Kavanaugh - Codes of Silence and Whispers of Discontent A Perspective on Mandatory Continuing Education (MCE)

Codes of Silence and Whispers of Discontent
A Perspective on Mandatory Continuing Education (MCE) 

by Patrick B. Kavanaugh, Ph.D.


(Codes of Silence ....(Part II) was written for the January 2002 publication of the MSPP News. It was written as a response to information published in the Michigan Psychologist, the newsletter of the Michigan Psychological Association (MPA), which asserted that legislation mandating continuing education (MCE) for all psychologists in Michigan had passed into law.  Codes of Silence ...(Part II) expresses Whispers of Discontent with the codes of silence surrounding the introduction and passage of this legislation. Since the announcement of MCE for Michigan psychologists, it was subsequently learned from a spokesperson from the Department of Consumer and Industry Services (CIS) that they have no intention of implementing CME at this time. This essay attempts to raises questions about mandatory continuing education as one of the more significant trends in the psychological community.)  

In the winter of 1923-24, the training committee of the Berlin Society  imposed  standards and regulations on the learning activities and experiences of the candidates (Safouan, 2000).  In so doing, psychoanalysis became institutionalized.  And psychoanalytic education became subject to a technocratic rationality in which the institutional wisdom, oversight and discourse replaced everything in the realm of the candidate's individual and personal choice.  A supposedly uniform and objective method of assessing, evaluating and making decisions was applied to each phase of the candidate's education.  Regulations and standards now applied to the selection of candidates; the requirement of a personal analysis of 6 months duration; the designation of training analysts;  in collaboration with the training analyst, deciding when the candidate was ready to participate in further stages of training; and, deciding when the candidate's personal analysis was completed.  A triumph of triangulation prevailed between analyst, institute, and analysand; other-as-third became an integral aspect of institutional(ized) training.

In the summer of 2001, the consortium, a coalition representing the pedagogical and political interests of arguably the four major psychoanalytic associations in this country, adopted national  healthcare standards and regulations for psychoanalytic education and training.  In so doing, psychoanalysis became institutionalized even further.  And psychoanalytic education became even more entrenched in a technocratic rationality that further elaborates the standards and regulations that apply to the selection and elgibility of candidates (mental health professionals); the extensive didactic course work (3 years minimum); the frequency and duration of the training analysis (3 times/week for three years minimum); and, of the supervised control cases (2 adult cases, 3 times/week minimum). Further, the training institute assumes responsibility for evaluating the candidate's educational experiences through the Candidate Progression Committee. The consortium now plans to establish an independent and autonomous National Accrediting Board in Psychoanalysis. The image of the analyst as a mental health professional now standardizes, qualitizes, and homogenizes psychoanalytic education.

Since the founding of the Berlin Institute in 1920, a science and pathology driven model of knowing and understanding human being has provided the organizing conceptualization of the purpose, the content, and the institutional format of our pedagogic enterprise.  Codes of silence... have enveloped principled differences and disagreements with its educational philosophy, model, and practices; its conceptual foundations and healthcare ideology; and more recently, its healthcare accreditation standards. Whispers of Discontent... have been echoing through the hallways of our training institutions since shortly after the institutionalization of psychoanalysis in the winter of 1923-24.  This discontent centers on the inability of our educational institutions to match their institutional forms of training to our theory of psychoanalysis (Safouan, 2000).  Codes of Silence and Whispers of Discontent (Part 1) considered some of the major sources of this silence and discontent.  Gathered together, these whispers of discontent speak a rather strong historical voice that breaks our traditional codes of silence and calls for the radical reappraisal of our pedagogic enterprise  --- the Consortium's standards for education and training notwithstanding. ...And the  institutionalization of psychological education, psychoanalytic or otherwise, continues.

In the fall of 2001, the Michigan Psychological Association (MPA), the state psychological association affiliated with the American Psychological Association (APA), successfully shepherded the passage of legislation mandating continuing education (MCE) for fully and limited licensed psychologists. This legislation requires a minimum of 36 hours of continuing education credit every two years in order to continue licensure after January 1st, 2004.  Regulations and standards now apply to the continuing education of all Michigan psychologists in the practice community. With the passage of mandatory continuing education the triangulation between psychologist, educational institution, and government, first  legitimized with the licensing of psychologists in the late 70's, now interweaves with an equally  complex triangulation of psychologist, MPA-APA, and government in order to renew our government-issued licenses. Other as third is now an integral aspect of the psychologist's continuing education; its educratic rationality now extends -indeed, mandates- its  wisdom, oversight, and discourse into the psychologist's everyday professional life. A pre-authorized education for the psychologist is now more clearly written from the socio-political ideology and text of various professional-political-legislative institutions.  

