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On the Relationship of Experimental Psychologyand Psychoanalysis: Commentary by Peter Fonagy(London)Peter Fonagy Ph.D., FBAa

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To cite this article: Peter Fonagy Ph.D., FBA (2000) On the Relationship of Experimental Psychology and Psychoanalysis:Commentary by Peter Fonagy (London), Neuropsychoanalysis: An Interdisciplinary Journal for Psychoanalysis and theNeurosciences, 2:2, 222-232, DOI: 10.1080/15294145.2000.10773311

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Sachdev, P. (1999), Is the reduction of mental phenomenaan attainable goal? J. Neuropsychiatry & Clin. Neu­rosci., 11 :274-279.

Searle, J. R. (1969), Speech Acts: An Essay in the Philoso­phy of Language. Cambridge, MA.: Cambridge Univer­sity Press.

Nancy S. Foldi, Ph.D.Department of PsychologyQueens College CUNY65-30 Kissena BoulevardRoom NSB-E318Flushing, NY 11367e-mail: nsfoldi@qc.edu

Peter Fonagy

On the Relationship of Experimental Psychology and PsychoanalysisCommentary by Peter Fonagy (London)

It is by universal misunderstanding that all agree. For if, by illluck, people understood each other, they would never agree[Charles Baudelaire, Intimate Journals, 1877].

The Obvious Misunderstanding

I gradually realized that I must have totally misunder­stood Paul Whittle's superb, elegant essay, filled to thebrim with wisdom, humor, and staggering cultural andhistorical perspective. I surmised that I must have mis­understood him because I found myself in almost totalagreement with everything he wrote. Yet I thought Iheld the diametrically opposite view.

I chuckled at his description of psychologists andpsychoanalysts reading each other's papers, the im­plausibility of a debate, the profound misunder­standings that are· inevitably entailed in critiques,psychoanalysts' naIve and misinformed perceptions ofpsychologists, and psychologists' incredulity that suchthings as psychoanalysts still existed. I shuddered withpainful recognition when, describing exceptions to hisrule, he accurately diagnosed that the individuals whoattempt to bridge the divide "are disregarded orthought of as 'unsound' by one or both sides." He isso obviously right that the overwhelming situation isstill one of separation.

His metaphor of the gulf, gap, or chasm betweenpsychoanalysis and psychology generated associationsto dreams I used to have as a child where, standing onan elevated, unstable surface, I suddenly found myselffalling and aware of the inevitability of a disastrousend. "Do I know about the 'fault line'?" I have beenliving on it for the last 25 years! Just as the life he

Peter Fonagy is Freud Professor of Psychoanalysis, SUb-Departmentof Clinical Health Psychology, University College London, London, UK;Director, Child and Family Center, Menninger Clinic, Topeka, Kansas.

describes, mine has been split between different dis­courses. Also, I too have long worked in an academicdepartment of psychology, one with equal claims tohaving participated in the creation of the discipline inthe United Kingdom, with both experimentalists andpsychoanalysts in leadership positions throughout itsearly history. I believe Flugel, Spearman, and Burt allhad substantial exposure to psychoanalytic ideas, andmore recently, De Monchaux and Sandler were activeon the faculty, all living the kind of dual existence thatWhittle so clearly elaborates.

I totally agree with his claims that the demonstra­tion of therapeutic efficacy by itself cannot validatethe theory, nor do laboratory tests of psychoanalyticideas have the power to confirm or refute (Fonagy,1982). That is not to say, of course, that experimentaltests of psychoanalytic therapy should not be per­formed, just that we should be clear that the need forthis is by and large administrative rather than theoreti­cal, rooted in the way that psychoanalysis is inter­twined with publicly funded mental health services.Whittle's dichotomy of the subject matter of experi­mental psychology as being mental process, while thatof psychoanalysis is mental content, is a challengingand true statement of a perceived state of affairs,though perhaps less than totally accurate in terms ofa deeper scrutiny. Colleagues and I have attempted tobroaden psychoanalytic conceptualization of pathol­ogy from that dominated by distorted mental represen­tations to a more comprehensive model of pathologythat also takes account of dysfunctional mental pro­cesses (Fonagy, Moran, Edgcumbe, Kennedy, andTarget, 1993). When Kleinian analysts talk of thoughtas antagonistic to fantasy, being fervently resistive,they are in fact discussing the vulnerability of mentalprocesses to unconscious dynamic forces (Segal,1972).

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So what is Whittle's way of bridging the gap(nay gulf) between the enterprise of psychology andpsychoanalysis? He suggests that because the methodof psychoanalysis is to fill gaps in self-narrative andself-awareness, which are inevitable because of thelimitations of conscious reflection, and because psy­choanalysis can provide amply in this regard, the crite­ria for truth are satisfied at least for those who areparticipants in the process. This is a sophisticatedstatement of what has come to be known as the herme­neutic position, notably adopted by a number of keyfigures who have been builders of bridges in a previ­ous incarnation (e.g., Schafer, 1994; Spence, 1994).It is hardly surprising, given the therapist's primarycommitment is to fill gaps in a text, that she or hecan have little truck with "the cognitive asceticism ofexperimental psychology." Given the overriding needfor explanation, the overproduction of theory in psy­choanalysis is also hardly surprising.

