What kind of discipline is psychoanalysis?

Int J Psychoanal (2015) 96:731–754

doi: 10.1111/1745-8315.12351

What kind of discipline is psychoanalysis?1 Ricardo Bernardi Asociación Psicoanalítica del Uruguay (APU), Canelones 1571, 11200 Montevideo, Uruguay – [email protected] (Accepted for publication 15 October 2014)

Current controversies involving clinical, conceptual and empirical research shed light on how psychoanalysis confronts its nature and its future. Some relevant debates in which Wallerstein, Green, Hoffman, Eagle and Wolitzky, Safran, Stern, Blass and Carmeli, and Panksepp have participated are examined regarding the characteristics of their argumentation. Agreements and disagreements are explored to find ways that could have allowed the discussion to progress. Two foci are highlighted in these debates: (a) whether a clinical common ground exists in psychoanalysis and what kind of procedure could contribute to further clarification; (b) complementation of in-clinical and extra-clinical evidence. Both aspects are scrutinized: the possibility of complementing diverse methodologies, and the nature of the shared clinical evidence examined in clinical discussion groups such as those promoted by the IPA Clinical Observation Committee. The importance of triangulation and consilience is brought to bear regarding their contribution to the robustness of psychoanalysis. So as to strengthen a critical perspective that enhances the discipline’s argumentative field, psychoanalysis should take into account arguments from different sources according to their specific merits. By doing this, psychoanalysis increases its relevance within the current interdisciplinary dialogue. Keywords: comparative psychoanalysis, epistemology, neuroscience, conceptual research, empirical research

Introduction How useful is it to complement the understanding that comes from psychoanalytic clinical practice with the findings of other types of research? This question has occasioned heated controversies. These controversies are a sign of the discipline’s health – provided they allow practitioners to clarify their debates and determine shared criteria so as to stimulate further development and questioning within the areas of disagreement. Debates among different theoretical foci have always existed in psychoanalysis, and, historically, they have allowed us to clarify different points of view, for example The Freud–Klein Controversies 1941–1945 (King and Steiner, 1991). But these debates have been less efficacious in finding ways of clearing up these differences (Bernardi, 2002). This difficulty in achieving advances is to a great extent due to the notion that mainstream psychoanalytic theories are akin to Kuhnian paradigms and that they determine what 1

Translated from the Spanish by Arthur Brakel.

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questions are valid as well as the metapsychological premises according to which these questions should be answered. Presenting theories in a way that limits arguments’ scope is, in fact, a defensive strategy. It puts each theory’s premises out of bounds in the debate, and precludes any examination of the degree to which clinical material and other sources of knowledge jibe with one another (Bernardi, 1989). Nonetheless, these debates have made it possible to consider the theories to be alternative hypotheses, and they have allowed analysts to incorporate them within their conceptual, referential and practical operative schemes (see Pichon-Riviere, 1998b; Bleger, 1971) as well as in analysts’ explicit and implicit theorizations (see Sandler, 1983 and Canestri, 2006, 2012). Current debates over clinical, conceptual, and systematic empirical research constitute a privileged field for a deep examination of some of the challenges to the advancement of psychoanalytic knowledge. My purpose in this piece is to analyze those debates and to evaluate the routes we can take to move ahead and clarify our differences. My point of departure comes from van Eemeren (1993) and van Eemeren and Grooterndorst (2004) and their pragmatic-dialectic theory of argumentation. I shall pay special attention to arguments that are included in, or, contrariwise, that are excluded from, psychoanalytic argumentation. Consequently, based on Toulmin (1958, 2001) I shall also examine the type of discourse that these inclusions and exclusions generate. The ultimate object of this analysis and evaluation of the controversy is not necessarily consensus. It is, rather, to bring about conditions that will allow us to progress in our interaction among the different positions. I hope to achieve better fundaments for each position and thus for the entire psychoanalytic discipline. These controversies require us to listen to and carefully consider the other’s points of view, which is not an easy task, as all analysts know. For this reason, our revisiting these debates and examining their arguments from different perspectives can help us clear up certain impasses, false oppositions, and matters that are still open to discussion and that can lead to future advances. To begin, I shall examine the controversies related to clinical research in psychoanalysis. I discuss matters relating to the existence of a clinical common ground and the relation of that common ground to specific metapsychological theories. Contemporary international discussion groups, especially those dealing with observations of patients’ transformations, provide us with conditions for a quasi-experimental study of how analysts with different theoretical and technical backgrounds observe a given clinical material. Then I shall examine the polemics related to complementing clinical evidence with evidence from other research methods or with findings from other disciplines. Finally, I shall discuss the value of consilience processes and triangulation strategies and their relation to psychoanalytic theory’s robustness. I also address the likelihood of developing a rational critical discourse that will widen our field of discussion. This will add complexity to our field but it will also strengthen the exchange between psychoanalysis and other disciplines that contribute to our knowledge today, and it will strengthen psychoanalysis’s relevance in these endeavors. Int J Psychoanal (2015) 96


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Pluralism and common ground: The Wallerstein–Green controversy Let us begin with the 2005 polemic between Green (2005b) and Wallerstein (2005a, 2005b) on pluralism and common ground in psychoanalysis. Wallerstein has addressed these matters in several publications (1988, 1990, 1992). He asserts that, notwithstanding our theoretical and technical pluralism, when we get close to the experience of psychoanalysis itself, we can perceive a common clinical theory. This common clinical theory is hard to square with the canons established at the more abstract (metapsychological) levels, which are made up of metaphorical constructs that cannot be tested. This is not the case with clinical theory (Wallerstein, 2005b, p. 624). Whereas compartmentalization prevails on the theoretical level, Wallerstein believes we can see convergence in clinical practice, and he expects that this convergence can be reflected on the theoretical level (2005b, p. 626). For Green (2005b) current discussions do not contain convincing examples of that common ground. Instead, they demonstrate a pseudo pluralism in which there is no space available for others’ ideas. Our common ground cannot be a sort of ‘Esperanto’ that sets aside each outlook’s principles (p. 631). Likewise, Green does not trust the effects of dialog with other disciplines since whatever interfaces there might be could introduce potentially fatal ‘viruses’ into truly psychoanalytic thought (p. 630). In response to this, Wallerstein (2005a) points out that Green ignores the problem of who decides what ideation is ‘truly psychoanalytic’ (p. 636). Notwithstanding the contrast between Wallerstein’s optimism and Green’s pessimism, one can stress certain points of agreement. Both settle on putting clinical practice first. They emphasize psychoanalysis’s place as a bridge between nature and the culture that draws from both sources. And, on a hypothetical level, they both agree on the type of procedure that, based on clinical material, would allow us to compare different theories. Green says: The only valid procedure is to show how some clinical material consisting in, thus based on, the exposition of a sequence of sessions and on a psychoanalytic process revealed at sufficient length can demonstrate the kinship between two different theories, which we must remember are based on different techniques and interpretations. Now, to my knowledge, this exercise has never been attempted. (2005b, pp. 628–9, italics in the original)

This material, Green goes on to say, should respect ‘the subtle and sometimes contradictory meanders in the analytic process and not only take into account the aspects that are of interest to quantitative researchers’ (2005b, p. 632). I shall return further on to this hypothetical procedure Green proposed and Wallerstein agreed with. What is open for discussion are those points related to how psychoanalysis can make use of the methods in the natural and cultural sciences as well as to how we can establish a clinical common ground to use as a reference point for analysts working in different theoretical and technical frameworks. Copyright © 2015 Institute of Psychoanalysis

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These matters have been the object of controversies, some of which I examine below.

