Implications of the Empirically Supported Treatment Movement for Psychoanalysis

In this article, I critique the empirically supported treatment (EST) movement and discuss the limitations of traditional psychotherapy research from a psychoanalytic perspective. The EST movement is based on a medical model that assumes that a psychotherapeutic treatment can be conceptualized independent of the human relationship in which it takes place. Psychotherapy and psychoanalysis are, however, treatments only in a metaphorical sense and are more akin to educational processes than medical treatments. Every therapeutic dyad is unique, and research that treats therapy as a standardized, disembodied entity will not contribute to our understanding. Nevertheless, there is a real need for psychoanalysts to become more actively involved in psychotherapy research both for political and scientific reasons. Although I do not believe that “empirical validation” in the form envisaged by the American Psychological Association task force is a realistic goal, I do believe in the value of microscopic studies of therapeutic process, particularly in the context of research-informed case histories.     

Locating dialogue a reply to flax

The thoughtful discussions of my paper by Alan Schore, Wilma Bucci, and James Fosshage raise important considerations about the relationship between theory, research, and the micromoment interactions constituting the activity of psychoanalysis. For the opportunity afforded by their contributions, and to Psychoanalytic Dialogues for publishing our exchanges, I express deep gratitude. I am initially impacted by the appreciation shown by my colleagues for the approach I am illustrating to clinical attention and its value for an expanded and, in certain ways, revised scope of psychoanalytic activity. In particular, I am appreciative of the ways that each commentator has taken up my emphasis on expanding psychoanalytic attention beyond symbolic pathways of exchange and has further contributed to understanding how this can occur. As part of a consideration of points of convergence and difference between us, I address how such convergences and differences shape both the values and pitfalls of comparisons across research, theory, and practice.     

The Role of Affect and Worldviews as Orienting Dispositions in the Perception and Acceptance of Nuclear Power1

Recent research in risk perception has examined the role of affect and worldviews as orienting dispositions that guide people's decisions about complex and risky topics such as nuclear energy. This study tests and supports the hypothesis that worldviews and affect-laden imagery are highly predictive of perceptions of risk from nuclear power and support for that technology. Furthermore, affect and worldviews each contribute independently to the prediction of nuclear support. We find also that a person's affective imagery associated with nuclear power is systematically related to their worldviews. We conclude that affect and worldviews appear to play similar roles as orienting mechanisms, helping people navigate in a complex, uncertain, and sometimes dangerous world. The implication of this view for the practice of risk communication is briefly discussed.     

The Talking Cure in the Cross Fire of Empiricism—The Struggle for the Hearts and Minds of Psychoanalytic Clinicians: Commentary on Papers by Lester Luborsky and Hans H. Strupp

I outline the arguments advanced by Lester Luborsky and Hans H. Strupp on the current controversy regarding empirically supported treatment (EST). I support Luborsky's criticisms of some current attempts to provide empirical support for psychoanalytic treatment, but, unable to endorse the conclusion that therapies are equally effective, I argue that substantial evidence does exist to guide clinicians, even if this evidence is not yet accessible through a mechanical process of review. I also suggest that Luborsky's “open verdict” on the length-of-treatment issue is too conservative: Longer psychoanalytic treatments have been repeatedly associated with superior outcomes across a range of measures. I agree with Strupp that the current emphasis on EST is probably motivated primarily by economic rather than ethical conditions. However, I criticize Strupp's largely negative treatment of the issue of treatment “manualization” and argue that, though manualization is a mixed blessing, only a clear, structured, and coherent framework that guides the therapeutic process can enable the therapist to withstand the interpersonal pressures inevitably generated in the consulting room. I conclude by arguing that there is a need for refinement of the concepts and methods by which outcomes are evaluated in order to help psychoanalysis and psychotherapy become a more specific family of treatments for particular conditions.     

