I’m a psychoanalyst. So it was with great interest that I read Daphne Merkin’s New York Times Magazine article about her forty-year history of psychoanalysis and psychoanalytic psychotherapy. Merkin is a terrific writer, a brave observer of her inner life, and a lively critic of the professional cultures devoted to studying and healing inner lives. She found the New York psychoanalytic culture reassuring, even if not always helpful. She says:

“…aside from the fact that the unconscious plays strange tricks and that the past stalks the present…..[there is] a certain language, a certain style of thinking that, in its capacity to reframe your life story, becomes—how should I put this?—addictive….Whether [it does] so rightly or wrongly is almost besides the point.”

For decades I’ve heard that it doesn’t matter what theory a therapist holds, what his or her formulation about the patient might be. What matters, the cliché goes, is simply the presence of an attentive relationship. Merkin’s variation on this theme is that her idealization of her analysts’ wisdom and the rhythms and imagery of a psychoanalytic conversation have been more comforting than anything she’s been offered in the way of interpretation and insight. The process, in other words, was more important than the content or outcome.

Read the full article at HuffingtonPost.com

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.

Read the full article in Psychoanalytic Quarterly