DIRECTORS' COLUMN

By Seth Warren, PhD

I am pleased to be able to present Nancie Senet's second article in a series on the scientific status of psychoanalytically-oriented approaches to psychotherapy (in her first article she discussed the evolving contributions from neuroscience to our understanding of clinical process and treatment outcomes.)

In this article she covers some of the "nuts and bolts" of research in psychology particularly, with the aim of helping all of us to be more critical and knowledgeable consumers of research. Some of this material can lead to a "glazing over" of the eyes, it can be dry and distant from our own personal clinical concerns. But Nancie's purpose, I think, is to acknowledge and recognize the ways such "empirical research" has been used and misused to shape and alter the nature of our field. She very rightly points out that the "experience-distant" language of clinical research and journals often covers over or conceals significant conceptual weaknesses in such research, though more practice-oriented clinicians may feel at a loss in debating or critiquing such material. Moreover, the structure and language of the research world is meant to characterize the relevant debates in terms of scientific knowledge and truth (versus non-truth), the reality is such debates in my opinion very often reflect the operations of power, politics, and money more than a search for the truth.

For example, even the definition of science itself has been shifted to diminish the value of personal and communal experience, instead privileging the role of the "empirical researcher." The underlying value structure that guides such privileging is largely concealed from view beneath the language of "objectivity" and scientific research methods. As an example from a book by anthropologist Wade Davis I am currently reading (The Wayfinders: Why Ancient Wisdom Matters in the Modern World), the Western conception of science rendered European colonists of Australia completely unable to grasp the world view of the aboriginal Australians, who obviously had nothing like the science we currently idealize and overvalue. And yet, without any statistics, without anything that would qualify today as "empirical research," this culture had developed over thousands of years a vast, valid, practical knowledge of virtually every aspect of their world, transmitted orally through an enormous and complex kinship structure, as true as anything we in the West might know. The people of this culture were acquainted with every plant and animal in their world, their uses and value, and had detailed and highly specific knowledge of their geography, topography, navigation, and a practical astronomy. All this without statistics, experiments, or a system of notation.

Like Nancie, I am very concerned that our culture devalues the importance and place of personal experience, which is, after all, almost always "empirical", and is, in my opinion, a fundamental source of the personal clinical world views each of us develops over the course of our professional lives. This of course includes the role of teachers, and supervisors, who likewise transmit and share their own personal clinical world views for our use, assimilation, and transformation.

In a sense, I believe we are being bullied by "research," being told in effect that other ways of knowing and learning do not count or have meaning and value, and that we should turn to the researchers who will tell us the best ways to do everything (how to do psychotherapy, how to teach children, what to eat, how to live, etc.)

It is no coincidence that psychoanalysis as an approach to understanding human psychology from the point of view of individual experience (as opposed to aggregated data from large numbers of individuals) tends to offer a valuable resistance to a world view that seems so little concerned with the personal, the private, the subjective, and the experiential.

Psychoanalytic Research Forum  

EBT (Evidence Based Treatment) is the Gold Standard?

or, What is a Gold Standard Anyway?

By Nancie Senet, PhD

Nancie Senet

Commonly, science is empirical in methodology meaning that hypotheses and theories are tested against observations in the natural world. Empirical research designs have been standardized to allow for the replication of studies and to compare the results to other studies. An RCT (randomized controlled trial) is the gold standard of design. Then mathematics are employed to quantify results and make it easier to visualize the importance or non-importance of the results as well as to make the comparisons. A theory to be tested, e.g., I believe that depression is related to self-criticism, is presented in terms of a null hypothesis. A null hypothesis states that there is no correlation between the two and that any relationship found occurs by chance, referred to as ρ, the probability that results occurred by chance alone. The idea is to prove that the null hypothesis is wrong; the results are not by chance. A ρ-value is chosen, usually .05 as a cut off for significance. After converting the results into mathematical terms using one or another statistical tests, a level of significance is obtained. If ρ < .05, then the results are considered to be statistically significant, I.e. they did not occur by chance. However, if ρ > .05, then the null hypothesis is confirmed and the results probably occurred by chance alone. So in the case of my proposed theory (depression is related to self-criticism) if my results attained a ρ < .05 my theory would be empirically supported. I could claim that my theory is correct. If however the ρ > .05, then I have to go back to the drawing board and rethink my theory.

In reality, the empirical methodology is way too reductionistic. So much so that when measuring complicated matters, it inhabits a world of its own rather than the one in which we live. Yes, more complex research designs that include many variables yielding results that are analyzed by all sorts of "sophisticated" statistical manipulations are also common. These studies, perhaps even more so than those of a simpler design, carry vulnerabilities that create problems with the validity of their results.

Validity is a really important topic. Invalid research yields no evidence to support either the veracity of your theory or the efficacy

of your treatment method. A good deal of the research currently published is seriously flawed, yet the results are broadcasted anyway as solid evidence for the theory or treatment modality. Jurgen Margraf writes that psychology is way up there at

the top of those professions using questionable research practices. In an article that can be found online at  

http://bit.l /KenPopeTheStateOfPsychology he states that psychology has had a four-fold increase in the rate of research  

article retractions since 1989. (The article is in German, but includes an Abstract in English.)

