W(h)ither Research? by N. Szajnberg, MD, Managing Editor

W(h)ither Research?
N. Szajnberg, MD, Managing Editor

Ip.net posted three papers on research in psychoanalysis: Wallerstein and  from 1971; and two recent works — the Kachele single case study group and an updated Wallerstein paper).  Click Here to Read These Papers 

Why read these?  More pointedly, do psychoanalysts care about research and in what manner?  For instance, Andre Green, among other French psychoanalysts, believe that recherche (not an exact translation of “research,” a possible faux amis) only takes place in the analyst’s office.

Leutzinger-Bohleber presented a breath-taking sweep of possible psychoanalytic — that is, a science of the unconscious — research(es) for the next decades[1]. Next week, we will be able to publish a research study on children by her in IP.net, but until then here is my modest overview. 

Leutzinger-Bohleber notes Freud’s personal course: from youthful interests in philosophy and humanities, through a harsh turn to natural sciences in Brucke’s lab, then, recognizing the limitations of neurology to comprehend (and treat) hysteria, a shift that resulted in his Dream book, a self-study that was nevertheless rigorous. Later in life, he returned to applying psychoanalysis to the arts — literature, myth, sculpture, even as he used the humanities to inform his understanding of the unconscious.  Freud addressed: what is the human condition, conflicts and their “roots in infantile fantasies, first object relations and he lifelong unconscious sources of thoughts, feelings and behaviors,” she writes.  And he created this “inconvenient but unique claim for self investigation and self exploration,” a technique that evokes skepticism and even suspicion from many.

She then categories psychoanalytic research into five approaches:

  1. Clinical: (“the study of unconscious construction of meaning, of personal and biographical uniqueness”}. While this takes place in our offices, she presses us that to do research on this requires “exact description and lucid consideration,” that is accessible to third parties.
  2. Conceptual: This category, first suggested by Sandler and Dreher in the 90’s can have an elusive quality, but attracts intellectuals, those in the arts, other disciplines.
  3. Psychoanalytic psychotherapy effectiveness: this falls into the more familiar (and often alienating) category of nomothetic studies. Wallerstein (below) divides our efforts in four phases.
  4. Experimental: looking at preconscious and unconscious processing of memory and dreams, often using ancillary methods such as FmRI. I add the whole discipline of emotions research (TAMAR: LINK TO MY PIECE ON EKMAN), that now uses both physiological and brain scanning techniques to look at how emotions are elicited, experienced and how to ameliorate negative emotions.
  5. Interdisciplinary: Collaboration with those in attachment research, embodied cognitive science, literature and cultural studies, anthropology and many others. This is a fruitful area, particularly as those in the arts and in neuroscience (such as Kandel) are interested in our discipline.

            I mentioned Wallerstein’s categorization of eras of empirical research into psychoanalysis.  These begin with 1. Retrospective studies; 2. Prospective, “defined groups” studies, which found 80% of treatments successful; and individual studies; 3. Systematic studies combining group comparisons and longitudinal single case studies, such as the Wallerstein/Menninger group and the German outcome study (the elegant Fonagy and Target study of child analysis was retrospective, so would fit both above and here); 4. Both studies of results and therapeutic processes and links to microanalysis, such as via video/audio recordings.

The Kachele et al paper included in Dr Richards’ post last year is an example of a single case study, in fact an audiotape and transcribed case that has been studied intensley by this group.  It is not likely that others could replicate this. Here is a thought experiment.  How many of us would agree to audiotape a full analysis? How many of us would agree to have our personal analysis audiotaped? And if someone did agree, what kind of bias comes from that agreement? 

In all the above, we haven’t mentioned child research, except for Fonagy and Target. We haven’t included developmental research, mother-infant studies. Ironically, these appear to have thrived more robustly than in adult work.

But, to return to the beginning in order to end at the end, whither research?  Our training programs, unlike graduate programs, do not have systematic research nor research training built-in.  Further, our discipline at times seems to “advance” by a form of “haut coutre,” what’s newly in fashion, rather than systematic reflection on what is working well for our patients, what is not.

Therefore, unless psychoanalysis as a discipline decides decisively otherwise, whither research could become wither research.

Next week’s post is by Dr. Leutzinger-Bohleber. She presents a radically unique in-school non-pharmacological approach to ADHD, demonstrating its effectiveness. This gives a whither to our re

[1] Hers was one of the final papers in the EPF in London in 2010 before a dwindled audience.

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