Roussillon_Research_Exploration

Research and exploration in psychoanalysis

René Roussillon

1. The issue of research in psychoanalysis — or, better, that of the relationship between psychoanalysis and research — cannot be dealt with straightaway as if, expressed in so many words, it was sufficiently clearly defined to be worked upon without any epistemological preamble. The manner in which the question is usually approached does indeed seem to me to be marked by a series of confusions that ab initio make the whole matter more obscure. Each of the components of the way in which it is worded carries with it a series of questions which, if they are not themselves taken into consideration, will prevent any progress being made.

In the first place, we have to know exactly what the term « psychoanalytic » means in this context, then the exact meaning of the word « research » — and adding the attribute « scientific » to it merely complicates matters.

Psychoanalysis — in so far as we can still use the singular form of the word, given the contemporary « Babelization » of both theory and practice — is made up of at least three fields; even though these are related to one another, it would be helpful to draw a clear distinction between them. Psychoanalysis is a technique — again, is the singular here still acceptable? — that one puts into practice; it is a clinical approach to suffering and psychopathology in human beings; and its metapsychology is a general theory of the human mind, a theory of the « psychical apparatus », as Freud put it, a theory of how the mind works. There are therefore at least three kinds of research or « explorations » in psychoanalysis: those that concern the practice of psychoanalysis, those that have to do with improving our understanding of clinical matters, and those in which the object of study is metapsychology. If we ignore these differences, we run the risk of creating confusion between theory and clinical applications, between clinical applications and technique, and between theory and technique. Respecting the hiatuses that separate and link together technique, clinical applications and theory is an integral part of psychoanalysis; it forms a fundamental part of its identity. I shall come back to the consequences that these elementary differentiations entail.

As regards research as such and its link with the idea of science, I have no intention here of opening up a debate, albeit a necessary one, concerning the definition of science and the scientific nature of psychoanalysis. There is no « scientific » definition of science that is other than rooted in its epoch and in the ideologies dominant at the time; this does not imply that the question is irrelevant, but that it cannot be resolved rapidly by having recourse simply to quantitative methods as though they would be enough to put an end to the question and define its key characteristics. Science exists even without a quantitative or experimental approach, and in every quantitative and experimental approach some ideology or other is involved. What is measured or observed is « constructed » by « theories » or systems of thought which make it « observable » or lead to its being (or not being) taken into account in methodology. To take just one recent example that has to do with our particular field, the resistances, uncertainties and particularities surrounding the « discovery » by the neurosciences of the importance of affect regulation [Damasio 1995] are quite explicit on that point. It took a whole century for the importance of affects, noted by Freud in 1895 in Studies on Hysteria, to be acknowledged and at last taken into account by « scientists ».

The question of the « scientific nature » of psychoanalysis and the specificity of its epistemology[1] would have to be examined, as would these same aspects of any approach to living beings. These issues would take me along paths other than those I want to cover in this article; for the moment, the introductory comments I have made will suffice for examining the issues I would like to discuss in some detail.

On the question of research and psychoanalysis, I would argue that it is important to draw a distinction — my approach here is similar to that of Widlöcher [2001] — between research studies « of » psychoanalysis — sociological, anthropological, epidemiological, etc, carried out by research workers who may or not be psychoanalysts — and those « within » psychoanalysis, carried out by psychoanalysts working as such in their identity as psychoanalysts. Each methodology constructs its object and its specific approach to that object, defining them in a distinctive manner.

2. To take another example: The well-known studies of the therapeutic effectiveness of psychoanalysis, carried out on the basis of epidemiological-type investigations, do not « measure » the same thing as the internal work done by psychoanalysts when they assess the effects of treatments that they have carried out. This is not because psychoanalysts are more « subjective » as regards their own work, looking at it through the eyes of Chimène, whereas other studies, external, are more « objective », but quite simply because the object of study is not the same in the two approaches.

In the one, results are measured with reference to the « objectivity » of a clinical picture and of its evolution assessed with the help of grids and other « objectivist » methods or based on « subjective » surveys of what the individuals concerned can consciously report. These methods do not take into account — or, at least, not properly — the dimension of the unconscious workings of the mind, a fundamental element for psychoanalysts.

In the other, outcome assessment is based on criteria intrinsic to the work of psychoanalysis itself — the manner in which analysands freely associate, the flexibility of their mental functioning, the type and organization of their defence mechanisms, etc — and takes into account the existence of unconscious mental life and psychic reality which are always active, forever being organized and reorganized according to the dominant drive-related pressures at any particular moment or the intersubjective situations in which they are engaged. These elements do of course have some relation to the « objective » clinical picture, but they cannot simply be superimposed on it or on the awareness that the individual may have of it. I am not neglecting the issue of the « therapeutic » effectiveness of psychoanalysis; what I am challenging is the relevance of the criteria adopted to evaluate that effectiveness.

In addition, if we say that epidemiological studies do measure something that has to do with psychoanalytic practice, the difficulty is to know exactly what it is that they do ascertain. Are they measuring an identifiable « object », the « practice of psychoanalysis », the « effectiveness » of that technique — as though the singular form of the word was in any way meaningful? Are they measuring the relevance or the irrelevance of certain practices adopted by some psychoanalysts, the quality of their training, the ideologies that cannot but infiltrate their technique, etc?

