|Scientific Advancement and Research in the EFPP|
by Olivier Nicolle
The appointment of a “Research Convenor“ as a co-opted member of the Executive Committee was agreed at the 2000 Oxford Conference. The main ends he was assigned to were to get in touch with diverse “research-concerned“ members among the EFPP, to help them knowing one another and making bridges, to report to the Executive Committee (EC) about the present situation of “research“ in the EFPP, and to propose some guidelines for an “EFPP scientific policy“ in the near future.
Previous and preparatory versions of this report were brought to the attention of the EC members during the Basel, Palermo and Stockholm meetings. A first discussion took place in Basel, and a consensual decision was taken: provided the agreement by the present EC (elected 2003), this report should be used as the basic reference for coming realisations and implementations pertaining to the “research issue“.
The purposes of this document are:
1/ summarising observations and notations made in the course of the two 2-years mandates I was appointed to by the EC as "Research Convenor"; thus, proposing and defending some basic ideas relative to the principles which should be applied, concerning "scientific advancement and research" in the EFPP.
2/ proposing some valuable ways of carrying out scientific progress, including research, in the EFPP.
3/ indicating some possible specific implications towards an implementation of the preceding basic points, aiming at realising a scientific policy of EFPP through the next decade.
This report is based on:
1/ scheduled (research workshops at the Conferences, and diverse national scientific occasions) or non-scheduled (personal) meetings with “research concerned“ individuals (among the EFPP and outside: psychoanalytical societies, EFP, universities)
2/ important contributions in the previous and present literature from psychoanalytical and research journals and books.
3/ my own experience and views as a member of a psychoanalytical society, as an academic and member of a psychoanalysis research team in the French national scientific network (CNRS)
1/ Observations, Notations, And Basic Ideas Relative To Scientific Advancement and Research In The EFPP
Like Freud in his time, each analyst feels at times torn between different positions, and at least two of them: on the one hand the necessity of going along the very unique path of his own analytical work with a unique analysand or patient, and on the other hand, another necessity: to assess, to compare, to search and find some communicable abstracted generalisation of the analytical experience and outcome.
As we know, these two approaches can neither be totally dissociated from each other, nor assimilated to each other, and, they nevertheless require very different - and often opposite - psychic positions.
When going to dialogue with “research-concerned“ individuals, different meanings of the word “concern“ indeed appear: very diverse and contrasted positions may be noted, from a fierce enthusiasm about every so-called “empirical“ research, to a radical rejection of any investigation of that type. Understanding the individual's opinion about this question obviously requires to integrate a very personal, intimate psychic position, but also structuring cultural backgrounds (Cartesianism, pragmatism etc. as Human Sciences references), more or less difficult national (economical, political) professional conditions, and institutional ties and interests (being an academic, or a member of a more or less conservative analytical society, or being a salaried member in a public health institution, or in a competitive research environment etc. ) These conditions have direct or indirect effects on our positions. Evaluating this diversity needs some preliminary clearing steps on that complex ground.
Besides, the comparative situation of psychoanalysis vis-à-vis analytic psychotherapy is a complex one, too, and determines partly the question of research.
In some analytical cultures, "psychoanalytical psychotherapy", especially in the public service, has developed progressively towards a more or less "symptom-centred" psychotherapy, together with a pivotal "analytical inspiration" at the theoretical level. Hence psychoanalytical psychotherapy is thought about as a “treatment“ proper, and a very huge influence of the medical scientific model may be noted. Therefore, scientific advancement is here most often meant as so-called "empirical“ research, and in the narrowest meaning of the word. This view leads mainly to symptom-focussed comparative quantitative studies, or to academic psychology research, where "objective" methodologies are applied to psychoanalytically-worded phenomena, with "outcome evaluation", "efficacy assessment", “comparative efficiency“ as the main goals.
