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Abstract
The author of this paper discusses three different research traditions in the psychoanalytic field, arguing that all of these are necessary to its growth and development. The traditions are those of empirical scientific study into the outcomes of psychoanalytic treatment, the development of psychoanalytic theory and technique within the clinical consulting room, and explorations on the boundaries between psychoanalysis and many neighbouring disciplines. On the first of these depends the legitimacy of psychoanalytic practice in public health settings, on the second the continued advance of fundamental knowledge within psychoanalysis, and on the third the broader influence of psychoanalytic ideas within the broader culture. It is argued that psychoanalytic institutions need to give more attention to all of these, and to develop a more active relationship to academic methods of enquiry.
Notes
1. This paper is a revised version of the paper originally given as the Annual Research Lecture of the British Psychoanalytical Society on 17 March 2010.
2. The more encouraging news, however, is that the range of psychological therapies receiving support in this programme is now being widened to include a psychodynamic approach, to be delivered in a manualized form.
3. Some recent developments in psychoanalytic thinking – towards relational and social constructivist approaches – in the USA may reflect a shift in its primary locus of activity from the milieu of ‘the clinic’ to that of the university (Rustin, Citation2006a).
4. Such dismissals usually overlook the empiricism (of a particular kind) of the British psychoanalytical tradition, with its distinctive attention to detailed clinical evidence.
5. One should note that research as it is now defined in the university system, and within its arrangements for governmental funding, is an inclusive term, referring to the development of knowledge in all recognized academic disciplines, the arts and humanities as well as the sciences.
6. It is rather likely, I believe, that psychoanalytic practice with children does achieve significantly better outcomes that the psychoanalytic treatment of adults, the reason being that many child patients still have the committed support and care of parents or parental figures, and of teachers and other adults available to them and have not yet suffered major failures in important parts of their life-courses. Whereas, some adult patients will have already endured a lengthy history of unavailing struggles with difficulties in their personalities or early formation, may have seen the irrevocable failure of important relationships, and perhaps a loss of opportunities to work in satisfying ways. Adult psychoanalysis may more often be unavoidably a work of painful recovery and recuperation, which cannot always make full reparation for losses already experienced. Child analysis may more often be able to set its patients going on a new developmental path. (The application of psychoanalytic approaches in the infant mental health setting can be especially remarkable in this respect, since here very short-term interventions can avert catastrophes in the relationships of mothers with their babies, and set things back on a benign course.) A larger presence of child analysis and child psychotherapy in the activities of the British Psychoanalytical Society might thus lead to a significant lightening of its prevailing mood, and to an enhancement of a grounded basis for greater clinical optimism.
7. It was called a Childhood Depression Study.
8. One's thought is that the more rapid improvement in the family therapy cases was the outcome of, in psychoanalytic terms, family projections being soon lifted from the young adolescent. While the more lasting improvement in the psychoanalytic cases was the outcome of deeper shifts in the nature of the adolescent's internal objects.
9. Peter Fonagy took over following the death of Professor Phil Richardson who originally started the research.
10. This term is a reference to the ideas of Gilles Deleuze and Felix Guattari (1987).
11. There are large issues regarding the complete transferability of medical models of disease and treatment to the psychological sphere, and ongoing differences between psychiatric and psychoanalytic understandings and classifications of mental illness, which affect this question. For one thing, psychiatric technologies which might promise to remedy most common forms of mental illness remain widely deficient. For another, what counts as mental illness and wellbeing are much more subjective issues than is usually the case in regard to physical wellbeing. For many people, treating bodies as machines is one thing, regarding minds in this way is another. Some psychotherapists and psychoanalysts are now strongly opposing the close link between psychoanalysis and health provision which is assumed in the project for the state registration of psychotherapists.
12. Since psychoanalytic psychotherapies prescribe a large measure of autonomy for their practitioners, often expecting them to discover the real nature and explanation of their patients’ psychological difficulties only in the course of therapeutic treatment, their broad professional reputation is critical in determining their value to mental health services or indeed to individual clients. Thus, in this sphere, establishing good treatment outcomes in some major areas of illness may enhance the credibility of these therapies in others.
13. What is meant here by psychoanalytic is work essentially focused on the transference relationship. Is the equation of transference, the idea of intensive therapy, with frequency of sessions, necessarily valid? One can certainly find counter-instances to this proposition.