Psychoanalysis is not an « exact technique » in the way that we speak of « exact science »; it is not everywhere identical but varies from one country to another, from one analyst to another, from one counter-transference to another. Psychoanalysis as an identifiable and measurable « technique » just does not exist, unless we limit ourselves to purely formal criteria (the setting) — and even in that case…. It is never sufficiently identical to itself as regards its process for that question to be in any way meaningful within the psychoanalytic domain itself. In practice, psychoanalysis is always a specific adventure between, on the one hand, a given analyst belonging to a particular school of thought, with his or her own theories and emotional attitudes, and, on the other, a given analysand with his or her own particular life-history, interpreting the events and relationships of that life-history in terms of a given pattern of drives or processes of internalization…. That does not imply, however, over and beyond these variations, that we can find no common ground which would enable us to differentiate between psychoanalysts and other psychotherapists; but this cannot be done in any exact or measurable way — it has to be thought about differently and in accordance with quite other criteria. For example, « within » the practice of psychoanalysis itself different techniques or « clinical » hypotheses would have to be compared.

Lastly, even if we were to accept the validity of an epidemiological approach to the assessment of psychoanalytic practice, the whole issue would then focus on how to interpret the results. They could not pose any challenge to « the practice of psychoanalysis », which is only a theoretical myth; at most, they could involve only some kinds of psychoanalytic practice, certain aspects of the training followed by psychoanalysts, certain theories or ways in which they are put into practice, and certain ways of assessing therapeutic outcomes.

These studies « of » psychoanalysis may involve certain « social » aspects of psychoanalysis, its « image » with respect to public opinion, its effect as measured against a certain conception of psychological disorders and mental illnesses. Although they may be worth taking into account as regards a social « policy » concerning psychoanalysis and the associations that manage its implementation and training procedures, they have nothing to do with psychoanalysis as such, intrinsically. They are not studies carried out « within » psychoanalysis but are « about » a psychoanalytic « object » constructed via methodologies that are not those of psychoanalysts. The fact that they are then implemented by psychoanalysts rather than by « scientists » from other epistemologies is entirely irrelevant.

Obviously, it cannot be said that a « social » assessment of psychoanalysis is of no concern to psychoanalysts — but it cannot, as it sometimes threatens to do, « summarize » the whole question of the relationship between psychoanalysis and research.

 

3. « Interface » research between psychoanalysis and other approaches to the human mind — ethology, the neurosciences, the biology of the brain and of its functions, direct clinical observation, anthropology, mythology, etc — seem to me to make contact with psychoanalysis — or, to be more precise, with psychoanalytic « theory » — in a more stimulating way. These studies, conducted within their own epistemological framework, meet up with certain paradigms of psychoanalysis in such a way that a dialogue is set up, or even a confrontation that proves to be heuristic. For example, the research at present being carried out in biology or ethology concerning the function of affects or emotions in regulating the way the mind works ought to be able to enter into a « dialogue » with the metapsychological concept of affect and perhaps even modify or develop this. Studies of the neuro-biological approach to the mechanisms and processes that govern the activity of ideational representation — another paradigmatic concept in psychoanalytic metapsychology — or the workings of memory inevitably « come up against » the metapsychological view of these; this is the case even when we give due care and attention to the epistemological hiatus between these different theories of representation. It is not possible to ignore the theory of the failure of processes of « meta-representation » [Frith & Sisley 1990] in the psychoses, because those processes help us to elaborate on the « psychoanalytic » question of the representation of representation and that of the representation of absence of representation. Again, in another interface domain, there is the research carried out, by those who argue in favour of attachment theory, on the representation of « observed » babies as distinct from the « baby » we encounter in clinical practice. Here, too, we have to accept the epistemological hiatus as regards measuring what is observed: the type of object constructed via observation is not the same as that of the clinical practice of psychoanalysis, which has much more to do with the manner in which the analysand « signifies » what he or she is having to deal with and internalizes interactions with the environment, and with the way in which the infantile sexual dimension « interprets » objective history. Psychic reality must therefore be given full weight — and this is true also of the reality of subjectivity and of the drives and their representatives, which make observed « facts » meaningful. It is necessary also for any encounter with epistemology to respect the true complexity of the issues involved. In all probability, the poverty of the conception of psychoanalysis that we find in most of our colleagues from the cognitive sciences or neurosciences is equalled only by that of most psychoanalysts concerning the research that is carried out in these other fields. It is often difficult to set up a true dialogue, because in the background there may be too much over-simplification and perhaps even gross distortion of the other person’s thinking.

However, when these studies do succeed in establishing a certain number of essential clinical « facts », we could hardly imagine psychoanalysts, who are necessarily interested in everything that involves the mind, ignoring them, failing to take them into consideration or not trying to integrate them into their metapsychology. Psychoanalysis has to do with processes of representation and meaningfulness, and with the transformations that the mind and subjectivity bring it to bear on life « events » and on some incidents and specific aspects of these; it cannot ignore anything that may increase our possibility of representing and understanding what occurs both on the biological and interactive levels, within an interactive epigenesis. How are we to think properly about how things are internalized and transformed if we do not have a better representation of what they are « objectively » or « biologically »?

