In no other field of medicine—only in psychoanalysis—are neither students nor researchers able to study systematically the actual therapies given by practitioners. Medical students, interns, and residents in other fields watch the experts treat patients and learn; only in analysis must we rely on anecdotes, vignettes, and narratives, with all their imprecision, vagaries of recollection, and absence of crucial detail.
This issue of unavailability of data is one with which the Committee on Scientific Activities (CSA) has been grappling since 1986, when Hartvig Dahl posed a related problem to the CSA: those few analyses tape recorded for scientific purposes were in danger of disappearing with the passing of the analysts who had recorded them. The treating analysts could not leave recordings to the scientific community at large; they would need a specific organization to assure adequate safekeeping.
In response to the issues raised by Dahl, the CSA began a year-and-a-half of considerations. Having broad experience collecting and presenting taped analytic material for scientific purposes, I began the effort to meet these crucial needs of psychoanalytic research, which culminated three years later in the formation of the Psychoanalytic Research Consortium (PRC). Joining me were George Klumpner, then chairman of the CSA, who had previously published a CSA statement on the ethics of recorded analyses in psychoanalytic research. Donald Burnham, Chairman of the Ethics Committee of The American, and Jerome Biegler, Chairman of the Committee on Confidentiality.
In considering the advantages of forming a consortium, the CSA found four principal ones in addition to the original benefit of protecting psychoanalytic data after the death of the analyst:
A well-administered facility permitting access to recorded psychoanalyses by qualified investigators would encourage scientific work in psychoanalysis, since problems of data collection and dissemination are central hurdles to psychoanalytic investigators.
A central facility would facilitate the comparison of results when different research procedures ware applied to the same clinical data.
Establishing adequate procedures for safeguarding and disseminating data, and the availability of a group skilled in various aspects of this work, would stimulate many aspects of psychoanalytic research.
A central library of research materials would grow each time materials were processed for investigators. Grants to investigators by NIMH and private foundations to obtain materials for research from a central facility would enhance an important part of the infrastructure of research in our field.
Once a consensus was reached in favor of a consortium, the next problem was whether a consortium could be formed within The American. The situation became more urgent when a major analytic investigator with an important collection of tapes developed threatening health problems. With the blessing of the CSA, several members set up a consortium as an autonomous group, with no connection with The American, to facilitate an early establishment of the consortium. The Fund for Psychoanalytic Research funded the legal work necessary for incorporation and the development of adequate safeguards. Eight persons, all with analytic training, who were interested in research joined together to form the Psychoanalytic Research Consortium, which was incorporated as a public charitable organization in April 1989; five were from the CSA. Each member of the Board of Directors of the PRC brought something special to the task. They include Sherwood Waldron Jr., President and Chairman of the Board; Robert Wallerstein, PRC Vice-President; Nancy Miller, PRC Secretary; Alice Brand Bartlett; Robert Galatzer-Levy; Leonard Horwitz; George Klumpner; and Lester Luborsky.
The consortium has devised extensive procedures for preserving confidentiality. They include prooflistening of each tape and review of each transcript for revealing information, which is then deleted. Investigators or educators are provided material that were collected in other cities. Legally binding agreements are made with those granted access to the materials, and the strictest limitations are placed on publication of raw materials. Procedures are also in place for the approval of researchers and their projects and for the development of relevant databases. Erhard Mergenthaler of the Ulm Textbank and Charles Stinson of the Program for the Study of Conscious and Unconscious Mental Processes have been recruited as consultants.
So far, the PRC has received or been promised recordings from more than 30 analyses by 10 different analysts, as well as a fair number of psychotherapies by analysts. Four teams of investigators and two analytic educators are in the process of using materials, for which fees are charged to support the organization.
The use of PRC materials in the education of candidates is an exciting new development that may have great value in promoting the scientific growth of psychoanalysis. As more institutes teach issues in psychoanalysis and psychotherapy by the joint study of raw data, more research efforts may be stimulated and, in turn, encourage the collection of additional analyses by a wider group of analysts than heretofore. One special aspect of the PRC approach that facilitates the work is the provision of tape recordings, with proper names blanked out, to enhance the study of the transcripts and to increase the information gained by the listener.
Problems remain. The vitally important funding to date by the Fund for Psychoanalytic Research has not nearly sufficed to support the administration of this project, and funds from distribution of materials are still minimal. The PRC must collect materials, preserve them, and distribute them, all of which tasks require significant financial support. Efforts are underway to supplement present funds by application to private foundation sources.
The Directors of the PRC remain enthusiastic despite these difficulties. There is a shared feeling that, for new discoveries in analysis, as in any science, we must employ new methods of observation and data collection. The collection of a substantial number of analyses by different analysts and making them available to investigators may constitute a significant new source of data, leading, in turn, to new theoretical development.