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Once upon a time, in 1957, psychoanalyst Franz Alexander conceived the idea of using controlled naturalistic observation of psychoanalytic cases as a means of increasing our understanding of the psychotherapeutic process. Funding was obtained and the study begun.
The first year was spent developing an appropriate methodology. Cases were to be treated by Alexander, the principal investigator on the project. The therapist and members of an observational team were independently to fill out worksheets immediately following each session. The worksheet included seven major subsections—“Observer as person,” “Free style chronological dynamic account of the hour,” “Events of the hour,” Interventions,” “Therapist as a person,” “Intrapersonal processes,” “Shifts and changes”—several of which had a number of subsections. Technical jargon was to be avoided; personal information on the feelings and attitude of the observers was to be recorded. Session transcripts and observer notes were time coordinated. For a while, the patient's galvanic skin response was recorded, and a keyboard was developed for the therapist to record his instantaneous reactions. The keyboard was soon discarded, however, as it was discovered that it interfered with the therapist's ability to concentrate on the patient. A coordinator took the various data and spent several days per session integrating them into a coherent description of what happened. The observer team and coordinator then met and reached a consensus as to what had occurred during a block of treatment.
After the year of methodological refinement, two patients were seen. One was a 35-year-old married psychologist with two sons whose chief complaints were anxiety headaches and recurrent impotence.