Whittle stresses the playful nature of this theory­building exercise. He hints at, but does not make ex­plicit, the dangers of this kind of play. The danger,of course, is reification, which, following Ryle, RoySchafer drew our attention to in the mid-1970s(Schafer, 1976). Just as the nonmentalizing child can­not yet sustain the notion of playas real yet unreal(Target and Fonagy, 1996), so the psychoanalytic psy­chotherapist is vulnerable to failing to recognize thatpretending to be a scientist is not quite the same asbeing one. To learn "to play with reality" is an ad­vanced capacity, which sadly all but the greatest ofpsychoanalysts (Freud himself and a mere handful ofothers being notable exceptions) have failed thus farto achieve.

That experimental psychology, as Whittle pointsout, is a hostile playground, should surprise no one.We also have to agree with Whittle that the makingof narratives may be so fundamental to human func­tion, so central to the experience of personal meaning(Bruner, 1990), that a discipline which has the system­atic elaboration of such narratives at its core will re­main forever vital to the study of the nature of man.Whittle suggests that pluralism is defensible becausethe content of mind, just like the content of a coral, isdefined by what happened to have floated past, not byits nucleus, and because the assertion of a singularreality, at least so far as human nature is concerned,is inherently suspect.

I got to the last page of the paper before I had anygenuine sense of a disagreement. Whittle ultimatelyproposes a dialectic between experimental psychologyand psychoanalysis. He feels it enriches psychology

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through offering an alternative perspective. This is un­doubtedly true. The long line of psychological "dis­coveries," which have psychoanalytic observations attheir roots, testify to this (e.g., learned helplessness,life-events research, attribution theory, attachmenttheory, cognitive behavior therapy). But by this veryassertion, to which there is much truth, he implicitlyconsigns psychoanalysis to its current mode of beingand allows himself to be used as an apologist for itsshortcomings, accepts and in fact embraces its pro­found limitations, and makes his authoritative state­ment vulnerable to misuse by those who, unlikeWhittle, might wish to reject the truth of psychology,do not intend for psychoanalysis ever to communicatewith any other field of scientific knowledge, who hopeto promote an attitude of paranoid mistrust of ad­vances in our understanding of human nature achievedthrough any process other than clinical consultation.

So I conclude, given that I agreed with all hisarguments, I must have misunderstood Whittle's con­clusions. Or, alternatively, his arguments are equallyconsistent with quite the opposite position to the onethat he favors and which I should like to take thisopportunity to outline.

The Internal Problems Facing Psychoanalysisin the Twenty-first Century

Whittle is successful in seeing off some of those whowish to ··challenge psychoanalysis from the outside(e.g., Grunbaum, 1984; Crews, 1993; Webster, 1995).He is, however, less successful in relation to, or atleast is silent about, the powerful challenge from be­havior geneticists who have questioned the importanceof any kind of psychosocial influence in the causalframework for personality and psychopathology, letalone those mediated by unconscious processes (Scarr,1992; Rowe, 1994). Not only are environmental ef­fects apparently quite minor, but even those that ap­pear to be relevant to psychological traits have beenshown, at least in part, to be genetically mediated(Plomin and Bergeman, 1991; Kendler, Neale, Kess­ler, Heath, and Eaves, 1993; Kendler and Karkowski­Shuman, 1997; O'Connor, Deater-Deckard, Fulker,Rutter, and Plomin, 1998). Also, the lobby for evi­dence-based treatments was relatively mute at the timewhen the original lecture was delivered. Six yearslater, the entire psychoanalytic enterprise has beenshaken to its core, at least in North America and manycountries in Europe, by the insistence on empiricallyvalidated treatments (EVTs, Gunderson and Gabbard,

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1999). To be fair, these kinds of challenges are beyondthe explicit focus of Whittle's paper, but they do radi­cally alter the social and scientific context of thedebate.

What I want to focus on, however, in discussingWhittle's contribution, is the relative complacencythat it may (perhaps inadvertently) encourage in psy­choanalysts. In my view, not all is well in the psycho­analytic playground and a journal such as Neuro­Psychoanalysis has a key role in addressing the prob­lems of the discipline.

Pluralism may have its justification, but over re­cent decades psychoanalysis has witnessed an increas­ing fragmentation of theory, evident in the decline incitations of recent psychoanalytic articles published inmajor psychoanalytic journals (Fonagy, 1996). Thevast majority of currently published psychoanalyticpapers are never cited by anyone. This is in markedcontrast to even the late 1970s and early 1980s whenaverage citation rates in the year or two after publica­tion were at acceptable levels for an academic disci­pline. That social scientists or psychiatrists should loseinterest in psychoanalysis is one thing, but for psycho­analysts to become apparently indifferent to the workof their colleagues spells to me the possible imminentdemise of the discipline. Pluralism has gone beyondacceptable boundaries, and psychoanalysis faces theo­retical entropy with all contributors jealously pro­tecting their own ever-shrinking psychoanalytic patch.