An empirical science, a hermeneutic discipline, or a special science: On what sort of evidence is psychoanalysis based? According to Green and Wallerstein, how we proceed will depend on how we consider the nature of psychoanalytic knowledge. Is psychoanalysis a natural science, a hermeneutic discipline or a science sui generis? Or is it a clinical way of thinking that is enriched by all these traditions? In this piece I adopt the latter point of view. It is not totally accurate to say that psychoanalysis is situated ‘between’ nature and culture, or ‘between’ determinism and hermeneutics (Laplanche, 1991), or ‘between’ hermeneutics and science (Strenger, 1991). Nature and culture make up part of the complexity of human reality, which psychoanalysis as a discipline embraces. It is more accurate, therefore, to say that psychoanalysis addresses matters – some of which pertain to the empirical science tradition, others to hermeneutics, and others inherent to the psychoanalytic method. I use the term ‘tradition’ as Laudan (1977) does, which is similar to Lakatos’s (1970) notion of research programs. These traditions can have progressive or regressive effects depending on how useful they are to formulate and solve new problems. The empirical science tradition has fostered different types of research, not only at an experimental level (e.g. Shevrin, 1995), but also at a clinical level (e.g. Hanly, 1990, 1992, 1995), Etchegoyen, 1999, 2001). If psychoanalysis wants to avoid circularity, it needs to show in one way or another that clinical or extra-clinical experience can bring to bear something more than what is already in the premises of psychoanalytic theory. However, an excessively radical attempt at eliminating the elusive and metaphorical character of many psychoanalytic hypotheses can end up impoverishing our clinical work and our theoretical pondering. The hermeneutic tradition has privileged the ideographic perspective. It has concentrated on the complexity and on the manifold meanings of individual situations rather than on explaining general phenomena. Along with traditional, reconstructive hermeneutics, one can also find hermeneutic schools that privilege deconstruction or ‘not-knowing’. These schools emphasize the mystery in which knowledge is rooted and that requires the ‘negative capability’ that Keats (1958) speaks about. This is an invitation to carry on within the realm of uncertainty and doubt – it is an abandonment of the search for facts and reasons. But in my opinion it is not necessary to oppose ‘negative capability’ and clinical facts. Bion (1992, p. 304), based on this idea by Keats, claims we need a sort of listening capable of tolerating ignorance and highlights, at the same time, the search for ‘selected facts’ that make sense of phenomena that up to then seemed unrelated. The role of language and the comparison of a patient with a text that needs to be interpreted were also defended in the psychoanalytic hermeneutic tradition. Its most extreme instantiation has been considered ‘verbal creationism’ (Ahumada, 1994). Even though it would be excessive to say that Int J Psychoanal (2015) 96



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speech creates the subject, it would be fitting to make an exception concerning the metaphors that we, along with our patients, create in the clinical situation. These metaphors not only reflect intersubjective reality, but one can also say that they create it, as Davidson maintains, when they provoke new emotional experiences in analyst and patient (in Quintanilla, 1999; de Le on de Bernardi, 2013). Similar to what Freud described for dreams (Freud, 1900, p. 525), these ‘navels’ typical of the communication in psychoanalytic sessions bring us closer to patients’ zones of mental growth and to our own ability to understand. Taking this complexity into account, we can conclude that if the hermeneutic way of understanding, which in itself is enriching, compels us to liken the patient to a text, we lose sight of the facts. And with this loss we can no longer examine matters empirically, and as a consequence our outlook becomes restricted and impoverished. Do we move forward if we define psychoanalysis as a unique or science sui generis? A science with its own canons that are independent from those of other sciences, with its own standards, independent from those of the other sciences? Assoun (1982) based psychoanalysis’s specificity on the originality of the epistemological space Freudian writing had opened. But, if we define psychoanalysis as the science of the unconscious, how can we solve the problem of its varied and discrepant theoretical formulations? It is hard to conceive of a science that only takes into account a single method and whose object of study is constructed based on visibly divergent theories. Green’s proposal to consider psychoanalysis as a clinical way of thinking (‘pens ee clinique’) provides an adequate solution to these dilemmas (Green, 2002). Starting with our clinical base, we can appeal to both scientific tradition and to hermeneutics so as to develop psychoanalysis in several different theoretical and practical directions. To do this we must accept the tension or polarity present among these traditions. Freud set out to create a natural science based on a hermeneutic method. If we want to delve into the depths of human beings, we cannot avoid this paradox nor the tension that arises from the forces that pull in opposite directions. For this reason we must avoid putting an excluding ‘or’ between these different dimensions and accept an ‘and’ that is inclusive and complex. This ‘and’ will allow us to appeal to different traditions according to the matters being considered. Nonetheless, the usefulness and the nature of this complementariness is at the center of the controversies I shall next address.

Hermeneutics versus empirical research: Hoffman’s polemic with Eagle, Wolitzky and Safran The current controversies concerning the relation between psychoanalytic clinical understanding and systematic empirical research concerning processes and outcomes can be fruitfully examined through Hoffman’s (2009, 2012) polemic with Eagle and Wolitzky (2011) and Safran (2010). To understand this discussion, let us begin with an oft-asked question in the field of health care: How much, how, and where do patients benefit from psychoanalytic treatment compared with other possible therapeutic Copyright © 2015 Institute of Psychoanalysis


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approaches? As evidence-based criteria have become stronger, both in medicine and psychotherapy (Sackett et al., 1997), doubts have arisen concerning whether psychoanalysis and dynamic therapies can respond to those criteria. In his title ‘Psychotherapy research evidence and reimbursement decision: Bambi [psychotherapy, especially dynamic psychotherapy] meets Godzilla [evidence criteria]’ Parloff (1982) graphically describes this weakness. But, even though the methodological problems were not inconsiderable, the patients’ benefits in these treatments could be validly and reliably assessed. Based on meta-analysis such as one finds in Leichsenring (2008), Glass (2008) acknowledges these results in his editorial: ‘Psychodynamic psychotherapy and research evidence: Bambi survives Godzilla?’ As Shedler (2010) points out, the results of psychodynamic psychotherapy, when measured by the effect-size (that is, basically, when commensurate), are in fact greater than those achieved by anti-depressive medication or by benzodiazepines. Studies of this sort have been on the rise (e.g. Sandell et al., 2000; Fonagy and Target, 1994, 1996; Fonagy et al., 2005; Leichsenring, 2009; Leuzinger-Bohleber et al., 2003; Sandell, 2012). To show the current expansion of this sort of research, we can add rigorous empirical studies of a unique case (K€ achele et al., 2008) and neuroscience studies (Beutel et al., 2010). Nonetheless, the psychoanalytic relevance of this research has been strongly challenged. In a provocatively titled article: ‘Doublethinking our way to “scientific” legitimacy: the desiccation of human experience’, Hoffman (2009) vehemently opposes the privileged role that, in his opinion, the ‘objectivists’ research methods claim to have. In his opinion this presumed privilege is harmful to the analyst’s clinical work, which is based on the in-depth study of individual cases and uses a constructivist hermeneutic paradigm that takes into account each case’s uncertainty and singularity. Hoffman maintains that those who want to equate both types of knowledge fall into a ‘doublethinking’ similar to what Orwell describes in 1984 (2009, p. 1057). The use of diagnostic categories, whether or not they are psychodynamically based, is also held to be detrimental in acknowledging a person’s unique character. From this perspective it is hard to move clinical theory beyond the patient/analyst narrative construct, as Hoffman shows in a vignette in which he refuses to turn his patient’s dread of death into a diagnostic category. In their response to Hoffman, Eagle and Wolitzky (2011) wonder why the antagonism between the two forms of understanding exists. They maintain that each method addresses different issues and for that reason, rather than consider these methods in conflict with one another, it is worthwhile to use the evidence each one brings forth according to what sort of problem one is dealing with. They add that if our goal is to become cognizant of something affecting a particular person, the way to do that is to study the clinical case extensively. If, on the other hand, we want to know the overall results of a particular therapeutic approach, we should appeal to systematic empirical research. Privileging one method over another does not depend on the method, it depends on the method’s adequacy in addressing the issue at hand. Thus Eagle and Wolitzky propose that combined efforts will allow Int J Psychoanal (2015) 96