Philosophical, Political, and Educational Differences 
Regarding Mandatory Continuing Education

Of the nearly 6,000 psychologists in the state of Michigan (100%), How is it that a state association representing only about 1,000 psychologists (16%), petitions the Board of Psychology in 1999 to adopt CE requirements that are mandatory for each of the approximately 5,000 other psychologists?  And through their various institutional arrangements and legislative advocacy team, successfully initiates and shepherds the legislation into law?  If MPA takes on the self-assigned role of representing the legislative interests of Michigan psychologists on issues of practice and regulation, then why did they not consult with other psychological organizations and survey  members of the significant majority (84%) as to their respective positions regarding continuing education? and their educational philosophies, models, and sets of practices? What organizational codes of conduct were followed by the MPA? And, Why is it that there was such a low profile for MCE legislation until after its successful passage? What codes of silence enveloped the How and Why of such legislative initiatives and efforts? Insularity from the members of the larger psychological community breeds an institutional discourse -and, arrogance- wherein the few know what is best for individual members, other psychological organizations, and the profession...And the leadership of national and state associations wonder why there has been a steady decline in organizational membership during recent years.

Through the MPA's institutionalized power relations with the American Psychological Association, the Michigan legislature and the Michigan Board of Psychology, a rather paternalistic mandate for continuing education has passed into law.  Such mandates rest on the assumption that without a sovereign imposing His structure and direction through standards and regulations, psychologists would not be interested in -or, be capable of creating- meaningful educational experiences.  Such a view of people, as citizens and professionals, underlies such hierarchically organized institutions; such a philosophy of education underlies the consortium's standards and MPA's initiative for mandatory continuing education; and, such legislative mandates ensure the perpetuation of the  existence and power relations of such institutions. Matters of continuing education are now resituated in an educratic system that triangulates the psychologist with the socio-political ideologies and discourses of the APA, the MPA and various governmental entities.

Probably most, if not all, psychologists are in agreement that continuing education is a defining aspect of professional life.  It seems to me, however, that many psychologists in Michigan belong to neither the APA nor the MPA as neither organization represents their philosophical, political, or practice interests in matters of healthcare.  And now in matters of education.  A certain symmetry forms around the idea that members of a profession mandated to report other citizens and professionals to various governmental agencies for various reasons are now required to self-report her or his pre-approved educational activities to a governmental entity in order to continue holding a government-issued license to practice psychology which, in turn, mandates the reporting of others to governmental agencies.

For the time being at least, questions of institutional discourse, power configurations, and political objectives are moot. As psychologists, we are situated in a healthcare ideology and matrix; we practice at the intersection of its ethical,  legal, and political discourses.  And mandatory continuing education is now the law of the land.  There are other significant questions to be addressed by each member of the professional community.  And there is not much time.  There is soon to be a public hearing held by the Rules Committee of the Michigan Board of Psychology at which time the Board will hear from psychologists before deciding the specifics of how the continuing education plan is to be implemented.  And one of the central questions to be answered is:  What constitutes continuing education?  Will your 36 hours of mandatory continuing education over the next two years presume a science and pathology driven model as the way of understanding human being?  Does one size fit all?  Will you be able to meet the MCE requirements to continue practicing by participating in educational experiences that further your understandings of the world, people, life, ... and psychology?  Such questions are inseparable from the philosophical assumptions underlying the knowledge base to be learned; the practice guidelines to which one subscribes; the code of ethics to be studied; and, the particular requirements that define an approved sponsor or program.  

What Constitutes Continuing Education?