It is in this sense that there cannot be any fundamental incompatibility between the various approaches. It is inconceivable that clinical facts « proven » by means of methodological techniques other than psychoanalysis can contradict in the long term certain theoretical assertions of psychoanalysis without there being some kind of serious discussion and confrontation to clarify the situation. Such a dialogue, with respect being paid to each epistemology, will necessarily facilitate progress in theoretical outlooks and formulations. There must be at least one level at which different methodologies dealing with the same clinical object can come together or interface with each other, even if the epistemic object is constructed differently.

Let me develop the example I mentioned above. Even if we take care to differentiate clearly between the « baby of an observation » and the « baby of psychoanalytic practice with an adult », a clinical study of early disorders and of resilience cannot fail to raise theoretical and clinical issues concerning the relationship between the psychological aspects of attachment or developmental theory and psychoanalytic conception(s) of infantile sexuality. That will be even more the case if the « baby » is observed during actual clinical work with infants and the « reconstructed » baby comes from the psychoanalytic treatment of an adult.

Psychoanalytic treatment of children raises that particular question in a very crucial manner. That relationship, which is theoretical, clinical, and practical, will have to be explored as a matter of urgency if we want to avoid seeing a gulf open up between practitioners of child and infant psychoanalysis and those who deal mainly with adults. It is interesting — although somewhat puzzling — to note that this kind of formal research, carried out on the basis of psychoanalytic or related epistemologies, has been developed to a much greater extent in the case of infants than in that of adults. Perhaps the psychoanalysis of adults does not lend itself particularly well to that approach; there may, however, be other reasons worth exploring. Perhaps the complex nature of the transformations that the individual’s subjective life-history — retroactive or deferred re-organizations or dis-organizations — have brought about in the significant events of his or her early childhood make them to some extent difficult to pinpoint as regards their characteristic features. Looked at from another point of view, they could be seen as being differently « observable » from what direct observation would evoke.

As this example suggests, interface studies may well have an impact on psychoanalytic theory, practice or clinical approach. Without being research « within » psychoanalysis, these studies do call certain aspects of psychoanalysis and psychoanalytic research into question in so far as they involve a way of looking at the mind, its construction or its fundamental paradigms. There is nothing to prevent us thinking that they might well lead to new developments in psychoanalytic theory, practice or clinical approach — or at least that a productive dialogue might be conceivable.

4. I would like now to discuss more specifically the idea of research « within » psychoanalysis. In my view, there are three possible directions that can be followed; these are quite distinct from, but potentially related to, one another. They concern the means by which « enacted penetration » of unconscious psychic reality can be expressed: setting, counter-transference, and theory. Research into each of these three dimensions should be looked upon quite specifically: the setting offered to analysands; « clinical » research based on psychoanalysis, i.e. into psychoanalytic practice and the significance of any modifications made in accordance with the patient’s state of mind at the heart of the transference; and research into models of intelligibility and the « clinical dimension of theory » that these entail.

The reader may perhaps be surprised by the fact that I have placed at the top of this list research into the setting offered to analysands. This of course implies that we accept the fact that the practice of psychoanalysis is not limited to the « coach-and-armchair » set-up but that it can be envisaged also — without using what then becomes the pejorative name « psychotherapy » — in other settings. I am not talking here of what Green has quite justifiably called « the work of the psychoanalyst », which indeed can be conceived of in a whole series of different settings depending on where the actual treatment is carried out (general hospital, psychiatric unit, perinatology, « defectology », etc), with no particular set-up. I am talking about situations that involve psychoanalysts working in settings that are now well-established (analyst and analysand sitting facing each other or side by side, group settings, family groups, psychodrama, child analysis, etc). Under pressure from concrete practical situations — psychoanalytic work with both participants sitting facing each other is probably the most widely used setting nowadays, psychoanalytic work with groups and with families can no longer be ignored… — the developments in our thinking on this point is giving rise to research into the specific nature of the psychoanalytic process and the particular modifications that have to be introduced given the characteristic features of the setting and its indications. It should be pointed out, nonetheless, that most of these major research projects — or rather major « psychoanalytic explorations » –, those that have given rise to published writings that are unanimously acknowledged to be fundamental contributions to psychoanalysis, have taken as one of their starting-points the « transfer » of psychoanalytic practice towards new settings involving new objects.

I shall give some examples of what I mean, mentioning only analysts universally accepted as such and from previous generations. Melanie Klein developed the most important part of her work through her practice of child analysis, inventing a specific kind of setting for child patients. W. R. Bion began his exploratory work with « experiences in groups », based there too on a specific setting, before moving on to the study of the psychoses. D. W. Winnicott took as his starting-point the work he had done in « therapeutic consultations » with very young infants; he often included one or the other of the child’s parents; that « established situation » which he used in some of his consultations has all the typical features of a specific setting for very young children. Nowadays, major advances in psychoanalytic thinking take their inspiration from what we could call the « borderline situations » of psychoanalysis; what Winnicott called analytical « research » treatments are an attempt to « transfer » psychoanalytic practice to the treatment of patients described as « borderline », « psychosomatic » or even « violent », sexually or otherwise…. Each of these clinical explorations requires, most of the time, the introduction of specific measures, a « tailor-made » setting in order to adapt as closely as possible to the demands and particularities of the psychoanalytic process in those transference situations.

