When this piece appears, I will have chaired five DPE Progression Committee meetings. In nearly all institutes, there is a committee composed of a group of faculty members who follow the development of candidates throughout training and ultimately determine when to recommend graduation. My first meeting as chair of this DPE committee, held in February 2020, was also serendipitously the initial meeting for nearly all the participants, representing 21 APsaA institutes. Many were newly appointed chairs, and others were first-time representatives sent by chairs who were unable to attend. Oblivious to the pandemic that was about to dramatically reshape our lives, we anticipated assembling twice a year. Instead, a core group of 15 to 20 progression chairs has been meeting remotely far more often, providing inter-institute collegial consultation and enrichment.
The Committee's work prioritizes the educational value for candidates of progression work while securing the necessary conditions and resources for doing so. We pursue our original objectives: to share ideas about meeting the many challenges in candidate progression and eventually to develop recommendations for best practices. In addition, the persistence of the pandemic has created greater need for input from colleagues as we must rethink some fundamental aspects of progression work, while maintaining an analytic stance and optimal educational environment. Relationships between members also provide opportunities to consult between meetings and share important documents used to make decisions about candidates' progress (e.g., criteria for advancement and graduation, supervisory report forms, and educational policy statements that appear in candidate manuals).
Committee members have come to appreciate the considerable range and variability of institute settings and cultures in which we work. While most institutes organize the progression committee as part of the education committee, two institutes abolished their progression committees and created other structures to carry out aspects of this work. Some committees convene monthly or bi-monthly to review a small group of candidates each time. Others hold all-day meetings once or twice yearly to review everyone at once. Committee composition ranges from all institute TA/SAs to a cohort of advisors specifically designated to oversee individual candidates.
Most progression chairs encounter persistent difficulty in receiving frank and timely evaluations from supervisors and securing their compliance with the policy of sharing full reports with candidates.
Other differences involve the size of the institutes and degree of integration of the adult psychoanalytic program with other programs, such as training in psychotherapy and child analysis. Small institutes—where there are few active faculty members and classes launch every other, or every third, year—have different needs and concerns than large institutes that contain many faculty members and robust annual classes. In some institutes, changes in APsaA since the sun-setting of the Board on Professional Standards (BOPS) have fueled conflicting perspectives about educational practices. Faculty members with different visions and expectations of their candidates' learning may work at cross-purposes rather than having a healthy dialogue.
Our discussions, nevertheless, underscore much common ground. Foremost is our shared concern about securing useful feedback to ground progression decisions and communicating this feedback transparently to candidates. Most progression chairs encounter persistent difficulty in receiving frank and timely evaluations from supervisors and securing their compliance with the policy of sharing full reports with candidates. Candidates vary greatly in producing effective and timely clinical process reports; this challenge is less pronounced in institutes with a robust clinical writing curriculum. With one exception, all institutes employ competency criteria for evaluating candidates' progress, whether in combination with, or instead of, quantitative immersion criteria. Nearly all institutes employ formal procedures for approving each new case at a specified time in candidacy (whether in the progression committee or a colloquium);
by contrast, in a handful of institutes, candidates can begin new cases at any time, assuming their ongoing clinical work presents no concerns and clinical reports are up to date. Providing feedback to candidates is approached in a variety of ways. In some institutes, written summaries of the committee's deliberations are prepared by progression chairs or co-chairs, or by the candidate's advisor, while in others feedback is conveyed orally by advisors or supervisors who attended the review. In yet others, candidates access supervisory reports online for discussion with their supervisors.
As a platform for the DPE Progression Committee to explore common ground and contrasting approaches, an extended dialogue took place at two of its meetings in 2020 between two Committee members from two New York City training institutes. Justin Richardson (Columbia University Center for Psychoanalytic Training and Research) and I, Arden Rothstein (Psychoanalytic Association of New York (PANY) affiliated with NYU Grossman School of Medicine), discussed the principles and concerns guiding major changes in progression in our institutes. We had both elaborated on this material in publications. Richardson and his colleagues did so in a JAPA paper entitled “Beyond progression: Devising a new training model for candidate assessment, advancement, and advising at Columbia” . I described my institute's process in an International Journal of Psycho-Analysis paper entitled “Fostering the educational value of candidate evaluation” . Remarkably, both groups identified nearly identical problems in their existing progression process but formulated and implemented sharply contrasting changes.
Both found:
A lack of clarity about existing criteria for progression and graduation.
The process by which progression committee members applied criteria could be unfairly subjective.
Feedback to candidates was neither systematic nor routinely candid and educationally optimal.
