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The reason that I am “arguing with the angels,” as Owen puts it, is that the angels need the help. The tendency in psychoanalysis to argue from theory and received wisdom rather than empirical observation and actual patient-specific outcomes has always been our field's Achilles heel, generating a host of so-called principles of technique that have led us to assume unnatural roles and treat patients in bizarre ways (e.g., analytic abstinence). The more bizarre we appear to be, the more we claim a special knowledge that justifies setting us apart from other helping professions. We cannot demonstrate that we actually help anybody better than nonanalytic practitioners do, so we act as if that shouldn't matter because our theory is deeper, more subtle, and more complex than that of those other folks. The more we are ridiculed by a popular culture preoccupied with quick-fix cures, the more we comfort ourselves with the notion that “they” don't appreciate the power of the unconscious like we do.
It is in this context that I examined the postmodern critique of positivism and empiricism in psychoanalysis. What I found was old wine in new wine skins. There is, on one hand, a new appreciation of the ways that the analyst's participation, both theoretical and personal, affects the clinical field. On the other hand, the critique of positivism tends to mystify how analysts understand their patients. By turning the process of intersubjective empathy, inference, and understanding into an almost infinitely complex endeavor, enshrouded in ambiguity and uncertainty, postmodern epistemology distracts us from developing clinical methodologies that use observable patient-specific data as guideposts to improve our understanding and therapeutic efficacy. In this sense, the postmodernists perpetuate the tendency to neglect therapeutic aims in psychoanalysis (Bader, 1994).