As yet, however, there is still no general theory of analysand-specific settings or of the effects of varying the various parameters of these. Such a theory would be of great interest, particularly as regards the definition — always a problem and forever changing ground — of the identity of psychoanalysts and psychoanalysis. The future of psychoanalysis no doubt lies in attempting to think even more deeply and in a « tailor-made » fashion about the most appropriate forms of setting that accompany psychoanalytic work with different analysands and the various « internal states » that bring them to psychoanalysis. The guiding principle here is that each setting — or non-process, as Bleger puts it — should make possible a kind of process that has its own specific features, through which it « organizes » the transference such that a particular pattern, or in Freud’s words « transference relation », can be identified and interpreted. The mind is complex, and each kind of setting makes it possible to analyse some aspects of it but not others; it does not bring into operation the same psychological patterns — or at least does not make them function in the same way. The main topics of research into analysand-specific settings would, in my view, be the exploration of the diversity of these transference patterns and relations, together with the diversity and specificity of the manner in which psychoanalysts work within these parameters.

It could nonetheless be argued that we still need much more research into the basic setting of psychoanalysis — the couch / armchair set-up –, its characteristic features, the different ways in which analysands make use of it, the various dimensions of their free associations and of the analyst’s evenly-suspended attention that it reveals. The different ways in which psychoanalysts actually work show how urgent it is to explore the effects of these variations, their implications for the structuring of the analytical field, and the processes that can then be interpreted — or, alternatively, that are thereby excluded. There is an urgent need for this kind of research, both from the point of view of psychoanalysts themselves and taking into consideration the cross-cultural dimension of psychoanalysis.

5. I would now like to discuss possibilities of research into the couch-plus-armchair setting itself. That kind of research seems to me to be the most difficult of all to set up and to think about. It would have to overcome the obstacles inherent to the practice of psychoanalysis itself, which is individual, applies to the experience of a limited number of cases, and is always prone to the impact of the analyst’s counter-transference both on the emotional level and in its epistemological or theoretical dimension. I will later say a few words about how to take some of these difficulties into account. The main issue, however, concerns taking heed of the epistemological particularities linked to the existence of and respect for the hiatus between theory and practice which is typical of psychoanalysis and which has an impact on every attempt to carry out research or explorations in that field.

Generally speaking, every research procedure implies testing hypotheses or models that are then « evaluated » with reference to some clinical material or other. The practice of psychoanalysis, however, demands that any « foreknowledge » or « pre-existing theory » be put to one side; that procedure therefore comes up against the risk that any working hypothesis may function as a kind of « machine » that influences and distorts the validity of the clinical process itself. The danger is that the counter-transference interplay may find itself cut off, with the production of ad hoc clinical material that is dependent on the initial hypotheses. It is well known that such a threat is present whenever clinical material is called upon to « prove » a given model or theoretical hypothesis.

The practice of psychoanalysis is based on the requirement to put aside any pre-existing theory; this implies that any research within psychoanalysis will always come up against issues that involve something that is impossible to decide. As Donnet’s work has amply shown, the instruction to put theory to one side is a fundamental tenet of its practice, but just as it cannot claim to be nothing more than pure subjectivity — which would give the interpreter in the course of a session a status akin to that of a demiurge — it cannot give rise to falsifiable objectivity (in Karl Popper’s sense), which would erase the counter-transference aspect on which the practice of psychoanalysis is based.

That epistemological impossibility to reach a decision is a consequence of the particular nature of the relationship between practice and theory in psychoanalysis. On the one hand, « psychoanalytic » evaluation of any theory or of any research findings requires this to be brought into actual practice. The theoretical coherence of any given postulate, its precision, its acceptance as such into metapsychology are not in themselves sufficient; it will have to prove its generative potentiality as regards interpretation or free association, and be effectively subjectivized in order to prove its objectivity.

Conversely, the practice of psychoanalysis cannot in itself be sufficient proof of its validity; theoretical models are required to account for this or, rather, to determine its rightful place. Clinical practice must be able to be transferred into the basic theory in order to find its rightful place.[2] This is indeed a transfer, a displacement, because the « object » is no longer envisaged in the same way in theory as in practice. This is one of the modalities of the hiatus between theory and practice that must, nevertheless, be supplemented by a dialectical relationship that reunites / separates theory and practice. Some idea of that relationship can be obtained with the help of a twofold paradoxical prescription.

Practice ought to be able to « deconstruct » theory[3], and therefore any project of « preliminary research »; this implies that the clinical dimension of psychoanalytic treatment should have the opportunity of « refuting » theory or even of « analysing » it. Theory puts forward a set of benchmarks for the practitioner that cannot be ignored, models that behave like « attractors » for psychic intelligibility. From that point on, however, we cannot minimize in practice the influential effects of these theoretical attractors or of those that come from a « researcher’s » role. The pre-existing theory that will potentially have to be « validated » through actual practice may well « seduce » that practice — it may have the virtual counter-transference effect of a « prediction that is fulfilled » or, conversely, it may produce a transference rebellion against the ready-made thinking of the theory. Practice must therefore « survive », in its principles, the seduction effect of « research » — this is brought about by the analysis of what could be called the « theoretical counter-transference » — in order to give the clinical process the opportunity of « refuting » the theoretical prediction that is being applied. If that is not the case, the theoretical attractor would indeed function as though it were a machine for influencing. For any research to be significant, it must also « survive » that deconstruction; it will then be co-founded by practice.

Conversely, research must also be able to call clinical practice into question or even to « deconstruct, analyse or refute » it; practice that is worthy of the name will be that which « survives » the threat of its refutation by theory. In that way, theory will not prevent clinical practice from existing in its own, different, way.