The very concept and meaning(s) of psychology as theory and practice has been changing during the past quarter of a century.  The days of a monolithic psychology with its emphasis on linear causal knowledge are far behind us.  Indeed, a positivist science and language of pathology is but one perspective amongst many in understanding human being-ness.  The pluralism of contemporary psychology contrasts boldly and sharply with the uniformity of the logical positivism of yester-year.  There is a variety of theoretical and methodological positions in contemporary psychology that derive from the orientations of existential-humanistic, hermeneutical, narrative, semiotic, cultural, relational, transpersonal and integrationist psychologies.  These psychologies premise different understandings as to the basic nature of people, posit different methods of knowing about people, and assume very different purposes, objectives, and understandings of the therapeutic discourse. These different psychologies have differing conceptions of the world, self, and other  as well as different understandings of the concepts and meanings of Identity, the Subject, Causality, and Truth.  The world of differences that characterizes our contemporary understandings of psychology speaks to the many possible and equally meaningful interpretations of human behavior.  And the many different and equally meaningful educational models, philosophies, and forms for continuing education.  

Many of these different ways of thinking in the psychological community converge around an overarching concern that spans individual differences: the human "lifeworld" of the subject, e.g., the lived experiences of the person's everyday life (Schneider, 1998). These psychologies emphasize three main elements that distinguish them from psychology as a causal empirical science: the interrelated wholeness of experience, access to such wholeness in the therapeutic discourse, and the qualitative or descriptive accounts of such processes.  And in my view, the emphasis of such humanistic-existential-hermeneutic psychologies on the depth and variety of human experiences represents what psychology - and, psychoanalysis - is in the process of becoming.  In our conceptually rich and multiverse community of scholars, there is a growing appreciation and respect for the infinite variety of differences amongst people. How is the question of continuing education to be taken up by the Rules Committee in ways that matches the variety of forms and experiences of education with the particular concept and meaning of psychology for which the feminist, object relationist, behaviorist, forensic, humanist, phenomenologist, and other psychologists seek to continue education? Will the Rules Committee  provide the opportunity for psychologists to continue an education that reflects their respective beliefs, values, and systems of thinking?

What are the educational processes and experiences that contribute, for example, to the psychologist's continuing education  as a logical-positivist? which differs fundamentally from continuing education as an humanist-hermeneuticist? Continuing education for the logical positivist might be guided by the more traditional assumptions underlying Descarte's I think therefore I am, which embraces a world view resting on linearized assumptions of time, place, logic, and causality.  Such causal empirical theories generated from a paradigm of biology, medicine and the natural sciences commit continuing education and its bodies of knowledges to a Newtonian-Cartesian world view in which science and its methodology  is the paradigm of knowledge production.  Continuing education for some of our more contemporary psychologies, however,  might be guided by the underlying philosophical assumptions of Lacan's I think where I am not, therefore I am where I do not think which embraces a world view resting on such imprecise and non-empirical constructs as non-linear matrices, determined but unpredictable dynamical systems and, much to the positivist's consternation, ...spirituality.  Hermeneutic-humanist theories that generate from a paradigm of philosophy (phenomenology), the humanities (history), and the arts are outside of a Cartesian framework.  Their understandings derive from a fundamentally different conceptual framework.  It is virtually impossible to coherently combine both points of view, humanist-hermeneutic and logical positivist, in the same educational model and set of practices.

Different philosophical assumptions lead to very different answers to the question, What constitutes continuing education?  And also, to very different political objectives. For example, our more contemporary psychologies speak from a new and different science that understands life as lived in a non-linear, uncertain, and unpredicatable matrix.  As it represents the legislative interests of all Michigan psychologists on issues of practice and regulation, will the MPA be advancing an ongoing program of education to the public, the courts, the legislature, and the Board of Psychology that for hermeneutic-humanist-existential psychologists, and perhaps for some others as well, human behavior cannot be predicted or controlled? 