There are other analytical milieus, where "psychoanalytical psychotherapy" is essentially understood as "psychotherapy with a psychoanalyst", and viewed as a "complex psychoanalysis". Therefore, the basic assumption is there that psychotherapy issues are genuine psychoanalytical issues. Consequently, the scientific advancement of psychoanalytical psychotherapy tends there to be grasped and designed as an investigation about analytic and therapeutic processes. Thus, these investigations are thought about in the same way as any other psychoanalytical research: the subject of the research determines the methodology. In other words, it means that the analytical matter will therefore require true (even if not “classical“) analytical settings and analytical methodology, including: clinical contradictory comparison, analytical discussion and assessing of analyst's or therapist's own interventions or no-intervention, interpretations, silence etc. through diverse supervision situations, long-term follow-up and analytical evaluation of inter-subjective processes, maximal integration of patient's transferential and of analyst-researcher’s counter-transferential positions, maximal integration of latent elements (including institutional ones) etc.
Yet, another aspect has to be taken in account. There are difficult national situations, where psychoanalysts and genuine psychoanalytical psychotherapists working in the public sector feel like, and sometimes indeed are, pressured by health or insurance authorities to quantify and prove the effectiveness of their "treatments", in the way all public sector medical practitioners are. Scholars and academic people feel like, and sometimes indeed are pressured to produce and publish "research data and results" to prove the quantitative data-based quality of their teaching and clinical work. Too often, without any consideration of the specific subject of our discipline, the rightful requirement of rational theory and practice seems having turned into a new ideology: "evidence-based" (i.e. quantitatively based and compared) becomes an automatic argument of authority, as sterilizing as theology before the Renaissance.
First of all, this pressure towards producing "empirical research" is worrying because "outcome data" means merely here "quantitative data", the obtaining of which required evaluating procedures which will necessarily slant the inter-subjective analytic and/or therapeutic situation. Actually, measuring "efficacy" for instance, requires interpersonal standardized comparisons which regularly neglect and fall short of integrating the individual's intimate history, and they can't but neglect it. They also suppose having an ideological point of view on the psychic function of symptoms as negative elements which have to be uprooted. Besides, as we know, a sudden representation or an invading emotional state, for instance, are "empirical facts", even though their quantum is too difficult or impossible to assess without destroying the whole analytic or therapeutic setting. Classical so-called “empirical“ research, in its present situation and means, faces therefore this dilemma: either grossly slanting the analytical situation and processes, or bringing structural bias into the experimental situation. And these are just a saucerful of the so many unsolved epistemological problems arising in the complex encounter of psychoanalytical matter and “empirical“ research.
Moreover, accepting and implementing the classical “empirical research“ methods may lead to analytically unacceptable ethical consequences. The well-known supporters of video cams and microphones (not to speak about ECG and/or EEG, MRI and else) embedded into the therapeutic situation obviously do not speak about their own readiness to such a setting during their own personal analysis or analytic psychotherapy. Do we have to conclude that in the “empirical“ future, only the private clinic patient will deserve a genuine analytical therapeutic situation, and that the public service patient will be fit for “empirical research“?...Or that specific cohorts of research-patients should have to be recruited?
Thus, a large majority of us don't feel any link between this type of research and their daily personal practice of psychoanalysis or psychoanalytic psychotherapy. Besides, the "evidence-based as a religion" has a deterrent effect: it results in strong difficulties at publishing genuine, original and creative clinical reports and papers, and at developing specific psychoanalytic clinical issues, for those of us who do want to be implicated in genuine psychoanalytic inquiry. When preparing the EFPP research workshops, I noted more than once that people interested in presenting a genuine analytical issue, were underestimating themselves and defining their work, for instance, as “just some notations about two-three cases“. They were living it just as bearing some kind of a personal witness and not as a possible “scientific advancement“, surely not as a part of a “(clinical) research“. And I still have in mind the reaction of a very respectable EFPP-founder. Hearing to some remarks about the huge development of psychoanalytical investigations in France, he answered in a somewhat despising way: “I never understood why…, it's just clinics, they don't do any research, they speak philosophy…“
Some other disciplines, more or less close to ours but very different (psycho-pharmacology, neuro-physiology, brain imagery, cognitive sciences), developed very recently and very hugely, and this fact leads some of those EFPP members I met to wish some kind of a true scientific dialogue. That dialogue could be indeed fruitful if, and only if, we know how to defend actively our own epistemological points of view, and explain our own psychoanalytical positions and practice. The cognitivistic “unconscious“, for instance, if very far off the analytical dynamic “unconscious“, even if the same word is used. Psychiatry today is no more the classic, then humanistic psychiatry we knew till the '70. It merely became devoted to psycho-pharmacological targeting, from which any psycho-pathological thinking almost disappeared. Two-three years ago, the last WPA Conference in Asia noted that the development of empirical methodologies and thinking in psychiatry overshadowed the necessary clinical training and practice of to-day's psychiatrists, so that this organization claimed that it should have to stress again in the near future the importance of clinical training… Such an irony would it be, if psychoanalysts and analytical therapists should insist to get into a so fiercely running train, when at this very minute psychiatrists are now begging to rush down!...