I am not particularly happy with the way I am putting things here ; their only value, in my view, is that they emphasize the fact that the reciprocal transfer of theory to practice and from practice to theory gives rise to a paradoxical confrontation in which both theory and practice have an opportunity of being deconstructed / founded together. It is that process which any research in psychoanalysis will necessarily encounter.

Psychoanalysis is not simply a set of theoretical postulates, nor is it merely the application of a practical technique; a way of actualizing a method of analysis, it is also a specific way of linking theory and practice that defines a particular epistemological standpoint.

6. After these preliminary considerations, I must begin to put forward some issues that lend themselves to explorative research in psychoanalysis. One way of doing this — I shall merely mention this — would be to attempt to take as a basis published work that psychoanalysts themselves acknowledge as being significant contributions to the theoretical corpus of psychoanalysis; this would therefore be a « retroactive » mode of research. The idea would be to discover, within the psychoanalytic community, a starting-point based on what analysts have « retained » of the clinical, practical and theoretical developments of psychoanalysis, what facilitates its « development » — leaving aside any notion of « advances » — or presides over its paradigmatic evolution. The starting-point would therefore be not so much the research itself in terms of a deliberate procedure as the idea of a clinical or theoretical « discovery » that makes us reflect upon the conditions under which it may become possible.

From that point of view, research is no longer seen as having its source in an approach defined as such ab initio but, in a manner that conforms more to the psychoanalytic way of thinking, one that is acknowledged « retroactively » as such. A particular way of practising psychoanalysis discovers retroactively the clinical or metapsychological research issues that are implied by it; it discovers that it has contributed to the « exploration » of part of the psychoanalytic domain.

We could therefore begin to reflect on the features common to all of the outstanding work done by the psychoanalysts whom I mentioned earlier, those that are retroactively felt to be a « discovery », hence their impact in terms of « research » or exploration.

The basis of that approach is very different from the usual situation. The idea is to reflect on how psychoanalysts who have made a significant and acknowledged contribution to psychoanalytic thinking carried out their work, to see whether any specific features of it can be identified, and whether we can, as a result, develop our conception of research « within » psychoanalysis. By « significant contribution », I mean either original and heuristic descriptions of certain clinical situations or models (or parts of models) of some ways in which the mind works that have made an important contribution to promoting or modifying a paradigmatic development. For me, acknowledgement by the psychoanalytic community is the criterion, one of the most essential criteria of « research » in psychoanalysis — not only « clinical » research but also that which investigates models of intelligibility.

Thinking about what already exists is the starting-point of that approach, the idea being to identify the main themes and characteristic features, to isolate from the spontaneous « research » (or, better, « discovery ») that psychoanalysts do those principles that have proved effective. I would argue that the starting-point of such an approach is the question of the counter-transference in psychoanalysis or, rather, the way in which every true analyst continues on a personal level to « explore » the workings of the mind through his or her practice of psychoanalysis — or, more modestly, certain aspects of it.

Taking the counter-transference as the starting-point implies first of all accepting the idea that the very foundations of the practice of psychoanalysis have to be looked for in the tension that is set up between the fact that psychoanalysis is a profession performed by psychoanalysts and simultaneously an opportunity offered to them (and an obligation imposed on them) to continue their personal psychoanalytic exploration. « Research analyses » and productive psychoanalytic « explorations » are those in which the analyst — perhaps because of a particular « moment » in the transference or a confrontation with a borderline situation phase — comes up against something unknown and unexplored or even not wholly owned in his or her personal analysis. The analyst then has to go beyond the level of intelligibility acquired up to that point. It is that transference moment, emerging as a question linked to the counter-transference and therefore based on the practice of psychoanalysis, which inaugurates an approach that is indeed one of research. It is not the whole of that research, it is not its ultima ratio, but it is its starting-point.

The characteristic feature of the destiny of that process is the nature of what will be called upon in order to explore that dark area and what will become of it. It may remain essentially private: in this situation, for their own good as well as for that of their patients, analysts explore some hitherto un-thought-about element in their own subjective past, an obstruction to their idea of the work of psychoanalysis, so as to overcome that difficulty for themselves and for their patients. For an analyst, that kind of work has the effect of a discovery; it may remain private and be no more than the way in which that particular analyst has come to own part of his or her psychic reality. Fortunately for all concerned, we can think of this as being a frequent occurrence and that it need not be made public — unless the analyst feels the need to make known the good news of his or her personal development of the clinical aspects of psychoanalysis.

The situation is quite different when the point at issue is seen to be not simply that particular analyst’s counter-transference but an echo of a clinical or theoretical dilemma shared by the rest of the psychoanalytic community; the analyst decides to transfer that particular clinical experience to the metapsychological domain, carrying out the necessary theoretical work for communicating the heart of that experience so that it can participate in the debate about conceptions which remain problematical. Thinking about that particular clinical experience thus takes on another function: it is no longer a simple « clinical » exploration in a particular set of circumstances, but begins to acquire the status of a « contribution » that takes its place within a given history, it begins to acquire the status of a « research ». It lies at any rate at the inception of that.

It will only become a true « research » if, from that moment, it brings about the kind of work required to create a generic form, a model that can be exported over and beyond the particular clinical situation in which it originated, one which gives itself the means to acquire a third-party status.

