On Empiricism: A Response to McKinley and Shedler

The role of empirical research has become a central debate in contemporary psychoanalysis. At the heart of this debate lies the question of what kind of research, if any, is suitable for the study of psychoanalysis. The current methodological and statistical approaches used in mainstream psychotherapy research confront major challenges in studying psychoanalysis. The culture of randomized, controlled clinical trials makes it very difficult to validate treatment approaches that are not brief and/or circumscribed to a standard manual. As such, psychoanalysis is by default excluded from any such research designs. Moreover, conforming to such empirical demands brings major dangers. As McKinley points out in the previous issue of this Review, embracing empiricism may lead to an artificial quantification of the psychoanalytic process that reduces the most significant elements of psychoanalysis into measurements rather than meaning.

Because of such concerns, many psychoanalysts believe that the psychoanalytic process resides in the subjective experience of the patient and the therapist and cannot be studied by objective empirical measures (Tuckett, 2000; Perron, 2002; Green, 2003). Only the case study has the means to represent these dimensions. There is no question that the case study method, as first used by Freud, has been instrumental in building the core of psychoanalytic theory on the structure and functioning of the mind, the dynamics of the analytic setting, and psychoanalytic technique. However, it too has significant limitations. The case study by its very nature covers only part of the psychoanalytic process, because it is filtered through the analyst's subjectivity. Unless the analyst has full access to aspects of his experience that are dissociated or repressed, these aspects will inevitably influence what is being reported while escaping representation. Moreover, the only access to the patient's conscious or unconscious experience is conveyed through the anal