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us to find and combine the legitimate and appropriate uses of both methodologies. Safran (2010) underscores subjectivity studies’ need to find a midpoint between objectivism and relativism, which is a need common to other disciplines such as anthropology and sociology. He adds that to do this it is not useful to counter objective evidence with interpretation or vice versa. Psychoanalysis must not close ranks in a defensive position because, looking ahead toward the future, psychoanalysis needs to establish a constructive dialog with the greater academic community instead of turning inwards. In his final reply, Hoffman (2012) does not believe that his stand implies a polarization or ignorance of empirical research. It can be useful for analysts to keep this research, as well as novels and films, in mind. But one must always keep a check on their method’s epistemological status and not give in to objective tyranny. And for this reason Hoffman maintains his dialectic and constructivist critical outlook. What is striking in this controversy is Hoffman’s vehement and even combative tone, which does not help to focus on the aspects being discussed. This controversy’s focus does not appear to lie in the coexistence of clinical studies and systematic empirical research, but in the privilege of systematic empirical research and scientific and objectivist ideology – according to Hoffman. The controversy gets bogged down when it should move on to a second issue: which method turns out to be more useful for which kind of questions, and when is it useful (Bernardi, 2003, p. 135; Bernardi, 2002, p. 869)? Hoffman does not answer these questions with clarity. If, as Hoffman affirms, analysts can keep more than one idea in mind, the disputed point is the role each idea can play. Even though Hoffman criticizes some analysts who suggest a scientific paradigm, he brings to bear no examples of how these analysts’ clinical work has been prejudiced by their interest in empirical research. Nor is it clear why it is necessary to contrast individual understanding and diagnostic conceptualization. Particular understanding has a privileged place during a session, whereas the reflection that seeks to conceptualize the phenomena observed according to analytic categories or dimensions find a more appropriate place after the session. Nonetheless, at certain times, for example in the case of enactments, it can often be useful and necessary to take ‘a second look’ at the analytic field, which we find takes place during the session itself (Baranger and Baranger, 2008; Baranger, 1993; Baranger et al., 1983). Green, as well, underscores that there are times when the analyst’s normal floating attention should give way to a broader understanding of the transferential moment owing to the patient’s global set of conflicts (Green, 2002). As this controversy demonstrates, conditions that are adequate for psychoanalytic clinical understanding and the utility of complementing this understanding with the contributions of other methodologies can produce areas in which the agreement is only partial and in which there are key issues that could not be clarified. At this point it seems worthwhile to remember Green’s proposal (accepted by Wallerstein): to explore disagreements based Copyright © 2015 Institute of Psychoanalysis


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on proceedings related to clinical material, which I shall examine in the next section.

From clinical observation to theoretical inference: The threelevel model for observing patient transformations (3-LM) The international psychoanalytic community has developed diverse group experiences (Working Parties and Working Groups) that provide a privileged arena for questioning the common clinical ground among analysts, and for addressing their possible complementarity with other research methods. Owing to their direct bearing on the subject of this paper, I shall refer to the working groups using the ‘Three Level Model for Observing Patient Transformations’ (3-LM) (Altmann de Litvan, 2014). This model was proposed by me to the IPA Clinical Observation Committee which developed and applied this model in different countries and contexts with analysts using different techniques and different theoretical orientations (Bernardi, 2014a,b). The model is a set of guidelines or heuristics for observing and describing patients’ changes or transformations by taking material from different periods in their analyses, usually separated by several years. This material is examined in three successive steps or levels during intensive group sessions that can last between 10 and 12 hours. The 3-LM is similar to the procedure proposed by Green and Wallerstein in examining clinical material that is sufficiently ample entailing the participation of analysts with different theoretical frameworks and different interpretive styles. The discussion’s three steps correspond to inferential levels in progression, which leads from the observational to the theoretical pole. This model provides questions that help to explore each one of these levels (Bernardi, 2014a, 2014b). The program’s first level assumes a phenomenological point of view and seeks to observe patients’ changes as they appear to the actual analyst and to the group members’ ‘third ear’ (Reik, 1968). This stage concentrates on clinical observation, according to Freud (1914, p. 77) the foundation of psychoanalysis. However, today we are more aware of how theories can influence what people observe, inducing them to see the material according to their previous assumptions. But so as to avoid circularity we must make sure that clinical experience tests for things that were not implied in our premises. This is the aim of 3-LM’s first level. Taking into account that psychoanalytic observation is participant observation (or perhaps we should say observing participation), the first level concentrates on those moments that have special resonance for each participant, and for the group – first in the initial interviews (considered anchor points) and then in later sessions. Of special interest are the changes in the analytic relationship, for example in the way patients ‘use’ their analysts and their own mental and bodily resources in their sessions and in their own lives. Comparing the diverse members’ ways of listening helps to have a ‘second look’ (Baranger and Baranger, 2008; Baranger, 1993; Baranger et al., 1983). To the extent the transference and countertransference accentuate the participatory role in the process, analysts need to reclaim their role as observers of themselves. Thus 3-LM can be considered an ‘observation of observation’ since analysts Int J Psychoanal (2015) 96



