Psychoanalytic research: Is clinical material any use?

1. This is a much-revised and written-up version of the Phil Richardson Memorial Lecture given to the Association for Psychoanalytic Psychotherapy in the NHS, March 6, 2009.

Abstract

Practical [limitations of RCT design] include the dilemma that while the RCT may be the only convincing method currently available to investigate causality in the relation between treatment and outcome, nevertheless the recognition of this fact should not lead us to forget that it is also, in many ways, lamentably inadequate to the task (Richardson, 2001, p. 170).

I have argued that the case study, now held in disrepute, is nevertheless necessary to test psychoanalytic hypotheses and, if properly formulated, can indeed test, not merely generate, hypotheses (Edelson, 1986, p. 89).

This paper discusses some of the issues in the current debate about the evidence of the validity of psychoanalytic knowledge. It argues that there is a place for single-case research as potentially as rigorous as other science-like disciplines, provided that the research design is carefully chosen and a prediction is formulated precisely. Research confidence in clinical material, always the empirical basis of evidence in psychoanalysis, has declined. This paper questions what needs to be done, what conditions to apply, in order to rehabilitate clinical material as an important evidence base for psychoanalysis. Public servants with fiscal or risk-management pre-occupations want specific outcomes in terms of changed people. However, outcome studies can tell us little about the details of what interpretations to formulate and how to use them. This paper, like psychoanalytic interventions themselves, may challenge unspoken assumptions.

Keywords:

• science: hermeneutics
• single case research
• binary questions
• subjectivity

Notes

1. This is a much-revised and written-up version of the Phil Richardson Memorial Lecture given to the Association for Psychoanalytic Psychotherapy in the NHS, March 6, 2009.

2. In science in general, a similar distinction is made between ‘pure’ research for the sake of knowledge itself and depends on the innate function of curiosity in human beings, and ‘applied’ research which is about the effectiveness of a technology and how the knowledge can be put to work, satisfying the instrumental aspect of the human mind that seeks to control and use nature.

3. In an early attempt to try out evidenced clinical research my paper on repression and splitting attempted to describe difference between these concepts on a binary basis using clinical material from a single case (Hinshelwood, 2008).

4. In the paradoxical but common occurrence of the analyst being right but a resulting negative therapeutic reaction taking place, then the interpretation cannot be regarded as correct unless it addresses that negative therapeutic reaction, and hence brings it out as a post-interpretive movement towards that reaction to guilt or envy. That, after all, is the paradox.

5. The two kinds of theoretical data arising need more elaboration which unfortunately must be done elsewhere (submitted for review).