Beyond the hermeneutic/scientific controversy: A case for a clinically sensitive empirical research paradigm in psychoanalysis

Clinical Evidence, Triangulation of Perspectives and Contextualization. Part 1: The Beginning of Carla's Treatment

We propose to critically evaluate and strengthen the level of clinical evidence in psychoanalysis, using a strategy of triangulating clinical phenomena from different perspectives and increasing contextual knowledge. Insufficient discussion of alternative hypotheses and limited contextual information are two Achilles heels of psychoanalytic case presentations. We examine the concept and quality standards of clinical evidence in psychoanalysis and related disciplines, with particular attention to the contribution of the three-level model (3-LM). We analyze the case of a patient treated with transference-focused psychotherapy (TFP), making explicit the theoretical-clinical agreements and disagreements of the authors. We discuss the strengths and limitations of triangulation and contextualization, concluding that they make clinical work and psychoanalytic writing more reliable, transparent, auditable, and replicable.

The Clinical Relevance of Interdisciplinary Research on Affect Regulation in the Analytic Relationship

After more than a century of existence, theoretical development, research, and clinical practice within the psychoanalytic movement have consistently demonstrated that psychoanalysis is not a unitary and autonomous discipline. This has been evidenced by the various ways in which psychoanalytic thought and practice have been informed by and have established a dialogue-more or less fruitful-with related disciplines (neurosciences, developmental psychology, psychotherapy research, attachment theory and research, feminism, philosophy). This dialogue has contributed to a better understanding of the functioning of the human psyche, and therefore of the analytic process, informing clinical interventions. In turn, it has enriched research on psychoanalytic practice and process, underlining the fact that research in psychoanalysis is fundamentally about clinical practice. Since its origins, psychoanalysis has made explicit the work on the patient-analyst relationship as the terrain in which the analytic process unfolds. For its part, research in psychotherapy has demonstrated the relevance of the therapeutic relationship for the good development and outcome of any psychotherapeutic process. This supports the argument that research in clinical psychoanalysis should be research on the impact of the analyst interventions on the analyst-patient relationship. In this context, a central element of what happens in the analytic relationship refers to affect communication and therefore, affect regulation, which is manifested in the transferential and counter-transferential processes, as well as in the therapeutic bond. On the other hand, affective regulation is found at the crossroads of etiopathogenesis, complex personality models and psychopathology, allowing the understanding of human functioning and the staging of these configurations in the patient-analyst relationship. In this way, research on affective regulation in the analytic process is proposed as a path that exemplifies interdisciplinary research and scientific pluralism from which psychoanalysis enriches and progresses as a discipline. The case of a line of research on affective regulation in psychoanalytic psychotherapy is illustrated. The need to resort to other disciplines, as well as the translational value of our research and its clinical usefulness, is discussed.

Walking the middle ground between hermeneutics and science: A research proposal on psychoanalytic process

In 100 years of clinical research and 40 years of empirical research, the concept of psychoanalytic process continues to elude a consensual definition, probably because the problem and methodology must be approached in a different way. This article outlines the empirical implications of the epistemological model exposed in a previous article, by proposing a scientific, innovative, and clinically sensitive research programme for the study of psychoanalytic process. This proposal is an attempt at developing psychotherapy research that is founded on psychoanalytic hypotheses derived from a two-person psychology. The research programme focuses on the interactional nature of the analytical work, and on the relationship between the implicit (unconscious) and the explicit (conscious) levels of the analytic endeavour. The authors propose that this research programme be articulated around three methodological approaches: (1) the use of systematic case studies; (2) the adoption of the events paradigm for accessing the salient phenomena of the psychoanalytic process; and (3) a micro-analytic approach to the specific phenomena occurring within relevant sequences of interaction. These ideas are illustrated with a description of the micro-analysis of a clinical case. This article is intended to contribute to a constructive dialogue between psychoanalytic practice and psychotherapy research.