An APsaA research summit took place in Boston on Sunday, July 26, 2015, immediately following the IPA Congress. Its purpose was to sharpen and reinvigorate APsaA's support for research. The time and place allowed for a diverse group of expert researchers in attendance and a head start on formulating recommendations for APsaA's effective reengagement with the scientific aspect of its mission.
The meeting was proposed by Andrew Gerber, head of the Science Department, and I was the moderator. There were 42 participants, including APsaA researchers; non-APsaA researchers from the U.S., Argentina, Belgium, Canada, France, Germany and Italy; and non-researcher members of APsaA who are committed to supporting analytic research. Three APsaA past-presidents, the current president and president-elect and the executive director were present. Also present were the president-elect and two past presidents of the Society for Psychotherapy Research. This combination of scientists and administrative leaders set the stage for serious and productive consideration of what it will take to ensure APsaA's enduring attention to science and its successful support of research.
Three APsaA researchers began the meeting by addressing prominent areas of analytic research—outcome, process and conceptual research. Barbara Milrod, an analyst investigator whose work has had major support from the National Institute of Mental Health, spoke about outcome research and the importance in the modern scientific world of randomized controlled trials (RCTs). She implored the group to recognize there is a crisis facing psychoanalytic and psychodynamic treatments in the U.S. because there is insufficient evidence regarding efficacy and little public domain support for psychosocial interventions other than cognitive behavioral therapy. She showed data regarding the concomitant lack of interest in research on the part of analytic clinicians.
Her data and comments set the stage for an important discussion of the disengagement of the analytic community from analytic research.
Sherwood Waldron presented on the topic of process research. Unlike RCTs that investigate effectiveness of interventions on a large scale, process research focuses on the interactions between two people in order to identify essential dimensions of mind and possible mechanisms of change. Insofar as process research is based on video- and audiotaped transcripts of treatment sessions, the method provides an educational tool as well as a research tool.
Waldron's comments set the stage for an important discussion of the need for education about analytic research in candidate training and in the larger analytic and health care communities.
Bob Galatzer-Levy spoke about conceptual research. He defined research broadly as any activity that is directed toward developing knowledge and uses a methodology that is spelled out and can be critiqued. He argued for the value of a research agenda that includes research on psychoanalytic theory, child development, application of analytic thinking to community needs and social policy, and the use of psychoanalysis in the humanities and social sciences. He too urged the group to recognize the crisis APsaA and the profession of psychoanalysis face because of relative inattention to analytic research. He referenced past attempts to find political solutions to professional problems, including APsaA's support for research, and implored the group to contribute to a rational, thoughtful approach to an enduring research program within APsaA.
In highlighting APsaA's inconsistent attention to research and the fact it has been tied to inspiring individuals rather than a shared sense of mission within the membership, he set the stage for an important consideration of the tension between organizational and scientific aims and the challenge inherent in bridging the gap between them.
There were strong differences of opinion among attendees regarding what would be most important for APsaA to support: large randomized controlled studies; small pilot projects (including those of early career researchers who can use their data to develop their research interests further); outcome/process/conceptual research; and psychoanalytic or psychodynamic therapy research. The possibility of defining a common project, perhaps in the form of supporting one large study, was discussed but a pluralist approach seemed most persuasive.
There was complete agreement that the first step APsaA needs to take is to reactivate the Fund for Psychoanalytic Research. This agreement reflected a theme regarding the importance of fundraising and potential methods of achieving it.
Charles Fisher, the new chair of the Fund for Psychoanalytic Research, made clear his intent to restart the Fund as soon as possible.
Harriet Wolfe, M.D., is president-elect of APsaA.
It has been dormant for over a year. He described his plan to establish a multiple portal structure for the Fund. This approach will invite proposals for outcome, process and conceptual research projects. (For this purpose “conceptual research” designates all research that does not specifically investigate process and/or outcome.) Projects of similar nature will be compared with each other in a review process conducted by research experts in that area who are experienced in scientific review.
APsaA currently budgets a relatively small amount of money for research. It is certainly not enough to support large-scale studies. Regardless of the specific research direction chosen, substantial outside funding will be needed.
Two actions will greatly increase the likelihood of improved funding:
The demonstration of a commitment to research on the part of APsaA members. If a high percentage of members donate to research, even if the dollar amounts are low, potential donors can feel confident that the experts (analysts themselves) think research is important.
