Psychoanalytic Core Competencies

CATEGORY I:  HOW THE ANALYST APPROACHES ANALYTIC WORK

1.  ANALYTIC MIND AND ATTITUDE:  As evidenced in interactions with or reflections on the patient (even if these are not included in what is said to the patient), the analyst demonstrates:

A.     A patient, non-judgmental, and neutral attitude of curiosity and open-mindedness in relation to all material, presented non-verbally and verbally, not presumptuous or imposing the analyst’s own values.
B.     Emotional openness and attunement as shown in an attitude of tolerance, non-defensiveness, and sensitivity to the analyst’s and analysand’s thoughts and feelings. *
C.     Openness to learning from and about the patient, including the impact of trauma, social discriminations, (such as, but not limited to, race, ethnicity, gender, sexuality, religion, class, disability), culture, constraining cultural features, and violence. GSRE* 
D.     Flexibility of thought and a tolerance of uncertainty and ambiguity in ongoing work, avoiding premature or rigid conclusions. *
E.     A willingness to self-observe and self-reflect and consider how the analyst’s own issues, sensitivities, reactions, mistakes, and challenges can impact the work. *   
F.     The capacity to look beyond the verbal and non-verbal manifest material, with attention to what may be unconscious or not consciously available. *
*Although identified here as contributing to the analytic attitude, attention to what is not consciously available, affect, and ethics are expanded more fully in separate competencies.             
*GSRE items reflect integration of diversity items within individual competencies based on research findings. Diverse identity characteristics may include gender and sexual identities, racial, ethnic, cultural, class and religious identities as well as other identity characteristics.

CATEGORY II:  KNOWLEDGE

2.  KNOWLEDGE OF PSYCHOANALYSIS: THEORY AND APPLICATION:  The analyst demonstrates an understanding of:

A.     Psychoanalysis as method of clinical inquiry and treatment.
B.     Knowledge of the following domains as utilized in an analytic process, when applicable: *
        i.      A variety of theoretical schools.
        ii.     Key constructs of psychoanalysis, including but not limited to theories of development, psychopathology, unconscious, non-conscious or
               unformulated states, transference, countertransference, defense, resistance, internal objects, and therapeutic action.
       iii.     Contemporary schools of thought including those related to the external context, to the impact of trauma, to the development of the sense of self,
              and to diverse identity characteristics.  GSRE
      iv.      How experiences of power, privilege, and systemic inequities which may not be readily apparent to the analyst or analysand and can be analytically
               considered within the psychoanalytic relationship. GSRE.
*N.B. Theoretical knowledge can be demonstrated in the clinical work itself and in the narrative about that work without necessarily being specifically formulated. 

CATEGORY III:  ASSESSMENT

3.    DIAGNOSIS, ASSESSMENT AND FORMULATION  

A.     INITIAL DIAGNOSIS AND SUITABILITY:  The analyst demonstrates:  
         i.     The use of an open-ended evaluation to develop a working hypothesis as to the reason(s) analysis is sought that considers the patient’s
                capacities, strengths, vulnerabilities, and ego functions (e.g., reality testing, defenses, impulse control, affect tolerance and modulation, symbolic
                thinking, object constancy, self-cohesion, defenses, and character organization), and is informed by a knowledge of development. This hypothesis
                seeks to identify what is making a patient suffer, an attempt at an initial diagnosis that can be used to reflect on how the analyst can assist the
                patient.
        ii.       An openness to variable presentations related to cultural context and assumptions, biological and environmental strengths and vulnerabilities, as
                well as an understanding of the effects of and interplay among various analytic constructs such as object relations, development, intrapsychic
                conflict, deficit, trauma etc. as determinants of psychic development, psychopathology and character.  GSRE
        iii.      The ability to consider how factors such as the conversion or referral process, prior treatments, health status, trauma history, and use of medication
                might factor into the case.  GSRE
        iv.     The capacity to consider, explore and determine whether the patient may be able to sustain a deepening analytic process as contrasted with more                    structured, supportive, explanatory, or educational interventions, enabling the analyst to recommend analysis or determine when analysis might                     not be the preferred treatment.  This could reflect the capacities of patient or analyst or other variables, for example, financial constraints, conflicts                    related to over-identifications, analyst-analysand “fit,” and safety concerns in high-risk patients,