Response to Strenger

Despite certain apparently common values, Strenger's critique is addressed largely to an inaccurate account of my views. It is also internally contradictory in various ways. On one hand, for example, Strenger favors a dialectic of science and the humanities as they bear on psychoanalysis; on the other hand, he declares science to be the exclusive psychoanalytic “metaphysic.” Remarkably, he claims that my critique of technical rationality is tantamount to advocating a passive reflective stance on the analyst's part, precluding anything akin to “coaching” to foster change. But I've written consistently about the dialectic of proactive therapeutic influence and critical reflection on that very influence and its implications. What's unacceptable about technical rationality is its positivist confidence about the effectiveness of prescribed interventions based on allegedly scientific evidence. With his lengthy survey of extra-analytic studies, Strenger evades engaging my specific arguments since they are strictly about the unwarranted privileging of the findings of psychoanalytic process and outcome research relative to clinical experience. He mistakenly equates my repudiation of such privileging with rejection of the value of “science” altogether for psychoanalysis. Finally, Strenger's claim that my “dialectical constructivism” eschews formulating universal truths about human nature ignores my consideration of human potentials for both denying and confronting mortality and the associated challenge of human agency. Embracing that challenge constitutes a moral position for psychoanalysis that is unequivocally opposed to uncritical compliance with culturally shaped demands for various types of therapeutic services.     

Psychotherapy in France: the legacy and the future

This paper looks at the present situation of psychotherapy in France. In studying the historical background to the introduction of psychoanalysis in France since the 1920s, an assumption is made about the similar changes in paradigms brought about by the emergence of a new field, whether this be psychoanalysis or psychotherapy.     

Psychic Truth and the In-Session Work of the Analyst

I seek to address one of the issues most affected by the postmodern culture, such as the crisis of rationality and truth, and try to reformulate its place within the psychoanalytic clinic using the contributions of Freud and Ferenczi, who drew the matrix of a passionate dialogue about the truth and the analyst work that has nurtured many contemporary theoretical developments. Essentially, the major influences of postmodern thought in psychoanalysis are to emphasize the importance of the patient–analyst interaction, the role played by the analyst in the patient’s transference and the rejection of the model of the analyst as a distant observer who interprets without having anything to do with whatever happens within the mind of the patient. Consequently, because both postmodernism and psychoanalysis are concerned with human subjectivity and love for truth, although indeed understanding them from different perspectives, both schools of thought become easily interrelated. I conclude that psychoanalysis, committed as it is with the search for truth, cannot ignore the influence of postmodern thought, as well as the postmodernist movement should not disregard all theoretical consistency provided by psychoanalytic theory and metapsychology.     

Evidence: wanted,alive or dead

This paper is meant to link the philosophical debate concerning the underdetermination of theories by evidence with a rather significant socio-political issue that has been taking place in Canada over the past few years: the so-called ‘death of evidence’ controversy. It places this debate within a broader philosophical framework by discussing the connection between evidence and theory; by bringing out the role of epistemic values in the so-called scientific method; and by examining the role of social values in science. While it should be admitted that social values play an important role in science, the key question for anyone who advocates this view is: what and whose values? The way it is answered makes an important epistemic difference to how the relation between evidence and theory is appraised. I first review various arguments for the claim that evidence underdetermines theory and shows their presuppositions and limitations, using conceptual analysis and historical examples. After broaching the relation between evidence and method in science by highlighting the need to incorporate epistemic values into the scientific method, my discussion focuses on recent arguments for the role of social values in science. Finally, I address the implications of the approach outlined for the current ‘death of evidence’ debate in Canada.     

A Preliminary Report Comparing Trauma-Focused and Present-Focused Group Therapy Against a Wait-Listed Condition Among Childhood Sexual Abuse Survivors with PTSD

Summary

The movement among states to promulgate, publish, and implement treatment standards for programs and providers of treatment for men who batter has gained increasing momentum in recent years. This movement, in turn, has created controversy. On the one hand, there are those who view the process of standards development, as well as the products, as essentially good and evolving. On the other hand, there are those who have argued that the process has been flawed, exclusionary, and the products based more on philosophy than sound science. The present paper describes the thoughts of a researcher who also served as chair of a state standards committee. The role of research in standards development and evolution is discussed. The role and contribution of researchers to a collaborative process of standards development and implementation is discussed. Suggestions for enhancing the collaborative process are provided.     