Click HERE to read the rest of this article

A LOOK AT RECENT CPPNJ EVENTS  

CPPNJ colleagues and friends gathered at Fairleigh Dickinson, braved a snowy forecast to attend our Cultural Forum, and faced the challenges of technology - specifically, streaming the video "Black Psychoanalysts Speak." Fortunately, there were a few "techies" among us and the presentation continued after some delay.

"Black Psychoanalysts Speak" is a film about listening to the OTHER. It addresses the difficulties we all have in "developing a language to talk about race...race is not a biological reality but a social construct." The participants featured in the film speak of their growing recognition that the mind has a social context, and is by its very nature relational. One of the speakers seen in the film is Cheryl Thompson, PhD. She points out that the original psychoanalysts who came from Europe to America had lived through their own "alienation" from the generic White population in which they had been embedded. They had their own experience of "racial trauma," which was not acknowledged at the time.

The Black psychoanalysts in the film discussed the concept of "othering." They shared their own experiences of "outsider status" in the course of their psychoanalytic training. Based on their personal journeys, they emphasized the need for empathy, curiosity and respect when, as therapists, we deal with our patients in a multicultural setting. They stated that it is important for us to ask questions and to listen carefully to our patients rather than assuming we understand. Opening ourselves up to cultural differences in therapy means we must strive to be "radically undefended."

Following the film, Ruth Lijtmaer, PhD and Cheryl Thompson, PhD, shared their own stories of "being Other" as analysts. Participants also entered into the "storytelling" and a camaraderie quickly developed.

A special thanks to Marlene Rybinski, Gayle Coakley, Roslyn Gawthney and Marlene Emery for their help with registration and CEUs.

By Cheryl Nifoussi, MSW, LCSW, LMFT

Cheryl Nifoussi

The snow storm and cold temperatures did not stop 33 psychotherapists from braving the elements to hear Ken Frank 's presentation, "Integrating New Methods into Current Psychoanalytic Practice," given on Friday, March 6, at the Northern Region Area Luncheon, held at FDU Metropolitan Campus.

We enjoyed Ken's thought provoking presentation, and the opportunity to exchange ideas with colleagues, by the fireplace, in a room with a beautiful view of the frozen, snow covered Hackensack River on a sunny day...keep reading below for a lovely summary of Ken's presentation by Judy Kaufman.

Many thanks to Ken, and also to Judy Kaufman, who was instrumental in arranging for him to speak. Special thanks to Karen Glick and Mitchell Milch, a great team, for taking charge of registration and welcoming everyone. Thank you, Rose Oosting, for your help with publicity. Thank you Carol Marcus and Wendy Winograd for arranging CEUs - not an easy job. And to the amazing Cathy Van Voorhees - we could not have done it without you!.

Our last Northern Region Event for the year will be a Bagel Brunch, on Sunday May 3, from 11am to 1pm.  Chana Kahn has very graciously offered to host this event at her home in Teaneck. More details will be coming soon. 

Liesa Rosner and Harlene Goldschmidt

Mitchell Milch, Karen Glick and Kenneth Frank

Janet Hoffer and Hope Eliasof

By Judy Kaufman, PhD

Kenneth Frank

On Friday March 6, Ken Frank presented "Integrating New Methods in Current Psychoanalytic Practice" at the Northern Region Area Luncheon held at FDU's Metropolitan Campus. Ken spoke about the shift in psychoanalysis to a psychoanalytic psychotherapy informed by socio-political changes in the culture. The psychoanalytic approach remains powerful; we need to preserve its tenets: psychodynamics remain the most preferred way of understanding personality; the analytic stance, the analytic way of understanding the psychotherapy relationship and the personal narrative co-constructed in the psychotherapy remain the cornerstones of psychotherapy. However, as psychoanalytic therapists we can and need to do more. We need to be willing to integrate multiple approaches and methods.  

Ken spoke to the shift from a "one person" model to a "two person," more open way of working, consistent with relational theory. Two important areas of progress are the focus on therapeutic momentum in the session and on action oriented work between sessions. This approach recognizes the impact of contemporary life on the inner world. Advances in neuroscience command that we as psychoanalysts broaden our methods. Cognitive neuroscience has shown the plasticity of the brain, and it's ability to change with experience.

Interpretation is important as the way to pave the way for new interpersonal experiences. Yet, experiential work remains the template for changes in neural pathways. Ken discussed several examples of ways he introduces tasks both in the sessions and between sessions.

One illustration was the use of an internal systems model utilized in the session to deal with early trauma. Ken suggested and discussed ways that we can borrow methods from such modalities as CBT, DBT and EMDR to use within the frame of our psychoanalytic understanding and technique. A lively and informing discussion from a receptive audience confirmed the relevance and importance of an integrative approach in our psychoanalytically focused treatment model.

Chana Kahn and Naomi Fox

Cheryl Nifoussi and Judy Kaufman

Elizabeth Buonomo, Joseph Armentano and Elise Aronov

Member Presentations and Publications

Daniel Goldberg, PhD

"The Critical Challenges in Becoming a Couples Therapist," presentation at the Trinity Counseling Center, Princeton, NJ. March 12, 2015. 

Upcoming 2015 Events

Thank you for joining us. Look for our next newsletter in April 2015.