From another point of view, some of us may feel more secure, and more independent, through attaining clear, and if only possible, quantitative assessments of their work. We all know how the strange analytical situation can be at times such a factor of doubtfulness and inner uncertainty.
Besides, we have to take a more exact account of well-known – and less known, too - weaknesses in our thinking: concepts' extension, analyzability, diagnostic and prognostic, for a few examples. No doubt that some of these issues could at some point be helped by very cautiously designed epidemiological follow-up research, for instance.
Moreover, we cannot ignore the political imperatives of the EFPP , which certainly consist in caring on conservation and protection of psychoanalytical positions, but also in caring on the fullest availability of analytic psychotherapy opportunities for patients of different types in the public sector through the diverse European countries.
Lastly, EFPP may wish to help its members to confront new disciplines, or recently developed fields, and new practitioners, so as to make our specificity more recognized, improving and developing our links with universities and research institutions.
Faced to these facts, EFPP cannot be satisfied just in lobbying about professional protection, official certifications, and training levels, even if these goals seem today of the highest importance. If EFPP aims at gathering through Europe a majority of these psychoanalytic psychotherapists who care for the future and who are concerned with their specific values, EFPP should also be implicated in studying and elaborating thoroughly the practice, and striving towards the scientific advancement of the discipline too, simply because there lay the keys of future.
Therefore, the EFPP scientific policy shall insist simultaneously on making basically a clear differentiation among methodologies and among research subjects, and welcoming and helping the different kinds of research and inquiries made by EFPP and related members. Neither excommunication, nor confusion:
This differentiation is proposed on an epistemological basis, though it aims also at making a right place to the political and professional interests of EFPP members and organisations. It does not prevent both types of research to be accepted in the EFPP. In the contrary, it seems politically important that "empirical" research would also be accepted, if and when its basic limits are recalled and acknowledged.
In the very same line, and for enhancing and making clearer that very important differentiation, it seems advisable that EFPP official scientific activities, and the EFPP texts and declarations, should be indicated as pertaining to "scientific advancement and research", and not only to "research", because of the very specific meaning of this word today (synonymous to "empirical inquiry"), especially in the English-speaking educated world.
Let us now turn to this larger issue of “scientific advancement“ in a broader, and if just possible, analytical way.
2/ Some Valuable Ways For Carrying Out Scientific Advancement in the EFPP
Working in depth.
Psychoanalytical psychotherapy, as a discipline, even more than psychoanalysis, has important difficulties gathering a deep and consensual core of concepts and techniques. Very often, it would be necessary for analytical psychotherapists to return to what constitutes our foundations, to rediscover them, and to redefine them: Freud's work, the works and clinical contributions by the great founders and successors until this day, too: they elaborated the psychoanalytical and psychotherapeutic clinics. Some signs of hope do appear, but a sometimes muddled and provincialist , if not superficial pluralism, followed the collapse of the previous analytical “orthodoxy“, and resulted from the various economic, cultural, training and professional backgrounds. Result is that our discipline sometimes seems like enduring a disintegrative process, through superficially organized groups, which have nothing in common except their hope to be considered as "psychoanalytical" ones. These difficulties are evident in Europe, and around the world too. In Europe we certainly have clinical and intellectual resources to face them, and probably in the EFPP too , if EFPP creates the conditions of a rigorous, continuous and deep common scientific and epistemological work, and not only a political-professional union.
Learning from and with peers.