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observe their own observation: that of the analyst presenting the material and that of the other participants. These different perspectives interact with one another in the group, and this interaction enriches the material through the prism created by triangulation of multiple observers and multiple theoretical perspectives. The use of language free of jargon, as in the informal communication among colleagues is requested. Can we conclude that this level is free from theory? The answer to this question is more complex: what we can gauge in this second look is how the material resonates with each analyst according to the theories they have employed in their own clinical practice. From an epistemological point of view we can say that just as an astronomical observation implies the theory of the telescope, in analytic observation we rely on the triangulation of the participants’ observation which is made according to each participant’s referential and operative scheme (Pichon-Riviere, 1998a, 1998b; Bleger, 1971). Therefore, this process requires a non-simplistic idea of observation that takes into account the existence of other subjective perspectives. The second level seeks to identify the main dimensions of the changes using categories acceptable to analysts of different theoretical persuasions. To this end 3-LM is based on present-day psychoanalytic diagnostic systems such as: the Operationalized Psychodynamic Diagnosis (OPD-2, 2008), the Psychodynamic Diagnostic Manual (2006) and the Level of Functioning Scale in Section III of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5, 2013). This endeavor has been made possible by the high level of conceptual concordance among the three systems (Bernardi, 2010, 2013; Zimmerman et al., 2012). In their quest for common elements in the different psychoanalytic traditions, the OPD-2 has sought a form of operationalization that would take in the ‘least common denominator’ (OPD Task Force, 2008, p. 14). But the extent to which these concepts can be considered part of a shared clinical theory is controversial. I shall return to this issue below. In 3-LM’s third level, participants discuss the analyst’s work according to their explicit and implicit theories and they examine different theoretical hypotheses that could explain and better contribute to the patient’s process of change. I shall now offer an example of how the group process explores analytic material. Mara, toward the end of her adolescence showed scant initiative and was caught up inside a family itself closed off from society. In the first level of discussion, Mara’s declaration: ‘On my own I’m a rolling stone’ resonated with all the participants. With her family, however, she felt she lived in a ‘gilded cage’. This also resonated in the group. For all the participants both metaphors, along with others that came up throughout the participants’ associations with other fragments of the clinical material, evoked different aspects of Mara’s analysis. Participants felt that as time went on they discovered new dimensions in the clinical material. These new dimensions suggested a complexity that, when examined closely, led to yet-to-be-defined depths. On this initial level of examination, differences in theory help to develop a larger group sensibility owing to how each participant hears the material, which gives way to an enriching polyphony. In one of the groups Copyright © 2015 Institute of Psychoanalysis


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an experienced participant remarked that it was extremely useful to see how the others applied their theories to the clinical material. Another observed that despite their protracted discussion, he could not pinpoint many of the participants’ theoretical orientation. In the group discussion cultural differences also came to the fore: for example, according to where the analysts came from, some considered Mara’s dependence on her parents pathological, whereas others saw it as a cultural phenomenon, typical of Mara’s society. At the second level of examination, translating these experiential metaphors or intuitions into conceptual categories entails greater difficulty, related to the question of to what extent is it possible to objectivize subjective phenomena and to what extent this is theory-dependent. When Mara managed to achieve greater personal autonomy, some participants preferred to see it as a modification in her identity, and more specifically in her sense of agency. For others, instead, it would be better to consider this a change in the patient’s subjective position. It is noteworthy that both points of view addressed the same material, but they differed in their theoretical connotations and semantic contexts. It is likely that terms such as ‘changes in selfdirection’ used by the DSM-5 (American Psychiatric Association, 2013, pp. 775 ff.) scale could be acceptable for all participants, as far as the clinical reference is concerned, but they would be scarcely interesting to many of them, or they might even be unacceptable because they evoke next to nothing. What this shows is how hard it is to find formulations on the conceptual level that are widely shared in addressing clinical material. Still, this difficulty does not indicate the need to reject diagnostic conceptualizations, as Hoffman proposes, or a radical incommensurability among points of view, as Green suggests. On the third level of the 3-LM, discussion rarely hinges on the major psychoanalytic schools. As a matter of fact, the clinical material offers no arguments in favor or against these schools as general theories. Rather, participants concentrate on partial theories related to the cases’ specific problems. For example, in Mara’s case, participants concentrated on trauma theories, related to events in her history, or on theories of therapeutic action. The latter received special attention because Mara, during many years of analysis, improved significantly at the same time that she cut back on her number of weekly sessions when she had to depend on her own resources. Returning to clinical theory, the existence of resonant internal phenomena that are shared is indubitable. These shared phenomena can be translated into mutual metaphors or mini-models (Leuzinger-Bohleber and Fischman, 2006) when analysts can connect them to their own clinical experience. At this level we can speak of clinical intuition, or an inference or ‘guessing’ that seeks the most likely explanation for an observation, which is similar to Pierce’s concept of abduction (in Hoffmann, 2005; Leibovich de Duarte, 2000). As we move on to inferences that require more abstract concepts, agreement diminishes, but does not disappear – especially if one pays more attention to the referential dimension than to theoretical connotations. Int J Psychoanal (2015) 96



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One can find similar inferential levels in other psychoanalytic work, as in Green’s (1983) description of the dead mother (Bernardi, 1995). Availing himself of quasi-artistic resources, Green’s descriptions at the first level are characterized by figurative or metaphorical language that enables him to describe the uniqueness of this particular clinical configuration. “The patient spends his life nourishing his dead, as though he alone has charge of it. Keeper of the tomb, sole possessor of the key of the vault, he fulfils his function of foster-parent in secret” (1986, p. 164). On a second level we find clinical categories of a more general nature: “The mother, for one reason or another, is depressed. [. . .] In any event, the mother’s sorrow and lessening of interest in her infant are in the foreground” (p. 149). On the third (more abstract) level we find metapsychological explanations: “The first and most important [in a series of Ego defenses] is a unique movement with two aspects: the decathexis of the maternal object and the unconscious identification with the dead mother” (pp. 150–1, italics in the original). Whereas on the first level Green provides us with dramatic descriptions with an evocative force that resonates with all analysts, in the following sections we see the richness with which Green is able to extract metapsychological concepts – but these concepts probably do not attain the same level of consensus. To conclude, it may be more fitting to speak of degrees of shared clinical meaning than it is to speak of a common clinical theory. Moving on to the notion of complementarity between diverse categories and methods, we saw that for Hoffman the use of diagnostic concepts leads to a failure to acknowledge patients’ individuality and a dissection of their experience. Still, it is not clear why this should necessarily be the case. Even though we are all unique, we are not so unique that we do not share comparable characteristics. Based on the clinical variables Green has set up, nothing, in principle, stops us from studying (as it has been done) statistical associations between both factors. Indeed, it is possible to calculate the weight of risk factors according to well-established methodologies. The effect of the recommendations in technique that Green proposes can also be the subject of empirical research. Studies such as these do not stand in opposition to one another. Rather they complement each other – especially with the extraordinary experiential value that Green’s descriptions transmit. We can favor one or another methodology according to what the particular context of our inquiry requires. The 3-LM groups issue a report of the group discussion. After the discussion participants fill out and hand in questionnaires evaluating members’ opinions concerning patients’ changes and the activity’s usefulness. Before the group discussion and using Likert’s scales, the opinion, and therefore the degree of agreement among the participants is registered. It is also possible to evaluate 3-LM’s validity in relation to other assessment methods (concurrent validity) and its predictive validity by comparing the group’s opinions to the patients’ future development. In addition, qualitative studies are being developed concerning the metaphors employed in the groups or concerning the evaluations of patients’ changes by analysts from different cultural contexts. The combination of qualitative and quantitative methods is in accord with current tendencies in the social sciences. When we go from Copyright © 2015 Institute of Psychoanalysis


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a quantitative methodology to a qualitative one we need to reformulate concepts such as reliability and validity according to different criteria such as trustworthiness, recursivity, contextuality, or the examination of anomalous cases. It is necessary to take a step beyond so as to come up with generalizations with other requirements regarding samples and statistical procedures. Our method must adjust to the questions being asked. To do this, we need to substitute an excluding ‘or’ with an ‘and’ that is problematic and without a doubt complex – but inclusive.

