Jonathan Shedler Replies

By Jonathan Shedler

Jonathan Shedler: I am concerned that the author seems to have profoundly misunderstood my article. The author refers repeatedly to “Shedler’s call for more research employing experimental methodologies.” I was not “calling” for anything. Nor am I a fan of randomized controlled trials as a method of inquiry for understanding psychotherapy. Far from being a fan, I think this particular research method is distinctly unhelpful. I was simply reporting on the research that exists, that has been conducted by others. The author has attributed to me beliefs I do not hold and is critiquing primarily his own fantasy about what I believe and advocate.

This is a good illustration of the problem in our field: People talk past one another. An article that was intended primarily to reassure psychoanalytic practitioners that empirical research supports what we do (and does not, as widely reported, favor CBT over psychoanalytic therapy) has somehow become, in the minds of this author and others, a “call” to radically jettison everything of value in psychodynamic thinking. What a sad commentary on the state of our field, and our collective inability to engage in virtually any constructive dialogue, even among ourselves.

DIVISION/Review: In 2004 you published a review in JAPA of a book entitled: Clinical and Observational Psychoanalytic Research: Roots of a Controversy (Sandler, Sandler, Davies, eds.). One key point that you make in that review is that not only should clinical psychoanalysts be open to the possibility of research but that research methodology can and should be open to psychoanalytic theory and its principles: that the task is finding a way to develop optimal matches between theory and research.

Many clinical psychoanalysts assume that research methods and indeed all empirically testable hypotheses will necessarily be overly rigid and that they can never be attuned to the significant and subtle clinical questions that arise in psychoanalytic practice. This is a view associated with Andre Green and it seems to be the position being argued by McKinley as well.

Your position instead seems to be that rigid and narrow research methodologies are unfortunate and unnecessary, that it is indeed possible to develop research methods which would meet the standards of clinical psychoanalytic judgment.

Jonathan Shedler: Yes, you understand my view correctly. Many academic researchers have been quite uncreative about developing methods suitable for addressing questions relevant to psychoanalysis. They have started with a commitment to certain methodologies, and then asked questions that fit the procrustean bed of the methodology, instead of starting with the important psychological questions, and then figuring out how to develop methods that are suitable for addressing those questions. That is not science versus psychoanalysis; it is just bad science by any definition of science.

Given the bifurcation in the field between science and practice, how could it be otherwise? Most academic researchers don’t even know what questions a psychoanalytic thinker would consider relevant. Both analysts and researchers share the blame for this situation—most academic researchers have not made much effort to find out what dynamic thinkers consider important, but psychoanalyst have been so dismissive of research and so (suicidally) insular that they have not bothered to communicate with researchers who might well have an interest in analytic thought. In fact, historically, analytic institutes turned away generations of academic psychologists who truly wanted to learn psychoanalysis, and thereby made enemies of multiple generations of academic researchers who might otherwise have contributed greatly to psychoanalytic knowledge. And even despite this state of affairs, there has still been some extraordinarily creative research by analytically minded empiricists, as I tried to show in my JAPA essay, that I think would be of great interest to many analysts. But many people within psychoanalysis—like our colleague (McKinley) who wrote the critique of my article—don’t take notice. And so we (psychoanalysis) remain in a state of isolation that is not splendid in the least, then feel aggrieved when we are shut out of dialog in the larger mental health world that we never attempted to participate in to begin with.

DIVISION/Review: I do think that your more complex and nuanced point of view about research gets eclipsed by the eithor/or debate on empiricism per se. Empiricism as something of a world view is associated then with all manner of administrated clinical practices: manualized treatment models, evidence-based decision trees, etc. Young psychoanalysts—and indeed many not so young ones—wonder if it will be possible to continue to practice in the spirit of independent judgment formed upon the experience of a personal training analysis and effective supervision or whether that will be undermined by a shift toward prescribed techniques and suitably testable hypotheses.

Jonathan Shedler: I think your assessment of the situation is correct. The reality is that the opportunity for a psychoanalytic career really is threatened. But this kind of either/or thinking (which, I think, reflects a breakdown in the collective capacity for mentalization) further marginalizes psychoanalysis and exacerbates the very situation that is threatening us. Perhaps there is also an identity issue at work—if one’s identity (analytic or other) is vulnerable or fragile, than one must prop it up, even at the cost of constructing a kind of collective false self.

Can empirical methods address such issues as transference, resistance, conflict, and unconscious mental life more generally? They can, but doing so requires a change in the way most of us think about research. Historically, psychological and psychiatric researchers have tried to maximize the reliability or reproducibility of their measures by eliminating clinical deduction and inference, or reducing it to the lowest common denominator. An alternative is to harness clinical deductions and inferences.

Mark McKinley Replies To Jonathon Shedler

I welcome Jonathan Shedler’s clarification and applaud his efforts to find creative methodological solutions to studying the complex phenomena that emerge in psychodynamic psychotherapy. The thrust of my paper, at least as I intended it, was not to address Shedler specifically, but rather to use his article as a platform to critique some potential implications for the field regarding pressures to demonstrate the efficacy of psychoanalysis through experimental methodologies. It seems Shedler also shares, at least to some degree, concerns regarding particular traditional empirical methods as he states, “Nor am I a fan of randomized controlled trials as a method of inquiry for understanding psychotherapy.” Unfortunately, instead of elaborating upon or constructively building from this potential ground of commonality, Shedler seems to side step my concerns by assuming a personalized critique on him; he suggests this is yet another example of how “People talk past one another.” Perhaps his experience of talking past each other may reflect a certain level of personalization as oppose to debating ideas qua ideas. This rhetorical maneuvering has the potential to interrupt the dialogue for collaborative thinking; something, I believe, Shedler and I both see as troublesome, yet clearly very challenging to practice. The aim of my commentary was not only to highlight potential dangers, but also to strive to avoid a collective collapse in thinking when contending with complex issues.