Supervisors often focused on the patient rather than the candidate's development and failed to convey critical comments forthrightly in writing, although they sometimes did so in progression discussions.
At Columbia, the changes implemented were responsive to negative views from candidates and some faculty members about the way progression was carried out. Candidates experienced progression advisors as double agents, both mentors and evaluators, and did not form the close bonds that were hoped for. Learning in supervision was sometimes compromised by candidates' motivation to meet numerical immersion criteria. Some candidates tried to keep patients in treatment by avoiding sensitive issues or did not openly report aspects of their work to their supervisors. By contrast, at PANY, changes were catalyzed by a new chair's view that existing criteria were vague, internally contradictory, and most importantly, did not promote an educationally valuable analytic perspective; the substance and regularity of supervisory and advisory feedback also needed much improvement.
At Columbia:
Immersion requirements were reduced: The total of 90 months of analysis among three supervised cases, with one lasting at least 36 months, was reduced to 60 months total, with one case at least 18 months. The required frequency of analytic sessions for candidates' supervised analyses and personal analyses changed to 3–5 from 4–5 times a week.
The Progression Committee was eliminated, and advisors were replaced with non-reporting mentors requested by candidates.
Routine Committee discussions of each candidate—considered by many to be insufficiently respectful of adult learners and their privacy—no longer take place.
A committee led by the Chair of Training—comprised of the chairs of Curriculum, Faculty Advancement, Faculty Development, Evaluation and Referral, and Mentor Committees—addresses policy issues formerly handled by the Progression Committee.
To increase communication between candidates and analytic supervisors, supervisory assessment forms were revised; narrative descriptions are now supplemented with ratings on a five-point scale—from exceeds goal to having difficulty—for each of Columbia's specified learning objectives at each level of training. A key criterion for graduation is average ratings from supervisors on achievement of learning objectives delineated for senior candidates.
Candidates receive feedback by reading their supervisors' reports and discussing them in supervision. In addition, all supervisors of each candidate read each other's reports and may choose to discuss them. Training issues are generally handled by candidates' supervisors; in the rare instance when this is not possible, the Training Committee becomes involved.
At PANY:
Quantitative criteria were replaced by two purely qualitative evaluative frameworks intended to promote analytic thinking: (1) psychoanalytic competencies and (2) “phases of analysis,” immersion criteria based on delineation of features of a deepening analytic process. Both were developed by a task force over a two-year period. Removal of quantitative standards discourages “bean counting” and efforts to “keep” a
patient in a treatment that is not deepening analytically over a considerable period of time.
A corresponding supervisory outline was created to prompt supervisors to provide richly informative narrative comments directly addressing these criteria. Rather than assuming there will be a regular unfolding of competencies with level of candidacy, it is believed candidates will demonstrate individual developmental trajectories.
Supervisors are to share their annual supervisory reports in full with candidates for discussion prior to sending them to the progression advisor.
The Progression Committee was preserved with no ambiguity about the progression advisor's role: to receive and integrate all evaluative material, most importantly, supervisory reports, instructors' reports, and candidates' clinical process reports and self-assessments. Supervisors attend annual reviews of senior candidates and one of two yearly reviews of in-class candidates; in direct discussion and with a spirit of generativity, advisors and supervisors identify goals individually tailored to each candidate's current development and consider ways to help that candidate appreciate and meet these goals.
To ensure that feedback following each Progression Committee review is communicated to the candidate advisee, advisors meet with the candidate to address impressions of growing proficiency as well as areas in which further development is expected; when there is disagreement among supervisors, the advisor helps the candidate to understand the reasons for this.
Central to PANY's approach is recognition that evaluating candidates is a complex endeavor. It is essential to be sensitized to and remain aware of the potential shaping influence of countertransferential and other personal reactions from all involved, supervisors and advisors alike. Distortions deriving from such reactions can occur even when evaluative criteria are clearly delineated. The progression committee can serve a critical check and balance function on such reactions.
Many progression chairs participating in the DPE committee were familiar with these issues. When supervisors write reports that feature the patient's, rather than the candidate's, development or do not convey honest impressions of the challenges with which a candidate struggles, this can seriously compromise the progression committee's ability to make optimally informed decisions. The presence of committee members/advisors who do not fulfill their roles in an active, independent manner—for example, those who are less than thorough in reviewing all feedback about a candidate, or inhibited in attempting to understand divergent opinions when they exist, or deferential to idealized supervisors—is another common impediment in the ability of a progression committee to successfully fulfill its role. In such instances, committees may have difficulty functioning as a third that perceives trends in a candidacy that may not be evident to individual advisors or supervisors and minimizes the intrusion of personal reactions to candidates.
