Empirically controlled research studies in psychoanalysis, though still yielding modest harvests, are nonetheless increasingly featured in articles, in books, and at psychoanalytic meetings. In light of the present dearth of funds for psychotherapy research in general and psychoanalytic research in particular, the persistence and flowering of such enterprises are indeed auspicious. In this regard, the number and variety of empirically controlled psychoanalytically informed investigations conducted over the last two decades in the San Francisco Bay Area have led some to regard it as a Mecca for psychoanalytic research.
Several research group enterprises are currently operating in the area, each directed by and involving members of the San Francisco Psychoanalytic Institute, in addition to a number of solo projects. Interestingly, one out of six of the Institute's graduate analysts—and the same ratio exists among candidates—has participated in such research (defined here as empirical study that rests on the use of controls in the testing of psychoanalytic hypotheses). The high proportion of local analysts actively engaged in these endeavors may be accounted for by the good fortune that the Bay Area attracts and retains psychoanalytic researchers, and by the cross-fertilization afforded them by the teaching and research environments at Departments of Psychiatry or Psychology at UC Berkeley, UC San Francisco, Stanford, and Mount Zion Hospital.
These universities and institutions have also been a significant source of candidates for psychoanalytic training at the San Francisco Psychoanalytic Institute, which itself actively fosters an atmosphere conducive to empirically controlled psychoanalytic research. The required curriculum for the past five years, for instance, has included a seminar in the validation of psychoanalytic propositions (focused both on the philosophy of psychoanalytic science controversy and on controlled empirical research in psychoanalysis). Outside of the curriculum, the Institute's Research Committee sponsors a biennial scientific meeting for the entire Society, in which some area of nonlocal psychoanalytic research is summarized and evaluated. San Francisco's is one of the few psychoanalytic institutes to offer grants earmarked for research conducted by its members or candidates. The Emanuel Windholz Memorial Fund for Psychoanalytic Research and Clinic, which endows the program, offers grants of ten to twelve thousand dollars every other year.
Currently under way in the Bay Area are the following research' programs:
Calvin Settlage, M.D. leads the Child Development Research Group of the SFPI, the other members of which are Joseph Afterman, M.D., Sandra Bemesderfer, Ph.D., Shahla Chehrazi, M.D., Kent Hart, M.D., Kristin Nelson, Ph.D., Daniel Silver, B.A., Philip Spielman, M.D., and Jane Welker, M.A. A Seattle-based research group affiliated with the San Francisco group is directed by Dr. Joseph Okimoto, a candidate in the Seattle Institute for Psychoanalysis. The San Francisco group has completed a study of mother-child interaction in the second year of life which delineates the appeal cycle phenomenon, and is currently investigating the regulation of aggression in mother-child and father-child interactions. The Seattle group engages in studies parallel to these, but in an Asian-American population. Using operationalized concepts from the rapprochement subphase, these workers seek to elucidate features of development, in particular the appeal cycle, a normal repetitive pattern that bears on the interventive promotion of mental health. The study of regulation of aggression may shed light on early development and pathogenesis. Through an analogy with the analysand-analyst relationship, the research findings have implications for psychoanalytic treatment.
Georgine Marrott, Ph.D., based at the Psychology Department at UC Berkeley, is conducting an empirical study of the “good hour.” Ten analysts, each having chosen a recent “good hour” and a recent “bad” one from an analytic case, identify the most to least descriptive features, based on process notes, by use of the Psychotherapy Process Q-Sort (a rigorous, wide array of behaviors in treatment formulated at Berkeley by Enrico Jones). Analysis of these Q-Sort descriptions will permit determination of the degree of consensus among analysts as to what a “good” or “bad” hour is like in fact (in contrast to normative theoretical notions of what they should be like). The data will also determine whether there is greater agreement on the features of a “good” hour than on those of a “bad” one.
Charles Marmar, M.D., and his colleague, Daniel Weiss, Ph.D., are conducting several studies within the Post-Traumatic Stress Disorders Program at the San Francisco Veterans Administration Medical Center (UCSF). They have developed, using audio/videotaped sessions of short-term therapies, a reliable measure of therapeutic alliance, as evaluated by patients, therapists, and clinical judges, which is shown to predict therapeutic outcome. This measure is readily applicable to a study of the phases of psychoanalytic process. Their findings show a relation between preexisting personality and individual responses to traumatic stress. For example, individuals who use dissociative defenses are more vulnerable than others to the development of severe and chronic post-traumatic symptoms.