How could this happen? Here I am in total agree­ment with Whittle, although less sanguine than he ap­pears to be about likely outcomes. Theory buildingis based on personal relationships, interpretation, andenlightenment through explanation (Fonagy, 1999).Psychoanalysts have always argued, and I agree, thatpsychoanalytic treatment provides a unique windowon human behavior that generates developmentallyrich and clinically powerful accounts. The main func­tion of theory for psychoanalysts is in explaining clini­cal phenomena. Theory is used as a heuristic devicerather than as a tool for deduction. The predominanttheory-building strategy in clinical psychoanalysis is"enumerative inductivism" (the accumulation of in­stances consistent with a premise). In treating a pa­tient, we have access to a set of observations, basedon assessment and the evolving treatment process.From this sample, certain observations are of courseselected as telling, and from these the analyst drawsconclusions about how the patient generally behavesand why he or she does so. The analyst will be predis­posed to focus on aspects of the patient's behavior andpatient-therapist interaction that make sense in terms

Peter Fonagy

of existing theoretical constructs. Induction is thusmade not just from the accumulation of observationsabout a particular individual, but also from formula­tions of past cases by other psychoanalysts in their"clinical theories" (Klein, 1976).

From a clinical point of view this is useful. Togather examples of the influence of an unconsciouspattern not only prepares the ground for interpreta­tions ("every time you are feeling such and such youdo so and so") but also helps the psychoanalyst to feelon firmer ground in working creatively to elaborate apicture of the patient's internal world. The difficultyarises from our understanding, as clinicians, of the roleof theory. We consider it to lend credence to inductiveobservations because we assume that theories havebeen inferred from a very large number of observa­tions, and subsequently tested against new, indepen­dent observations. What we can find ourselves doinginstead, however, is piling induction on induction.

The clinical usefulness and persuasiveness of in­ductive arguments can lead us, with the greatest ofease, to raise the status of "clinical theories" to laws,gaining the impression as we do so that we have atool for understanding that not only makes sense tous, but works for our patients and is furthermore sci­entific. I There are four conditions that would need tobe met for the accumulation of clinical observationsto be a genuinely adequate basis for psychoanalytictheory. These are: (1) a clear logical tie between theoryand technique; (2) deductive as well as inductive rea­soning in relation to clinical material; (3) the unambig­uous use of terms; and (4) a willingness to exposemore clinical work to detailed public scrutiny. Thefirst of these is essential if we are to be able to separatetechnique and theory. If technique has shown specifi­able relationship with theory, then the inevitable con­tamination of observations by technique can beidentified and studied. The second criterion, of deduc­tive reasoning, must be satisfied if observations are tobe capable of either proving or disproving theoreticalmodels. The third criterion concerns the labeling ofobservations in such a way that these can be described,replicated, and considered in relation to theoreticalpredictions. The final criterion would allow the data,clinical observations, to be selected and tested in rela­tion to different theoretical perspectives. None of these

I In fact, most clinical laws are, in any case, only probabilistic (Ruben,1993); therefore they could allow only inductive statistical explanationsrather than deductive-nomological ones (see Carl Hempel's 1965 Cov­ering-Role Model). While we know that child maltreatment can give riseto behavioral disturbance, this is by no means inevitably the case (e.g.,Anthony and Cohler, 1987).

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Ongoing Discussion: Paul Whittle

criteria has yet been adequately met, and in the follow­ing sections I will discuss some implications of this sit­uation.

Psychodynamic Clinical Practice Is Not LogicallyDeductible from any Psychoanalytic Clinical Theory

Psychoanalytic technique does not follow from theory(see e.g., Berger, 1985); there are several aspects tothis, some of which are touched on below.

1. Psychoanalytic technique arose largely on thebasis of trial and error, rather than having been drivenby theory. Freud (1912) willingly acknowledged this:"the technical rules which I am putting forward havebeen arrived at from my own experience in the courseof many years, after unfortunate results had led me toabandon other methods" (p. 111).

2. There is no one-to-one correspondence be­tween differing psychoanalytic frameworks and thetechniques used. It is as easy to illustrate how the sametheory can generate different techniques as how thesame technique may be justified by different theories.For example, Gedo (1979) states that: "principles ofpsychoanalytic practice [are] ... based on rational de­ductions from our most current conception of psychicfunctioning" (p. 16). His book claims that the pooroutcomes of developmental problems can be reversed"only by dealing with those results of all antecedentdevelopmental vicissitudes that later gave rise to mal­adaptation" (p. 21). However, what sounds like a de­duction, on closer examination turns out to be ahypothesis. It is one thing to presume and quite an­other to demonstrate that in therapy developmentalvicissitudes require to be sequentially addressed.Many have powerfully challenged the overuse of thedevelopmental metaphor (Mayes and Spence, 1994)and, even from within the self-psychology orientationto which Gedo belongs, the support for his strong as­sertion is limited (Kohut, 1984, pp. 42-46). In parallel,it is striking how clinicians using very different theo­retical frameworks can arrive at similar treatment ap­proaches (Wallerstein, 1990).