Is the triangulation of knowledge useful to psychoanalysis? In general our dialog with the humanities has occasioned fewer radical disagreements than our dialogs with the scientific field and with Health Sciences. The most thorny controversies have arisen precisely with those psychoanalysts working in related areas such as developmental studies and neuropsychoanalysis. Stern’s and Green’s controversy (Sandler et al., 2000) is useful for examining both the argumentation being employed and in the arguments that are not accepted as part of the shared debate. Green maintains that work such as Stern’s are of interest to psychology, but they offer scant help to psychoanalytic theory (Sandler et al., 2000, p. 24). According to Green, given the specificity of psychoanalytic listening, empirical research is irrelevant (p. 42) – it can even be harmful to psychoanalytic theory (p. 52). Regarding inner reality, the real child is not the true child from the psychoanalytic point of view. Stern answers Green by pointing out that it is worthwhile to take into account different research programs that complement the clinical information concerning the child. To study the phenomena that occur at the beginning (coup) does not mean one ignores the apr es coup (nachtr€ aglich) – just as examining what happens when the mother is present does not imply ignoring what happens when she is absent. But here my interest is not to discuss these matters. It is, rather, to emphasize Stern’s assertion, which has unfortunately not been addressed in the discussion, concerning the criteria used to evaluate the arguments in play during these debates. Stern proposes that we take into account not only the direct relevance of some finding, but also the finding’s indirect relevance since it can contribute to a theory’s plausibility (p. 74). Stern maintains that psychoanalytic theory can be seen as epistemologically protected in the face of ‘truths’ that may come from other scientific methods, but even so it cannot help but be exposed to doubts, difficulties, and perplexities. Theoreticians must also recognize the limiting conditions that the rest of our understanding of the world might suggest. In this vein I want to add that something we consider indirectly relevant because of its source, can nevertheless have direct relevance in sustaining a hypothesis. Here I am referring, for example, to Target and Fonagy’s (2002, p. 44) observation concerning the ‘early’ manifestations of the Oedipus complex. For the triangular situation Freud describes, children need to have a theory of mind and thinking abilities that allow them to formulate the meanings of the situation that arises among Int J Psychoanal (2015) 96



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the different agents involved therein. We cannot assign to children of a particular age abilities that they are yet to have. In this case, and many others, psychoanalytic interpretations cannot ignore the findings of developmental psychology. (As Wallerstein points out, a radical distinction between psychoanalysis and psychology is highly controversial.) I would like to add another example of clinical relevance in research findings. Many phenomena Stern has described in the mother-baby encounters have been essential in formulating the ‘now moments’ studied by the Boston Study of Change Group (Stern, 2004; Stern et al., 1998). One can see in these ‘now moments’ apparently surprising modifications in analyses. Whether or not one accepts these proposals, there is no doubt that they make relevant contributions to the development of psychoanalytic theory. The relevance of findings outside the psychoanalytic setting can also be seen in relation to neuro-psychoanalysis, whose value has been strongly challenged by Blass and Carmeli (2007a,b) and Carmeli and Blass (2013). These two authors consider neuro-psychoanalysis’s findings irrelevant and potentially negative, since they could lead to a biological reductionism contrary to a psychoanalytic understanding of meaning as well as to the role of discourse in reaching psychoanalytic understanding. Only in the cases of patients’ brain damage that may rule out the psychoanalytic method, knowledge of the biological substrate would have relevance for understanding the mind (Blass and Carmeli, 2007b, p. 21). Nonetheless, it is hard to slough off neuro-psychoanalysis’s contributions since it takes up Freud’s early interest in and reasons for building bridges to the neurosciences. It has come about precisely at the time in which neuro-psychoanalysis’s recent developments have justified searching for bridges between both disciplines. It has been shown that psychotherapy modifies neurotransmitters’ metabolism, as well as gene expression and the production of persistent modifications of synaptic plasticity. Studies of brain imaging allow us to infer which cerebral areas get activated or deactivated in diverse conditions, and how their activation changes as the patient gets better. The advances in neuroscience have, in turn, challenged psychoanalysis in sensitive areas. Freudian dream theory seemed to be of interest to neuro-biologists when dominant hypotheses, such as Hobson’s (2002), have shown that REM dreams imply cerebral structures and mechanisms with no room left for hypotheses about motivations, desires or, even, censorship. This is why Hobson considers Freud’s theory of dreams to be a fantasy without a future. Solms’s neuro-psychoanalytic research has modified Hobson’s point of view by differentiating the mechanisms implied in REM sleep from those involved with dreaming. In the mechanisms of dreams, it has been possible to show that cerebral locations and systems participate in ways compatible with psychoanalytic hypotheses. Curiously, Blass and Carmeli do not think it relevant that neuro-sciences might give us evidence for or against motivations as the source of dreaming. They maintain that psychoanalytic theory could dispense with the role of desire in the genesis of dreaming as long as one admits that dreaming is meaningful (2007b, p. 29). They believe that even if dreaming has no motivational source, such a lack would not invalidate psychoanalytic dream theory Copyright © 2015 Institute of Psychoanalysis


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(2007b, p. 29). It is surprising that these authors use such an argument to defend the irrelevance of neuropsychoanalysis. Even when many aspects of psychoanalytic theory must be reformulated, in no way is it possible to maintain that the role of desire and censure, as well as neuropsychoanalysis, are unimportant. Studies such as Etkin et al. (2005) and Beutel et al. (2010) suggest that current data allow us to split even finer hairs than was possible in the study of debilitating brain lesions that Blass and Carmeli cite. Patients with severe disorders make it necessary to choose between different therapeutic approaches that may complement or constitute alternatives to psychoanalysis (e.g. psychopharmacology). Brain imaging allows us to observe cerebral processes that are partially similar and partially different in distinct modes of treatment (e.g. top-down processes in psychotherapy and bottom-up in pharmacology). This checking could complement (note that I have said ‘complement’ and not ‘substitute’) the habitual clinical evaluations concerning the choice of treatment, its monitoring, and their likely outcomes. Research such as this can complement systematic studies of process and outcome. This sort of inquiry is without a doubt of interest to psychoanalytic practice. In turn psychoanalysis can offer models of interest to neuro-biological research (e.g., Carhart-Harris et al., 2008). Blass and Carmeli never take this into account. For them psychoanalytic discourse concerning unconscious meaning has nothing worth learning or worth proposing to the study of the brain. For them the only option to biological reductionism is to revive a hermeneutic position that either narrows or knocks down the bridges between nature and culture. Actually, neuro-psychoanalysis does not adopt biological reductionism or any form of simple monism. It is, rather, closer to a sort of ‘double aspect monism’, which Solms and Turnbull (2002, p. 56) defend. This double aspect monism follows a tradition that includes Freud, Spinoza and Schopenhauer, among others. It is in fact a type of monism because it postulates a single substrate, but it maintains that this substrate can be seen from different perspectives that are inseparable but irreducible to only one. Green (2005a, p. 363) also distinguishes ‘de facto monism’ from ‘structural dualism’. It is evident that there are correlations between mental and cerebral phenomena, but the extent to which they correlate is not obvious. Davidson does not believe that we can establish laws relating one of these levels to another given the anomalous nature of the mind-body relation (1994, p. 53). Thus he postulates a predicate dualism that does not accept that the mental and the physical can be nomologically related (1994, p. 123). These are not simple questions, and at the present time the interface between the mental and the physical is open to philosophical pondering and empirical research. Neuro-linguistics is faced with similar problems. Poeppel and Embick (2005) point out that the interface between both disciplines brings forth complex ontological problems as well as disparities among the objects of analysis since it is not the same to talk about syllables or morphemes and to consider them in terms of neurons or dendrites. But this does not rule out the value of neuro-linguistic studies, rather it stimulates its development and underlines its complexity. Int J Psychoanal (2015) 96



