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Roger Perron begins his critique by expressing his agreement with me regarding the need to develop research on, and within, psychoanalysis. His division of research into ‘applied’ and ‘fundamental’ does not quite correspond to my concepts of empirical and conceptual research, but, in so far as he intends fundamental research to mean the study of the psychoanalytic process, and applied research to mean the measurement of efficacy or outcome, I believe there is a need to integrate them with the goal of relating process to outcome in order to ascertain what is specific to psychoanalytic treatment as distinct from other forms of psychotherapy. In any case, he concludes his discussion reiterating his agreement that research is vital for the evolution of psychoanalysis.
But, here his questions begin: he expresses his concern about the aims and methods of psychoanalytic research in so far as, in his view, they raise the risk of ‘renouncing psychoanalysis itself’. Regarding applied research, he agrees with the need to carry out studies designed to evaluate the effectiveness of treatment, but questions how to conduct them. His concern centers on potential errors and false conclusions that may derive from methodologies inspired by ‘evidence-based medicine’, quoting a particularly poorly designed and questionable study carried out by INSERM in France. I agree that bad research is every bit as bad as bad clinical practice!
Regarding applied research, Perron questions the use of randomized controlled studies, given the impossibility of studying ‘homogenous’ patient populations. He believes that it is an illusion that we can measure different degrees of any particular symptom, and that it is not possible to divide patients up randomly into different types of treatment cells. What is neglected, he states, is consideration of indications of specific types of treatment for different patients. Finally, he questions the notion that the sole criterion of improvement might be the reductio