Four Domains of Experience in the Therapeutic Discourse

Clinical observation, based on the psychoanalytic method and recorded in case reports, has been the traditional mode of psychoanalytic research and has constituted the major knowledge base for development of psychoanalytic theory and technique. The unique potential of the psychoanalytic method as a source of data concerning emotional experience and communication has not, however, been adequately realized using this approach. The case report provides direct information concerning that component of the analyst's experience that is within awareness and able to be formulated, but cannot provide access to the analyst's unconscious experience, or the patient's subjective experience, either conscious or unconscious. New multi-perspective process research designs have been developed that incorporate the subjective experience of the analyst along with evaluation by consulting clinicians and application of objective measures. The new designs enable inference to the inner experience of both participants, including experience of which they may be unaware, and provide a basis for verification of observations. Epistemological and professional aspects of the traditional case report and new multi-perspective designs are compared, and the unacknowledged therapeutic impact of the analyst's traditional dual role as participant and observing instrument is discussed.