Olivier Nicolle: Psychoanalytic Psychotherapy, Psychoanalysis and Research. Workshop at the Oxford Conference

Two 90 minutes sessions will be dedicated in Oxford to the complex issues of research in our psychoanalytic and analytic psychotherapy fields.

Like Freud in his time, each analyst may at times feel torn between two different positions: on the one hand the unique path of his own analytical work with a unique analysand or patient and on the other hand, the will to assess, to compare, to search and find some communicable abstracted generalisation of analytical experience and outcome.

As we know, these two approaches can neither be totally dissociated from each other, nor assimilated to each other, and, they require different and often opposite psychic positions.
The relative situation of psychoanalysis and analytic psychotherapy is already a complex one.
In some countries or analytical cultures, "psychoanalytical psychotherapy" has developed progressively and differently, and sometimes, has even taken the form of a more or less "symptom-centered" psychotherapy, with a central "analytical inspiration" at a theoretical level and even in the formal training regulations. Therefore, research in these trends often risks resulting mainly in symptom-focussed comparative quantitative studies, or in academic psychology research, where so-called 'objective' methodologies are applied to psychoanalytically labelled phenomena, with "outcome evaluation" or "efficacy assessment" as a main goal.

There are other analytical milieus, where "psychoanalytical psychotherapy" is understood as "psychotherapy with a psychoanalyst" and viewed as a "complex psychoanalysis" and not as a simpler or shorter one. Therefore, a basic assumption is that psychotherapy issues are real psychoanalytical issues. Consequently, research on psychotherapy processes tends to be seen in the same way as any other psychoanalytical research, where the subject of the research determines the methodology. In other words, the analytical subject matter requires an analytical setting and analytical methodology.

This latter approach to research is historically framed into clear analytic methodologies, which are in themselves implied by genuinely psychoanalytic epistemological bases. These include: contradictory comparison, discussion and assessing of analyst's or therapist's own interventions or no-intervention, interpretations, silence in diverse supervision situations, long-term follow-up and analytic evaluation of intersubjective processes, maximal integration of patient's transference and of analyst-researcher's countertransferential positions, striving towards the maximal integration of latent elements (including institutional ones).

Besides, overwhelming social, economical and cultural processes have occurred since the late '40, which have exerted a huge influence on our practices and conceptions. Among these we can count, on the one hand a form of integration, and consequent expansion, more or less free of charge, of psychoanalytical psychotherapy into the health systems of many countries, together with a relatively unquestioned equation with purely medical treatments. On the other hand, some elements of the analytical theories (often "politically correctly" termed "psychodynamic") became part and parcel of the theoretical background of nearly every clinical psychologist, psychopathologist, developmental clinician or social worker.

Those facts - once evidence of real progress have in the last 10-15 years - come to reveal an opposite face and some perverse effects. Psychotherapists in the public sector are pressured by health or insurance authorities to quantify and prove the effectiveness of their "treatments" in the way all medical practitioners are. Scholars are pressured to produce and publish "research results" to prove the "scientific" (i.e. quantitatively-based) quality of their teaching and clinical work.
Consequently, we can now witness in our field a growing flow of "outcome research", based on extrinsic measurements of behaviours and a more or less pure academic experimental methodology. We are sometimes at risk of losing any remembrance of individual private fantasies and feelings, of instinctual, sexual and sensual trends, of thought processes and of the subjective experience involved in the therapeutic processes - not to mention transference - and last but not least, the researcher's countertransference. At times it is hard even to find any reference to… meaning. From another point of view, some of us may feel more secure in attaining clear quantitative assessments of their work, and we all know how this strange analytical situation can be at times such a factor of doubtfulness and inner uncertainty.

This situation results in a series of serious questions, to which some answers seem quite clear and others not at all. Is the problem of insurance company or national health system pressure a serious and 'hot' one? Surely yes. Has any one of us ever based one of his (her) interventions or no-intervention in a psychotherapy session solely on the data from a randomised controlled sample trial? Indeed not. It could be true that new analytic research settings have to be elaborated today. But, are we so sure that the devaluation and at times rejection of the genuine psychoanalytical research methodology is not primarily an effect of ideology and the result of the analysts' ambivalence? Are we so sure that tests, questionnaires, controlled conditions and randomisation do ensure that we get a step farther in the "analytical matter"? Can we expect to benefit from differentiating more clearly between these two approaches to research, namely "psychoanalytical clinical research" on the one hand, and "outcome research" on the other? If yes, is this from an epistemological or from a political point of view? How do we safeguard the living link between clinical experiencing and research? Faced with these objective difficulties, is it possible and reasonable to foresee a clearer research policy for the EFPP?

These issues and other core questions will be addressed in the Workshop sessions on Psychoanalytic Psychotherapy, Psychoanalysis and Research that will take place at the Oxford Conference, and will be co-chaired by O. Nicolle (Centre V. Smirnof de Psychothérapie and Centre National de la Recherche Scientifique - Paris) and Prof. Ph. Richardson (The Tavistock and Portman NHS Trust - London). EFPP researchers from various countries will present their own approaches, questions, and opinions.

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