Spotlight on Psychoanalytic Psychology, V. 27 No. 2

By Louis Rothschild, PhD

Welcome to the Spotlight Introduction for Volume 27, Issue Number 2 of Psychoanalytic Psychology. In choosing to Spotlight Marco Chiesa’s article “Research and psychoanalysis: Still time to bridge the great divide?” I am reminded of Paul Meehl’s contrasting of dust-bowl empiricism and clinical judgment (see Meehl, 1973). It was over fifty years ago that Meehl, a member of the American Academy of Psychoanalysis suggested that neither those who favor factor analysis nor those who favor psychoanalysis need take up castrating positions toward each other. Meehl was an expert in defending the uncertainty found in the clinical stance while simultaneously critiquing that very position through the argument that the liability of uncertainty could be a failure to make reasonable judgments, and that careful study could aid the clinician in the challenge of making decisions. This ability to engage multiple perspectives could well be considered a cornerstone of the psychoanalytic attitude that purports an affirmation of critical thought potentially leading to an appreciation of what we often call “the other”. In regard to the capacity to move beyond a position of paranoid/schizoid fantasies and enactments of castration in the meeting of psychoanalytic practice and research, Chiesa’s lead article in the current issue of the journal accomplishes a rapprochement toward what a Kleinian might call a depressive position.

Chiesa, the Director of the Personality Disorder Outreach and Research Department at the Cassel Hospital in the United Kingdom and a Senior Lecturer at University College in London notes that there has been a general failure to make progress in the rigid polarized debate between research and psychoanalysis. His significant effort to reduce antagonism affords one of the best explanations of the relationship between Evidence Based Practice and Empirically Supported Therapies that I have come across. There is a critique here of the narrow criterion set out by those who favor the randomized clinical trial as a gold standard research method. Also illustrated in his critique is a multi-method account of research that holds no single method as superior, and instead supports the democratic attitude of scientific critique. Footlight note to this Spotlight Introduction: As fortune would have it, an example of multi-method research including the view point of the analyst and an independent research team is also found in the current issue of the journal (Lingiardi, Gazzillo, and Waldron, 2010).

As noted in Chiesa’s article, arms of the American Psychological Association were central to privileging a research method bias toward randomized trials. However, as recently noted across our Division, Jonathan Shedler’s (2010) meta-analysis showing the efficacy of psychoanalytic psychotherapy was praised in a news release from the American Psychological Association affording a cogent example of science working on behalf of psychoanalysis. However, despite work such as Shedler’s, Chiesa’s findings suggest that American Psychoanalysis lags behind the European Psychoanalytic Federation and the British Psychoanalytic Council in such integration of research despite (noted herein) the well argued critiques of American researchers such as Safran and Luborsky.

Chiesa’s understanding of the current state of affairs suggests that a rejectionist position whose belief is that the only appropriate method to study psychoanalysis is psychoanalysis itself is held by a few charismatic and respected members of the psychoanalytic community. In this case, what he considers a minority opinion allows the perpetuation of the bias of a single method - psychoanalytic use of the single case study - and that this bias appears as rigidly held as those who favor the randomized clinical trial. Here Chiesa makes an additional argument that the single case study method is biased toward creating an atmosphere of uneven thought in which “theoretical bloating and fragmentation” (p.107) are the result.

Chiesa argues - quite well I think, that an integration between research and clinical psychoanalysis would have the benefit to soften uncritical practices. When I read this I think about what we want treatment to do - help reduce rigidity and an ability to work critically. I am impressed and hopeful in regard to the potential to address this divide well noted in a quote from Meehl (1973) whose referent is uncertain: Psychotherapy is the “art of applying science which does not yet exist.”

To this end, I would suggest that Psychoanalysis consider that Chisea’s arguments are quite in line with other practices concerning the human condition. In an Op-Ed piece, The Dali Lama (Gyatso, 2005) writes: “If science proves some belief of Buddhism wrong, then Buddhism will have to change. In my view, science and Buddhism share a search for the truth and for understanding reality. By learning from science about aspects of reality where its understanding may be more advanced, I believe that Buddhism enriches its own worldview.” He adds: “A deeper dialogue between all scientific fields and society could help deepen our understanding of what it means to be human and our responsibilities for the natural world we share with other sentient beings.”

References

Lingiardi, V., Gazzilo, F., and Waldron, S. (2010). Empirially Supported Psychoanalysis: The Case of Giovanna. Psychoanalytic Psychology, 27 (2), 190-218.

Meehl, P. (1973). Psycho-diagnosis: Selected Papers. New York: W.W. Norton & Co.

Shedler, J.K. (2010). The Efficacy of Psychodynamic Psychotherapy, American Psychologist , Vol. 65. No.2. Retrieved from: http://www.apa.org/news/press/releases/2010/01/psychodynamic-therapy.aspx

Tenzin Gyatso Sunday, November 13, 2005 Our faith in science. The New York Times. Retrieved from: http://snipr.com/spot27two