A major objective of our EFPP international conferences should be more and more the meticulous exchange of ideas and clinical facts, the follow-up of long and complex scientific procedures, as well as to learn from and with different peers, and not only an "identity-shaping experience" provided to so diverse European psychoanalytical psychotherapists. This supposes also that the expediency of consensual thinking would not prevent controversies from appearing and being developed, and the possible criticism from being formulated. It is not enough that these meetings would be carefully prepared as they indeed are. It is also necessary that the urgency of scientific progress, the complexity and specificity of the means to get this advancement in our domain, will constantly be reminded, and that individual or collective efforts in these directions will be steadied in every possible way, and that, as long as they respect the very specificity of our discipline, which is not always true.
Besides, the European context presupposes that we are sure to have the means to communicate: that means using good translations of our main languages as frequently as possible, too.
The scientific context presupposes that the speakers, contributors and guests would now be chosen according to their recognized real contribution in our discipline, and not on other grounds. It implies also that a more regular place would be made to people concerned with scientific progress and to research minded therapists, a place where some of them could dialogue about very diverse situations, projects, methods, procedures and subjects. The opportunities offered by EFPP are a rare occasion, comparing with either the university or even the psychoanalytic societies. We have to encourage regular scientific workshops, research corners, regular up-datings about long follow-up projects etc. in all our conferences, meetings etc. in a way that “scientific advancement“ would not be only a lip service.
Developing rigorous autonomous individual / small-group initiatives.
It's already known that an original and creative work cannot appear from a single invitation or from a simple participation in one or two coincidental conferences on different subjects, even though it can stimulate a beginner. Originality, and creativity, require producing thoughts and developing them in depth during long periods. Therapeutic and analytical processes too are long, and their ways often unpredictable. Time is necessary so that ideas confronted data, and time is necessary for ideas, concepts and results to be noticed, then modified or rejected. Concepts, to be useful, require to be elaborated, clarified, and revisited in a process of internal conflict and external debates about pertinent clinical data. Longitudinal observations, time-postponed follow-ups require also a long time.
EFPP has no money for funding research, but it is necessary that EFPP encourage and support much more different colleagues, often diverse in language and culture, to meet more often in a much less official and festive way on common problems, by comparing their practices, ways of reasoning, and discoveries sometimes. They should be encouraged to establish autonomous working groups, capable of widening their possibilities of developing thought and practice, inventing the therapeutic and psychoanalytical settings which they need, reporting more or less regularly to the wide Conferences about their difficulties and advancement. An actual way would be working in small groups of colleagues from various contexts, so that their understanding and their appreciation of peers' ideas would widen progressively along time and due to the alternation between meetings (which require personal involvement as well as rationally formulating one's thought), and separations (where new ways can be concretely investigated).
It is very important that along conferences and after, European colleagues will be encouraged and supported when building such small transnational groups about a common theoretical / clinical subject. They must be also encouraged to report about their work and contribution in a valid scientific context, within the EFPP (conferences, journals, IJPA, monographs, and now, books) and not only outside, giving EFPP colleagues and organisations the benefit of scientific advancement.
Evaluation of research, evaluation by peers, and publication
In our psychoanalytical and psychotherapeutic domain, one of the core evaluative elements about the rationality of our thinking is the degree of consideration of, and taking into account the unconscious and preconscious personal elements in our aware and rational speech. The (always partial) result of this consideration brings answers to questions as: do we give up obsolete arguments, do we agree to take into account the unexpected data of a seemingly non-relevant methodology, do we really understand better peer's unusual thinking and proposals, or do we clarify better the definition of a concept? If it is the case, we can expect the clinical work to be deeper, the elaboration of theoretical / clinical understanding to be clearer, and its development growing rich as our ideas will be more accurate. This fact in turn will be strengthened by discussions among colleagues with various perspectives. Moreover: ideas (for instance, about clinical innovations or on various methods of training) should lead to some implementation and to an evaluation of their consequences. Even if this evaluation cannot (in most cases) be grossly quantitative, however it must be both qualitative and systematic. Finally, we can hope that this advance will be translated in our publications.
