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).     

Followup in psychoanalysis: clinical and research values

Psychoanalysis has never developed a tradition of systematic followup study to evaluate outcome and to improve technique and theory for a variety of reasons, partly theoretical, stemming from the conception of the unfolding transference neurosis and its analytic resolution as the precondition for cure, and partly historical, having to do with the happenstance of its development as a private practice-based discipline and training outside of the academic setting. Freud, however, was never bound by such strictures and published whatever post-treatment data he acquired on all his best-known case histories. But following Freud most analysts, with some notable exceptions, eschewed followup activity as unanalytic. It is this tradition that more recent studies like those of Pfeffer in New York and the Psychotherapy Research Project of The Menninger Foundation in Topeka have squarely challenged. Data are presented from the Menninger project dealing specifically with the impact of routine planned followup on issues of treatment termination and resolution and on the nature of the post-treatment period. The degree and kind of patient cooperation with the followup inquiry, the impact of followup on treatment termination and resolution (both impeding and facilitating), and the role of followup intervention in relation to return to formal post-treatment therapy (or consolidating against it), are all discussed.     

Child of divorce: An overview

Children of divorce represent a diverse population at risk for subsequent psychological problems, whose interests are insufficiently understood or protected by the legal system or the mental health community. Although many children weather the stress of marital breakdown without psychopathological sequelae, a significant number show lasting difficulties. Information concerning the psychological adaptation of these children has increased rapidly during the past decade, but it remains unequel to the task of guiding family policy in this arena. Current knowledge identifies child gender and developmental stage as crucial factors that interact with the chronic stresses of postdivorce family life to produce short-and long-range impediments to the maturation of these vulnerable young people. There is a critical need to facilitate understanding and cooperation between the behavioral sciences and the legal profession on behalf of children in divorced families. The major research tasks relevant to enlightened public policy lie ahead.     

The growth and transformation of American ego psychology

The roots of ego psychology trace back to Sigmund Freud's The Ego and the Id (1923) and "Inhibitions, Symptoms and Anxiety" (1926), works followed by two additional fundaments, Anna Freud's The Ego and the Mechanisms of Defense (1936) and Heinz Hartmann's Ego Psychology and the Problem of Adaptation (1939). It was brought to full flowering in post-World War II America by Hartmann and his many collaborators, and for over two decades it maintained a monolithic hegemony over American psychoanalysis. Within this framework the conceptions of the psychoanalytic psychotherapies evolved as specific modifications of psychoanalytic technique directed to the clinical needs of the spectrum of patients not amenable to psychoanalysis proper. This American consensus on the ego psychology paradigm and its array of technical implementations fragmented several decades ago, with the rise in America of Kohut's self psychology, geared to the narcissistic disorders, and with the importation from Britain of neo-Kleinian and object-relational perspectives, all coinciding with the rapid growth of the varieties of relational psychoanalysis, with its shift in focus to the two-person, interactive, and co-constructed transference-countertransference matrix. Implications of this intermingled theoretical pluralism (as contrasted with the unity of the once dominant ego psychology paradigm) for the evolution of the American ego psychology are spelled out.     

Will psychoanalysis fulfill its promise?

Although Freud had aspirations of a university structure for psychoanalytic education the sociopolitical structure of the Austro-Hungarian empire precluded this, and psychoanalysis developed by default in the central European heartland within a part-time, private-practice educational structure. With its rapid spread in the post-World-War-II United States, and its ready penetration of American academic psychiatry, a counter educational structure arose in some quarters: the department-of-psychiatry-affiliated institute within the medical school. This article outlines beyond these other, more ambitious, academic vistas (the David Shakow model, the Anna Freud model, the Menninger Foundation, Emory University (USA), AP de BA (Argentina)); conceptions even closer to the ideal (idealized) goal of full-time placement within the university, with strong links to medicine, to the behavioral sciences and to the humanities. The putative advantages of such a structure are presented.     

The trajectory of psychoanalysis: A prognosticationy3

I present an overview of the development to this point of psychoanalysis as a discipline'both as a theory of the mind and a treatment of the disorders of the mind' and offer a prediction concerning evolving development over its (near) future. My focus is on the coherence of psychoanalysis as a theoretical structure, starting with Freud's strenuous endeavours to maintain the psychoanalysis that he had single‐handedly created as a unitary and unified theory, tracing then the breakdown of this effort, even in Freud's lifetime, into the burgeoning theoretical diversity or pluralism that characterises worldwide psychoanalysis today, and then going on to the beginning appearance of evidences' not yet widely remarked' of growing convergences from within very disparate and even seemingly very opposed theoretical perspectives, at least at the level of technical interventions and experience‐near clinical theory, with implications, however, even for the level of experience‐distant general (metapsychological) theory. Such a development, if sustained, as I anticipate, would strengthen the credibility of psychoanalysis as a science of the mind, amenable to growth through empirical research in accord with the canons of scientific method.     

Psychoanalysis in the university: the natural home for education and research

Psychoanalysis as a theory of human mental functioning and a derived therapeutic for disturbed functioning would have its natural home in the university, and Freud gave evidence of harboring such an ambition. But the sociopolitical structure of the early 20th century Austro-Hungarian Empire precluded this, and analysis developed, by default, its part-time, private practice-based educational structure. Psychoanalytic penetration of academic psychiatry in the United States after World War II made possible a counter-educational structure, the department of psychiatry-affiliated psychoanalytic institute within the country's medical schools. This paper outlines, beyond these, other more ambitious vistas (David Shakow, Anna Freud, The Menninger Foundation, Emory University [US], APdeBA [Argentina]), conceptions even closer to the ideal (idealized) goal of full-time placement within the university with strong links to medicine, to the behavioral sciences, and to the humanities.