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Nor is clinical practice challenged by neuro-psychoanalysis. As Solms points out, neuroscience is not psychoanalysis’s appeals court, just as psychoanalysis is not the appeals court for neuroscience. For Solms (2013, p. 18) psychoanalysis’s final court of appeals is the clinical field. The fact that each discipline is independent is what contributes precisely to increasing the value of both their convergences and their divergences. Blass and Carmeli’s argumentation only demonstrates that neuro-psychoanalysis is not what it does not aim to be, that is, a substitute for clinical practice. But their point of view fails to address the matter’s central issue, which is the value to be had from triangulating psychoanalysis’s findings with those of other methods and disciplines. Green (2005a) differs from Blass and Carmeli because he considers neuro-biology to be relevant. He is in favor of psychoanalysis’s being open to biologists since he feels that psychoanalysis cannot neglect human body (see p. 376). Even though Green sees scant bridges between neuroscience and psychoanalysis, he is gratified that some neuro-biological models, such as Edelman’s, have certain features compatible with psychoanalytic theory. For Green, psychoanalysis can only be open to neuro-biology to the extent that it continues to retain the nucleus of Freudian theory. We can appreciate this in Green’s discussions with Panksepp, who has managed to perform a ‘consilience exercise’ between psychoanalytic theory and neuro-biology. Panksepp compares concepts from both disciplines that are related to emotions and asks that Freudian theory be updated so as to adopt a way of thinking that can be renewed based on the accumulation of new findings (1999b, p. 35). Green (1999), on the other hand, points out that there are limits to this renewal arrangement since, for example, when dealing with drives, we cannot reconcile Panksepp’s terminology with that of Freud. Green maintains that Freud is the author who has demonstrated maximal internal consistency, and his work should not be set aside in our search for impossible compatibility among incompatible methods (1999, p. 44). Panksepp (1999a) counters that he does not reject Freud’s concepts, but he believes that it makes sense to revise them based on new findings concerning motivational systems. This is where the argument, in which both sides’ points of view (that of psychoanalysis and neuroscience) can interact, gets complex owing to the different criteria used in validating participants’ positions. Whereas Green privileges preserving psychoanalysis’s basic concepts, Panksepp advocates consilience in our dealing with the current state of knowledge. We should point out that Panksepp’s position does not eschew some of the aspects central to Freudian thought, rather he develops them differently from Green. Freud (1915, pp. 121–3) considered instinct to be ‘a concept between the mental and the somatic, as the psychical representative of the stimuli originating from within the organism [. . .], as a measure of the demand made upon the mind for work in consequence of its connection with the body’. It is logical, then, that psychoanalysis should pay attention to what happens on the other side of the border, that is, on the somatic level. Panksepp (1999a, p. 81) points out that since there is surely something like Freudian drives within the brain – as is the case with many other Copyright © 2015 Institute of Psychoanalysis


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psychological concepts – but at the level of the brain, the mental and cultural concepts of drive break up into many subsidiary biological processes. He goes on to suggest (p. 81) that in the interest of a fruitful hybridization between psychoanalysis and neuro-biology, one must accept the conceptual dilemmas that arise, and one must accept that we do not yet have all the answers. To this I add that the search for triangulation of findings carries with it another demand on psychoanalytic clinical thinking: we must not only observe with a binocular vision attentive to the conscious and the unconscious, but, when we form explanatory hypotheses, we must also keep in mind findings coming from other disciplines.

Discussion and conclusions The participants in controversies about research in psychoanalysis reviewed here coincide in their emphasizing the central role clinical work plays in psychoanalysis. On the other hand they diverge in the value they accord to contributions coming from other kinds of research, especially from systematic empirical research and from related disciplines. Whereas some consider this research to be useful and, indeed, indispensable, others judge it to be irrelevant and potentially prejudicial. Before delving into this matter, I should also indicate some points of agreement and disagreement in specific areas related to clinical research. So as to be as clear as possible, I shall summarize the conclusions arising from the analysis of each controversy in order to build up to this article’s final conclusions. The procedure Green proposed and Wallerstein supported is of exemplary value in finding routes toward clarifying and reducing disagreements. To what extent does this procedure show that there is a common clinical ground in psychoanalysis? Our examination of the 3-LM discussion groups has indicated that mutual agreement among their participants does not come about through abstract theoretical concepts – not even owing to more free-wheeling theorization similar to what Aulagnier (1979) has termed ‘floating theorization’. What is in fact shared is the resonance the clinical material acquires notwithstanding the analysts’ particular ways of listening deriving from their theories and personal experiences. This realization often manages to unleash internal resonance in other participants and allows them to perceive fragments of the material that at other times they could have missed. Thus, in order to be compared, psychoanalytic theories require a certain distancing from their abstract formulation. They need to be considered as they are internalized and form part of the referential scheme within which analysts function. Whereas at this level there is a common foundation and outlook among analysts of different persuasions, when we move on to diagnostic categories or more general and more abstract metapsychological theoretical explanations, matters get more complicated – but not impossible. Comparison is possible when we manage to turn abstract theories into mini-models or conceptual metaphors, which, when their use is widely accepted, become independent from the theoretical framework in which they originated (e.g. continent, mirroring, field). This allows us to think of them as potentially Int J Psychoanal (2015) 96



