Prologue: Studying How Psychoanalytic Treatments Work and for Whom

The necessity for psychoanalytic research has been well described, particularly regarding the systematic assessment of outcome for psychoanalytic psychotherapy and psychoanalysis. Increasingly psychoanalytic treatments have demonstrated efficacy in the treatment of various disorders. A previous issue of Psychoanalytic Inquiry (Volume 33, Number 6, 2013: “Manualized psychodynamic psychotherapies: Theory, treatment, and research”) provided a series of psychoanalytic psychotherapeutic treatments that have been manualized and studied, summarizing theory and techniques, a clinical case, and systematic studies. The series of articles demonstrated how operationalizing our concepts and treatments for the purposes of study can provide clarifications of approaches that have sometimes been poorly defined. These various approaches also indicated the value of modifications of psychoanalytic techniques, in part necessitated by short-term treatments targeting symptoms, in part generated by what appeared to work rapidly and effectively.

This issue shifts from examining outcome research on psychoanalytic treatments to assessing how therapy works and for what types of patients or disorders. For this purpose, studies on process variables in psychoanalytic treatments, including moderators (aspects of the patients, syndrome, or therapist) that affect outcome and mediators, or mechanisms of change, are described. Moderators are important in helping to define what treatment approaches work best for particular subgroups of patients or disorders. The mechanisms, or mediators, through which psychotherapy works have long been of interest to psychoanalysts. Determining mechanisms of change can be used to refine approaches to increase clinical effectiveness. As with treatment techniques and outcome, operationalizing possible moderators and mediators for the purposes of measurement and study allows for a clarification of these concepts. For instance, what exactly do we mean when we say the patien