This implies the need to compare that same mental pattern with other clinical experiences or with other models of intelligibility. I have the impression that that was the way Freud himself proceeded. This is where one of the difficulties of « clinical research » in psychoanalysis arises — the need for clinical comparisons. It could happen, of course, that, by chance, the analyst has a whole series of transference situations similar to the one that sparked off the exploration, so that the necessary work of comparison could then be carried out by that analyst him- or herself. Or perhaps the corpus of psychoanalytic writings already contains the essential clinical counterpoints, thereby enabling that analyst to carry out the work of extricating the elements that will make for a comparison or modelization of the experience. The seminars organized by various psychoanalytic associations are no doubt useful in promoting an external third-party viewpoint on the analyst’s experience. These modalities, however, although they are — as we can see from what analysts tell us about their training — very widespread among analysts, are somewhat indiscriminate in their personal « tinkering » (Levi-Strauss’s use of the word « bricolage« ); that is no doubt one of the factors that slows down the creativity of psychoanalytic research.

I have the impression that there is another possibility that some psychoanalysts make use of on a purely private basis; as far as I know no psychoanalytic association has made any attempt to encourage this approach. I do not know whether this abstention ought to be seen as a condition of how they function or, conversely, as a brake on their development.

For the past ten years I have been attempting to reflect upon and draw up a procedure that could compensate in part for some of the difficulties that I have just mentioned. It consists of a group-based « inter-vision » seminar, which enables a psychoanalytic « exploration » of “borderline situations” in psychoanalysis to be carried out. It is one example of the kind of research that can be undertaken within psychoanalysis while paying due respect to its epistemology and specific constraints.

A group of seven or eight psychoanalysts[4] hold meetings with an external analyst; the initiative comes from a number of analysts who wish to explore their own practice of psychoanalysis in a « group-based inter-vision seminar »[5]. They discuss the treatment of analysands who present specific difficulties related to « borderline situations » in psychoanalysis or other clinical issues, or perhaps even difficulties that occur in every psychoanalysis. The seminar group is not part of a basic training programme; the great majority of its members are experienced analysts, acknowledged as such by their respective psychoanalytic associations, who want to pursue their thinking about and exploration of their practice of psychoanalysis, either with cases that are known to be « difficult » or with fairly ordinary analyses that do, however, at one point present a particular difficulty for them. Often, these psychoanalysts are of the opinion that psychoanalysis cannot properly exist unless there are procedures that enable ongoing research to develop; in their view, research and exploration are intrinsic to the practice of psychoanalysis.

The analytical « cases » are presented either after several years of work or at the very beginning of treatment. Presentations to the group are made usually in three phases that can be fairly well identified, their heuristics having progressively been recognized over time.

In the first of these phases, the analysand’s past history, as reconstructed by the analyst while the treatment unfolds, is presented to the group. This is when we discover basic data about the analysand, his or her parents and principal objects that have enabled the construction of a sense of self, the major « events » of the analysand’s life and « significant » facts about his or her past history, memories, screen-memories…. Here, the work of the analyst consists in extracting, reformulating and piecing together a set of « facts » gleaned from preliminary interviews and in the course of the analysis, organized into a narrative of the analysand’s clinical history. It is clear that the « clinical aspects of the case » thus worked out are the fruit of the ongoing work of the analysis, that they depend on the transference / counter-transference situation and that they enable us to familiarize ourselves with the » theory » that the analyst has built up concerning the patient’s mind as it appears to function in the analytical situation. For the analyst, it is a « theory » of the analysis of that patient. The inter-vision group then begins to work on this, focusing on the « clinical dimension of the case » presented — not only the clinical aspects of that particular patient, but also the representation of the analysand to which it bears witness and to the specific features of the « construction » by the analyst of that representation.

Next comes a presentation of what I am tempted to call the « clinical dimension of the psychoanalytic process »: the preliminary interviews, the high points of the treatment and of the process of coming together, the various phases of the « transference » and « counter-transference », and the difficulties encountered during the treatment are described by the analyst. The clinical dimension of the problems of the analysis is worked on by the group, the analyst’s hypotheses concerning transference manifestations, those constructed as the analysis unfolds and those that he or she is in fact able to explore through the work of interpretation are presented to the group and worked on. This leads to a new representation of the « case », still based on the work done in the group on what the analyst has shared with them, although this time the focus is on the clinical dimension of the process. A more specifically « psychoanalytic » comparison between different points of view can then be carried out within the inter-vision group.

Then the most « significant » sessions of the latest month of the analysis are presented in as « verbatim » a manner as possible, together with the interpretations and the interpretative approach favoured by the analyst at that point. The « clinical dimension of the analytical session » and the « clinical dimension of interpretation » can then begin to be apprehended with the help of this kind of material. The analysand’s modes of free association, verbalization in the course of the sessions, the specific impact of the transference and the interpretative response that the analyst makes can all be grasped in their mutual interplay. Any hiatus between representations based on the « clinical dimension of the case », those based on the « clinical dimension of the process » and those that are based on the « clinical dimension of the analytical session » is then worked on in the inter-vision group. This group-related processing leads to an attempt at « virtually » exploring, in terms of « experiences in thinking », various models of intelligibility as regards the process that is unfolding and different kinds of interpretation or intervention during the sessions. A metapsychology of the succession of free associations in the sessions or a metapsychology of the interpretative modalities of the kind of mental states that lie at the heart of a given transference pattern may then be drawn up. It not infrequently happens that the group can then reflect on the « clinical dimension of the theory » that is de facto implied in the clinical manifestations reported.