In the Name of Psychoanalysis: Persistent Controversies and Evolution in Psychoanalysis: A Review of Impossible Training: A Relational View of Psychoanalytic Education by Emanuel Berman

In his book Impossible Training, Emanuel Berman stresses the historical roots of current standards of psychoanalytic training and demonstrates the persistence of controversies that have been present in psychoanalysis and psychoanalytic training from their inception. This perspective, of psychoanalysis and psychoanalytic education as evolving, encourages candidates and practitioners to be participants and creative voices in an evolving field rather than rote followers learning a trade. The author proposes ways that the transference of educators to the younger generation of psychoanalysts can facilitate or interfere with the training of candidates. Berman is applauded for shedding light on current controversies in psychoanalytic education by showing their roots in historical controversies. However, the author points out Berman's tendency to overvalue his side of the controversy rather than embrace controversy itself as in the best interest of the evolution and development of the field.     

‘Yes,we have bananas!’1

This paper takes as its starting point ‘identifying markers of Latin American psychoanalysis’. The authors see this theme as a compromise between two diverging approaches. On one hand, the conference at which the content was presented provided the opportunity for Latin American psychoanalytical thinking to be discussed and, as a reward to the best papers, to be published. On the other, both the conference and the reward are more indicative of the observer's biases than of the object's peculiarities. The authors consider that the conference mistakenly focused on the search for minor differences (secondary identifi cations) instead of looking for invariances (identities). Considering that uncertainty, pluralism and complexity are issues relevant to the whole of psychoanalysis in its current stage of development as a scientifi c discipline, the authors think that treating these elements as ‘identifying markers of Latin American psychoanalysis’ is evidence of prejudice brought about by a coloniser‐colonised relationship. To develop their argument, the authors discuss a paper on editorial criteria by Tuckett as a clinical case, and use an episode of Brazilian history as further illustration. They address issues such as conformity to cultural patterns; the search for certainties and proofs; the domination of some groups over others; and editorial power‐more specifi cally, its infl uence on the acceptance or rejection of scientifi c ideas. These issues have distracted attention away from the fundamentals of psychoanalysis by introducing other, extraneous aims. Publication plays a key role in feeding a possibly vicious circle wherein only a small proportion of scientifi c contributions manages to reach a wide audience‐exactly those contributions that conform to established patterns. The act of publication turns that portion into offi cial knowledge, while unpublished ideas become increasingly excluded.     

Homework

In commemoration of Dr. Aaron T. Beck’s enormous contributions to our field, I comment on the state of our knowledge regarding the role of homework in cognitive behavioral therapy. The available evidence suggests homework is a contributor to positive therapeutic outcomes in cognitive behavioral therapy. Although therapists play an important role in facilitating clients’ engagement with homework as they develop greater facility with CBT skills, little is known about the contributions of specific approaches to promoting homework engagement. I highlight some of these strategies and discuss the need for researchers to empirically evaluate them.     

Psychoanalysis, psychoanalytic science, and psychoanalytic research--1986

The present standing of psychoanalysis as a science and the vitality of psychoanalytic research effort are reviewed. The two are interdependent, since the possibilities for empirical research rest on the necessary assumption that psychoanalysis is indeed enough a science to be susceptible to knowledge advance by the (research) methods of science. Concerning our status as a science, I review attacks on our scientific credentials (both from within our ranks and without) by the logical positivists, by the hermeneuticists (a rubric comprising a variety of hermeneutic, phenomenological, exclusively subjectivistic, and/or linguistically based conceptualizations of our field), and the most recent by the philosopher of science, Adolf Grünbaum. I try to demonstrate what I feel to be the failure of each of these assaults, and why I feel there is no reason to see psychoanalysis as anything other than a scientific psychology and, therefore, in theory amenable to empirical research approaches. I then review the history and the current status of these systematic research efforts in psychoanalysis, and the reasons why these have been far less in scope and in accomplishment than has been possible or than has been needed. Here I have focused especially on research involving technique and our theory of change and cure--i.e., research on the analytic process; on what changes take place (outcome) and how those changes come about or are brought about (process).     