Enrico Jones, Ph.D., directs the Berkeley Psychotherapy Research Project in the Psychotherapy Clinic of the Psychology Department at UC Berkeley. Other SFPI contributors to these studies include Georgine Marrott, Ph.D., and Michael Windholz, Ph.D. This research investigates the nature of process in psychoanalysis and psychoanalytic psychotherapy through the study of single cases. Audio/video-recorded treatments are subjected to intensive study in order to describe and trace the evolution of the process in a longitudinal frame. It attempts to verify some of the postulates of clinical psychoanalytic theory. Another aspect is the development of outcome measures that move beyond assessing symptom improvement toward what might be termed change in psychological structure.
Mardi J. Horowitz, M.D., directs the Program on Conscious and Unconscious Mental Processes of the John D. and Catherine T. MacArthur Foundation at UC San Francisco in the Department of Psychiatry in Langley Porter Psychiatric Institute. Other psychoanalyst members include Norman Mages, M.D., Alan Skolnikoff, M.D., and Michael Windholz, Ph.D. The program has task forces of scientists at other sites, the most psychoanalytically represented one being that on control and defense, which includes George Vaillant, M.D., Michael Bond, M.D., Stephen Cooper, Ph.D., Christopher Perry, M.D., and Bram Fridhandler, Ph.D. The research concerns, person schemas, role-relationship models, control processes, and states of mind organized by person schemas that shift from one to another through active control processes that may accomplish defensive aims. The program has led to new methods for handling intensive single-case studies, showing, for example, how persons of different personality characteristics undergo such life events as bereavement or traumatic experience.
Joseph Weiss, M.D., and Harold Sampson, Ph.D., direct the San Francisco Psychotherapy Group, consisting of about 100 mental health workers. Its office is in the San Francisco Psychoanalytic Institute. They study the therapeutic process in psychotherapy and psychoanalysis, with fifteen projects currently under way. The findings concern unconscious mental functioning, psychopathology, and the process of therapy, and support the hypothesis
that the patient exerts control unconsciously over his repressions and lifts them when he unconsciously decides he may do so. The research also supports the hypothesis that the patient suffers from pathogenic beliefs and works throughout the therapy in accordance with an unconscious plan to disprove them. The research shows it is possible to predict the outcome of brief psychotherapy by calculating the ratio of pro-plan to anti-plan interpretations.
Robert Wallerstein, M.D., is principal investigator of a “Reliability Study for Scales of Psychological Capacities” at UC San Francisco in the Department of Psychiatry in Langley Porter Psychiatric Institute; four research psychologists—Kathryn DeWitt, Ph.D., Saul Rosenberg, Ph.D., Daniel Weiss, Ph.D., and Nathan Zilberg, Ph.D.—collaborate. In an attempt to deal with the problem of assessing structural change, they have spent several years developing elaborate, relatively “theory-free” scales of human psychological capacities they conceptualize as likely crucial to the study of psychic change in psychodynamic treatment, in a way that would allow, for instance, a comparison of outcomes by competing psychoanalytic paradigms. Their next phase will be the actual determination of the reliabilities of these scales using verbatim treatment transcripts.
Joseph Caston, M.D., has previously worked with the Weiss-Sampson research group, where he designed studies to test classical psychoanalytic and control-mastery hypotheses regarding the immediate effect of psychoanalytic interventions; he also developed a methodology to test for consensus (reliability) in complex psychoanalytic formulations, albeit with control mastery formats. In a study entitled “Can Analysts Agree? The Problems of Consensus and the Psychoanalytic Mannequin,” he recently applied this method to measuring the reliability of classical psychoanalytic formulations, using verbatim analytic transcripts; he demonstrated significant, highly correlated agreement between analysts on judgments of conflictedness, transference, defense-impulse configurations, wishes, and genetic-historical linkages. Noting that achievement of clinical consensus does not rule out the possibility that agreement might spuriously result from clinicians' stereotypical notions about cases (“psychoanalytic mannequins”), Caston devised a complex, rigorous method to test whether judgments about the particular clinical text overrides that bias. He found that in most domains of psychoanalytic formulation, with the exception of transferences, analysts do surpass stereotypical assumptions about the patient's dynamics, a finding epistemically crucial for psychoanalysis as a science.