How does research enter the psychoanalytic consulting room? For many analysts, keeping abreast of psychoanalytic research takes a back seat when days are already full with clinical work, supervision, and teaching. For others, the findings from outcome studies or empirical investigations of psychopathology and treatment process can seem vaguely beside the point. Some may quietly doubt whether it is even possible to capture the subtlety of the clinical exchange in the language of significance levels and randomized controls. Too often, as a result, the important work done by our research colleagues (most of whom are also clinicians) remains just outside the consulting room door.
For the last eight years, the IPA has mounted an effort, through its highly successful Research Training Program (RTP), to change hearts and minds by making psychoanalytic research more accessible to analysts who wish to pursue research as part of their professional careers.
Open to analysts, candidates, and researchers from allied fields, the RTP is a ten-day series of lectures and research workshops dedicated to helping new and continuing researchers improve their research skills and develop programs of psychoanalytic research. These analysts and academics from other disciplines have, in turn, gone back to their institutes, societies, and universities with a profound appreciation for the role that research may play in the working life of a clinical analyst.
During the summer of 2000 I had the opportunity to attend the RTP. The faculty and fellows (as the RTP attendees are called) are drawn from psychoanalytic communities worldwide. The 2000 faculty included some of the best and brightest in psychoanalytic research: Peter Fonagy (who coordinates the program), Sid Blatt, John Clarkin, Rainer Krause, Joy Osofsky and Mary Target. (In years past, Wilma Bucci, Robert Emde, Stuart Hauser, Peter Hobson, Enrico Jones, Horst Kaechele, Otto Kernberg, Erhard Mergenthaler, and Adolf Meyer have also been on the RTP faculty.) My “fellow fellows” came from the Netherlands, Sweden, Russia, Argentina, Greece, Finland, Germany, Belgium, Italy, Canada, and the United States. There were twenty-one of us in the 2000 program.
The RTP was one of the most useful conferences I've ever attended. From the start, the emphasis was on active engagement and collaboration. No one was permitted to remain a wallflower or passive spectator. In advance of the meeting, each of us was asked to submit a description of a research study, problem, or idea that intrigued us, and each fellow was assigned a research mentor from among the faculty. The centerpiece of each day was the individual research presentations by faculty and fellows; these were followed by a discussion of the aims, methods, or findings in the study presented.
As someone who is now mainly a clinician and a teacher (I had done some psychotherapy research as a postdoctoral fellow), I was happy to be at the RTP to explore resuming a research program once again. What surprised me was how the RTP further opened the window on the issues working analysts confront every day. The program highlighted my interest in how we transmit psychoanalytic knowledge. How do we determine what is effective in psychoanalytic treatment? What happens when our clinical experience with patients tells one story about therapeutic action and our theory tells another?
While each analyst must chart a course for himself or herself through difficult and contradictory technical and theoretical waters, the RTP convinced me that no analyst has to go it alone and that there are many ways to find good company in the service of advancing psychoanalysis. For me, one moment from the 2000 RTP stands out in particular.
Rainer Krause (RTP faculty from the University of the Saarland in Germany) presented his study “The Nature of the Therapeutic Process: The Significance of Unconscious Interaction Regulation.” The data from Krause's project included frame-by-frame observations of facial expressions in videotaped psychotherapy sessions, enabling researchers to code subtle shifts in affect, both in the individual participants and across the dyad.
The results indicate that people reliably diagnosed with a psychiatric illness show fewer facial expressions and less muscular activity than controls. However, when the psychiatric subjects engage in interactive dialogue with controls, the healthy subjects adapt, downgrading their affects to match that of their partners. Krause and his colleagues found a similar pattern of close affective
Kimberlyn Leary, Ph.D., is associate director of the University of Michigan Psychological Clinic and a senior researcher in the Program on Negotiation at Harvard Law School.
attunement in their videotaped samples of patients and therapists in face-to-face therapy. The longer the therapy went on, the more patient and therapist coordinated their affects.
Surprisingly, their results also suggest that high levels of affective matching were associated with poor outcome. For Krause and his colleagues, this result suggests that affective attunement is not sufficient for therapeutic change. In effective treatments, the therapist must do something with her patient's affects. Consequently, the real work of treatment takes place in how patient and therapist negotiate the gap between them.
Krause's presentation provoked energetic response from the RTP floor. The questions ranged from whether these results would generalize to analyses on the couch to the methodology of the study itself.
From my perspective, whether Krause's data can be extended to psychoanalysis proper is but one of the relevant questions. For me, his research is most important because it helps us to frame useful psychoanalytic problems. Krause's results give us what Sherry Turkle calls an “object to think with.”
Krause's research resonates with many of the debates in the contemporary literature. It highlights the need to study the myriad ways that analysts intervene “to do something” with their patients affects, even as it gives rise to new questions. Should we assume that all effective analysts do roughly the same thing? From the clinical reports in our journals and at our meetings, we know the answer is not necessarily yes. The range of clinical vignettes in the literature show that among analysts there are not only many routes to Rome but also some disagreement as to whether Rome is even the best destination. We must look at the different ways that analysts work effectively and the different goals that organize analytic work. When the individual case vignette (the staple of psychoanalytic education) is supplemented by aggregate data of the sort that is collected by researchers, we are able to ask new and different questions. This is science at its best.
Although the RTP provides a venue for researchers to hone their skills, its broader mandate includes building bridges between clinical analysts and analytic researchers. Psychoanalytic research should not be thought of as a “separate track” available for those with specialized interests. It should instead be seen as another lens through which we can view psychoanalytic questions. If we all have a stake in these questions, then we all have a stake in psychoanalytic research.