Research on the Efficacy of Psychoanalysis1

September 6, 1990

The crucial need for, and difficulty with, conducting efficacy research in psychoanalysis leads us to address the problem of lack of results of the research program of Judy Kantrowitz et al., as well as evaluate their newer direction. Their 15-year effort, which aimed to assess the effectiveness of psychoanalysis in a 21-case sample, initially attempted to establish criteria for "suitability for analysis" (analyzability) via pretreatment interviews and projective tests (Rorschach, TAT, etc.). The criteria were grounded in four global "psychological aspects": reality testing, affect availability and tolerance, level and quality of object relations, and motivation.

Results failed to show that these variables predicted analytic result or outcome. The study determined that patients did show "therapeutic benefit," by virtue of improvement in ego functions after psychoanalysis, in quality of object relations and affect availability and tolerance. However, no systematic relation between this kind of "therapeutic benefit" and "analytic result" could be discerned. At long-term followup, neither the treating analysts' assessments at termination nor patient self-assessments or ratings of their responses to psychological tests a year later predicted which patients would improve or maintain improvement (Kantrowitz, Katz and Paolitto, 1990); (Kantrowitz, 1987); (Kantrowitz, Katz, Paolitto, Sashin, and Solomon, 1986), (1987a), (1987b); (Kantrowitz, Singer and Knapp, 1975).

This failure to identify predictors of psychoanalytic outcomes has led Kantrowitz et al. to a hypothesis about "patient-analyst match," which refers to a broad field of phenomena, including similarity or complementarity of features of individual history, characteristics, attitudes and values, and countertransference configurations. They conclude that in 13 of 21 cases, match appeared central to outcome, but no specific data are reported. Their conclusions are based on