Academic journal article International Journal of Psychoanalysis

Can Research Influence Clinical Practice?1

Academic journal article International Journal of Psychoanalysis

Can Research Influence Clinical Practice?1

Article excerpt

After briefly reviewing the unfavourable reception accorded empirical research by parts of the psychoanalytic community, as well as some of the benefits to clinical practice of analysts being involved in research activities, the author examines whether the findings of process and outcome research in psychotherapy and psychoanalysis can help identify the most appropriate forms of intervention for producing therapeutic change, given the specific condition of the patient and the relationship that the individual establishes with the analyst. He argues that research findings can influence clinical practice on various levels and in different areas, and goes on to examine a number of related issues: the specificity of therapeutic interventions versus the relevance of common curative factors; the dyadic conception of technique and ways of understanding the therapeutic action of the treatment alliance; and the strategic or heuristic conception in psychoanalytic therapy. Finally, the author presents clinical material with the aim of illustrating how the knowledge acquired through research can be applied to psychoanalytic treatment.

Keywords: research and clinical practice, process and outcome research, adaptive technique, therapeutic factors, therapeutic alliance, psychotherapy and psychoanalysis

Introduction: Research and psychoanalytic practice

The relationship between research and clinical practice in psychoanalysis continues to be a controversial one. In this regard, Fonagy (2000) is suggestive. Through the 'grasping the nettle' metaphor of his title, Fonagy alludes to the difficult situation in which analysts who are committed to research find themselves, i.e. frequently frustrated and with a sense of futility as regards their clinical colleagues who tend to reject passionately the arguments and findings of research.

The hiatus between research and psychoanalytic praxis illustrates the complexity of the relationship between theory and practice. Although researchers and clinicians are ostensibly pursuing the same objective, namely, the improvement of treatment techniques, this commonality has been said to be more apparent than real. Whereas research seeks to reveal the causal relationships between interventions and improvement through the application of methodological controls, the attitude of clinicians is much more pragmatic: they are less interested in identifying the active ingredient than in achieving change itself. Thus, it can be said that the researcher seeks to maximize negative evidence, i.e. to increase the degree of questioning and critique of findings, while the clinician does the opposite, namely, maximize positive evidence in order to be able to act coherently in the therapeutic situation (Bowlby, 1979).

In my experience, however, this apparently radical difference does not actually appear in the way that one would imagine. Moreover, during the years in which I was in close contact with research activity and full-time researchers at the University of Ulm (1985-90), I observed in my own clinical work the completely opposite effect to what I had expected. After a brief period in which the clinical beliefs I had acquired during my psychotherapeutic and psychoanalytic training in Chile were subjected to systematic questioning within the highly critical context of the research group (this being a time during which I was overcome by strong feelings of uncertainty and contradiction), I soon became aware of notable changes taking place in many areas of my clinical work. These changes are consistent with what Safran and Muran have called 'clinical byproducts of research' (1994, p. 219).

The first of these concerns the emergence of a new empirical attitude, in other words, a habit of evaluating one's own theories in light of observed phenomena rather than selecting events with the-obviously preconscious-aim of propping up these theories. The widespread tendency to idealize the psychoanalytic method quickly gives way when a clinician gets involved in research activity. …

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