B.     ONGOING ASSESSMENT & FORMULATION:  The analyst demonstrates the capacity to:   

        i.        Make solid psychodynamic theoretical formulations, distinguishing between evidence and hypotheses, that are consistent with the theoretical
                orientation the analyst is using to conceptualize the case.  
        ii.       Identify and consider alternative theoretical hypotheses or orientations, modifying formulations when hypotheses are not confirmed by the
                process of the analysis.  
       iii.       Use one’s formulations and experience of the clinical situation to make theoretically informed interventions that are consistent with the espoused
                theoretical orientation(s) and to assess their timeliness and impact.  
      iv.        Show awareness of the relevance of the interplay between intrapsychic, contextual, external, and developmental factors, relational patterns, and
                alertness to shifts in this interplay over time, as well as to resistance to those shifts. GSRE
      v.         Assess and attend to progress, determining whether deeper work may be needed or psychoanalysis is no longer deemed helpful or useful to
                the patient, and when possible, to recognize and address impediments to progress. 
     vi.        Assess readiness for termination as detailed in Section 13:  Termination.  

CATEGORY IV:  ELEMENTS OF ANALYTIC TREATMENT - WHAT THE ANALYST DOES

4.  ETHICS:  The analyst demonstrates the capacity to:

A.     Maintain a professional identity that includes an uncompromising commitment to patient responsibility, integrity, and professional ethical standards.   
B.     Self-reflect on the impact of interventions and possible misjudgments.
C.     Recognize the need for and willingness to obtain personal consultation should issues emerge related to possible misjudgments, impairment, boundary violations, treatment impasses, financial misconduct, or other ethical challenges.
D.     Consider and maintain appropriate confidentiality through a rigorous commitment to keeping the patient’s identity, history, and words private, and only sharing with appropriate others the minimum information as is deemed necessary in writing, presentation, publishing, and/or consultation, and other areas where confidentiality issues arise, such as record keeping, insurance billing, etc. 
E.     Maintain the safety protections for confidentiality necessitated by the use of tele-communicative devices for in-office and tele-analytic treatment settings, electronic recordkeeping, and communications.  The analyst should understand and address their responsibility to remain up to date with threats to the privacy of electronic record keeping, communications, and tele-treatment, and their remedies.
F.     Reflect on and address competing ethical principles (such as patient/analyst needs) or subtle aspects of ethical considerations in the inevitable grey areas that arise in the course of analytic work and to refrain from intervening in a way that imposes the analyst’s personal agendas. 
G.    Reflect on the benefits and/or difficulties posed by supervision and/or personal analysis, when relevant.

5.  FRAME:  The analyst demonstrates the ability to: 

A.      Define, understand, establish, and maintain an attitudinal and procedural frame to contain intense work, while considering privacy, reliability, etc.
B.      Understand and engage a range of aspects or alterations of the frame. This would include the analyst’s or patient's absences, variations in frequency, treatment setting, use of the couch, the analyst’s or patient’s illness, fee and payment arrangements, enactments or other treatment factors that may affect the reliability and consistency of the analytic process.
C.     Identify and work analytically with resistances that are inherent in the external analytic frame, for example the resistances that are activated by the stability of the in-office frame or the flexibility of the tele-analytic frame as well as to appreciate the importance of the analyst’s internal frame and the vital role of frequency, consistency, dependability, and belief in the helpfulness of analysis and one’s ability to be of help.
D.     Recognize the impact of confidentiality issues on the frame both in tele-analytic and in-office treatment. 

6.  FOCUS ON UNCONSCIOUS:  The analyst approaches the work with attention to what is not consciously available, recognizing the central importance of the internal worlds of the patient and themselves.   The analyst demonstrates the ability to:

A.      Engage in symbolic thinking and self-reflection, shown by an awareness of and attunement to the influence of unconscious, unformulated or non-conscious factors on their own and the patient’s fantasies, thoughts, feelings and actions, even if these are not necessarily included in what is said to the patient.
B.      Reflect on to the multiple meanings and purposes of affects and attitudes, as seen for example in overdetermination, multiple function, and ambivalence.
C.     Enable the patient to recognize, be curious about, and accept the reality of an unconscious inner life, as reflected in dreams, repressed memories, defenses, fantasy, and associations.
D.     Explore, understand, and work with the ways in which trauma and other external factors may have had an impact on the psychic development, manifestations, and the inner workings of the patient’s mind.  GSRE
E.      Consider the ways in which gender, sexuality, ethnicity, race, culture, have been internalized and have an impact on the workings of the patient’s mind. GSRE