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alternative hypotheses whose degree of fit with the material can be examined critically. Clinical discussion groups allow participants to triangulate the observations made by participants using different theoretical models. They do this based on the insight analysts’ internalized frames of reference contribute to our understanding of the material as well as to the predictions or technical recommendations they allow us to formulate. This sort of inquiry is maintained within the clinical field. The disagreements in these controversies increase when we discuss methodologies that are beyond the clinical field. Let us now review the main arguments. On the positive side, we have emphasized these methodologies’ complementarity with clinical research and the use of one or another method according to the nature of the question being asked. The counter arguments maintain that systematic empirical research is irrelevant and that it may be prejudicial to clinical work. This last point has not been adequately grounded in the debates. Systematic empirical research’s putative damage to psychoanalysis comes from inferences made from certain statements whose interpretation is debatable. No point has been made from examples that show how clinical understanding has been damaged in specific cases. Contrariwise, some (e.g. Jimenez, 2007) defend not only the direct relevance of information furnished by systematic empirical research, but also their usefulness in promoting challenges concerning assumptions we analysts hold. As a consequence the battle against the injurious nature of empirical research seems to be waged against a strawman, or at least a fictitious adversary who has not been clearly identified. The matter of indirect relevance or of greater plausibility that a psychoanalytic theory can acquire from other disciplines merits careful consideration. The under-determination of scientific theory by evidence as discussed in modern epistemology is obvious in psychoanalysis and is the root of our proliferation of theories and our difficulty in choosing among them. This situation makes the robustness or solidity that a psychoanalytic theory (just like any other scientific theory) more important owing to the extent to which it jibes with the state of knowledge at a given time. In science, a hypothesis becomes more robust when it is supported by evidence generated by several different procedures coming from different contexts and diverse theoretical presuppositions. Nederbragt (2012) distinguishes various situations and strategies that can lead to increasing a theory’s robustness. The first is consilience, which is the phenomenon Whewell (1858) described. Consilience typically entails an inductive leap that comes about when a particular hypothesis formulated to explain one set of facts surprises us by its appositeness in explaining other facts of a different nature. Another situation is multiple derivation used at the level of local or partial theories. Beyond this, in this article I have examined triangulation from different perspectives concerning a particular phenomenon. Triangulation is a strategy that lets us open the door to more complex theories. Some authors do not distinguish between triangulation and consilience when they refer broadly to different ways one can seek convergent evidence and to the interchangeable processes leading to cross-fertilization among disciplines. Copyright © 2015 Institute of Psychoanalysis


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Qualitative research has distinguished and proposed criteria for different forms of triangulation: triangulation of data, of researchers, of theories, of methodologies, and contexts. The porosity (Wallerstein, 2009) among different types of research (e.g. clinical, qualitative, quantitative) favors searching for evidence coming from a multiplicity of sources. But this pluralistic approach need not make it necessary to renounce concepts such as reason or truth (Hampe, 2003). Triangulation strategies become more valuable when they arise from disciplines independent from one another and that employ different theoretical language. The interface between or among disciplines, in turn, requires a special effort in reflection. Such an effort will stimulate the revision and reformulation of each discipline’s concepts and perspectives. As Panksepp points out, triangulation of this sort can lead one to challenge traditional concepts, and it may be seen as a refreshing contribution that can rejuvenate different sectors of a particular discipline. Triangulation and consilience processes are not only useful when convergence of findings strengthens a hypothesis’s validity, they are also useful when discrepancies or inconsistencies appear among the different perspectives. Such discrepancies or inconsistencies are challenges that stimulate disciplines’ growth (Patton, 2002). The polemics examined here oblige us to ask: To what extent does psychoanalysis appreciate the benefits gained from the triangulation of findings? The 3-LM experience and its acceptance by analysts from different regions, as well as the similar experiences of other clinical discussion groups, suggests that analysts are willing to triangulate data, observers, theories, and clinical contexts. Methodological triangulation is, however, more problematic owing to a reluctance to use methods different from the method used in the particular analytic session. To put it clearly: this is a reluctance to compare the clinical intuitions and inferences concerning the processes and outcomes of analyses with the conclusions that come from empirical research on processes and outcomes. It is also a reluctance to complement the apres coup reconstruction of the child from an adult analysis with developmental studies, for example, research on attachment. And many analysts are also reluctant to discuss the meaning of their findings in relation to those coming from neuroscience. What is challenged in these debates is not the quality of a particular methodology employed in other disciplines, nor the validity of their findings. It is, rather, the possibility that psychoanalysis could benefit from the convergences or the challenges that could come from methods whose theoretical language is different from that of psychoanalysis. I have pointed out the effects on the robustness of psychoanalytic theory owing to our restricting the search for consilience. I would like, finally, to comment on the consequences of this restriction on psychoanalytic discourse itself. I shall base my considerations on Toulmin’s (1958, 2001) distinction of three points of view that one finds in scientific discourse: the anthropological point of view, the geometric or demonstrative point of view, and the critical/rational point of view. Int J Psychoanal (2015) 96



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When a scientific community or a subgroup within that community considers only its own findings to be valid, it tends to privilege what Toulmin calls the anthropological point of view, which favors the arguments that help unite its audience. This in turn reinforces rhetorical and persuasive argumentation. In many of the controversies examined here we have witnessed our need not to let go of those postulates that are deemed truly psychoanalytic, and this causes us to exclude data that challenge these postulates. This gets more complicated because our discipline’s very development and its clinical practice tend to cause different analytic groups to embrace specific psychoanalytic theories to the detriment of others, and this leads to the formation of schools of thought that, like great narratives, seek to account for everything that happens clinically from a single perspective. This results in our discipline’s fragmentation and to the privileging of ideas from Freud’s opus, or from some other select authors on whom we base our argumentation. This tack tends to consolidate geometric or demonstrative discourses that tries to derive its knowledge based on specific accepted and unassailable truths. (However, Freud and other psychoanalytic key authors were not of this ilk because they showed they could revise and renovate their ideas whenever that was necessary.) Demonstrative discourse based on established authority leads to different schools of thought, which, instead of bringing about a rich pluralism based on diverse alternative hypotheses worthy of clinical exploration, has turned psychoanalysis into multiple orthodoxies (Cooper, 2008). This is why it is necessary to build up a critical/rational point of view in dealing with the questions brought forth by psychoanalysis, which must be open to considering any type of argument and to evaluate it according to its own merits. When we restrict our argumentative field we also restrict the field of psychoanalysis. But attending to whatever comes from different methods does not mean that anything goes and that we should neglect problems found in the interface between psychoanalysis and the other disciplines – quite to the contrary. As I have pointed out above, these zones of interface require special efforts in conceptual analysis so as to allow both the establishment of correspondences and discrepancies between and among the different terms used in each discipline. Psychoanalysis can acknowledge a neighboring discipline’s findings without having to adopt its concepts or procedures. To return to an example studied above: process and outcome studies as well as neuroscience can furnish useful concepts for understanding psychoanalysis’s therapeutic effect. Similarly, other types of psychotherapy as well as psychopharmacologic treatment can bring up questions that must be addressed according to many different methodologies: e.g. What type of treatment benefits what sort of patients? How? With what therapist? Of course this does not exempt psychoanalysis from examining these matters from its own clinical perspective. Not everything that comes from a particular discipline is useful in another one. For this reason critical analysis at the interface level between disciplines is absolutely necessary and requires conceptual rigor. But the Copyright © 2015 Institute of Psychoanalysis


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solution is not to close ranks and instead to allow contact with other methodologies. To close ranks can be a grave mistake since the fear of threatening viruses may lead us to deprive psychoanalysis of necessary nutrients. Or, even worse, closing ranks could favor the creation of antibodies against those ideas that seek to renovate psychoanalysis. When we speak of relevance we must keep in mind not only what is relevant for psychoanalysis; we must also keep in mind what makes psychoanalysis relevant in the current state of knowledge. The controversies concerning psychoanalytic research (both clinical and empirical systematic) in essence are centered on the convenience, or lack thereof, of psychoanalysis keeping itself open to multiple spaces for inquiry and reflection. These spaces for inquiry and reflection are slim and fragile and can easily be lost. The first space opens up when psychoanalytic clinical observation allows the material to resonate within analysts without leading them to a premature interpretation. This first space in turn makes a second space available – a space in which different psychoanalytic theories are turned into alternative hypotheses in which, more than these theories’ premises, what is important is the extent to which they fit the clinical material at hand. Systematic research and dialog with other disciplines create a third environment in which it becomes possible to search for convergence of evidence using other methods and disciplines.

