Four Domains of Experience in the Therapeutic Discourse

Abstract

Clinical observation, based on the psychoanalytic method and recorded in case reports, has been the traditional mode of psychoanalytic research and has constituted the major knowledge base for development of psychoanalytic theory and technique. The unique potential of the psychoanalytic method as a source of data concerning emotional experience and communication has not, however, been adequately realized using this approach. The case report provides direct information concerning that component of the analyst's experience that is within awareness and able to be formulated, but cannot provide access to the analyst's unconscious experience, or the patient's subjective experience, either conscious or unconscious. New multiperspective process research designs have been developed that incorporate the subjective experience of the analyst along with evaluation by consulting clinicians and application of objective measures. The new designs enable inference to the inner experience of both participants, including experience of which they may be unaware, and provide a basis for verification of observations. Epistemological and professional aspects of the traditional case report and new multi-perspective designs are compared, and the unacknowledged therapeutic impact of the analyst's traditional dual role as participant and observing instrument is discussed.

Notes

¹Heisenberg, W. The Uncertainty Principle. Published in Newman, J. R. (Ed.). 1956, Vol. 2, pp. 1051–1055.

²Since this paper was accepted for publication in 2004, we have begun several new projects that involve application of computerized language measures to analyst's process notes, including notes by candidates at the New York Psychoanalytic Institute, for treatments independently evaluated as successful and unsuccessful. We are aware of the limitations of using treatment notes to provide information concerning the therapeutic process; our goal is to make inference to the analyst's experience, including experience of which he or she may not be aware, rather than inference to the process itself. This approach contrasts with the traditional method of the case report by using notes before they are filtered through the selection and revision process required in composing a report for publication, and by applying linguistic measures developed in a specific theoretical framework, rather than relying on formulated reports. This approach also has clinical value in supervision, as in the Buenos Aires study; we can even foresee a time when the supervisee will type process notes directly into a format that will allow the computerized linguistic measures to be automatically generated and available for ongoing supervision.