by Jane S. Hall
Measuring each other is, more often than not, a fruitless exercise and breeds strife where there should be encouragement, ill will where there should be generativity, falsification of material due to perceived requirements, and mistrust where there should be trust.
If we can agree that the practice of psychoanalysis includes intensive work with patients who suffer from both pre oedipal and oedipal conflicts, object hunger, developmental lags, mood disorders, character problems, anxiety inappropriate to the occasion, using the psychoanalytic techniques that include recognizing and using transference, counter transference, and projective identification to inform; action and enactment to explain; awareness and modification of resistance to proceed; and listening for fantasy that clouds wished for functioning; in a safe and consistent atmosphere, we should be able to know and explain just exactly what psychoanalytic work is. Whether this work takes place in person, over the phone, x times of week, using a chair or couch, and whatever theoretical backgrounds the analyst uses to think and to formulate, the difference between psychoanalysis and psychoanalytic psychotherapy is really nullified. (I differentiate psychodynamic psychotherapy which does not necessarily use psychoanalytic technique and instead, in my mind, is based on an intellectual understanding. Psychoanalytic work on the other hand, involves an emotional connection that resembles and recreates earlier connections, with the aim of reworking them.)
Shocking as this may seem to those entrenched in titles and labels, I believe that once we can reach agreement on what the psychoanalyst does, the extraneous issues will lose importance. Anyone who is ethically sound, and who has mastered the techniques and the theories that underlie them, should be greeted by her/his community of peers and the general population as a psychoanalyst. Every graduate of a credible analytic institute must be expected to succeed after appropriate immersion in the craft. Not every analyst will work well with every analysand due to the mix or match, however, every analyst should have the integrity to recognize his/her abilities and inabilities. And each analyst must greet the opportunity to consult with peers periodically.
Time and again I have listened to the ‘buts’ of this thinking – and I have never heard a cogent one: “I welcome being examined, it means my work is acceptable to a higher authority” is a quest for outside validation when it is the inner conviction in one’s work that is necessary. If we are honest, this conviction comes and goes over a lifetime of work and it can only be the work in the dyad that fosters it. There are moments or periods of time when we all wonder what we are doing or if we are doing it well. Without these moments of doubt and self correction we would not stay in shape. “I would never refer anyone to him/her” is a judgment usually based on a one-time impression, personal dislike, or transference gossip across couches. In either case, the analyst’s reputation will suffer at times. Conversely, high praise has its transference implications as well. An evaluator may think highly of a presenter based on many unconscious factors. The same can be said of restaurants, lawyers, and dentists. Reputations are self made. Each analyst has her/his referral sources based on good work and that in itself is measurement. A good practice is the measure of a good analyst. Boundary violations occur all too frequently with training analysts who have been corrupted by power. No test seems to predict unethical behavior.
Having been in the evaluative position frequently over the years I watched closely the dynamics that seem operative in such groups, for graduation and later for training analyst positions. The tension experienced by the presenter is usually palpable. With good chairs, this can be eased, and a level of comfort necessary to sharing one’s work is usually reached. Things can go wrong however, and I will touch on a few. Competition among the judges who wish to show off is not unusual. Unconscious dynamics are often at play and include ganging up, sadistic questioning, sarcasm, rigid or frozen listening, and even rudeness. It is not easy to turn down a well known contributor to the field. Chairs have been known to forget manners in the name of neutrality. And the subjectivity that goes into assessment is never measurable.
I have experienced few group evaluations that are not injurious on some level. The person being evaluated usually breathes a sigh of relief when interviews are over, even if he/she passes. Failures are rarely constructive. Careful attention and screening of a candidate will preclude inappropriate graduations well before the case presentation stage. Matriculation and readiness for control interviews can screen out candidates early on in the institute.
A national exam for competence after graduation could be constructed and taken when the graduate accrues the necessary hours of doing treatment and other immersion criteria. This credential would satisfy those who insist on an outside seal of approval and should serve as a uniform standard for all engaged in psychoanalytic work. Passing such an exam would give the analyst the right to analyze anyone he/she chooses.
Such an exam can be proctored over several days and I see the ACPE as the logical administer. Those who wish to take this national exam will work hard to pass without the fear of personal unfairness and should be able to take the exam more than once.
When excellence is expected it will rule the day.