Bulletin of the Psychoanalytic Research Society, Volume III, Number 1, Spring, 1994
For most of this century, theoreticians and practitioners have engaged in an ongoing -- often contentious -- debate regarding the efficacy of different psychotherapeutic paradigms. Unfortunately, these debates have often proceeded without reference to empirical data which could have proved valuable in testing different therapeutic approaches. Those days are gone. True, different practitioners continue to favor different treatment techniques. There will always be psychologists who identify themselves primarily with psychodynamic ways of thinking, just as there will always be those who call themselves behaviorists. Nonetheless, we all know what the prevailing therapeutic "paradigm" will be during the 1990s and beyond: managed care. Regardless of whether one regards him or herself as a psychoanalyst or a behaviorist, it is impossible to deny that psychotherapy during the coming years will be directed largely by economic concerns. Now more than ever we must take seriously the idea that psychoanalytic practice can only survive if it is linked with empirical data demonstrating its efficacy. Now more than ever we must look outside of psychoanalysis for ideas and findings that might improve psychoanalytic therapy.
I believe that the relationship between empirical research and psychoanalytic practice can be meaningfully divided into three phases. During the initial phase, which occurred during the first few decades of this century, psychoanalytic theory and therapy developed with virtually no attention to empirical data, either within or outside of psychoanalysis. At this early point in the history of our discipline, psychoanalysis was struggling to establish itself as a viable alternative to other forms of therapy, and -- not surprisingly -- psychoanalytic theorists and practitioners had not yet developed laboratory paradigms that would allow for rigorous testing of their radical new concepts.
During the 1940s and 1950s, a second phase was initiated-one wherein psychoanalytically-oriented researchers began to test and extend psychoanalytic theory via controlled laboratory (and, to a lesser extent, field) studies. This phase has continued to the present day. Unfortunately, however, despite the fact that numerous important empirical findings have accumulated during the past 50 years, psychoanalytic therapy has continued to develop more or less independently of these findings.
Clearly, psychoanalytic practitioners have an ambivalent, conflicted relationship with psychoanalytic researchers. On the positive side, many practitioners acknowledge that empirical research testing psychoanalytic concepts is an interesting exercise. If nothing else, it makes the discipline look good, and allows us to congratulate each other on how scientific our field has become. On the negative side, it seems that practitioners have rarely altered their approach to psychoanalytic therapy based on the results of these "interesting" empirical findings. Simply put, this phase in the development of our discipline has been characterized by polite acknowledgment of the value of empirical research by many psychoanalytic therapists. Nothing less, nothing more.
We are now entering a third phase in the relationship between empirical research and psychoanalytic practice. As economic pressures increase, and society increasingly demands evidence of psychotherapeutic efficacy, we must take seriously the proposition that psychoanalytic practice should be informed and influenced by empirical research. It is time to stop paying "lip service" to the idea of empirical research testing and extending psychoanalytic concepts, and instead begin to revise and alter our approach to treatment based on these findings. As psychoanalysis enters its second century, we can no longer afford to ignore the wealth of empirical data that might allow our discipline to compete more effectively in an increasingly competitive health care marketplace.
In my view, we can begin to work toward this goal by attending more closely to empirical findings in four areas. First (and most obvious), we must continue to conduct empirical studies testing the efficacy of psychoanalytic treatment techniques. There are several ongoing research programs in this area, and these research programs can provide important information regarding those aspects of psychoanalytic therapy that have proven effective (e.g., transference analysis; see Luborsky et al., 1985), and those aspects of psychoanalytic therapy that are not as effective as we had hoped (e.g., free association; see Bornstein, 1993).
Second, we must begin to attend more closely to empirical research testing other psychotherapeutic approaches. It is now clear that certain therapeutic techniques are more effective than psychoanalysis for particular kinds of problems. Knowing this, we can-if we choose to do so-integrate some of these techniques into psychoanalytic practice, increasing the scope of our treatment approach. For example, although behavioral techniques may be more useful than psychoanalytic approaches in treating simple phobias (see, e.g., Lambert, Shapiro & Bergin, 1986), there is no reason why some of these behavioral techniques cannot be integrated into a psychodynamic framework when treating a phobic patient.
Third, we must move beyond simply paying lip service to ongoing research programs testing and extending basic psychoanalytic concepts. There are a surprisingly large number of such research programs (see Masling, 1983, 1986, 1990; Masling & Bornstein, 1993), and many of these research programs have produced results which have important implications for psychoanalytic practice. We have a responsibility to modify what we do in the consulting room based on what our colleagues have discovered in the laboratory.
Finally, we must begin to attend to the wealth of important data that have been obtained by non-psychoanalytic researchers during the past several decades. There are dozens-if not hundreds-of ongoing non-psychoanalytic research programs which have important implications for psychoanalytic theory and therapy. These research programs have much to teach us about implicit memory (Schacter, 1987), the psychodynamics of childhood and adult attachment (Simpson, 1990), self-serving biases in person perception (Niedenthal, 1992), and numerous other issues relevant to psychoanalytic practice. We would be remiss if we did not integrate these findings into our therapeutic techniques. Beyond that, however, we may find that if we do not modify our therapeutic approaches to bring them into line with the most recent, cutting edge findings in this area, we might wake up one day and discover that we have no therapeutic approaches left to modify.