Approximately one month later, the seminar group discusses the sessions that have taken place in the month that passed since the previous meeting, in an attempt to draw up a clinical and technical assessment and adjustment based on the measurable effects of the inter-vision work done the month before. It may then happen that the « clinical dimension of the work of psychoanalysis », in its clinical, technical and perhaps even metapsychological aspects, are outlined at this point, based on what the assessment and adjustment work has revealed.

For those who are prepared — and able — to devote the necessary time and energy, there is a further step, after the group work has been carried out. Each analyst can then work by him- or herself on the processes that have been evoked and on the theoretical or clinical implications that have arisen in the course of the group work. It is at that point that theoretical and clinical models can be worked on.

This whole procedure is somewhat complex. Many comments could be made about it, but for the moment I shall simply outline a few of these.

The support offered by the group and the time devoted to thinking together about various issues often enable the presenting analysts to explore working hypotheses, intervention modalities and thought patterns, something that they might be reluctant to do if they were on their own. The seminar provides a third-party plurality of views thanks to which the analysts who present the material can look again at their « personal theory » concerning the patient and psychoanalytic practice; this enables them to go beyond the well-trodden paths that their training, with its specific aspects, has provided. Generally speaking, the work that is presented is selected because of some specific difficulty to which it has given rise for the analyst concerned, with the result that his or her usual way of proceeding no longer works: a special psychoanalytic « exploration » is required. These analyses inevitably call upon the analyst to be creative; by the same token, they give rise to specific kinds of anxiety in the analyst who ventures into a psychoanalytic domain that is, for him or her, at least partly unknown.

The clinical presentations are significantly different from the classical clinical illustrations that we generally find in seminars or in articles. They obviously go much deeper into various aspects of the work, they lie at the crossroads of various approaches to the clinical encounter, of various « prisms » in the analyst’s attention to the material. The « clinical dimension of the case » enables analysts to stand back, with a shift in representation compared to the « clinical dimension of the process » which is focused on what is actually transpiring in the treatment and on the history of the clinical encounter; in turn, both of these are quite different from the « clinical dimension of the session » and the analyst’s careful « word by word » listening to the patient’s free associations. This variation in the « enlargement » of the attention given to the clinical material highlights certain specific clinical elements, it requires work to be done on the attention given to the material and contributes to making manifest the implicit features of this. In addition to that first source of variation and the interesting differences that follow on from it, the fact that a group of analysts who themselves have different theoretical or technical backgrounds is paying close attention to the presentations gives rise to a « plural » form of listening which, because it is in itself complex, throws light on the complex nature of the clinical material.

As regards the importance of this procedure « for research purposes », I shall simply for the moment outline its various advantages. The group is of course presented with and reflects on the material after the session has taken place, in a time that is distinct from that of the actual work done there, so that, at least initially, it does not interfere with that work. The hiatus between theory and practice is respected as far as possible, thanks to that separation. The work is not focused on a research topic or on a specific problem situation, with the « seduction » effect that such a precondition may have on the way in which the material is considered. The analysis is reflected upon, in and for itself.

The presenting analysts are not looked upon as « trainees »; if what emerges from the group’s reflection does have an influence on the way they work, they remain « sole masters on board » as far as that is concerned. They themselves « decide » to make use of whatever they find helpful for the particular analysis they are presenting. In fact, most of the time, the work done in the seminar is that of a collective « multiple-voice » form of processing and its impact is based on that. One month after a presentation, the effect it had and the seminar processing of it can be « evaluated » with respect to any changes brought about in the session material. In one sense — somewhat mundane, admittedly — we can see if « it works », what works, and think about subsequent adjustments to be made in the ongoing work of the analysis.

In their everyday practice, analysts can do only a few treatments for « exploratory » or « research » purposes: their clinical experience and therefore the necessary possibility for comparison are thereby limited. They work in a particular manner — the one that they became familiar with during their training and went on to adopt as their own. The seminar helps them discover other ways of understanding and interpreting the clinical material of a given session; that at least makes them « work on » their models of psychoanalysis and their « transference » on to analysis.

Obviously these « inter-vision seminars » can be used simply as instruments for one’s own personal training. From that point of view, they are extremely useful, but I would argue that they offer also a real opportunity for psychoanalytic research.

Personally, I have been able to « accompany » in inter-vision seminars almost 70 treatments of borderline cases since the programme was first established ten years ago, covering from six to ten groups. My own experience as a psychoanalyst would never have given me the opportunity of encountering so much clinical « manna » for my research into borderline situations in psychoanalysis. The model described in the first chapter of my book Agonie, clivage et symbolisation [Agony, Splitting and Symbolization] is to a large extent based on that procedure; before it was published, I presented it to the seminar groups and discussed it with them.

