03.20.07

Luyten, P., Blatt, SJ Corveleyn, J (2006). Minding the Gap - JAPA 54(2)

Posted in Uncategorized at 8:05 pm by Robert S. White

 

Among the important reasons why psychoanalysis has suffered, many think that the lack of integration of empirical and clinical observations has prevented psychoanalysis from joining the mainstream helping professions.
 

This article, “Minding the Gap,” addresses the conflicting, at times, diametrically opposing views, of clinician and empirical scientist. To my mind, this article follows the lead set by Howard Shevrin and his many discussants in 1995, Is Psychoanalysis One Science, Two Sciences, Or No Science At All? A Discourse Among Friendly Antagonists.  J. Amer. Psychoanal. Assn., 43:963-986. In contrast to that previous publication, Minding the Gap is not only an up to date version of this long-standing debate about the role of science and psychoanalysis, but is also written in a clearer style which will be read both by clinicians and researchers, in a more friendly and clearer manner.
 

The paper discusses the differences between idiographic and nomothetic approaches: Looking at uniqueness of each individual versus identifying lawful regularities across individuals and interpretive approaches versus factual and probabilistic approaches. It distinguishes clinical approaches from systematic N=1 approaches and from formal narrative approaches to case material.
 

It discusses in a lucid manner the difference between Freud-bashing critiques from the scientific critiques of Popper (lack of falsifiability in psychoanalytic approaches—context of discovery of the clinical method versus the lack of context of justification) and Grunbaum (the fundamental contamination of empirical data by the analyst’s theoretical expectations).
 

The authors note the remarkable fact that despite the advancement in the study of narratives, clinical psychoanalysts (as well as empirical psychoanalysts) have not promoted this way of studying clinical analytic data, save a for a few attempts such as Jones and Ablon’s and Westen and Shedler’s application of the Q-sort technique. Among the reasons cited in the paper, the most interesting to me was their statement that “the prospect of having to give up cherished ideas, an inevitable correlate of research and dialogue with individuals of other persuasions, may engender fear—in clinicians that research will increasingly intrude on their “old ways,” and in researchers that reverting to methods other than quasiexperimental designs risks losing the hard-won and still precarious respectability of psychoanalysis as an empirical science.”
 

            A long quote from their paper gives a flavor of the way these authors approach the problem. I choose to highlight this quote because it is addressed to most of us who primarily clinicians. A central point for the field of psychoanalysis is that it needs to mine the vast clinical literature in a systematic way rather than in a non-controlled way. The authors state:

“However, if much of the “good stuff” in psychoanalysis comes from the case study method, why should we consider it as suited “only” for the purpose of generating hypotheses? Rather, shouldn’t we try to improve this method, so that it becomes more scientific? It seems that dismissing the traditional case study method is like throwing out the proverbial baby with the bathwater. Research over the last decades has shown that the traditional case study method can be adapted to confirm to appropriate scientific standards, and thus play an important role in empirical research on psychoanalytic hypotheses (Britton and Steiner 1994). Although notable attempts have been made to develop and introduce more rigorous qualitative (as well as quantitative) case study methodology into psychoanalysis (e.g., Boston Change Process Study Group 2005; Edelson 1984, 1988; Fonagy and Moran 1993; Fridhandler, Eels, and Horowitz 1999; Hauser, Golden, and Allen in press; Kächele, Eberhardt, and Leuzinger-Bohleber 1999; Messer and McCann 2005; Pole and Jones 1998; Horowitz et al. 1993; Tuckett 1994; Wallerstein 1986), relatively little use has been made of these developments. This is remarkable for at least two reasons (stress by Hoffman).
 To begin with, as we have noted, if many psychoanalysts believe that the case study method is the most appropriate way to investigate psychoanalytic theories, why have they not made greater use of these developments in case study methodology? Second, developments in the methodology of both qualitative (e.g., Denzin and Lincoln 1994; Forrester 1996; Miles and Huberman 1994; Yin 1989) and quantitative case study research (Bailey and Burch 2002; Kazdin 2003) have resulted in the increasing use of case study methodology and qualitative research in general in other branches of psychology, including clinical psychology and
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psychiatry (e.g., Crawford et al. 2002; Elliott, Fischer, and Rennie 1999; Fossey et al. 2002; Hauser, Golden, and Allen in press). The fundamental difference between this controlled case study methodology and the traditional uncontrolled case study method is that the former (and good qualitative research in general) uses a rigorous design, which includes clear hypotheses, a good description of the methodology used (e.g., participants, procedures, data collection procedures, analysis methods), and a clear separation of results from their interpretation. Although controlled case study methodology holds strong promise for psychoanalytic research, especially for those who believe that other methods do not do justice to psychodynamic hypotheses, it has been rarely used.”
 