3. Theory and practice have developed at verydifferent rates, with practice changing only in minorways during the twentieth century, in contrast to themajor strides made by theories. It is quite realisticto contemplate a single-volume account that wouldencompass most major technical advances (e.g.,Greenson, 1967; Luborsky, 1984; Kernberg, Selzer,Koenigsberg, Carr, and Appelbaum, 1989; Clarkin,Kernberg, & Yeomans, 1999), yet no single person

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could do justice to all the enormous theoretical devel­opments that have taken place over the same period.The discrepancy in rates of change is staggering, andwould be hard to understand were it not for the relativeindependence of theory and practice.

4. Psychoanalytic theory does not mainly con­cern practice. Only one volume of Freud's 23-volumecorpus is devoted to papers on technique. So what ispsychoanalytic theory about, if not practice? It wasintended as and remains an elaboration of a psycho­logical model and the way that this may be applied tothe understanding of mental disorder, and to a lesserextent, to other aspects of human behavior-literature,the arts, history, and so forth.

Inductive Rather than Deductive Reasoning Is Used inRelation to Clinical Material

As we have seen, theory is intrinsically contaminatedby the technique used to generate observations. Astechnique has evolved pragmatically and without aclose or fully coherent connection to theory, theorywill have been shaped by what has been found clini­cally helpful, rather than practice being dictated bywhat is true about the mind. (A theory may be truebut of little practical value, e.g., a mathematical theo­rem, or untrue but of great practical relevance, e.g.,religious belief systems.) Thus, while theory is a vitaladjunct to clinical practice, neither has been used in away that would have helped to validate the other.

A more powerful methodology would, of course,be the careful monitoring of all instances where a par­ticular precondition was not followed by the theoreti­cally expected outcome. Psychoanalysts are not alonewith this problem. Not only most clinical thinking, butin fact all human reasoning shares this flaw (Wasonand Johnson-Laird, 1972; Johnson-Laird and Byrne,1993). Even when specifically asked to evaluate thepremise that B always follows A, we tend not to noticewhen B does not follow A. This is referred to as afailure to negate the consequent. We almost certainlymiss many instances when the patient's reaction isnot as we would have anticipated on the basis of atheoretical formulation, and we therefore do not usethe disconfirmations to improve or discard psychoana­lytic theories.

To take a simplistic example, signs of uncon­scious anger-displaced onto the self and away fromsomeone ambivalently loved and now lost-are easilyfound in cases of depression, and Freud's wonderfuldescription (1915) continues to ring true. But what of

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cases where we can see the inward direction of anger,but it does not lead to depression? Such cases couldhave been used to test and extend the psychoanalytictheory of depression. To ask clinicians (and this mayapply not only to psychoanalysts) to note and act onsuch negative instances, however, seems to introducesomething alien to the therapeutic process, setting ther­apeutic and research aims against each other. Despitesome great exceptions such as Freud, the confirmatorybias identified by Wason, Johnson-Laird, and their col­leagues may be fatal, in most cases, to the popularnotion of clinician as researcher.

As clinical observations are used inductively bytheoreticians who are themselves clinicians, new psy­chodynamic theories readily emerge and obtain someconfirmation. Even if the extent of confirmation is notgreat, the theories are likely to survive because posi­tive instances are noticed and negative ones over­looked by those interested in the fate of the theory. Afurther problem arises in that new theories are seen assupplementing rather than replacing older ones (Sand­ler, 1983). Thus there are numerous partially incom­patible formulations that need to be concurrentlyemployed to provide comprehensive accounts. At anytime, psychoanalytic theory is like a family of ideas,with resemblances, relationships, and feuds, and withnew members expected to take their place alongsidethe rest and respect the authority of the ancestors, es­pecially Freud.

The Ambiguous Use of Terms

Perhaps in order to accommodate proliferating ideas,the definition of theoretical terms has been left vague(Sandler, 1983). This is neither unusual nor easilyavoided. It is the way that human language and allhuman conceptual systems deal with the complexityof the phenomena we require them to signify (Witt­genstein, 1969; Rosch, 1978). However, the absenceof operational definitions can encourage fragmenta­tion, and can also obscure important differences be­tween theoretical approaches.

In trying to prepare a treatment manual for childpsychoanalytic psychotherapy, we have had to studythe techniques and concepts used by psychotherapistswith different theoretical orientations (following AnnaFreud, Winnicott, or Klein/Bion). While these clini­cians were unable to agree on how to describe therationale of their work, it became clear that in factthey were using different theoretical framewor ks fora very similar technique, with similar aims. Equally,

Peter Fonagy

when we tried to achieve operational definitions forthe categories in the Diagnostic Profile, an instrumentdeveloped by Anna Freud for formulating the natureof a child's psychopathology, and used by all thosetrained at her clinic, it emerged that the same wordswere being used in very different ways by differentclinicians, who had always assumed that they weretalking and writing about the same phenomena.

