Studying What Factors Mediate Change in Psychoanalysis and Psychoanalytic Psychotherapy: How Systematic Study Helps to Determine Old Questions

To approach the issues raised in the five articles offered in this issue, I must first establish my own historical view of whether it is possible to study dynamic psychoanalytic psychotherapy with existing methods and measurement scales and to determine if such study provides a better scientific answer to the question of what makes the patient better, more adaptive as well as less symptomatic. The queries are as old as psychoanalysis itself and derive from Freud’s (1893–1895) eager attempt to establish psychoanalysis as a cure for hysteria. Indeed, what became of that enterprise is a huge edifice of psychoanalytic theory and a new theory of mind that has dominated a century of Western thought, and may even be bigger than the therapeutic question. Nonetheless, the treatment was born out of an attempt to change people and help them lose their symptoms—this is what occupies us in this issue. Let me answer, with a cautious statement, that I believe it is possible to study psychoanalytic treatments to some limited extent, and that the enterprise is worthwhile, as well as socially responsible and professionally necessary in a world seeking evidence-based treatments. The therapy known as psychoanalysis has developed and changed over time and spawned many who have offered variations in the approach. To some, these new treatments are no longer recognized as psychoanalytic; others lie close enough to the core ideas to qualify as variant forms within the primal corpus. This more conservative, but also varied, group has not always been willing to join those studying the more behavioral treatments in solving hard empirical queries of what works for whom. This issue is an important attempt to gather together those serious about such questions who have accomplished a research corpus that I now scrutinize for their contribution to the hard questions raised. Freud (1893–1895, 1894), himself, provoked the queries concerning what works, even in his earliest papers. He indicated that lifting the paralyzing and repressedmemories of hysterics to consciousness also did away with the symptoms, both verifying his hypothesis regarding cause and offering a mediator that invoked causative power. He also pointed to two other proposals that involve etiology: childhood trauma and abreaction, along with making the unconscious conscious, which was later called insight. His own thought evolution was added to by his co-analysts and theoreticians, leading to a richer and broader scope for analytic practice. I touch on some of those early additions, as they are vital to grasping the significance of the current articles, which provide a modern foray into understanding change. Before I proceed, I first introduce a series of events from the past that provide the scaffolding for this research project. Other therapies within and outside of medicine and psychology, especially in the United States, added to the rigor that must be adopted if one is to secure a sense of evidentiary probity and lessen bias concerning the mediators of change. Two approaches that are most salient were psychopharmacology using randomized controlled trials (RCT) and cognitive behavioral therapy (CBT), which, from the start, utilized both behavioral and psychoanalytic insights as well as empirical tests of efficacy, including RCT’s. Both areas employed time-limited, symptomand diagnosis-centered case selection arranged in a manner that can be studied by carefully separating factors that can be measured in Likert scales, in checklists, and in controlled studies. The results