Certification, Standards, and Competence

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Posted September 27, 2007

The OpenLine discussion of these issues has taken a refreshing turn, with some new contributors taking us beyond complaints about certification to a broader discussion of psychoanalytic education, assessment of competence, and maturation of training analysts. I have given a lot of thought to these issues and feel that there are no simple answers. My views are as follows:Psychoanalysis needs national standards for its own strength and its credibility to the larger world. Even our largest institutes are subject to wide variations and idiosyncrasies. Given the subjective nature of analysis, a national consensus about the central essence of psychoanalysis and the basics of competence – common denominators regardless of the analyst’s preferred theoretical viewpoint – carries much more weight in validating it as a treatment method.

How to assess competence at all stages of training has to be an ongoing concern, while doing our best with what we have. National certification is a check on local variation, of value to individual analysts as well as the institutes that trained them. While it is one criterion for appointment as training and supervising analyst, I differ with those who assume that is its only function. Analysts in my acquaintance have viewed it like board certification in other fields, as an opportunity to learn and grow and as an independent assessment of their competence.

I don’t think it should be just an assessment of ability to write about cases; the written case reports and oral discussion should be vehicles for communication about how one works with analysands, thinks about them, relates to them emotionally, understands the analytic process in the presented case, and deals with one’s own feeling responses. This kind of communication has after all been the foundation of scientific discourse and rich discovery throughout the history of psychoanalysis. Through the conduct of the certification examination process (including continued examinations if needed) the applicant should be given every opportunity to communicate his or her work. Needless to say, applicants should be well informed in advance about what is expected and how the process works, and it should be blind to the applicant’s institute, professional background, and other possibly prejudicial information.

Much as there have been some well-publicized, highly objectionable incidents, other people seeking certification in recent times have found it to be respectful, collegial, and stimulating. BOPS is making a concerted effort to study and improve certification, and I believe that the dedicated people who are conducting and studying certification deserve our respect and gratitude.

The institutes have a heavy responsibility to assure that candidates personally experience the essence of psychoanalysis, however we define that. In my view that is the sole reason for having additional measures beyond graduation to qualify people as training analysts to analyze them. Certification is one useful step but it does not suffice as due diligence. That is the reason for immersion standards, and it is why institutes take additional steps to review the overall clinical psychoanalytic experience of potential TSAs and then engage them in a lengthy consultation with an analyst who is outside the institute to explore their work in depth. I see this consultation as the core of the process.

There are excellent reasons for requiring candidates to work with a training analyst while they learn to conduct psychoanalysis. However, a very serious clinical and ethical problem emerges when a person becomes a candidate while in analysis with a non-TA (and perhaps as an outgrowth of that analysis.) Forcing someone to change analysts for administrative reasons while in the middle of an analysis sends a powerful negative message about preserving the integrity of a personal analysis. I am among those in BOPS who have pressed for an alternate pathway applicable in individual cases, but a satisfactory solution has not emerged from several serious efforts to address it. We must try again.

In rich discussions on OpenLine people have described or proposed ongoing clinical conferences among faculty in which analysts present cases to the group; those who emerge as demonstrating competence are selected to be TSAs. Such conferences now exist as study groups, which in my experience are safer places to expose one’s clinical work to scrutiny and discussion, because trust develops within the ongoing group and confidentiality is better assured than in a larger conference open to many faculty members. This is helpful as recent graduates evolve towards the experience base needed to be a TSA, but it still is far short of the depth achieved in an ongoing consultation with a colleague from another institute about psychoanalytic work over a period of months.

Experience does count. In Denver I talked with a person who does therapeutic process research using the SWAP card-sorting method. As an incidental finding his group noted that variance among multiple raters of clinical material diminished in a linear relationship to the training and experience of analysts. I thought this was an important observation and urged him to publish it.

In my view, the training and supervising functions could be separated, and the TSA designation should carry no special privileges beyond being eligible to analyze and supervise candidates during their training. All faculty should be free to teach seminars and serve on committees of their institutes and BOPS.

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