7.  AFFECT TOLERANCE AND MANAGEMENT: The analyst demonstrates the ability to:

A.      Reflect on, tolerate, and contain a wide range of their own and the patient’s powerful feelings (such as uncertainty, anxiety, rage, hate, love, and erotic desire and other, intense, or disturbing affects) and the array of difficult dynamics including idealizations, devaluations, negative or erotic transferences, and projections) as these unfold between patient and analyst during an analysis. 
B.      Sit with and bear witness to painful realities, memories, and subjective experiences that the patient has been able to bring into the analysis, such as might occur with racism, sexism, or trauma, and consider how these may present in the here and now of the analytic relationship. GSRE  
C.     Tolerate and engage with the patient to understand intense or disturbing feelings within the dyad, including, for example, the patient’s unconscious or unformulated wishes, and destructive impulses toward the analytic treatment, while maintaining an affective involvement with the patient that resonates flexibly with what the patient does and does not need from the analyst.
D.     Remain curious and reflective in the face of intense feelings, without diminishing these feelings in either the patient or the analyst by responding in ways that are excessively distant, indifferent, minimizing, rejecting, punitive, or overly reassuring.

 

8.  ATTUNEMENT FACILITATING DEVELOPMENT OF A COMPLEX RELATIONSHIP:  The analyst demonstrates the ability to:

A.     Be attuned to and empathize with the patient’s relevant affective experiences, vulnerabilities, conflicts and difficulties, and the ability to use what they learn from the patient in the service of the treatment.     
B.     Explore all aspects of the patient’s experience including their experience of diverse identity characteristics of both members of the dyad.  GSRE
C.     Use authentic, sensitive, timely, tactful, experience-near interventions as seen in:

a.      The appropriate use of language, words, or silences and to assess and work with their impact.  

b.      A recognition of the protective nature of defenses and patterns that are being challenged.

c.      The judicious use of self-disclosure with intent to facilitate the progress of the analytic work.

D.     Provide a safe environment with affective involvement that is neither too distant nor intrusive, facilitating the development of an intimate and connected relationship, where the analyst demonstrates the ability to move thoughtfully and sensitively through empathic immersion, rupture, repair, and moments of intimacy.
E.     Be aware of the analyst’s own impact on the patient as evidenced by:
               i.      Recognition of shifts in the patient in response to affects, actions, and the person of the analyst.
              ii.     The use of self-reflection and attention to blind spots, where conscious and nonconscious biases could operate, on the parts of both the patient
                     and the analyst.     
              iii.     An understanding and willingness to explore with the patient the inevitable power dynamics inherent in the relationship.

9.  DEEPENING TREATMENT AND THE ANALYTIC PROCESS:  The analyst demonstrates the capacity to facilitate, recognize, understand, and describe the nature of an analytic process where treatment deepens, and to accurately reflect shifts in the patient’s capacities.

A. Impediments to Deepening:  The analyst demonstrates:

     i.          Recognition, understanding, and tolerance of the inevitable ways analysts and analysands can use defenses or other mechanisms to
                interfere with knowing, understanding, and changing.

    ii.          An ability to expand the patient’s conscious awareness of the nuanced, patterned, and complicated workings of defenses
               and resistance, and their role in reflecting core conflicts and the essence of the patient’s difficulties and informing the analytic work.

B.  Deepening:  The analyst:

    i.         Facilitates the deepening of the treatment, as characterized, for example, by a more complex understanding of how the external and
              internal inform and impact one another, by movement in the treatment from the external into the inner world, and by increasingly elaborate
              and complex transferences, (as described in 10.C. Transference). 

    ii.        Demonstrates recognition of improvement in the analysand’s functioning when present such as the development of a self-reflective or
              self-analytic capacity, shifts in interpersonal and intrapsychic relational patterns. changes in the analysand’s way of perceiving and relating
              to self and others, an increasingly enlivened and authentic experience of self and other, and an increasing capacity to use one’s internal
              experiences freely and creatively. 

             iii.      Identifies and reacts appropriately to shifts in the patient’s capacities as seen in the analyst’s ability to work with both progressive and regressive
                       trends.

C.  Articulating the Process:   The analyst conveys:

                        i.          How the story of the patient’s psychic life unfolds, becoming more elaborated and integrated as the analysis progresses.

                        ii.          The actual process of the analysis and how it evolved as a result of the analytic process between the analyst and patient, by describing the patient’s
                                  experiences and expressions, the analyst’s verbal or nonverbal responses to these, and the effects of the analyst’s interventions on the analysand,
                                  the analytic relationship and the analysis.
                       iii.          An understanding of the ways interventions can facilitate or impede deepening. 