Helping My Patients Find New Spontaneous Ways of Responding Emotionally: A 30-Year Long Journey as a Psychoanalyst

I started my journey as a psychoanalyst with the conviction that I had to provide my patients, through interpretation, with explicit information about their instinctual unconscious that they didn’t have access to. Now I think that through words (often using highly metaphorical, poetic language, with its tone and rhythm), patient and analyst coconstruct new forms of relating, that is to say, new forms of mutual regulation of emotions. The aim of therapeutic change is that patients find new, spontaneous forms of reacting emotionally. This change, from the psychoanalysis of suspicion to the psychoanalysis of the secure base from where new regulating strategies are co-constructed, is parallel to the change in values observed at a social level: central values of industrialized society, such as obedience, authority, discipline, etc., are being replaced by values such as authenticity and respect for one’s uniqueness in electronic societies.     

Daniel Stern: Microanalysis and the Empirical Infant Research Foundations

ABSTRACT

Daniel Stern changed the face of psychoanalysis, as well as that of infant research. He was a brilliant, innovative, and playful thinker. Psychoanalysis particularly values his contributions on the relevance of infant research to adult clinical practice and theory, for which he is best known. But this work has its foundation in his early empirical infant research, which is less well known. I believe that a better appreciation of the original empirical basis of his work using microanalysis will deepen our appreciation of his later thinking.

In this article I return to the beginning of his work, using frame-by-frame microanalysis of film and, particularly, his first paper published in 1971. I sketch out some of the important findings and ideas emerging from this paper that continued to influence his thinking throughout his career. This research was conducted in the 1970s, the period in which I worked with him directly.     

Worldviews about change: Their structure and their implications for understanding responses to sustainability,technology, and political change

People hold different perspectives about how they think the world is changing or should change. We examined five of these “worldviews” about change: Progress, Golden Age, Endless Cycle, Maintenance, and Balance. In Studies 1–4 (total N = 2733) we established reliable measures of each change worldview, and showed how these help explain when people will support or oppose social change in contexts spanning sustainability, technological innovations, and political elections. In mapping out these relationships we identify how the importance of different change worldviews varies across contexts, with Balance most critical for understanding support for sustainability, Progress/Golden Age important for understanding responses to innovations, and Golden Age uniquely important for preferring Trump/Republicans in the 2016 US election. These relationships were independent of prominent individual differences (e.g., values, political orientation for elections) or context-specific factors (e.g., self-reported innovativeness for responses to innovations). Study 5 (N = 2140) examined generalizability in 10 countries/regions spanning five continents, establishing that these worldviews exhibited metric invariance, but with country/region differences in how change worldviews were related to support for sustainability. These findings show that change worldviews can act as a general “lens” people use to help determine whether to support or oppose social change.     

Infant observation: A range of questions and challenges for contemporary psychoanalysis1

The author attempts to integrate several perspectives within the field of infant observation that reflect the analyst's personal experience as a clinician, as a professor at the analytic institute and as a researcher in the field of psychoanalysis. Can infant observation contribute to analytic technique, theory and training? If so, what would be the nature of such contribution? To answer these questions, the author reviews the literature on infant observation from Freud to the present, highlighting Latin American contributions to this subject. She makes reference to the role of technological innovations, which have allowed videotaping, repeated observations, temporal segmentation and computerized programs, thus giving rise to microanalytic research. This discussion prompts the question about the contributions made by systematic research to clinical practice. To tackle this question, the author presents both a clinical vignette taken from her personal experience, and the current debate on this subject as it appears in the work of Daniel Stern and André Green. Finally, she presents some conclusions that are part of an ongoing debate in the psychoanalytic field.     