A certain number of issues, fundamental to the practice of psychoanalysis as it is at present, are thus being worked on — « transversally », i.e. cutting across the various schools of thought or trends in psychoanalytic practice. The relevance and limits of interpretations systematically focusing on the here-and-now of the session, the importance and interpretation of « sexual » material in the dynamics of the process as compared to « narcissistic » trauma, the meaning and function of issues to do with separation in the economics of analytical treatment, problems involved in processing traumatic areas and post-traumatic states of mind, working-through destructiveness in the course of an analysis, the effect of me / not-me confusion on the narcissistic aspects of the transference, and so on — all of these topics can be looked at over a lengthy period of time and in a situation in which the ideological impact of the various schools of thought is lessened thanks to the constraints imposed by the clinical dimension of the case being presented as well as by that of the group itself.

I would argue that this way of proceeding deserves to be called “research” in psychoanalysis, even though there is no statistical assessment of the treatments discussed. The opportunity of evaluating month by month the effect of the analysis carried out by the inter-vision group on the cases being presented, and of adjusting the style and form of the analyst’s interventions depending on the particularities of the analysand’s transference, pays due respect to the epistemology and ethics of psychoanalysis; it also enables learning to be transferred from one analysis to another, together with any models that have been constructed.

Until now, supervision has been looked upon as being a useful procedure for training future psychoanalysts and perhaps also in certain cases where some major difficulty or other arises in the course of an analysis. That conception implies that psychoanalysis can be learned and that there comes a moment when it is known and can be considered to be acquired « once and for all ». I do not share that point of view; the practice of psychoanalysis is to my mind conceivable only if it includes the idea of ongoing research within psychoanalysis itself. In addition, when we realize how important the research-supervision or inter-vision group is for the participating analysts and the analyses that are presented, we could say that in analyses where issues involving narcissism and the sense of identity are very much to the fore (and that may already be too narrow a limitation) a research-supervision group may well be a necessary adjunct to the process itself.

For the moment, in most psychoanalytic associations, research and reflection concerning psychoanalysis take the form of work-discussion seminars that often, given the number of participants and the types of presentation, involve such narcissistic issues for the analysts concerned that only a limited degree of personal involvement is possible. There is often a marked contrast between what they actually do in their work and the manner in which it is « displayed » in these « institutional » settings; this is the case even when matters of validation or training programmes do not enter directly into the picture. That way of working has little to do with « psychoanalysis » and is hardly conducive to exploration and research into psychoanalytic practice and theorization.

In our local university, in the context of PhD seminars that bring together clinical psychologists and psychiatrists (most of whom have some personal experience of psychoanalysis), the procedure is the same, and is based on the « extreme situations » that these clinicians encounter in their work with patients. Clinical research into severe anorexia in adolescents treated in hospital settings, into sexual delinquents or criminals treated in the medico-psychological unit of the local prison, into homeless people on the streets, into accompanying hospitalized cancer sufferers or patients who, after a heart operation, are in intensive care, into groups of psychotic children treated in day-care centres, etc — this is the kind of work that can be discussed in inter-vision groups.

I shall conclude this paper by stating quite simply that research in psychoanalysis — indeed, clinical research as a whole — is above all a matter for the psychoanalysts and clinicians involved; I would go on to argue that it is also a matter for all psychoanalysts and clinicians, whatever their status, who are members of the relevant associations. Any reflection on clinical research in psychoanalysis requires the invention of procedures specifically designed for psychoanalysis, procedures that enable the actual practice of psychoanalysts to be apprehended over and beyond group ideologies. It requires also that metapsychological concepts be devised in order to be able to think about the mental structures that organize those transference patterns that psychoanalysts have actually to deal with in the various settings in which they practice.

 

 

References:

Bertrand, M. (2003). Trois défis pour la psychanalyse [Three challenges for psychoanalysis]. Paris: Flammarion.

Donnet, J.-L. (1990). Psychanalyse. Questions pour demain [Psychoanalysis: questions for the future]. Paris: Presses Universitaires de France.

Guillaumin, J. (2003). La psychanalyse: un nouveau modèle pour la science [Psychoanalysis : a new model for science]. Paris: Esprit du temps.

Roussillon, R. (1990). Psychanalyse. Questions pour demain [Psychoanalysis: questions for the future]. Paris: Presses Universitaires de France.

Widlöcher, D. (2001). “La place de la recherche clinique en psychanalyse” [“Clinical research in psychoanalysis”]. Special issue of the Revue Française de Psychanalyse: Courants de la psychanalyse contemporaine [Trends in contemporary psychoanalysis].

 

 

[1] See on this point Guillaumin [2003] and Bertrand [2003].

[2] This is what Donnet [1990] calls a « meta » operation.

[3] I am here applying the paradox of the « use of the object » to a different domain: in order to be discovered and established in its exteriority, the object must be destroyed and yet survive. It is therefore destroyed / found. A possible analogy would be a theory that is destroyed by / founded on clinical practice. Cf. my conference paper at a UNESCO symposium [Roussillon 1990].

[4] The participants make their own choices of who should be part of the group, and they choose the external analyst who will act as the seminar leader. They make these choices mainly so as to ensure the creation of an atmosphere of basic security required by the clinical work that is “laid bare” in a group seminar. In my experience, in this kind of group there are references to a great variety of theories; I feel this to be an essential requirement if we are to avoid being influenced by what could be called an ideology of psychoanalysis. The plurality of theoretical points of view, showing respect for differences of opinion and for those who present their clinical work, are fundamental requisites for such groups.

[5] The seminar is group-based because, although the work done in it is mediated by the group and takes support from the group dimension, it is not in itself focused on group-work in the narrow sense of that term.