The healthcare revolution has unexpectedly broadened in concept and meaning, moving far beyond the socio-political-economic parameters first intended by the insurance industry, governmental bodies, and the various regulatory agencies. Healthcare has broadened to include an evolving view of psychology, medicine, and science, a view premised on radically different understandings of the world, life, people, the body and mind.  This emerging world view generates very different understandings of the meaning and concept of such terms as health, healing and curative factors. And there is a dynamically changing concept and meaning of the physician and psychologist as healthcare professionals.  The emphasis of our more contemporary psychologies on an interrelated wholeness of experience speaks from this world view in which everything in the world is inseparably interconnected; the world is complex, holistic, and multi-textured. This world view rests on the thinking of theoretical physics; the mysticism of the Eastern and Asian philosophies; and, a systems theory that speaks to the inexplicable spirituality of the something more of the person, e.g., the mind, the psyche, the soul. And such ways of thinking conceptualize, for example, the interrelated wholeness of the person as bodymindspeaking in contrast with the more traditional Cartesian construction of mind and body as separate entities.The more narrowed and restrictive meaning in the bio-medical sense of modernity is no longer reserved for the terms health and healthcare.  

A psychological discourse is one of the most significant voices in our culture to maintain the importance of the complexity and uniqueness of individuality. Our opportunities for continuing education must reflect and encourage a deep and unabiding respect for the personal and individualized nature of the educational experiences of those who aspire to knowing, translating and speaking the uniqueness and complexity of such a discourse. Hopefully, continuing education opportunities will encourage participation in those experiences that are most meaningful for the individual psychologist.  As recently noted by McLoughlin, some states allow licensees to include activities as varied as journal reading, consultation, providing or receiving supervision, teaching a psychology class, personal psychotherapy, serving as an officer in a professional organization, conducting a research project, publishing a paper, or preparation for board exams as part of fulfilling their CE requirements (2000).  

"The time has come, the walrus said, 
to talk of many things: 
of shoes--and ships--and sealing wax-- 
of cabbages--and kings..."    

The Walrus and the Carpenter by Lewis Carroll from Through the Looking Glass and What Alice Found There (1872)  

And of continuing education and its related questions...

If our more contemporary psychologies are to be recognized in meeting the requirements for 36 hours of mandated continuing education, the Rules Committee has to hear from you or from some collective voice that speaks and represents your continuing educational interests. Your silence becomes a voice of complicity in perpetuating the codes of silence that encourage an institutional wisdom, oversight and discourse to structure everything that remains in the realm of your personal choice regarding continuing education.  In such an instance, the institutional discourse of the MPA-APA-Rules Committee speaks the other-as-third that will govern(the)mental of your continuing psychological education. The rules to implement the plan for continuing education are far too important to be left to the political nature, expediencies, and compromises of such a discourse.

Carpe Diem....

Current past president of the Academy for the Study of the Psychoanalytic Arts, Dr. Kavanaugh is a Distinguished Psychologist and former president of the MPA.  He recently completed two terms in office as president of the International Federation for Psychoanalytic Education, has served as Director of Clinical Training in an APA approved doctoral program in psychology, and has been a member of the teaching and supervisory faculty of various pre- and postdoctoral training programs in the Detroit metropolitan area.

Dr. Kavanaugh received his doctorate in philosophy (psychology) from the University of Windsor in Ontario, Canada.  Since the completion of his doctoral studies, he has been active in the academic, organizational, and practice areas of the psychoanalytic-psychological community.  In the academic area, he has served as Director of Clinical Training and member of the core teaching and supervisory faculty in the doctoral program in psychoanalytic psychology at the University of Detroit; as a member of the teaching and supervisory faculty in the Program for Advanced Studies in Psychoanalysis in Wyandotte, Michigan, an interdisciplinary program for the study of the analytic discourse; and, as a member of the teaching and supervisory faculty in the pre-and post doctoral educational programs at the Detroit Psychiatric Institute, the Wyandotte General Hospital, and the V.A. Medical Center in Detroit.  In the organizational area, he is the founding and current president of the Academy for the Study of the Psychoanalytic Arts; past president of the International Federation for Psychoanalytic Education; the Michigan Psychological Association, and the Michigan Society of Clinical Psychologists.  In the practice area, many of his professional interests during the past 35 years are directly related to experiences in the discourses of various residential treatment facilities.

Dr. Kavanaugh is a recipient of The Distinguished Psychologist Award  from the Michigan Psychological Association and the Master Lecturer Award from the doctoral students at the University of Detroit.

Currently Dr. Kavanaugh is in the private practice of psychoanalysis in Farmington Hills, Michigan:

Office:     31805 Middlebelt, Suite #305
               Farmington Hills, Michigan, USA  48334
               Phone: (248) 626-6460
               Fax:      (248) 626-4808