Monograph Series (No. 4)
The Psychoanalysis Unit of University College London and the Anna Freud Centre
International Universities Press, 2000; Madison, CT; 208 pages

The author of this book is a well-credentialled and experienced psychoanalytic researcher. She approaches her subject matter from a number of angles including historical, philosophical, scientific and most importantly from the perspective of clinical psychoanalytic practice.

Dreher examines Freud and shows that the task of defining and refining concepts was an ongoing one for him. From the beginning, psychoanalytic ideas have been informed by and developed from empirical findings from the consulting room. In turn, the formulation of key notions (eg. dynamic unconscious) has provided tools which then enable further empirically derived observational data to be collected and understood (eg. infantile sexuality).

The stated claims of contemporary conceptual research include the preservation of “reasonable elements” in a concept and “perhaps homogeneous use” – the latter as rejoinder to the criticism of lack of clarity and inconsistent usage of tenets. This type of research then is an ongoing endeavour which attempts to systematically clarify the central and core notions of psychoanalytic theory and practice. Such clarification examines issues such as logical consistency and the usefulness of concepts. Particular attention is paid to our profession’s implicit use of concepts.

Contrasting and at time conflicting views are presented about what constitutes pukka research and methodology. Dreher sees conceptual research as belonging to the tradition and spirit of the philosopher Kuhn whom she understands to emphasise the socio-contexual aspects of scientific process. This contrasts with a strictly logico-rationalistic approach. Irrespective of one’s methodological leanings and ideology, the point is cogently made that there can be no theory-independent observation of facts. Hence the necessity for ongoing and careful reflective thought in the research venture.

Eminent researchers Thomä and Kächele are quoted with regard to contemporary scientific standards and requirements of quantitative empirical research. They claim that the need for rigorous hypothesis testing and other methodological considerations such as objectivity render invalid Freud’s claim of the inseparable bond between research and treatment.

The author takes a divergent tack. She examines the primary data of the psychoanalytic encounter with special attention paid to the importance of the non-verbal dimension of affective states, communications of latent meaning in figures of speech and the like. The richness and complexity of this raw data manifests most clearly in what we collectively call the transference and counter-transference. In the author’s view, to limit data to observable (most often verbal) phenomena is to run the risk of reductionism. From this angle, the analyst’s input into the research is not only not a contaminant (as is sometimes claimed) but is indeed necessary to validate the independent research analysis of any clinical material.

The author gives a comprehensive account of the problems and limitations of single case studies. Traditionally this has been approached by panels of experienced practitioners and study groups. Whilst discourse at this level can be understood as a search for consensus and correlation, it is the author’s view that it hardly constitutes valid research. Conceptual explication remains at a descriptive level with no attempt usually made to develop any given concept that might be used prescriptively. In making a plea for a more systematic approach to conceptual research, controversies inevitably arise regarding the usefulness of such a qualitative approach and matters of validity, reliability and methodology are mooted.

The author describes some current empirical quantitative research endeavours. Attempts to operationalise and “measure” transference (eg. Luborsky et al) utilise paradigms that purport to identify core conflicts, relationship prototypes and narrative patterns. In Dreher’s opinion, this unduly restricts and impoverishes the concept of transference. Furthermore it overlooks what is already known and readily acknowledged about transference, unconscious meaning and communication.

The author introduces the reader to the history and development of the Hampstead Index Project. Utilizing their own clinical case material, therapists constructed an index comprised of “units of observation” which were thought to be “clinically relevant”. From these beginnings, conceptual clarification ensued. Feedback to clinicians and application to clinical material evolved. The publications of Joseph Sandler et al in the 1980’s and 1990’s were the outcome of this clinically informed and informing research. Dreher regards this work as a paradigm for conceptual research noting that the integration and participation of treating therapists was crucial to the success of the project.

There is a detailed description of a conceptual research project on psychic trauma. The design of the research method was comprised of a literature analysis, interviews of psychoanalysts by psychoanalysts and evaluation and discussion within the project group. It soon becomes evident to the reader that much conceptual ambiguity and indeed contradiction exists within the term “psychic trauma” and its use in clinical practice! The project group proposed a new term “psychic traumatopathy” in an endeavour to denote the pathological consequences of traumatisation. Subsequently this term was found to be a useful framework within which to consider and reflect upon clinically observable phenomena such as dissociation, symbolisation impairments and transference enactments.

In the concluding chapter Dreher puts forward a strong case for the importance of conceptual research in “problem solving”. She differentiates concept-using discourse from concept-reflecting discourse – the latter being important to clarify ambiguous and often implicit meanings associated with the use of a given concept. Moreover the preservation of useful concepts, the modification of existing ones and the introduction of new ideas and conceptual tools are further desirable objectives for the development of our science.

This book should appeal not only to those interested in formal psychoanalytic research (conceptual and/or empirical) but also to anyone with a keen interest in theory. The relationship between clinical practice and theory is an intriguing and complex one. The mutuality and interdependence of each upon the other is clearly explicated. The author’s capacity to provide an historical overview of conceptual research and development is admirable. Some repetition is present especially in regard to philosophical matters. This is a minor criticism and perhaps unavoidable in a work which explores “foundations”. Arguably the underpinnings of concept development leading to an exposition of theory needs repetition not only in the field of formal psychoanalytical research but also in day-to-day clinical practice!