Developments in psychoanalysis in recent years have gone relatively unnoticed by the outside world. If we are to ensure the survival of our discipline, we must revitalize the concept of psychoanalysis as a science. Freud came to psychoanalysis by way of Brück's laboratory, and it remained his ambition to establish the science of psychoanalysis. Early on, he recognized that the neurobiology of the day was not sufficiently developed to enable the integration of his new discoveries with the current biology. Nevertheless, he aspired to develop psychoanalysis as the science of the mind, using a new methodology of his own design. To do so he emphasized the neutral, objective perspective of the analyst and relegated the significance of the personal influence of the analyst to the clinical art of psychoanalysis.
In its first half-century, psychoanalysis developed on the basis of clinical case description, which was the tradition in medical science. Only in the latter half of the last century have some of the methods of bench research become the favored method of scientific reporting, a shift that has contributed to the widening division between clinical art and empirical science.
As Otto Kernberg pointed out in 1986, our educational institutes resemble art academies more than they do universities. Analytic students develop their skills independently through exposure to seasoned clinicians who serve as their analysts, supervisors, teachers, and mentors. They learn how analysis was practiced by other analysts, past and present, and how schools developed around new theories and charismatic analysts. The student analyst develops his or her own unique use of theory and style of technique. Although most analysts have had exposure to empirical science early in their careers, it is the rare exceptions who have such a background as part of their psychoanalytic grounding or thinking. We feel we can differentiate between “good” analysis and “bad” analysis. However, in our current world, such subjective judgments will not convince a skeptical scientific and general public. Empirical research is needed to establish the credibility of our science.
To develop the science of psychoanalysis it will not be sufficient for researchers simply to demonstrate what we already know: that psychoanalysis works. There already is ample systematic evidence for the efficacy of psychoanalysis in aiding many persons for whom it is an appropriate treatment. Before we can convince others of the value of psychoanalysis, we will need to expand our own vision of psychoanalysis to include an objective scientific perspective.
The challenge will come in developing and promulgating a scientific perspective that becomes a part of our professional lives. At present, when we discuss analysis with our colleagues or teach it to our students, we do so as fellow clinicians. We respond to the patient's material and compare our thoughts with those of the analyst. This time-honored approach to clinical material is an extension of clinical technique and has led to many important innovations and discoveries. Our capacity for empathy, while an invaluable tool for certain kinds of study, may impede a more objective approach to fundamental questions. For the purposes of scientific study, we will need to step back from the dyadic relationship and reshape the way we study psychoanalysis to include a more objective perspective. Such a reorientation will be needed in our psychoanalytic organizations as well.
The recent APsaA Task Force on Psychoanalytic Science, which was chaired by Allan Compton, presented a multifaceted report that included a wide range of recommendations for increasing the presence and impact of a scientific perspective within the APsaA. These recommendations were approved unanimously and enthusiastically by both Board and Council in Chicago in May.
About twenty-five years ago, a similar task force, under the chairmanship of Heinz Kohut, presented a comparable report and offered the Council three alternative actions. One was to do nothing; another was to create a division of the APsaA dedicated to science equal to the Board (education) and Council (membership). The Executive Council settled for the intermediate choice: to form a new committee. The resulting Committee on Scientific Activities, in spite of appreciable efforts, has had relatively little impact on the actual functioning of the Association.
Clearly our attitudes toward science in psychoanalysis are ambivalent. If the goals of the Task Force on Psychoanalytic Science are to be realized, we must minimize the impact of our ambivalence. The reasons behind such resistance are several. As mentioned earlier, medical science traditionally developed around the case study method, and only in the last half-century have studies of populations replaced studies of individuals as the basis for scientific innovation. Statistics replaced detailed clinical description, and the study of nuance was replaced by the study of trends and averages. More recently, empirical methods closer in spirit to psychoanalysis itself have been developed and are available for future studies.
As the core mental health disciplines turned more and more to the methods of empirical science, many practitioners who preferred to work with patients as individuals turned to psychoanalysis and moved away from the type of science presented in their earlier training. Indifference toward research is prevalent in our institutes and societies, most of which have distanced themselves from neighboring universities.
One of the strongest resistances to empirical investigation could be labeled a countertransference to research. As we know, analysis has changed dramatically in the past quarter-century. Freud framed his theory of technique in quasi-scientific terms, and for many years a one-person psychology lent itself to such an approach. The participant-observer analyst potentially could be both practitioner and researcher at the same time. Current analytic thinking includes appreciation for the impact of the analyst on the process. Each analyst develops his or her own unique style of analysis, which incorporates unconscious countertransferences that were once considered interfering contaminants. Our technique
reveals more than we recognize about ourselves, and we grow uncomfortable at the prospect of such self-revelation to an outside observer. So long as we can control what we reveal and can explain it to our listeners, we are comfortable reporting to colleagues. Observation by “unempathic scientists” is a more challenging prospect. [See “Science” column, page 14.]
If we can move beyond our ambivalences and resistances, the prospects for the future are exciting. The gap between neurobiology and psychoanalysis perceived by Freud existed for many years, and only in the last quarter-century have the neurosciences achieved the level of sophistication that psychoanalytic psychology has had for many years. Unfortunately, the two disciplines developed along separate and divergent paths.
The time has come to close this gap to attempt to develop what Freud hoped would be a “scientific psychology.” The delineation of the human genome has highlighted the importance and necessity of such an integration. We now have the potential for a biological delineation of the individual, but even the most dedicated geneticists recognize that this is only a part of the explanation for the uniqueness of the individual. Personal experience, including subjective processing and development, constitutes the other half of this equation. Our science has collected enormous amounts of data on the role of intrapsychic experience in the evolution of the person. We need to find ways to convert these findings into a form that would be assimilatable into the discoveries of modern neuroscience.
The Task Force on Psychoanalytic Science has presented us with a plan that will enable us to work to re-establish psychoanalytic science. Science advisors are being added to each of our governing bodies. We plan to incorporate a research perspective into our psychoanalytic educational programs and expect to develop a cadre of psychoanalyst-researchers. As in areas of clinical practice, we plan outreach to neighboring scholarly disciplines and invite researchers to become research associates of the APsaA. We will establish priorities for the APsaA's science initiative and hope to strengthen funding for research efforts. The previous century saw the remarkable progression of psychoanalysis and its integration into mainstream culture. The next century offers the prospects of an even more consequential psychoanalytic-scientific revolution. Our future depends on it.