03.20.07
Luyten, P., Blatt, SJ Corveleyn, J (2006). Minding the Gap - JAPA 54(2)
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
592
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