The validation of variables implicated by psycho­dynamic theories admittedly poses a formidable chal­lenge. Most of the variables are private; many of them(for example, "splits in the ego," masochism, andomnipotence) are complex, abstract, and difficult tooperationalize or test precisely. Accounts of changefocus on very remote variables. However, while theclarification of terms and concepts is laborious, it ispossible (e.g., Sandler, 1962). It is also essential if weare to find out where theoretical differences are real,and to test these against each other, and where theymay only be imagined.

Allowing Clinical Observations to Be Shared andTested

Clinicians' narrative reports are necessarily selectivein ways that undermine their scientific usefulness(Brown, Scheflin, and Hammond, 1998). Psychoana­lytic theory confirms that we cannot expect any partic­ipant in an interaction to be unbiased, to introduce noerrors, omissions, and distortions. Far more importantthan bias, however, is that interactions are largely gov­erned by nonconscious mechanisms, unavailable to in­trospection. There are quite dramatic illustrations ofthis-Krause's (1997) studies of facial expressions inface-to-face psychotherapy and Beebe's (Beebe, Lach­mann, and Jaffe, 1997) and Tronick's (1989) workon mother-infant interaction. The crucial informationwas never consciously known to the participants, andcould not have been reported, only observed.

There is a constant tension between making reli­able, accessible observations, and a potentially fatalproblem: that making recordings of analytic sessionsavailable for study is an unacceptable intrusion thatwould interfere with the process and change it beyondrecognition. It is clear that we must do everythingpossible to gain informed consent to any procedurepotentially affecting clinical work, and to protect con­fidentiality. However, this is not an insuperable prob­lem in other areas of psychotherapy research and neednot be so in the future for psychoanalysis. We do notknow to what extent audiotaping might interfere with

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Ongoing Discussion: Paul Whittle

key aspects of the psychoanalytic process. However,those clinicians who have experience of psychother­apy process research claim that even videotaping psy­choanalysis does not need to distort the clinical work,as long as the patient's reactions are included in thematerial to be analyzed (Jones, 1993).

It seems then that psychoanalysis needs to find away of opening up its work to outside observation, sothat technique and theory, and the relationship be­tween them, can be studied and evaluated. If psycho­analysis in the twenty-first century declares itselfinaccessible to controlled observations and hypothesestestable by those other than the analyst, it will depriveitself of the interplay between data and theory thatcontributed so much to the growth of other sciencesduring the twentieth century. In the absence of a sub­stantial collection of data, psychoanalysts would con­tinue to fall back upon either the indirect evidence ofclinical observation or an appeal to authority.

Making Links with Experimental Psychology

The Past and the Present

As Whittle points out, there is little love lost betweenpsychoanalysis and psychology. How much the deeplyrooted epistemic differences, which were Whittle's fo­cus, and how much economic and political considera­tions may be responsible, is hard to say. As we haveseen, British psychology was not always antagonisticto psychoanalysis. The antagonism emerged from anembryonic clinical psychology with a strongly positiv­istic orientation (Eysenck, 1952), which was quitenaIve in its approach to mental disorder (Ullmann andKrasner, 1969; Wolpe, 1969), embracing a simplisticand mechanistic approach almost as a counterweightto psychoanalysis. I believe that there were major eco­nomic as well as scientific considerations entailed inthis opposition. In the United States at least, psycholo­gists were excluded from psychoanalytic training byan unimaginative, rigid, and deplorably arrogant med­ical psychoanalytic leadership. Such economic factors,however, fail to account for the opposition of Frenchpsychoanalysts to psychology. In some of the Frenchpsychoanalytic literature, psychology appears to be lit­tle short of a term of abuse. Yet nonmedical analystshave been active in France since the earliest days (Leb­ovici and Widlocher, 1980).

There is a further problem involving clinical psy­chology and psychoanalysis. The pressure for moregenerally accessible and therefore cheaper and quicker

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psychological treatments is a direct consequence ofthe postwar egalitarianism in health care, particularlystrongly felt in Europe. Psychoanalysts who experi­mented with briefer, more focused therapies (e.g., Ma­lan and Osimo, 1992) were not well tolerated by theprofession, ever watchful for corruption of standards,and imbued with an abhorrence of superficiality. Psy­choanalysts, with some notable exceptions (e.g., Kern­berg, Selzer, Koenigsberg, Carr, and Appelbaum,1989), were, to say the least, not vigorous in the exper­imental development of new therapeutic techniques,and, by-and-Iarge, stuck to the' 'one size fits all" prin­ciple.