In most disciplines, publication comes further to a rigorous supranational evaluation by peers. Publishing generally points out to the realization of a "new" work, but very often also reports about any verifying "replication" of an already made experiment. Besides, publishing constitutes a reward for a long work too, and, concerning academic people, represent a sine-qua-non condition in the promotion of their career (“publish or perish“). It is therefore essential that a rigorous transnational evaluation by peers will (generally) protect against prejudices, internal accommodation, and organizational political opportunity.
EFPP should not only create these new conditions of work and publication, but must also insure its own scientific value in the widest meaning of this word..
3/ A Specific Implication: The European Scientific Committee of the EFPP
Thus, problems connected to scientific progress and to research in our fields are very complex: they cannot be approached only by occasional decisions, or without a long and deep experience of our discipline and practice, without knowing the various models and methods of research in various disciplines, without any taking part in the academic and psychoanalytic milieus, in the national and European scientific institutions, too.
The Convenor's activity during the last 4 years consisted in a general evaluation of the scientific situation in the EFPP, and of the future necessities.
If EFPP wants now to treat this issue thoroughly, and to support a scientific policy, the Executive Committee (EC) will have to dedicate for that goal the organisational and human means which seem necessary at implementing the previous recommendations (parts 1/ and 2 /). That means that a continuous and coherent structure of several persons should substitute for the Convenor, giving time, creativity, and…diplomacy to each one of the specific implementations.
Two ways seem to-day valuable, one of both having to be decided:
1/ Constituting an European Scientific Committee (ESC) of the EFPP , counting 3 members at least, one representative of which will participate in the Executive Committee, replacing the Convenor, the office of which is now terminated. These members of the ESC might have 4, or twice 2 years mandates, and 2 of them might sit in turn among the EC during 2 years each.
This way of appointing and advertising an ESC of the EFPP would let know the pledge of EFPP to manage a balanced scientific policy, facing the present opportunities, and confronting the actual dangers too. Vis-à-vis the psychoanalytical societies and institutes, EFPP would indicate that it wishes to care that "empirical research", which is occasionally supported by universities, medical institutions and various research authorities, will indeed join, but not endanger the EFPP-supported genuine analytic inquiry, which stems from psychoanalysts' and psychoanalytical psychotherapists' real day-to-day practice.
Setting-up this ESC must not simply reflect, as usual, the inner institutional situation of EFPP (according to the different countries, sections, languages and so on). But it must reflect the diverse problems to be resolved or the ways EFPP wants to promote in dealing with them.. On no account, for instance, all the members of the ESC could be favoring the same type of methods and subjects. One of the members should be an academic but not all of them, one should be a psychoanalyst affiliated to any well established society, but not all of them. They should be co-opted by the EC , and should not stand for being elected.
Their office would consist in implementing, centralising and keeping coherent and well-balanced the scientific policy of the EFPP . They should be involved in the choice of subjects and themes, and in the scientific preparation of the various conferences and meetings. They should also inform the EC and make it aware about scientific aspects to be considered through the various EFPP activities . Thus, they should help and encourage small groups meetings, and keep linked with these small groups' work. They should organise reporting, evaluation by peers, and different ways of publishing, too. So should they be systematically involved in the orientation and the scientific preparation of the EFPP publications, and later establish an European Reading Committee, which will provide to these publications an academic recognition. So, these publications would give evidence of the progressively improving scientific quality of EFPP , and encourage in return an internal scientific advancement. Members of the ESC should also take care of, and organise the links of EFPP members and national networks with the IJPA , within the framework of the existing EFPP-IJPA agreements.
2/Setting up an EC internal Scientific Working Party (SWP) (ref: Bruxelles EC Meeting Minutes) could be valuable, but only as an intermediate step. Its main advantage would be its lighter and faster feasibility. Provided that its aims should be the same ones as those of the future ESC, its main disadvantages might well dwell in its very definition: a lack of external expertise and recognition.
But such a SWP would be a fair basis for preparing an international EFPP meeting specifically dedicated to the scientific advancement and research issue in the EFPP, to the introduction of some of the above implementation proposals, by contacting and making bridges with possible future ESC members, for instance.
Leaving the Convenor's office, my hope is that this report will help the Executive Committee taking right decisions about these issues, insuring a deeper involvement of people concerned by scientific advancement.
Paris, March 2005
|last modified: 2005-03-11|