The mounting of a vigorous development campaign to seek outside funds for research.
There are several important tensions between organizational aims and scientific aims that require continued discussion.
The researchers present disagreed about the relative value of investigating psychodynamic psychotherapy (PDP) process and outcome as opposed to psychoanalytic process and outcome. Those in favor of focusing on psychoanalysis proper argued research on psychoanalysis is limited and it is an appropriate focus for a specifically psychoanalytic organization. Others felt PDP is sufficiently similar to psychoanalysis that advances in knowledge about it are likely to benefit psychoanalysis proper.
Those in favor of increased attention to PDP research were alert to the societal impact of the scientific results obtained. They emphasized that APsaA needs to join the public discussion of the Institute of Medicine (IOM) report released in July 2015, titled “Psychosocial Interventions for Mental and Substance Use Disorders: A Framework for Establishing Evidence-Based Standards.”
The report emphasizes the need to support research that strengthens the evidence base for the efficacy of psychosocial interventions in mental health and substance abuse treatment and to define the key elements that account for an intervention's effect. The clinical guidelines and outcome measures that result from further IOM discussions will inform approaches to reimbursement and to application of the Affordable Care Act. In connection with these public policy directions, it is important to study ways of making analytic approaches to patient care broadly accessible.
Finally, without continued support for PDP research, the chances of PDP being funded by insurance companies and acknowledged as vital by health care planners will diminish and perhaps disappear.
How can APsaA make research an ongoing, vital aspect of its mission? Past support has been intermittent and often tied to passionate, effective individuals. When their participation is lost, interest in research wanes again. While it is difficult to imagine psychoanalysts would not support advances in knowledge made through use of careful methodologies, it appears many analysts are actually ambivalent about research.
I want to suggest we need to pay careful attention to both scientific aims and organizational aims as we go forward and be mindful of their interaction. Scientific aims are necessarily free of bias regarding research results if true advances in knowledge are to be obtained. Some analysts may be ambivalent about analytic research because it could demonstrate the elements they believe to be most important are not. There may indeed be other elements that are responsible for outcome. And outcome can be discovered to be poor as well as good.
Advances in science require funded research. This may be where things start to get murky. How can our members be expected to give annually to research if they feel ambivalent about it or have no idea what sort of research is being done and why? How can outside donors be recruited to augment our budget for research if we ourselves demonstrate a lukewarm attitude to research?
I believe there are a few organizational interventions that can substantially move things along. First the Science Department needs some administrative help in order to keep the APsaA membership informed about current projects and research results; to provide information about grants and projects to the Committee on Public Information so the public is informed of research results and priorities; to create materials and organize appointments for fundraising; to maintain communications within the broad research
community, including IPA colleagues, that may promote research collaborations; to help APsaA's director of public affairs with social media and press contacts regarding research; and to assist the chair and members of the Fund for Psychoanalytic Research in accomplishing their work. In addition to its other functions, this type of administrative support would help educate APsaA members about the exciting and even discouraging aspects of their research colleagues' search for knowledge.
A more fundamental approach to educating analysts about the value of research would be to develop required research curricula for analytic training utilizing approaches that are designed to grab the interest of clinicians and demonstrate the relevance of research to analytic practice. These would be approaches to analytic practice and thinking based on evidence, not on authority or historical wisdom. For some this would mean a shift in paradigm.
As a professional membership organization, APsaA has not been able to welcome analytic researchers who are not clinicians as full members. Analytic researchers have participated in allied organizations, such as the Psychodynamic Psychoanalytic Research Society (PPRS), that offer diverse communities of experts but sit outside of APsaA and maintain a distance between APsaA and the knowledge it could better support and use. I suggest that APsaA's Board of Directors consider proposing a new membership category called research scientist in order to include non-clinical analytic researchers with demonstrated expertise and scholarship in psychoanalytic/psychodynamic research as full members in APsaA.
APsaA's Science Department will be undergoing changes that will benefit the intellectual and practical lives of APsaA members and enhance the knowledge needed to serve patients optimally. We are recruiting a new head of the Science Department, as Andrew Gerber must focus on leading Austen Riggs. Stay tuned for updates on department leadership, scientists' advice on research priorities, the work of the Fund, and steps toward significant fundraising for research. I look forward to the promotion of deeper psychoanalytic knowledge and better psychoanalytic treatment through our Association's support of research. I hope all members will contribute, according to their abilities, to the Fund.