Psychology rapidly took advantage of the gap inthe market for short-term treatments and suggested arange of brief therapies, some, like schema-focusedtherapies, quite congenial to psychoanalytic theory(Young, 1990; Ryle, 1994; Meichenbaum, 1997). Theybuilt new therapies from within psychology, using theideas they were taught as students of experimentalpsychology, and quickly generated a range of alterna­tive procedures with a respectable evidential base(Roth, Fonagy and Parry, 1996). The emphasis onbrief psychosocial treatments for neurotic patientsmay be a short-lived phenomenon. The clients whobenefit from 16 sessions tend to benefit even morefrom psychoactive medication; and those for whommedication is insufficient need longer-term care. Butthrough clever marketing, brief therapies establishedthemselves as genuine (cheaper and more clearly ef­fective) alternatives to long-term therapy, and are nowpoised to take over the traditional domain of psycho­analytic practitioners, the treatment of severe and en­during mental disorder, particularly personalitydisorder and psychosis (e.g., Tarrier et aI., 1988; Li­nehan, 1993).

In brief, the forced separation of psychology andpsychoanalysis has not only contributed to the reduc­tion of psychoanalysis to a state perilously close tointellectual bankruptcy, but more importantly it hasencouraged the development of alternative modes ofclinical practice that have more hostility than affinitytoward the psychoanalytic tradition and manifest ev­ery sign of being able to take over from it as the preem­inent intellectual force behind the delivery ofpsychosocial mental health interventions. The biggest,as yet not fully recognized, danger lurks, as always,in the new generation. Psychoanalysis owes its preem­inence to the creative talent that its ideas were ableto attract over the last century, individuals who wereunequivocal intellectual giants within their generation(Melaine Klein, Winnicott, Fairburn, Guntrip, Andre

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Green, and many others, mostly on the Editorial Boardof this Journal). Will psychoanalysis in its currentstate be able to inspire and recruit the same caliber ofintellect in the next?

The Future

What could reverse the fortunes of psychoanalysis?How could the relationship between psychology andpsychoanalysis change to the benefit of the latter?Quite honestly, I am less concerned with what psycho­analysis might be able to contribute to modern psy­chology, although this could also follow from aconvergence of these "enterprises." In brief, I agreewith Whittle that debating the issue of psychoanalysisbeing a science has many of the hallmarks of inflictingphysical punishment upon an equine that passed awaysome time ago. Important as these debates might be,I think they miss the essence of the issue for threereasons.

First, even if psychoanalysis managed to meetcriteria for scientificity, there is no guarantee that ourtheories will be taken seriously. There are plenty ofexamples of scientific theories that are of little concernto anyone. The question is perhaps as much of per­ceived relevance as of possession of the label of sci­ence. Second, there is obviously a limit to how far thediscipline of psychoanalysis can go in meeting thesecriteria before it ceases to be psychoanalysis. Third,the criteria are abstracted from the properties of disci­plines generally agreed to be sciences, but there areplenty of exceptions. Which are the criteria that psy­choanalysis must take seriously, and which are theones we can neglect? And who decides which iswhich?

Rather than talking about science, I think it wouldbe more helpful to talk about an attitude or culturethat characterizes science, but which is by no meansexclusive to it. Below, I list some aspects of the changein attitude that might be required if psychoanalysiswere to decide to adopt a more "scientific attitude"in the hope of bringing it closer to psychology and, atthe same time, addressing some of its epistemicproblems.

The evidence base. Most psychoanalytic theo­rizing has been done by clinicians who have not testedtheir conjectures empirically. Not surprisingly, there­fore, the evidential base of these theories is often un­clear. In asking for evidence, I believe we are notreturning to operationalism, verificationism, or other

Peter Fonagy

discredited residues of logical posItIvIsm (e.g.,Leahey, 1980; Meehl, 1986). By placing the focus ofexplanation into a domain incompatible with con­trolled observations and testable hypotheses, psycho­analysis deprives itself of the interplay between dataand theory that has contributed so much to the growthof twentieth-century science. In the absence of data,psychoanalysts are frequently forced to fall back uponeither the indirect evidence of clinical observation oran appeal to authority.

The validation of variables implicated by psycho­dynamic theories poses a formidable challenge to theresearcher. Most of the variables are private; many ofthem are complex, abstract, and difficult to operationa­lize or test with precision. Psychodynamic accountsfocus on very remote etiological variables that are un­likely to be readily encompassed within an empiricallybased psychological model. Even when constructs areapparently operationalizable, they are rarely formu­lated with sufficient exactness that they could be sub­mitted to disproof. For example, concepts such assplits in the ego, masochism, and omnipotence, arerarely defined with the exactitude necessary for opera­tionalization.