In short, this paper, for which the Introduction and the two discussants as well the rejoinder by the authors flush out many details, deserves to be recognized as an important scholarly contribution which promotes the integration of science and clinical work.
 

Leon Hoffman

03.18.07

Wilson, M. (2006) Nothing could be further from the truth

Posted in Uncategorized at 8:51 pm by Robert S. White

6/13/06

Mitchell Wilson, in his article entitled “Nothing could be further from the truth”: The role of lack in the analytic process (JAPA 54/2, 2006), examines the paradox that falling short, getting over-involved, making mistakes often furthers analytic work.  Wilson correctly notes that much analytic work is characterized by presence, by the offering of interpretations and new objects.  Other analytic work is characterized by lack, loss or absence.  To try to grasp something is to lose it. At times, this is the experience of confusion, of not knowing.  To be obsessively filled up is to avoid surprise and openness.   To the Western person, nothingness is associated with terrifying undifferentiatedness, Satre’s nausea or Bion’s beta elements and psychosis.

I think Wilson has trouble with the concept of nothingness.  He uses it mostly in the sense of  the presence and absence of objects.  He is saying, correctly, that we cannot privilege presence without considering and giving equal weight to its opposite.  Both are meaningful experiences. However, he hints at another meaning of nothingness.  It is that all linguistic concepts, all words are necessarily incomplete, never fully capture experience.  For example: “the analyst knows that his or her knowledge is incomplete…this knowledge and the words to formulate it are lacking” (p. 417).  This would be the origin of the Lacanian idea that transference closes up the unconscious.  The very use of words causes a kind of lack, a cutting off of experience.
 

I think we can clarify the meaning of nothingness by examining the Buddhist conception of nothing.  Wilson’s first meaning of nothingness, that of the dichotomy between presence and absence, are both attributes of being.  Both are important in everyday experience and neither should be privileged over the other.  Wilson’s second meaning, that of a critique of language itself, is of much more interest to the Buddhist.  In this sense, nothing (the Chinese wu or the Japanese mu) can take on two related meanings.  Words and other linguistic concepts are ultimately empty in terms of a full experience of reality.  Language is bound by its own constructs and internal rules and cannot provide a true and necessary relationship to nonlinguistic reality.  All distinctions in language are arbitrary concepts that actually obstruct what is experienced.  There is an unbridgeable gap between the signifier and the signified.  In this sense, every assertion, every interpretation both reveals and conceals.  We cannot do without words, they exist as practical instruments for everyday use.  Yet words rigidify and obstruct the grasping of new and surprising meanings.
 

The second meaning of nothing comes from the Chinese Tao, meaning way or path.  It refers to the undifferentiated source of all things.  All reality is grounded in something more primordial that either Being or Non-being, form or no form.  Nothingness is identified with absolute being.  All being emerges out of non-being, something timeless and unchanging.  Non-being, here, is not the negation of being but a third term, a kind of undifferentiated matrix.  I would think of Loewald or Winnicott here.
 

The Zen equivalent of mu is no-thought (Japanese munen).  This is not an unconscious state or a negative state.  It is not passive as it requires both an active effort to break from thinking, from intellectualization, from any intent, and a full participation in the present.   One learns to empty oneself, eliminate all conscious strivings and become spontaneous and responsive to the flow of events.  Not to interfere with patterns of change but to contemplate them and be harmonious with them. Only in breaking from linguistic restraints and in the search for a deeper reality can we really achieve the openness and surprise that Wilson wants to find.  I believe that the way to achieve these goals is not, ultimately to analyze presence and absence, but for the analyst to cultivate the stance of no-mind.  We then can search for the experiences that hide behind works and are concealed by words.

I will close with a poem by Bashō

Ah, the stillness!

Penetrating into the rocks

A cicada’s chirp

Robert White