Translations of summary Recherche clinique, conceptuelle et empirique. Quels enseignements tirer des controverses actuelles?. Les controverses actuelles au sujet de la recherche clinique, conceptuelle et empirique permettent d’eclairer la facßon dont la psychanalyse fait face a son developpement. L’auteur de cet article examine certains debats parmi les plus pertinents (auxquels ont participe R.Carmeli, et enfin J. Panksepp) selon les caracteristiques de leur argumentation. Explorant les accords et les desaccords, il part a la recherche des moyens qui auraient permis d’avancer dans la discussion. Il met l’accent sur deux des points qui emergent de ces debats : a) les conditions d’existence d’un terrain d’entente clinique et la marche a suivre pour contribuer a clarifier davantage encore les aspects qui le definissent; b) l’utilite de l’apport de preuves cliniques et extra-cliniques. A partir de l’experience issue de groupes de discussion centres sur l’observation clinique, il soumet ces deux aspects a un examen attentif qui porte et sur la nature des preuves cliniques recueillies et partagees au sein de ces groupes et sur la possibilite de confronter ces preuves avec d’autres methodologies. Il souligne l’importance des strategies de triangulation et de consilience pour ce qui est de la contribution qu’elles apportent a la solidite de la psychanalyse comme au renfort d’une perspective critique qui vient enrichir le champ argumentatif de la discipline et valoriser les arguments issus de differentes sources selon leurs merites respectifs. Tout ceci contribue a la pertinence de la psychanalyse eu egard au dialogue pluridisciplinaire actuel. € nnen wir aus den aktuellen Debatten Klinische konzeptuelle und empirische Forschung. Was ko € ber klinische konzeptuelle und empirische Forschung wirft Licht auf die lernen?. Die aktuellen Debatten u Art und Weise, wie die Psychoanalyse sich mit ihrer eigenen Entwicklung auseinandersetzt. Wichtige Diskussionen (an denen sich R. Wallerstein, A. Green, I.Z. Hoffman, M. Eagle & D. Wolitzky, J. Safran, D. Stern, R. Blass & Z. Carmeli sowie J. Panksepp beteiligten) werden mit Blick auf die charakteristischen € Besonderheiten der Argumentation untersucht. Ubereinstimmungen und Meinungsverschiedenheiten werden mit dem Ziel erforscht, Wege zu finden, auf denen die Debatte vorankommen kann. Der Beitrag unterstreich zwei zentrale Fragen: a) Gibt es einen klinischen „common ground”, und welche Verfahren k€ onnten seine weitere Abkl€arung erleichtern? b) welchen Vorteil hat es, klinisches und außerklinisches Material zusammenzuf€ uhren? Ausgehend von der Erfahrung der Diskussionsgruppen zum Thema klinische Beobachtung werden beide Aspekte im Hinblick auf die Art des in den Gruppen zur Diskussion gestellten klinischen Materials und die M€ oglichkeit einer erweiternden Erg€anzung durch andere Methoden € anomenen wird mit untersucht. Die Wichtigkeit von Triangulierungsstrategien und Ubereinstimmungsph€




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Blick auf ihren Beitrag zur Robustheit der Psychoanalyse unterstrichen, aber auch um eine kritische Perspektive zu st€ arken, die dem Diskussionsfeld der Disziplin zugutekommt, indem sie dem eigenst€andigen Wert von Argumenten aus unterschiedlichen Quellen anerkennt. Dies erh€ oht die Relevanz der Psychoanalyse f€ ur den aktuellen interdisziplin€aren Dialog. Ricerca concettuale clinica ed empirica. Cosa possiamo imparare dalle attuali controversie?. Le attuali controversie sulla ricerca concettuale clinica e su quella empirica aiutano a chiarire come la psicoanalisi affronta la propria crescita. Si prendono in esame alcuni dibattiti rilevanti (ai quail hanno partecipato R. Wallerstein, A. Green, I.Z. Hoffman, M. Eagle & D. Wolitzky, J. Safran, D. Stern, R. Blass & Z. Carmeli, e J. Panksepp) per valutare le caratteristiche della discussione. Si analizzano i punti di convergenza e quelli di divergenza, alla ricerca delle modalita che avrebbero potuto permettere alla discussione di progredire. Si sottolineano i due punti principali di questi dibattiti: a) se esista un terreno comune nella clinica e che tipo di procedure potrebbe contribuire a ulteriori chiarimenti; b) se sia opportuno cercare la complementarieta di evidenze cliniche ed extra cliniche. Basandosi sull’esperienza di gruppi di discussione di osservazione clinica, si esaminano entrambi gli aspetti riguardo la natura dell’evidenza clinica condivisa raggiunta nei gruppi e la possibilita di completarla con altre metodologie complementari. Si sottolinea l’importanza di strategie di triangolazione e di fenomeni di convergenza per il contributo che sono in grado di apportare al vigore della psicoanalisi. E anche per rinforzare una prospettiva critica in grado di migliorare il campo di discussione nella nostra disciplina, entrando nel merito delle argomentazioni che provengono da fonti diverse. Questo contribuisce a rendere pi u rilevante l’apporto della psicoanalisi all’attuale dialogo interdisciplinare. n clınica conceptual y empırica. ¿Que podemos aprender de las controversias actuInvestigacio ales?. Los debates actuales sobre la investigaci on clınica conceptual y empırica iluminan la manera en la que el psicoan alisis enfrenta su naturaleza y su futuro. Se investigan algunos debates relevantes (en los que participan R. Wallerstein, A. Green, I.Z. Hoffman, M. Eagle y D. Wolitzky, J. Safran, D. Stern, R. Blass y Z. Carmeli, y J. Panksepp) en cuanto a las caracterısticas de su argumentaci on. Se exploran acuerdos y desacuerdos en busca de caminos que podrıan haber facilitado el avance de la discusi on. Se destacan dos ejes de estos debates: a) si existe una base clınica com un, y que tipo de procedimiento podrıa contribuir a clarificarlos mas y b) la conveniencia de complementar comprobaciones clınicas y no clınicas. Se examinan ambos aspectos: la posibilidad de complementar diversas metodologıas y la naturaleza de la evidencia clınica compartida que se estudia en los grupos de discusi on clınica, como, por ejemplo, los grupos que promueve el Comite´ de Observaci on Clınica de la IPA. Se subraya la importancia de on y los fen omenos de consiliencia en lo que hace a su contribuci on a la las estrategias de triangulaci robustez del psicoanalisis. Ademas, se destaca el fortalecimiento de una perspectiva crıtica que enriquece el campo argumentativo de la disciplina mediante la valoraci on de los argumentos de distintas fuentes seg un sus propios meritos. Este enriquecimiento contribuye a la relevancia del psicoanalisis para el di alogo interdisciplinario contemporaneo.

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