It should not, however, be too readily assumedthat the empirical data that are most useful in the con­text of justification, which allow optimal control ofvariables, minimize threats to internal validity andmaximize the possibility of causal inference, are alsomost helpful in the construction of a psychologicaltheory. Whittle (and also Westen, 1991) points to therelative paucity of rich theories within current psy­chology that are based on controlled studies. Indeed,many psychological theories of psychopathology ex­plicitly acknowledge their indebtedness to psychoana­lytic ideas, which have inspired specific lines ofempirical investigation. Clinical data clearly offer afertile ground for theory building, but not for distin­guishing good theories from bad or better ones. Theproliferation of clinical theories currently in use, is thebest evidence that clinical data are more suitable forgenerating theories and hypotheses than for evaluatingthem. The convergence of evidence from several datasources (clinical, experimental, behavioral, epidemio­logical, biological, etc.) will provide the best supportfor the theories of mind proposed by psychoanalysis(Fonagy, 1982).

Thus, future psychoanalytic work should moveaway from enumerative inductivism and developcloser links with alternative data-gathering methodsavailable in modern social and biological science. Togather such data, without obliterating the phenomena

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that such investigations aim to scrutinize, is an im­portant challenge to the current generation of analysts.

Moving from global to specific constructs. Be­cause of their role in "story-telling," psychoanalyticconstructs by necessity lack specificity. Psychoana­lytic constructs and techniques need to be more tightlydefined. For example, psychoanalytic developmentalmodels have generally aimed at a level of abstractionwhere a one-to-one relationship could be identifiedbetween a particular pattern of abnormality and a spe­cific developmental course. Within modern psycho­logical models of psychopathology, the trend is towarddifferentiation and specificity. Evidence is rarelyfound to link entire classes of disorders (e.g., border­line psychopathology) with particular pathogens (e.g.,transitional relatedness; Masterson and Rinsley,1975). Specific pathogens should be linked to specificsubclasses within diagnostic groups. Concepts such asobject relationship tend to be treated as singular phe­nomena, yet even at a descriptive level they encom­pass a number of subservient functions (e.g., empathy,the quality of self-object representations, the affecttone of relationships, the ability to maintain these andinvest emotionally in them, understanding interper­sonal interactions, etc.). We need to be more specificabout particular aspects of object relations which wefeel may be commonly implied in specific disorders.

While the interest of psychoanalysts in globalconstructs is understandable in terms of their clinicalpriorities, it would seem desirable nevertheless to shiftfrom this interest toward greater concern with specificmental processes, their evolution, their vicissitudes,and their role in pathological functioning. There maybe a trade-off between explanatory power on the onehand and differentiation and exactitude on the other.But it should be remembered that analyses on a globallevel offer only an apparent power of explanation.Inexactitude ultimately causes fragmentation and pre­cludes the possibility of genuinely integrating observa­tions across individual case reports. The shift ofattitude toward the scientific would imply the study ofgroups of individuals (series of cases) and a focus onspecific mental processes rather than global descrip­tive characterizations.

The routine consideration of alternative ac­counts. A tradition of comparative psychoanalysisneeds to evolve where alternative frameworks areconsidered side-by-side in specific contexts. In currentclinical reports, there is a notable lack of serious con­sideration of alternative accounts when relationships

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are proposed between clinical observation and theory.The aim here must be twofold: (1) to be able to ac­tively implement the principle of parsimony, which ishard to do unless explanations are placed side-by-side,and (2) to identify the best-fitting account among rivalaccounts. This approach should be extended so thatexplanations from outside psychoanalysis are consid­ered, as they may suggest better or complementaryways of understanding the data. The challenge for thefuture must be more fully to explore alternative ac­counts, identify the appropriate subpopulation towhich they are best suited, or discontinue their usehaving replaced them with a better-fitting alternative.Such an endeavor requires systematic scrutiny.

Understanding the interaction of the intrapsychicand the environmental. One of Freud's major histori­cal achievements was the firm establishment of a psy­chological and psychosocial causation of mentaldisorder. Interestingly, many psychoanalytic accountslack sophistication in considering the impact of theexternal worlds. This is understandable since the focusof psychoanalysis is upon the intrapsychic. Yet thelack of sophistication leaves psychoanalysis vulnera­ble to accusations of mother-blaming and an unrealis­tic overemphasis on external influences during theearly years of life. We know that constitutional andparental risk factors interact in the generation of risk(Rutter, 1999). Psychoanalytic models need to becomegenuinely transactional as well as able to embrace thewider social and cultural context within which objectrelations develop. To take but one example, placingthe individuated self at the peak of a developmentalhierarchy involves ethnocentrism, as well as patholog­izing a mode of functioning that may be adaptive inmany cultural contexts. Psychoanalysis needs, not justa more sophisticated system of diagnostic categoriesfor the individuals, it needs its own system for catego­rizing the nature of environmental influence.

Collaboration with other disciplines. Whilemany psychoanalysts welcome knowledge from re­lated fields, active collaboration with neighboring dis­ciplines is patchy, and usually focused on specificfindings or ideas consistent with a particular author'spreconceptions (cf. Wolff, 1996). For other psychoan­alysts, the separateness of the psychoanalytic disci­pline from others whose subject matter overlaps withours has been a source of pride to the extent that ana­lysts have been criticized for including too many bib­liographic citations to nonpsychoanalytic workamongst their references (Green and Stern, 2000). The

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fear appears to be that fields adjacent to psychoanaly­sis have the potential to destroy the unique insightsoffered by clinical research.