10.  TRANSFERENCE:  The analyst demonstrates the ability to: 

A.      Recognize and work with transference and understand its ongoing nature and evolution in impacting and informing the treatment.
B.      Be available for and facilitate the development of manifold transferences, conceptualize their increasing elaboration and complexity, such as through the revival of past conflicts, recovery of repressed memories, reconstruction, and an integration of past and present within the transference and demonstrate how such conceptualizations enhanced the analyst’s understanding of their patient and the patient’s understanding of themselves.
C.     Interpret within the transference using language consistent with the analyst’s theoretical understanding, chosen methods, and goals that is also succinct, not intellectualized, experience near, and understandable to the analysand. (G). 
D.     Persevere, working analytically with intense, erotic, negative, and/or persistent transferences and resistances at a deep level.
E.      Engage the patient to work with the possible ongoing impact of previous or concurrent ancillary treatments, if present, on the multiple possible transferences. 
F.      Understand transference as it relates to identity characteristics of both members of the dyad and how these affect the analytic process GSRE, as seen in:
              i.     The interplay between the analyst and patient’s conscious and unconscious attitudes and biases.
             ii.     The meanings and impacts of the analyst’s and the patient’s identity characteristics as both intra-psychic and social experiences that are created
                    by the dyad within the analytic space.
            iii.     The analyst’s and the patient’s experiences of their bodies, sexes and genders in the analytic space.  

11. COUNTERTRANSFERENCE:  The analyst demonstrates the ability to:

A.    Understand that their reactions to the patient, including their own fantasies, associations, reveries, bodily sensations, and other reactions can be important ongoing sources of information about the patient and the analytic interaction, and/or represent aspects of the analyst’s psyche the analyst needs to explore.  The analyst shows the capacity to use this information effectively either internally or to inform their work with the patient.  

B.    Manage countertransference(s) without prioritizing the analyst’s own needs, for example, managing sadomasochistic or hostile reactions without projecting/blaming, and wishes for approval without soliciting affirming responses.  

C.     Understand countertransference experiences as they relate to identity characteristics of both members of the dyad and how these affect the analytic process.  GSRE

12. ENACTMENTS:  The analyst demonstrates the ability to: 

A.     Identify the inevitable enactments in an analysis non-defensively and understand their meaning, joint creation, function, manifestation in the analysis, and the ways they may serve to advance the work. 
B.     Recognize and address an enactment through self-reflection which enables the analyst to step out of the experience to work through salient issues, particularly those with destructive elements, while tolerating turbulence and avoiding excessive prolongation of the enactment, or other disruptions to the frame, such as stalemate, narcissistic mortification, perpetuation of further enactments, etc., to safeguard the analytic process. 
C.     Expand the patient’s conscious awareness of the nuance and complicated workings of enactments, including its benefit as a resource for understanding for both the analyst and analysand. 
D.     Reflect and consider how enactments may provide deeper information about unconscious processes related to issues of identity characteristics. GSRE.

13.  TERMINATION:   The analyst demonstrates the ability to:

A.     Assess readiness for termination or whether termination is being considered defensively to avoid facing conflicts over dependency and needfulness or other areas that are relatively hidden based on discomfort, fear, or shame.
B.     Reflect on the nature, distinct components, dynamics, and impact of any termination process, whether a planned termination or a premature termination, including transference, countertransference and reworking inherent in the process.
C.     Reflect on and discuss how a planned termination was jointly determined and/or the meaning and determinants of an interrupted analysis.
D.     Understand the rationale and dynamics of any post-analytic contact if present.

Category V:  Overall Consistency and Coherence

14.  COHERENCE AND CONSISTENCY: The analyst:

A.    Is relatively consistent in demonstrating the competencies across the discussion of multiple cases.

B.    Shows relative coherence in the application of theoretical knowledge and interventions within individual cases, even if thinking flexibly and changing approaches when the situation warrants.

Category VI:  Competencies Specific to Child & Adolescent Analysis

In addition to the competencies described in Categories I-V, in work with children and adolescents, applicants will need to demonstrate these additional aspects of competency. 

