Psychoanalytic Research Today

One is not usually concerned about whether research is “psychoanalytic.” The critical questions are, rather: Does it address an interesting question and is it well done? However, last year Clinical Neuroscience Research, the official journal of the Association for Research in Nervous and Mental Disease, decided to devote two issues to “Research in Psychoanalysis and Psychodynamics.” Steven Roose and I were invited to serve as guest editors, and we set out to select papers considering all three questions: Is it interesting, is it good, and is it psychoanalytic?

The association, founded 84 years ago, is a society of neurologists, psychiatrists, and scholars interested in neuroscience and related fields. It has an annual scientific meeting and, for the last four years, has published its own journal. Most of the topics are decidedly neuroscientific (e.g., “Molecular and Cellular Approaches to the Treatment of Brain Disease,” “Biology of Schizophrenia and Affective Disease,” “The Dementias,” “The Conscious Brain,” “Convulsants and Anti-convulsants from Bench to Bedside”). Clearly our issue was going to be different, but at the same time we wanted to engage our audience, relate to the traditions of the society and the journal, and make certain that the difference that persisted was in relevance to psychoanalysis, not in being interesting or being good.

The issues have just been published (Clinical Neuroscience Research, Vol. 4 Nos. 5-6, May 2005) and we are proud of them. The process was interesting, and sheds some light on contemporary “psychoanalytic” research. We included 11 papers, five by psychoanalysts interested in research, six by other researchers interested in psychoanalysis.

The first two papers are on attachment and separation, their biologic substrate and psychologic phenomena. They discuss infants, rat pups and prairie voles, oxytocin neuroimaging, and home visits designed to enhance parent-infant relationships.

The next four papers address the neurobiologic substrate of behavior, with discussions of stress, psychotherapy, anxiety, depression, and psychoanalytic constructs; and review their relation to endocrine, immune, and functional neuroimaging studies. The authors are primarily neurobiologists talking to analysts rather than the other way around. They attempt to translate their views across disciplinary boundaries, thus, “The physiology of the stress response shares many features that skillful therapists observe in the lives of their patients as they…[avoid] scenarios, which they find almost unendurably painful” (Gold, 2005, p. 323), or “Frontostriatal systems subserve top-down processing in the CNS, thereby contributing to numerous important psychological functions, including the control of impulses and drives that are established within affective systems, and the construction of experience according to preestablished conceptual schemas-processes that likely underlie cognitive distortions, projection, and transference phenomena” (Peterson, 2005, p. 361).

The next set of three papers are by analysts, about analytic treatments, and will be more familiar to analysts, although perhaps more controversial. They represent state of the art discussions of empirical research in psychoanalytic therapies. The first, an “exhaustive review of the psychotherapy outcomes literature,” concludes that while brief psychodynamic psychotherapy appears to be comparable to empirically supported treatments, “no trial has shown it to be superior,” and that existing studies of long-term psychoanalytic psychotherapy “failed to unequivocally demonstrate that psychoanalysis is efficacious relative to either an alternative treatment or an active placebo” (Fonagy, Roth, Higgitt, 2005, p. 373). The second describes one of the most robust randomized clinical trials of a specific psychodynamic treatment (Otto Kernberg's “Transference Focused Psychotherapy for Borderline Personality Disorder”) ever undertaken, and reports preliminary findings (Clarkin, Levy, Schiavi, 2005). The third addresses an important methodologic issue, treatment manuals for long-term psychodynamic psychotherapy and psychoanalysis, arguing that, “Manuals for psychoanalysis are necessary if psychoanalytic outcome research is to meet the methodological standards set by the medical and scientific research communities” (Caligor, 2005, p. 396). Many analysts would respond that if this is true, such research is impossible.

While the first two sets of papers address developmental and neurobiologic concepts fundamental to psychoanalytic theory, and the third addresses problems in studying the efficacy and process of treatment, the fourth and last set of two papers is likely to be of greatest immediate interest to practicing clinicians. They both discuss the relation between psychoanalytic and psychopharmacologic treatments. The first, a study of current practices, reports that more than half of analysts have prescribed medication for an analysand and a third of analysands are taking medication, primarily for mood disorders (Cabaniss DL & Roose SP, 2005). The second, which I discussed in more detail in these pages a few months ago, describes the predictive value of early trauma on the differential response to pharmacotherapy and psychotherapy (Craighead & Nemeroff, 2005).

There were only 11 papers, and none discussed language, family, culture, somatic symptoms, dreams, or any of a number of other subjects that have engaged the interest of psychoanalysts interested in research and researchers interested in psychoanalysis. However, we believe that even this small sample demonstrates that the field is alive and well, although still in its infancy and in need of support and nurturance. One cannot predict what its future will deliver—that is the nature, and the fun, of research. However, based on this evidence one can promise those interested in entering the profession not only currently rewarding clinical experience but also new ideas, new findings, and continued scientific growth.