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Harriet S.MeyerMD, Contributing EditorDavid H.MorseMS, Journal Review EditorRobertHoganMD, adviser for new media
To Sigmund Freud, the psychoanalysis that he brought into being just over a century ago was clearly a biologically rooted natural science within the framework of the physicalist-physiological tenets of the Helmholtz school of medicine in which he was raised, and it had its proper place in the then differentiating array of biological sciences. Yet curiously, Freud had a strong aversion to efforts at systematic empirical research into psychoanalytic propositions. Responding in the 1930s to Saul Rosenzweig, a US psychologist, who had written to him that he had experimentally confirmed some psychoanalytic concepts, Freud said that psychoanalysis had no need of such studies, since its conceptions had been amply established by repeated observations in the clinical psychoanalytic situation, though, of course, such efforts as Rosenzweig's could do no harm. This dismissive stance toward empirical research by the founder of psychoanalysis has had, over the 100-year history of this discipline, a powerful inhibitory effect upon the development of the systematic research so central to the incremental knowledge advance of any science, psychoanalysis included.
The volume reviewed herein is a most impressive demonstration of how far psychoanalysis has progressed beyond Freud's dour perspective. Serious empirical psychoanalytic research took root in the United States along with the explosive growth of the total biomedical research enterprise that was given such impetus in the wake of World War II, with the establishment of the National Institutes of Health, among them the National Institute of Mental Health. Central to this psychoanalytic research enterprise has been the intensifying study of the processes and outcomes of psychoanalytic therapies, with two central questions: (1) what changes are actually achieved or are achievable in psychoanalysis and the array of psychoanalytically-based dynamic psychotherapies?—the outcome question; and (2) how are those changes brought about, through the interaction of what factors (variables) in the patient, the therapist, and the patient's evolving life situation?—the process question.
This volume is a truly striking documentation of this now almost exponentially growing body of research findings and conclusions, going back to the first simplistic counting of results in a series of cases reported in Boston in 1917—barely a decade after psychoanalysis came to the United States—and proceeding with a thorough overview, chapter by chapter, of just about every major process and outcome study in all the years since. Each is discussed with thorough appreciation of its reach and accomplishment, its methodological and often substantive advance over earlier studies, and also its methodological weaknesses and substantive limitations. A caveat: with but a few exceptions this survey is limited to the US scene, which is appropriate enough, because systematic empirical research in psychoanalysis flourished to begin with and has grown most extensively, within the Anglo-American pragmatic tradition. (Today serious psychoanalytic research is also powerfully represented in Germany and Great Britain—referred to a little in this volume—and also Scandinavia, Holland, Israel, and, more recently, Italy, Spain, and Latin America.)
What does all this add up to? The authors convincingly present the impressively accumulating data on the broad effectiveness of the psychoanalytic therapies and the less well-established (to this point) evidences of the mechanisms by which these results are achieved. Additionally, the authors lay out comprehensively and astutely all the now available computer-based technologies as applied to transcribed, audiotaped psychoanalytic sessions that provide the base for the methodologically ever more rigorous studies that should finally put to rest all the now thoroughly refuted charges that psychoanalysis can only be a faith, not a science, since its propositions are allegedly fundamentally untestable. The data marshaled so carefully in this volume already go far to put such allegations aside and to make the case for the effectiveness of psychoanalytic therapies in reaching far beyond the goals, in terms of productive living, of those other therapeutic efforts aimed essentially at simple alleviation of distressing symptoms. This, of course, is especially important in the current managed-care health universe with its calls for cost-containment and evidence-based therapy.
A trivial complaint: the book is badly copy-edited, with frequent misspellings of names, faulty citations, and, worse, many articles cited by author and year that have failed to make it to the reference list at the end. But none of this really detracts from a most important survey of the therapy research literature in psychoanalysis and an essential book for a discipline historically so uneasy about its scientific status. This is a must-read for all concerned with what psychoanalysis can do to alleviate human mental and emotional distress.
Psychoanalysis: Does Psychoanalysis Work? JAMA. 2000;284(13):1712–1713. doi:10.1001/jama.284.13.1712-JBK1004-2-1
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