In our theory and practice as psychoanalysts, we have a tendency to idealize and elevate process goals over therapeutic outcome. This tendency is problematic because it deprives us of a vital check and balance in our technique and can lead to an implicit pessimism about our ability to systemically evaluate and modify our theory of therapeutic action. This trend in analytic thinking is traced, and vignettes are presented to illustrate it. Speculations about the reasons for the tilt toward process goals and away from therapeutic goals are offered.
Psychoanalysis is under attack today by a wide range of critics who dispute its efficacy and condemn its length and cost. Our own attempts empirically to study exactly what we do-e-and how well-have been plagued by serious flaws in our methodology (Bachrach, et al., 1991). Many of our research programs, for instance, have not reliably demonstrated a strong correlation between the development of an analytic process and therapeutic change or clearly superior comparative long-term cures. In addition, the qualitative methodology for validating our clinical propositions has come under intense scrutiny and criticism. Psychoanalysts’ preferred method for substantiating clinical formulations has always been the case report. As critics such as Griinbaum (1984), Spence (1987), and Edelson (1988) have pointed out, this format and our general style of argumentation are riddled with epistemological and logical problems, e.g., arguing by appeal to authority or by tautology, the use of a priori reasoning, etc. As psychoanalysts, we are having increasing difficulty defending our results and the logic of how we achieve them.
