As data were being collected for these projects, a debate was raging about the scientific status of psychoanalysis. In the last three decades three factors have conspired to shift the profession s attitude towards research. One, the recognition that opening the doors to nonmedical applicants had much to offer the field, since many colleagues from the psychology discipline were steeped in research methodology and have conducted highly sophisticated research. We now are faced with a demand for research efforts that demonstrate the efficacy of psychoanalysis to prevent it from being further marginalized or from disappearing entirely. Without it we have little credibility.
Patients now have hundreds of psychotherapies and psychopharmacologic agents from which to choose.
They are likely to be highly educated and capable of asking penetrating and entirely legitimate questions. When patients were lining up at the analyst's door in the fifties or sixties, these questions were either not asked or treated as associations to be analyzed. We now see a tendency to exclude psychoanalysis and psychoanalytic therapies from official practice guidelines and are also witnessing Stalinist purges of psychoanalysts from academic departments because the discipline they practice is not seen as scientifically rigorous. Randomized controlled trials on psychoanalysis as a treatment would be extraordinarily expensive, exceedingly complicated, and probably limited in what they can teach us. Moreover, by the time meaningful results were available, the train would have already left the station without us.