It seems early in my career to trace its trajectory, but if the reader can excuse the audacity I'd like to trace just such a course in order to provide some comments on the role of the researcher/analyst.
After completing my clinical psychology internship at Columbia Presbyterian Medical Center and graduating from the University of Massachusetts at Amherst, I saw an advertisement in the APA Monitor for a postdoctoral research position at the Glass Institute for Basic Psychoanalytic Research. The Glass Institute, only a few months in existence when I joined, provided a rare, if not unique opportunity to conduct psychoanalytic process research. Its stated mission was to “develop a scientific basis for evaluation of contemporary psychoanalytic treatment and for improvement of treatment methods; and to rebuild the interface between psychoanalysis and social policy”. The Institute pursued these ambitious goals with an intense sense of purpose driven by its founder Leslie Glass and by its scientific directors, Wilma Bucci and Richard C. Friedman. Several projects captured this mission: one was a conference I initiated aimed at discussing the relevance of psychoanalytic principles in addressing the problems of disenfranchised populations; another project involved the development of a multi-systemic, psychoanalytically-based approach for treating violent adolescents.
The Glass Institute quickly grew to fund doctoral students from a variety of academic institutions around New York City. The level of intellectual discourse at the meetings led by Dr. Bucci was no less than exhilarating. At these roundtable discussions, advanced students from psychology doctoral programs around the city and abroad (Italy, Canada and Argentina) would discuss a wide range of theoretical issues and make presentations on a diverse set of ongoing research projects. Glass expanded its mission to attract researchers to psychoanalytic training by creating research fellowships at major psychoanalytic institutes. It was with the first of these fellowships that I joined investigators at the Bernard L. Pacella Parent Child Center of the New York Psychoanalytic Institute to systematically study their parent/child groups, and to test a number of formal hypotheses that had grown out of several years of careful direct observation.
My ongoing research and analytic training have opened many doors leading to a career path that includes an academic position, a psychoanalytically based private practice, and a role as principle investigator in a collaborative study being conducted at the Pacella Parent Child Center, where a group of investigators and I are studying the relationship between the mothers' capacity for symbolization and the child's development of symbolic functioning. I believe that it is this type of research — in essence, longitudinal case studies, in contrast to research focusing on aggregate data collected on a large number of subjects — that yields the most meaningful and interesting findings.
Part of what complicates the dual role of analyst and researcher is the economic climate affecting these fields and placing them in what is, perhaps, unnecessary conflict with each other. Managed care companies have a large stake in this dilemma. In effect, outcome research has been elevated to the status of the final arbitrator of truth about the utility of our theories and treatments. Nevertheless, a growing number of investigators have come to accept, in some cases with disillusionment, the limitations and incompatibility of outcome research as a means for studying and developing the psychoanalytic method.
By now it is a widely accepted conclusion that outcome research can no more confirm or disconfirm the effectiveness of psychoanalysis than it can the effectiveness of any other type of mental health treatment, including medication (with the possible exception of anti-psychotics). This is true not simply because of the changing nature of the manifestations of intrapsychic conflict, but also because in the pursuit of evidence-based treatments, outcome studies end up providing evidence for research-based treatment and have little to say about how psychoanalysis is actually practiced. It is important to recognize that the most important challenges to, and modifications of, psychoanalysis have never come from outcome studies. They have fittingly come from the exposition and intensive study of the single-case design. The case study has been the vehicle par excellence for discovery, for the generation of hypotheses and conjectures, and for the assessment of the usefulness of interpretations and other interventions over time.
Photo by Sebastian Zimmerman
This is not to say that psychoanalysis can or should remain secluded from psychotherapy research. Rather, an important distinction needs to be made between outcome research and process research. Process research, with its focus on the context of the analytic relationship between patient and analyst, and with its attention to subtle changes over time during the course of a treatment captures something of the analytic process that outcome measures cannot. Process research contributes to the endeavor of discovery that has traditionally inspired both clinician and researcher. It is in the study of the single case through the application of process research methods that the researcher and analyst find common ground that does justice to each discipline, allowing for important developments in both fields.
For several years, I have been interested in the study of referential activity, a construct developed by Wilma Bucci as part of her multiple code theory that describes how, through narratives, a person links different systems used to process and respresent information, including emotions. My growing understanding of referential activity through my ongoing collaboration with Dr. Bucci has influenced
Christopher Christian, Ph.D. is a candidate at the New York Psychoanalytic Institute. He is Assistant Professor of Psychology in the Clinical Doctoral Program of Long Island University, Brooklyn Campus. He has a private practice in New York City. Email: .
my clinical work by allowing me to more readily detect subtle changes in the narratives of my patients. My clinical training, in turn, has helped me appreciate the role that anxiety and defense play in effecting the variations detected by the research methods that we use. Taken together, this cross-paradigm exchange has afforded me a deeper understanding of the clinical process and led to richer discussions about mental functioning and how psychoanalysis works.
There have been significant shifts in our conceptions of research, best understood as a particular paradigm with its own rhetorical and persuasive discourse, goals, and agendas. I have come to recognize the immense value of a cross-paradigm exchange between research and clinical work, remaining, all the while, aware that neither epistemology has the cornerstone on truth. Both broaden my understanding of patients and the work I do with them.