When supervisors write reports that feature the patient's, rather than the candidate's, development or do not convey honest impressions of the challenges with which a candidate struggles, this can seriously compromise the progression committee's ability to make optimally informed decisions.
Members of the DPE Progression Committee are invited to consult with the group about recurring issues in candidate progression at their institutes. Such exchanges can catalyze communication outside of our group meetings among individual members. At times especially sensitive, confidential matters can be discussed fruitfully with colleagues outside of the local institute community.
We have considered the following issues:
The conflict some small institutes confront between maintaining clearly stated educational expectations for progression and disrupting small candidate cohorts or negatively impacting applications for training. There are instances, for example, where candidates who, in the absence of doing supervised clinical work, are nevertheless allowed to progress with their classmates. There is ultimately a compromising effect when progression decisions and educational policies are waived in an effort to keep candidates happy. With such occurrences, when there is not synergy between clinical immersion and course participation, the cohort's morale is typically affected. And those candidates who have the illusion they are progressing may become disgruntled when they learn they are far from graduating. We also recognize the importance of admissions committees sensitively considering the feasibility of applicants' capacities to meet educational expectations and clinical immersion over time.
The complexities of temporarily combining small class cohorts when candidates go on leave of absence.
Perspectives on approving new
supervised clinical work in the event a candidate shows signs of serious medical illness.
As all of us struggle to adapt to the extraordinary challenges of the pandemic, the DPE Progression Committee devotes a portion of each meeting to issues specific to this context. The practice of working remotely with ongoing cases, supervision, and personal analyses had already been established by the time of our second (June 2020) meeting. Members shared their institutes' perspectives on candidates beginning new supervised analyses remotely, especially first cases and new personal analyses. Despite APsaA's June 2020 announcement that work done remotely would count toward graduation, several Committee members remarked that beginning candidates, who can be especially anxious, often express their anxiety through questions about what counts. We considered that such manifest candidate concerns represent a view that remote analysis is not real analysis. We wondered: Is this message being subtly conveyed by training and supervising analysts and other educators?
To allow for the complexities of working remotely, institutes that require a specific number of supervised cases to progress to the next year of classes extended the deadline for beginning a first or second case. Some institutes postponed their incoming 2020–21 classes for a year. Most proceeded as usual but with remote classes; many remarked that having a new class was “a bright spot” for faculty last year.
Some institutes found creative, sometimes whimsical ideas for celebrating graduation: sending a bottle of Champagne to each graduate or asking graduates to prepare a personal video.
Throughout, our Committee emphasizes the importance of helping candidates think analytically about the significance to individual patients of working remotely; this involves responding to their questions in terms of their clinical meanings rather than emphasizing administrative policies. Which aspects of psychoanalysis are crucial? It is not the frame per se that makes for an analytic process but rather a psychoanalytic perspective, even though aspects of the frame surely facilitate the development of analytic process.
Justin Richardson and his colleagues at Columbia reported, in a 2020 JAPA article entitled “Emergency remote training in psychoanalysis and psychotherapy: An initial assessment from Columbia,” the results of their survey of candidates' early responses to remote training in questionnaires circulated several months into the pandemic. They found candidates favored remote classes and supervision but strongly preferred in-person personal analyses and clinical work. Several other progression chairs agreed that many candidates continue to appreciate remotely conducted supervision and classes because they afford more accessibility and save commuting time.
Several specific issues will need to be confronted in the aftermath of Covid by all institutes, and perspectives of faculty working in progression will play an important, even decisive, role in charting our way forward:
A handful of candidates have begun cases with patients who, when the pandemic ends, will not be seen in person since they live at great distance from the candidate's office.
Some patients, having experienced the benefits of saving time commuting to the analyst's office, will not wish to return to in-person sessions.
When, how, and on what basis will in-person work resume, and who will make this determination? We can help candidates approach this issue analytically through exploring patients' fantasies about safety. Institute policies should not be announced as rules to be followed with each case; instead, progression committees can help identify what is best, in terms of education, for individual candidates. At the same time, supervisor-candidate pairs can weigh what is best for any candidate-analysand pair.
In conclusion, progression chairs regularly meeting together and sharing creative solutions to commonly experienced issues enhances our journey in psychoanalytic education. We have built a network that provides the benefit of counsel and knowledge of the effective practices of colleagues.
Dr. Arden Rothstein, Training/Supervising Analyst and former Student Progression chair at the Psychoanalytic Association of New York, catalyzed a major revision of candidate evaluation emphasizing its educational value. Her publications focus on psychoanalytic education, learning disabilities, and diverse clinical topics.