There can be no singular approach to such collab­oration. Taking a more scientific attitude to psycho­analysis while carefully protecting its insights is thechallenge for the clinician-researcher of the twenty­first century. As long ago as 1982, I proposed thatmuch that has been learned in psychology about men­tal processes was applicable to psychoanalysis andshould be integrated with it (Fonagy, 1982). Since thattime, together with a number of colleagues, we havebeen working on integrating the mental function asso­ciated with the representation and understanding ofmental states with psychoanalytic ideas. This is justone of a wide range of mental processes or modules(Fodor, 1983) to which psychologists have drawn ourattention and that clearly deserve and require psycho­analytic scrutiny. Systematic study could achieve ahigher level of integration and a great deal of in­creased sophistication in the way that psychoanalyststalk about remembering, imagining, speaking, think­ing, dreaming, and so on. All that is required for boththese integrative initiatives is a more scientific attitude,a broader range of methods, and an openness to andexcitement about new ideas.

Conclusion

In summary, I feel that in order to ensure a future forpsychoanalysis and psychoanalytic therapies withinpsychiatry and clinical psychology, the practitionersof these arts must change their attitude in the directionof a more scientific (psychological) enterprise. Thiswill require the evolution of a new breed of psychoan­alytic clinicians, the psychoanalytic researchers, whotake it upon themselves to advance their field, usingNietzsche's words, "by laborious struggle," demon­strating "courage, simplicity, and abstemiousness."

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Commentary by Egle Laufer (London)

I am grateful to Paul Whittle for opening up a discus­sion about experimental psychology and psychoanaly­sis that makes it possible to discuss the gulf which hesays has developed between the two disciplines duringthe past century. I found the analogy he draws, of thedifferences between the two disciplines as being likethat between two totally different cultures, completelyconvincing and I admire his ability to move with suchease between the two. But I am much less happy withhis idea that this gulf has come about to allow for adivision of labor between the two where both arethriving in their own domain. Because, according toWhittle's views, this implies that both disciplinesagree to privilege experimental psychology with theknowledge about the functioning of the mind that isscientifically proven and thus not open to challenge,while leaving psychoanalysis the task of "increasingpersonal insight" or addressing "human nature," andwhere its ideas and concepts belong to the' 'religious"as opposed to the' 'irreligious" of experimental psy­chology. That is not how I would view psychoanalysis.

I welcome what seems to be a wish and hope onhis part that this gulf can begin to be bridged in thetwenty-first century. He seems to be basing this wishon his own experience of his awareness of needing toenrich his own thinking in order to get beyond theconstraints imposed on his thinking by experimentalpsychology. Isolated as I am in my own culture, Ihad not appreciated the extent to which experimentalpsychology in identifying itself as an experimental sci­ence, has felt constrained to limit its field of observa­tion purely to the psychological phenomena which canbe made predictable in the laboratory. In having tostay in that confined area, I thought that Whittle is

Egle Laufer

Young, J. E. (1990), Cognitive Therapy for Personality Dis­orders: A Schema-Focused Approach. Sarasota, FL: Pro­fessional Resource Exchange.

Peter Fonagy, Ph.D., FBASub-Department of Clinical Health PsychologyUniversity College LondonGrower StreetLondon WC1E 6BTTel.: 00 44 171 391 1791Fax: 00 44 171 916 1989e-mail: p.fonagy@ucl.ac.uk

also saying how it has taken him away from a senseof being involved in how people function in their innerlives, something he calls human nature, and as if hehas to look for somewhere other than experimentalpsychology in order to feel free to use his imaginationand his own experiences to know something abouthuman experience.

The casting out of psychoanalysis from the irreli­gious back into the religious cultural domain seems torelate to the accusations made against psychoanalysisthat its concepts are based on belief and not on pre­dictable and verifiable discoveries. In 1895 Freudwrote "A Project for a Scientific Psychology" inwhich he attempts to state the psychological findingsregarding motivated behavior, affects, and consciousand unconscious mental functioning, which he had ar­rived at through his clinical work, in purely neurologi­cal terms. For Freud the scientist, the setting of theanalytic consulting room with the couch and the ob­server sitting behind the subject replaced the labora­tory situation to which he was used. In this laboratory,he introduced a revolutionary concept as a result ofhis observations of the patient's response to his roleas the doctor who was trying to help alleviate suffer­ing-that of conceptualizing the relationship of thepatient to the doctor as governed by transference thatchanged the reality of the situation into one coloredby the patient's past and repressed memories. In doingthis, he both provided a microscope for the investiga­tion of the relation between past experiences and thepresent experience of relationships but also made therelationship between the observer and the patient intothe central tool, thus bringing into the laboratory situa­tion the effect of the observer on that which is being

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