioning whether you are really an analyst, and a good enough analyst. Do not wait to feel you are an analyst in order to launch the process of getting certified. Instead, start writing, and, in the process, you will discover you are an analyst. It will hit you all of a sudden that this process of preparing for certification and going through the examination will consolidate your identity as an analyst.
In the middle of my adult certification interview, I read the process notes from a powerful termination session in which my patient assessed how she had changed in her view of herself. She had “grown up” in her nine-year analysis, which spanned from late adolescence into adulthood, and I had helped her to heal her early trauma. Forgetting I was in the interview for a moment, I said, “This is profound; what we do as analysts is really cool.” Although my interviewers maintained their professional demeanor and poker faces, I could detect a warm gleam of knowing connection in their eyes.
During my child certification interviews, I read the notes of the analysis of a preschool child who was mute. As I read the process notes from one session, I blurted out, “Oh my gosh, that was an intuitive interpretation, I really am an analyst.”
But the new process of certification is different from the process of years ago. I dare say if I had gone through the process years ago when I finished analytic training, I probably would not have such a positive view; the process was not nearly as collegial and user friendly. I joked with Harvey Schwartz, the chair of the Certification Examination Committee, on one occasion, “Your cell phone must be the bat phone to certification (if you remember the old red phone Commissioner Gordon used to summon Batman).” Every time I called, Harvey was available: I called to review cases to clarify that I met the criteria;
Beverly J. Stoute, M.D., practices child, adolescent, and adult psychiatry and psychoanalysis; serves as a supervising analyst, Emory University Psychoanalytic Institute; associate child supervising analyst, New Orleans Birmingham Psychoanalytic Center, and corresponding member, The New York Psychoanalytic Society and Institute.
I called to clarify the details of the procedure; I called to ask for mentors; I called to tell him my mentor had not called me back; I called to say I was nervous and was not sure I would finish the fifth case; I emailed him (by now figuring I had called too much) and said, “I did it.”
When I arrived at the meeting the day of my exam, Harvey met and greeted each of us personally. He asked if we were okay, he asked if we felt understood, he asked if the process was collegial. I thought, how could you not do well. Every interviewer was collegial, respectful, and aware of our normative developmental anxiety and seemed to want to give us the opportunity to show what we knew. The child certification interviewers seemed to love talking about the cases almost as much as I did, and they invited me to discuss, agree, or disagree all in the service of certification or, quite frankly, of learning. It was an amazing and awe inspiring experience. As I left the hotel and jumped in the cab to get to the airport to catch my flight, I felt I had crossed over and become a full-fledged psychoanalyst, and my interviewers had made me feel very much a part of the fold. I received two calls the following day letting me know I had passed each exam. Going through the process of certification reminded me of how amazing it is to be an analyst.
…standards are necessary and certification can and should be a positive developmental experience and achievement.
What happened was something I would never have predicted. In the process of discussing my patients and demonstrating my competency as an analyst, I conveyed what I thought would be impossible to convey: the passion and the magic that I see as an analyst, that in moments we rarely get to share, in that intangible match of an analyst-analysand dyad, we are transformed by a relational and transferential human connection—analyst and analysand alike. We bring insight to our patients as they transform us in our understanding of who they are in their transference, and they remind us of our quintessential humanity. Months later, I was in my office one day, and something happened to me that I used to see in others, my senior teachers whom I always admired and used to think: How did they know that? I began listening in a calmer way. One day I sat listening to a troubled man tell me his life story in a pressured and detailed way over the course of the hour and a half initial consultation session. I put my pen down, cleared my mind and thought to myself, why is he really here? What happened was not planned or rehearsed. I opened my mouth and what came out was a lucid compelling retelling of his life history with a formulation of his conflict and why I felt he had come at this point in his life looking for understanding without which he felt he could not move forward in his personal life or career. When I finished, he replied, “No one has ever told me that or spoken to me like that before; when do we start?”
What I realized upon reflection was I no longer thought about what to say. I trusted that no matter what I did I had become an analyst and my mind would organize the information without effort; I could not help but think like an analyst and be an analyst. There was no anxiety, no pressure, just a calm understanding. All those years that I had delayed the process I did not need more knowledge, I just needed to trust what I already knew and consolidate my understanding and identity as an analyst. I discovered this in the process of certification; it is a process indeed. Writing up all those case summaries, making sense of the years of all those lives in treatment, and confronting myself in my memory as the participant and observer in the consultation room, had helped me understand the analytic process in a deeper way. There is an old adage: What does not kill you makes you stronger.
It was a moving developmental experience that allowed me to see how I had developed into a mature analyst; it gave me the opportunity to discuss my work with colleagues who assessed it and shared it with me as we all were reminded of our passion as analysts. This, I believe, is what the process should be. I was fortunate it became that for me. We need standards in our field. We need to help each other to become analysts, and certified compassionate analysts. The argument over the details of the process and the externalization of the process may continue, but standards are necessary and certification can and should be a positive developmental experience and achievement. To this debate, I offer a simple parallel. When I make a recommendation of analysis to parents, they often ask how are we going to figure out all those appointments and do you have the time in your schedule? My reply is always some variant of the same. If you are willing, and you give 100 percent and I give 100 percent, we will be able to work out the details. There will be times when you will be glad you made this decision, there will be times when you will hate me and hate coming to my office, but if we all survive it together I doubt you will regret it because it will get rid of the conflict that impedes your child's development, and you and he will grow and be forever changed.
For months after my certification exam, I would wake up and remind myself, yes it is real, it was not a dream. I really am a certified child, adolescent and adult psychoanalyst. How fortunate am I? There is nothing that compares to the full realization of an amazing and awe inspiring achievement based on one's own hard work and growth.
Editor's Note: The BOPS chair invited a guest columnist to write for this issue. You may wish to review TAP 48/2, “Pre-Graduation Certification,” page 5, for another view of this topic.