From psychoanalytic narrative to empirical single case research

The psychoanalytic literature is living not only from its theory, but also by its vivid case presentations. From a scientific standpoint, however, it often will be argued that the case material is applied only for the purpose to demonstrate that the specific theoretical presuppositions are correct. Therefore, many scientifically oriented colleagues demand that the frequent convincing literary anecdotes and short novels with their extreme subjective character should more often be substituted by verifiable, empirical single-case research. This is urged by the multiple theoretical diversity in our profession and the defensive position of psychoanalysis within today’s society. It is therefore invaluable to have unedited and uncensored texts from the verbal exchanges between therapists and patients. One example of such a verbal protocol is the presentation of Dewald (1972); another is that of Lichtenberg, Lachmann, and Fosshage (1996). Dewald wants to provide knowledge of the application of ego-psychology, whereas Lichtenberg and his co-workers relate to a broader spectrum of technical principles and a specific set of interventions. Helmut Thomä conducted a psychoanalytic therapy of 531 sessions with Amalia X covering a 5-year span, 517 sessions being audiotape-recorded. At that time, Thomä was a wellrespected psychoanalyst attached to the well-known and acknowledged principles of psychoanalytic technique. The full text is available for study at hand of qualified researchers via the Ulmer Textbank. At the onset of therapy, Amalia X was 35 years old. She lived as a teacher on her own and came to therapy for increasing depressive complaints. She especially suffered from religious scruples with occasional obsessive thoughts and impulses. Furthermore, Amalia X had to endure an idiopathic hirsutism. Her development and social adaptation had been affected by this observable fact, which she experienced as a stigma of a virile syndrome. She felt it as impossible to enter into any close sexual relationship. The presentation of this therapy of Helmut Thomä covers about 100 pages of the book. The following themes are described within the succeeding stages of the process: external situation, symptoms, body hair, sexuality, family, other relationships, self-esteem, relationship toward the analyst, idea of norm, relationship outside the family, topic of guilt, fear, the sexuality/masturbation topic of guilt, body, body hair related to sexuality, school, and anxiety. The case description not only contains many parts of the verbal interactions between therapists and patient; we can also read a longitudinal overview of the entire analysis built around changes in symptoms, manifest behaviors, general object relationships, and the specific transferences. Additionally, detailed cross-sectional accounts along the same dimensions are presented. This book documents the ‘‘longstanding work concerning the subject of psychoanalytic single case research’’ (p. xxiii) of the authors. In addition to the main authors Kächele and Thomä are included Joseph Schachter and several clusters of different authors from the Ulm Psychoanalytic Process Research Study Group. It should be remembered within this connection that Thomä and Kächele are the authors of three books that they edited over decades with international reputation, in which they developed the theory and practice of psychoanalysis based on systematic research on psychoanalytic processes and its results. Within this book, Thomä and Kächele reprint parts of their third volume from 2006 (Psychoanalytic Therapy, Research). In detail, it contains the following chapters: