Bulletin of the Psychoanalytic Research Society, Volume I, Number 1, Spring, 1992

Clinical Data, Empirical Data

Joseph Masling, Ph.D.

It is proper at the beginning of any new enterprise to examine the circumstances that give rise to it and the goals it is intended to fulfill. Those of us whose research is inspired by psychoanalytic concepts now have our own Section within Division 39 and with the present issue, we now have our own Bulletin to aid communication among researchers using psychodynamic theories and to make research findings easily available to the psychoanalytic public. Students looking for dissertation topics may find the Bulletin useful. It would be especially valuable if the Bulletin increases communication and understanding between the researcher-clinician and those who devote all their time to clinical work.

Barriers and misunderstandings between those psychologists primarily involved with experimental data and those primarily involved with clinical data are particularly unfortunate because they reduce the extent to which research can be enriched by clinical wisdom and therapy can be aided by research findings. While almost all of us who are engaged in research also do some clinical work, there is much less evidence that research results materially influence clinical practice. Luborsky, Crits-Christoph, Mintz and Auerbach (1988) have described the situation well: "Compared with the impact of the clinical lore, that of quantitative research on the practice of psychotherapy has been slight. Clinical and quantitative researchers have been inclined to keep their distance, and those who know one type of research tend not to know the other. The distance has come about more from the clinician's side; clinical researchers are likely to be guided almost entirely by the writings of other clinicians" (page 273).

One reason why full-time clinicians pay little attention to research must be the way graduate schools teach research skills, the trauma induced by the doctoral dissertation serving as a good example of how to kill interest in an activity forever. No matter how motivated a beginning graduate student might be to conduct research, by the end of Ph.D. training most students associate research with coercion, uninteresting topics, unavailable faculty mentors, and obsessive concern for method at the cost of vital content. The dissertation is the last piece of research most clinical psychologists ever conduct and may well be the last piece of research ever read carefully.

There is another reason why full-time clinicians lack interest in research. Many believe that experimental data do little more than confirm what they already know from their clinical work. Psychotherapists do not need to read about experiments on subliminal presentation of stimuli to learn that some cognitive processes operate below the level of conscious awareness. They already know that. The data clinicians observe in the process of therapy is sufficient evidence of the validity of their theories and methods to make research evidence either redundant or irrelevant. The words, memories, behaviors, and dreams of their patients present more compelling evidence than the results of experiments, many of which seem artificial, contrived, and devoid of relevance to clinical practice.

This trust in the merits of clinical evidence overlooks the difficult problem of how to account for the way in which different schools of psychoanalysis can point to clinical evidence provided from clinical practice to support their own particular positions. Moreover, the groups may differ on major issues-the importance of the Oedipal Complex, for example, or the origins of the need for attachment. How can all schools of psychoanalysis generate clinical data that support their own theoretical positions?

The answer is that clinical data do not emerge from the patient alone but from the intimate interaction with the therapist, whose theoretical beliefs lead to systematic investigation of some topics and relative ignoring of others. Murray (1956) demonstrated years ago that Carl Rogers showed interest in some aspects of his client's life and ignored other aspects, ultimately leading the client to discuss some issues but not others, a finding Truax (1966) replicated in a later case of Rogers. The implications seem inescapable: Part of what patients do and say, or do not do or say comes from the interaction with the therapist, who unlike Stephen Leacock's horseman who climbed on his horse and rode madly off in all directions, is guided by a systematic set of beliefs indicating that some content areas are more important than others and need more discussion than others. An elaboration of this argument can be found in Masling and Cohen (1987).

From this point of view, clinical data do not constitute sufficient evidence by themselves to provide sole support for any theory of personality. Cogent arguments on this issue have been made by Holt (1984) and Grunbaum (1984) among others. Empirical research is needed to provide the extra-clinical evidence Grunbaum has called for. This extra-clinical evidence is needed to supplement clinical evidence, not supplant it. I do not know anyone who thinks that extra-clinical evidence may challenge or deny the effects of psychoanalytic treatment, but such data can surely suggest alternative explanations for these effects (Massing, 1990). Moreover, empirical research can push theory into new areas of interest.

Despite popular belief psychoanalytic theories have been extremely heuristic, generating more experiments than any other family of personality theories. Our new Bulletin will help in this effort.


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