Thoughts on Measurement
by Jane Hall
The following essay is based on personal thoughts accrued over 40 years of experience including memories of my candidacy – and although there are those who have different experiences, I hope these ideas can be considered with open minds.
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 is intensive work with patients who suffer from both pre oedipal and oedipal conflicts, object hunger, developmental lags, mood disorders, character problems, inappropriate and overwhelming anxiety; 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 diminishes. 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 using the emotional connection between therapist and patient that resembles and recreates earlier connections, with the aim of reworking them.
Frequency increases as the patient wades in to deeper water.
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 and synthesized 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 after appropriate immersion in the craft must be expected to succeed.
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 so that inevitable blind spots can be recognized.
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.
Surely there are moments or periods of time when most of us 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 or poorly of a presenter based on many unconscious factors.
The same can be said of restaurants, lawyers, dentists, etc. 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 studied the dynamics that seems 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 anxiety can be eased, and a level of comfort necessary to sharing one’s work is usually reached. But all too often, things can go wrong and I will touch on a few.
Competition among the judges who wish to show off is not unusual. Unconscious dynamics are always 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 very few group evaluations that are not injurious on some level. The person being evaluated usually breathes a sigh of relief when interviews are over and even if he/she passes. Failures are rarely constructive and often result in doctoring cases in order to please examiners. Careful attention and screening of a candidate will preclude inappropriate graduations well before the case presentation stage. Matriculation and readiness for control interviews on the institute level can screen out candidates early on in the institute. In larger cities where there are several IPA institutes, evaluators can come from different schools.
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 and would award a certificat to hang on the wall for those who feel they must advertise their skill.
Such an exam can be proctored over several days and I see the ACPE as the logical administrator. Those who wish to take this national exam, administered blindly, will work hard to pass without the fear of personal unfairness and should be able to take the exam more than once.
One more thought: A board of psychoanalysis (ABP) that is being formed will be made up of people in the ApsaA, known for its conservative views. The idea of listing people who pass this test on a web page (for a fee) becomes naturally political and costly. In order to stay on the list there are yearly fees. The idea of profit for evaluators seems anti-analytic in my mind. Such an examination also undermines the education that graduation is required to offer, again for a hefty fee.
Comparing ourselves to dentist, plumbers, and other professionals implies that psychoanalysis is measurable. There has been no scientific evidence to support this idea of certification.
I end this brief essay with the hope and belief that excellence must be an internal expectation nurtured by this profession’s generativity and encouragement. Psychoanalysts are adults who seek others in consultation and who do not need outside stamps of approval. The work we do can be agonizing, difficult, and rewarding, usually after long periods of time. The analytic dyad is a private one and speaking about it never conveys the essence of the work. Actually it can be seen as an invasion of privacy. We promise our patients complete confidientiality. So, if there is ourside measurement it must find ways to assess competence by using concepts and even ‘canned’ cases.
Like good whisky or wine we improve with age. Jurgen Reeder writes intelligently about the psychoanalytic superego and I have been influenced by his scholarly book “Hate and Love in Psychoanalytic Institutions.”
Jane Hall
Janehallpsychotherapy.com