Psychoanalytische Therapie

A statement of the professional umbrella society DGPT is presented that was formulated in cooperation with the various professional societies and with the German Society of Psychosomatic Medicine and Psychotherapy and the Society of Child and Adolescent Therapy. The statement is a reaction to the public claim for effective evidence of psychotherapy and takes the opportunity for a comprehensive presentation of this field. In the introduction Alf Gerlach, as chairman of the umbrella society at the time of the formulation of this statement and now executive chairman responsible for coordinating research, describes the history of the development of the statement.There were two particular moments prompting this statement. On the one hand the Scientific Advisory Board for Psychotherapy as an advisory committee based on the law of psychotherapy, has presented demands for effective evidence that are incompatible with psychoanalysis. Thus, the recognition of psychoanalysis as a treatment method for illnesses was put in doubt. On the other hand, a suggestion was put forward to the Board to recognize psychodynamic psychotherapy as an independent entity. This questioned the unity of the psychotherapeutic field.The statement was passed onto the Scientific Advisory Board last autumn. It is intended for a professional audience and includes answers to important issues of this field. It will have an important role to play in future discussions about professional politics. For this reason, we have decided to begin the present issue of our journal with this statement and thus to open a wide discussion forum.

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Deutsche Gesellschaft für Psychoanalyse, Psychotherapie, Psychosomatik und Tiefenpsychologie e.V. (DGPT)In Verbindung mit:Deutsche Gesellschaft für Analytische Psychologie (DGAP)Deutsche Gesellschaft für Individualpsychologie (DGIP)Deutsche Gesellschaft für Psychotherapeutische Medizin (DGPM)Deutsche Psychoanalytische Gesellschaft (DPG)Deutsche Psychoanalytische Vereinigung (DPV)Vereinigung Analytischer Kinder- und Jugendlichen-Psychotherapeuten (VAKJP)Redaktion: Stephan Hau und Marianne Leuzinger-Bohleber

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Psychoanalysis in Austria after 1933-34

Our essay focuses on major developments of the history of psychoanalysis during the fascist and National Socialist years in Austria and sheds light on the re-establishment of psychoanalysis after World War II. With the consolidation of National Socialism in Germany in 1933 and Austro-fascism in 1934, any psychoanalytical reflection that was critical of political and cultural trends was extinguished. Vienna - once again - became the center of the psychoanalytical movement in Central Europe, taking over the role Berlin had played during the twenties. But, during the Austro-fascist system, psychoanalysis was isolated from an important part of its public. Psychoanalysts reacted by adopting an attitude of political abstinence, accompanied by self-censorship, they concentrated on training and clinical work, or they went into exile. Austria's Anschluß to the National Socialist Third Reich led to the final destruction of psychoanalysis. Nearly all Viennese analysts were affected by the anti-Jewish measures of the National Socialists and almost all of them fled the country. During the war years, a small group of people under the leadership of August Aichhorn tried to continue psychoanalytic training. Its members refounded the Viennese Psychoanalytical Society in early 1946. But, scientific traditions were broken and tendencies of anti-enlightenment, especially clerical and catholic prejudices, had continued from the time of Austrofascism and Nationalsocialism. The last chapter of our essay summarizes the research topics and the main historiographical studies done in the field.     

Advances in graphonomics: studies on fine motor control, its development and disorders

During the past 20 years graphonomic research has become a major contributor to the understanding of human movement science. Graphonomic research investigates the relationship between the planning and generation of fine motor tasks, in particular, handwriting and drawing. Scientists in this field are at the forefront of using new paradigms to investigate human movement. The 16 articles in this special issue of Human Movement Science show that the field of graphonomics makes an important contribution to the understanding of fine motor control, motor development, and movement disorders. Topics discussed include writer's cramp, multiple sclerosis, Parkinson's disease, schizophrenia, drug-induced parkinsonism, dopamine depletion, dysgraphia, motor development, developmental coordination disorder, caffeine, alertness, arousal, sleep deprivation, visual feedback transformation and suppression, eye-hand coordination, pen grip, pen pressure, movement fluency, bimanual interference, dominant versus non-dominant hand, tracing, freehand drawing, spiral drawing, reading, typewriting, and automatic segmentation.