Prologue

This is an Exciting and Daunting Time to be a Psychoanalyst. Our discipline has been evolving clinically and theoretically for over 100 years. Clinical treatment techniques are rich, and are ever being refined and debated by scholars within our field. From the perspective of the editors and authors of this volume, a more important debate is also beginning on how to assess the efficacy of our treatments. As psychoanalytic clinicians, we believe that we can see our patients benefit enormously from our concentrated work and intensive focus on unconscious aspects of mental life. Nonetheless, many clinicians, particularly in the skeptical psychiatric and medical community in which we exist, aver that these benefits have not been adequately demonstrated or “proved”; they are the products of our own subjective evaluation, with its great potential for distortion. Proponents of the need for more systematic evaluation of treatments do not accept our word and our clinical reports as an indication that this form of therapy will necessarily be best for any given patient with any given problem. Nor should they. Psychoanalysts have countered that efforts to assess clinical effectiveness more systematically distort the treatment process. Although this may in fact be partly true, it is not at all clear that the core elements of psychoanalysis would be lost in efforts to systematize and critically assess how we handle patients.

In this era of evidence-based medicine, our complex, rich treatment is becoming marginalized, not because of lack of effectiveness, but rather because the tools with which to study the effects of our complex work have not been adequately developed by our field, and studies have not been pursued in a serious, systematic, academic, and concerted manner. Some psychoanalysts have argued that psychoanalysis should remain separate from current medicine and psychiatry, particularly if being a part of this group requires any distortion of psychoanalytic treatment or va