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This is a superb paper! Had it been written two decades ago, our profession might have avoided some of the problems that have plagued us. This collaboration of two distinguished and highly regarded psychoanalytic psychiatrists will help to focus the field on some of its most pressing needs. While maintaining a fair and self-critical attitude, Gunderson and Gabbard have made explicit, in a most constructive fashion, what must be done if psychoanalysis is to remain a viable choice for patients and for policy makers.
The problem we face is that while there are many exceptions, most psychoanalysts are practitioners. As individuals they are limited in how much time and energy they can invest in dealing with complicated issues of research methodology, outcome, evidence, etc., and in developing broad and systematic outcome studies. Also limited is the amount of clinical information any one analyst possesses that might allow him or her to undertake systematic research. Analysts can, however, by systemically asking patients to monitor their progress, provide the case material needed for such studies.
Appropriately, Gabbard and Gunderson recommend that analytic institutes and associations accumulate information in sufficient amount to allow meaningful research. Further, they argue, analysts should band together as groups of individuals recognizing “the central importance of empirically derived knowledge.” The paper also calls for movement toward the needs of today's health care programs, including the need to show benefits derived from any financial expenditure on health care.
The authors serve the profession well by citing a number of contributions to the literature that move in the right direction, including a