Book Review

Research in Psychoanalysis: Process, development, outcome

N Engl J Med 1995; 333:1228-1229November 2, 1995

Article

Research in Psychoanalysis: Process, development, outcome
Edited by Theodore Shapiro and Robert N. Emde. 447 pp. Madison, Conn., International Universities Press, 1995. $60. ISBN: 0-8236-5795-7

The publication of Research in Psychoanalysis is most timely, coming as it does during a time in which strong and fundamental questions about psychoanalysis are being debated. Is there evidence of the validity of psychoanalytic theory? What data support the efficacy of psychoanalysis? What, if any, is the relevance of psychoanalytic knowledge to medicine, psychiatry, and the social sciences? Each contributor to this outstanding book tackles aspects of these penetrating questions. The presentations and accompanying discussions clearly convey the complexity of key issues faced by thoughtful psychoanalysts and psychoanalytic scholars.

The organization of the book reflects the editors' belief in the centrality of open dialogue from multiple perspectives. Three sections — process research, developmental-psychiatry and developmental-psychology research, and outcome research — represent major and relevant scientific domains. Excellent discussions by researchers (e.g., Spence) or seasoned clinicians (e.g., Arlow and Kernberg) greatly enhance each section and are an especially strong feature of the book. These pieces are critical essays, intelligently written and often deeply insightful.

I recommend several chapters to readers who wonder how sophisticated psychoanalytic investigators relate to contemporary science and philosphy. Caston and Jones thoughtfully articulate the methodologic dilemmas raised by the question “How will psychoanalysis study itself?” Spence provides a lucid discussion of the implications of these and other issues. In a section on the developmental implications of psychoanalysis, Main and Fonagy illuminate exciting advances in research on attachment, especially the psychometrically rigorous approaches to studying bonds between children and adults.

Wallerstein and Kantrowitz, experienced and thoughtful clinician-investigators, consider the future of psychoanalytic process-outcome studies. Wallerstein emphasizes “psychological capacities” in coping with conflict; Kantrowitz argues for a study of the goodness of fit — “the match” — between therapist and patient. The notion of goodness of fit is not new, but it seldom appears in psychoanalytic-outcome research. Skilled clinicians intuitively consider the “fit” between health care provider and patient. Nonetheless, the inherent conceptual and empirical complexity of the doctor–patient match may have discouraged serious empirical investigation of this topic.

Research in Psychoanalysis ends with dazzling discussions of multiple strategies in empirical research, single-case studies, and the place of narrative studies in psychoanalysis. This book is for readers interested in discussions of science, clinical research, and psychoanalysis. I believe it will be considered the gold standard for future discussions of research in psychoanalysis. Its publication offers hope for the future of psychoanalytic theory and its clinical applications.

Stuart T. Hauser, M.D., Ph.D.
Judge Baker Children's Center, Boston, MA 02115