14. What kinds of patient can in practice gain access to psychoanalytic treatment has consequences for what conditions analysts are able to investigate, as well as relevance for the mental health system. Some of the emphases in recent psychoanalytic theory – for example, the focus on borderline and narcissistic states of mind, may in part be a reflection of the categories of patient who have access to psychoanalytic treatment, as opposed to those who, by virtue of being seriously disabled by mental illness, usually do not. Thus the availability or otherwise of psychoanalytic treatments within public health settings may influence the evolution of psychoanalytic theory itself.
15. Latour is one of the principal figures in the field of ‘actor network theory’, an important current in the sociology of science and technology.
16. One problem for psychoanalysis in the mental health field is the frequent confusion of levels of argument about it. The innumerable questions which arise within the field (e.g. what kind of depression is this, or, what is going on with this particular patient), become confused with questions definitional of the field itself. It is as if to undertake the mapping of tidal patterns in a coastal area, geographers were first required to defend the laws of gravity, as the ultimate explanation of the dependence of tides on the moon.
17. Interventions such as vaccination and immunization, pioneered by Pasteur; the separation of water for drinking from sewage and other impurities; the development of drugs to destroy bacteria; medical record-keeping to keep track of infections and immunities; the organization of homes and hospitals to eliminate harmful bacteria, etc. One can say that the transformation of our whole world followed as an effect of Pasteur's and related discoveries.
18. Incidentally, the picture of theoretical pluralism if not chaos attributed to psychoanalysis by Wallerstein and others does not seem convincing when one focuses on the work of particular theoretical schools, such as Kleinian and post-Kleinian analysis in Britain, or Relational Analysis in the USA. In these ‘regional’ psychoanalytic communities one can see fairly orderly accumulations of knowledge and theory (Hughes, Citation2004; Rustin, Citation1997) and a diversity and differences no greater than are found at least in many social sciences, or in historical studies, for example.
19. For a brief survey see Rustin (Citation2006b, Citation2007, Citation2009).
20. Another impending project is to examine systematically the differences between audio transcripts of clinical sessions, made as part of larger outcome studies where audio-recording is required, and the standard written ‘process recordings’ which child psychotherapists make of sessions, both to test the accuracy of written-up clinical reports, and to see how far transference phenomena might explain discrepancies between these forms of record.
21. Here are some examples of topics of completed or ongoing research in child psychotherapy. An example of a development of application of classical theory is Janet Anderson's study of risk-taking children, from a small clinical sample of ten. She found different patterns of child risk-taking, explicable as different configurations of Oedipal relations within their families. Contrasting ‘types’ were families which excluded and failed to hold the unwanted ‘third’ represented by the child, and families which altogether disavowed the child's separate identity, throwing all blame for difficulties on to a hostile environment. In the middle were unstable combined patterns. She characterized these patterns of relation between child and family as no-haven (expelled child), illusory-haven (incestuous intimacy) and perilous-haven (oscillation between expulsion and incestuous intimacy) (Anderson, Citation2009). An example of the methodological testing out of the application of key concepts was Janet Philps’ study of children caught in a double borderline state – their own mental condition reflecting that of the placement limbo in which they had been left. Philps charted the children's oscillation, in therapy, between paranoid-schizoid and depressive states of mind, influenced from week-to-week by the impingements of the external care system. She demonstrated that these states of mind, from the evidence of clinical session notes, could be reliably discriminated by independent blind-rating of the data (Philps, Citation2009). An example of work leading to the development of an expanded clinical service was Marguerite Reid's study through once-weekly psychoanalytic psychotherapy of the maternal state of mind following the loss of an infant or small child and the birth of the next baby. This work gave a specific application of the psychoanalytic theory of mourning to this specific form of loss (Reid, 2003).
22. Some analysts and others are concerned at the present time about a possible decline in the intellectual fecundity of psychoanalysis in Britain, in a tradition which was so remarkably productive in the second half of the last century. It is very hard to assess such changes objectively, and even more so to assign convincing reasons for them. However, in most other scientific spheres today, including the social sciences, some measure of organization and dedicated funding seems associated with the production of research and new knowledge. Is it possible that the informal professional networks which were so productive of ideas in recent years, no longer suffice to sustain this in present conditions?
23. With Jeffrey Prager, I co-edited a two-volume anthology of this kind on Psychoanalytic sociology (Prager & Rustin, 1993).
24. This is located in the Centre for Research in the Arts, Social Sciences and Humanities (CRASSH) at Cambridge University.