Our Evidence Base

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Posted September 23, 2007

The hallmark of a vital science is that it evolves. Now well into its second century, psychoanalysis is no exception. A high priority for my leadership is that we must strengthen our evidence base and do a better job of assimilating it coherently. This applies to psychodynamic psychotherapy as well as psychoanalysis. I have been pursuing this objective for the last two decades.

Indeed, the real “elephant in the room” in American psychoanalysis today is a public image of it as “passé” – an interesting relic of the past that has profoundly influenced our culture to the point that people don’t even notice their assumption of unconscious mental life, the role of sexuality, or the effects of childhood on emotional development. The public perception rarely recognizes psychoanalysis as a living, vigorous science that continues to contribute to our knowledge of human mental life and to support a uniquely effective mode of treatment. This has a serious impact on our members’ practices and the professional training programs that should be generating our future candidates. It should compel our attention far more than our internal squabbles.

In her recent TAP article, “Science in the Association – Part I” (Vol. 41, No. 3, Fall, 2007, pp. 3-4) President Lynne Moritz outlines a comprehensive, forward-looking program to bolster our science within the organization as well as in partnership with Division 39 of the American Psychological Association. I heartily support this program and would do all I could to make it thrive during my tenure in office.

Evidence-based practice (EBP) is defined by the Institute of Medicine as the integration of best-researched evidence and clinical expertise with patient values (Institute of Medicine. Crossing the quality chasm. Washington DC: National Academies Press. 2001.) Our association is rich in clinical expertise and profoundly invested in patient values. We must concentrate on expanding and presenting our evidence.

There are many kinds of evidence, not exclusively randomized controlled double-blind trials (RCTs):

  • Psychoanalysis has come a long way based on intensive individual case studies, for which it is especially well suited. We may have opportunities now to meld our clinical insights from individual patients with findings from neuropsychology and neuroimaging – an approach that could be done in real time with psychoanalytic patients and circumvent the huge challenges of devising RCTs for psychoanalysis.
  • The folks revising the American Psychiatric Association’s panic disorder guideline are grudgingly having to accept the findings of Barbara’ Milrod’s rigorously executed RCT showing excellent results for psychodynamic psychotherapy with patients with panic disorder. We need many more of these for psychodynamic psychotherapy.
  • Studies of psychoanalytic process can help elucidate the crucial question: what is the essence of psychoanalysis regardless of the theoretical orientation of the analyst?
  • This in turn could inform our efforts to refine our evaluation of competence in psychoanalytic training and certification. Completing the objective, scientific study of certification that was sadly interrupted by political agitation would help to make certification as meaningful, fair, and collegially respectful a process as is humanly possible.

Freud just won’t stay dead. He’s in the New York Times again today, elucidating the human “hunger for absolute leaders and absolute truths” in terms of transference (Mark Edmundson, “Who’s Your Daddy?”, News of the Week in Review, September 23, 2007, page 13) APsaA is very much alive, with a membership of analysts rich in intelligence and creativity. Our challenge is to lead the way in support of a vital science that is, as always, ahead of its time.

(Posted to Elections List September 23, 2007)


I am not a researcher. However, I believe that research is vital to any scientific field including our own. It is also important to advocacy. In the American Psychoanalytic Association, while chair of the CGRI, I also chaired the Task Force on Economic and Scientific Information of almost twenty years ago, which instigated an up-to-date review of the efficacy data on psychoanalysis (Bachrach, Galatzer-Levy, Waldron, Skolnikoff, Does Psychoanalysis Work) and later encouraged Susan Lazar and Norman Doidge in their lively reviews. In the American Psychiatric Association, as founding chair of the Commission on Psychotherapy by Psychiatrists, I advocated for greater attention to the appropriate evidence base for all psychotherapies vis-à-vis somatic treatments. I later continued this concern with research with reviews in Psychiatric Services and Journal of Psychiatric Practice of books on efficacy of psychotherapy as they came out.

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