A.     Knowledge:  The analyst demonstrates and applies an advanced knowledge of child development and psychoanalysis, including: 
         i.          Common developmental pathways and an understanding of issues seen in working with the child or adolescent patient. 
         ii.          Variations in development, such as neurodevelopmental challenges, autism spectrum, attentional, mood, and learning disorders, and how these
                    may impact technique.                                  
        iii.          The psychopathologies of childhood, adolescence, and emerging adulthood.
        iv.          The evolution of gender/sexual Identity. GSRE
         v.          The impact of race, ethnicity, and cultural experience on evolving personality development and their influences on family dynamics, and
                    parenting styles. GSRE
        vi.          An ability to formulate a dynamic/developmental understanding of the child's inner world and how it contributes to the presenting problems.
       vii.          The capacity to formulate changes in technique based on the developmental level of the child.
      viii.          An understanding that therapeutic interventions in analysis have the additional goal of promoting development.

B.     Ethical issues specific to child work:  The analyst demonstrates an ability to:
         i.          Maintain appropriate boundaries with the child and with the parents.
        ii.          Manage the frame and age-appropriate boundaries regarding confidentiality and communications both with the parents and with the child,
                   respecting the privacy of the material from the child, and the clarifying the parameters of this with both the parent and the child.   
        iii.         Understand ethical and legal obligations to communicate outside the usual analytic boundaries when applicable e.g., mandatory reporting. 

C.     Work with Parents (and others):  The analyst demonstrates a nuanced capacity to work with parents and other entities in the child/adolescent’s life, as demonstrated by the ability to: 
         i.          Conceptualize the nature and foci of the parent work and its trajectory.
        ii.          Help the parents understand the reason for the analysis of their child and to work empathically with the inevitable anxieties and resistances
                   that will ensue. 
       iii.          Develop and maintain a therapeutic alliance with the parents to assist them with their parenting efforts, their understanding of their child, their
                   child’s analytic work, and the protection of the child’s analysis.
       iv.          Manage countertransference to the parents, while continuing to focus on the child.
        v.          Consider the impact of parent work on maintenance of the analytic frame and the effect of the frame on the parent work.
       vi.          Interact with schools and other entities in the child’s life, when necessary, sensitive to privacy and confidentiality, always being mindful of the
                   analytic frame.

D.    Affect and Action:  The analyst demonstrates the ability to:

         i.          Recognize, tolerate, contain, reflect on, and manage a wide range of affects and actions in action-prone child and adolescent patients.
                   These may include powerful feelings, such as uncertainty, anxiety, rage, hate, love and erotic desire and other, intense or disturbing affects.                               Actions may include dependent, passive, idealizing, sexualized, aggressive and risky behaviors. 
        ii.          Explore and understand action and behaviors as expressions of meaningful mental activity such as defenses against underlying affects or                          phase specific developmental strivings.
        iii.        Recognize, tolerate, and manage the analyst’s own reactions and countertransference to these affects and actions in the child, including as they                      relate to identity characteristics of both members of the dyad.

E.     Play in the Psychoanalytic Setting: The analyst engages in therapeutic play as seen by the ability to:  

                 i.          Recognize and facilitate play at different developmental levels, considering the impact of developmental deficits/delays.
                 ii.          Create a developmentally appropriate play environment, that includes toys, art supplies, and furniture, which facilitates play.
                iii.          Understand the meaning of the communication provided through play to deepen analytic understanding.
                iv.          Use the medium of play for intervention, including labeling affects, elaborating inner conflicts and fantasies, and working with defenses and                   
                           transference material.
                v.          Consider whether to offer interpretation (or not) based on the understanding of the child’s process, their need to remain in the play without interruption,
                          or their readiness to understand within but not outside of play.

F.  Transference:  The analyst working with child and adolescent patients demonstrates:

                i.          Awareness that children’s transference feelings towards the analyst can stir loyalty conflicts in the child and may feel threatening to the parents.
               ii.          The capacity to identify, understand and interpret the transference, while also recognizing the analyst's multiple roles as a new, real, or developmental
                          object, as well as a transference object; and to use this understanding to facilitate the therapeutic action.

G.  Countertransference: The analyst working with child and adolescent patients demonstrates an ability to:

                 i.          Recognize and reflect on the often-intense countertransference reactions that children can stimulate, including, for example, the commonplace feeling of                            seeing oneself as a better parental object than the actual parents or being caught up in a comparison of the child patient with one’s own children.                            ii.          Tolerate and manage the analyst’s reactions and countertransferences to people and situations in the child’s life, parental relationships, and intense                                    affects and actions in the child.
               iii.          Recognize that enactments between the analyst and child and/or the analyst and parents/significant others in the child’s life may reflect intense                                          countertransferences.

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