Evaluating psychoanalytic papers. Towards the development of common editorial standards.

Psychoanalysis has insecure foundations. Many of its core theories and therapeutic principles are contested from both within and without the discipline. While it often has little difficulty embracing new ideas it has terrible trouble rejecting old ones. Typically those within the discipline have dealt with this situation by destructive rationalisation, denial, splitting and idealization. Foremost is the tendency to multiply schools and paradigms and to rely on rhetoric and argument by authority. It is argued that to counter such inevitably destructive processes we need to find a way of improving constructive engagement with each other and to achieve a discipline that can grow on the secure foundations of gradually accumulating knowledge. Giving examples, the author describes the ongoing development of a methodology for evaluating psychoanalytic papers according to a common standard. It is proposed that it is possible to conduct reasoned international and cross-cultural peer review. This means that we can in principle evaluate and reach agreement as to the merit of psychoanalytic papers even though their authors may have backgrounds in profoundly different local style and local traditions of argument. Moreover, it is suggested, this can be done without creating the monster of an internationally homogenised style that would numb creativity and original thought.

Developing a grounded hypothesis to understand a clinical process: the role of conceptualisation in validation.

This paper argues the case that validation in the clinical process depends to a large extent on being as clear and specific as possible about the hypotheses being put forward. In sessions interpretations are made based on intuitive and quite spontaneous links arising from background orientations and what will be called clusters of observed clinical facts. Outside the session, a wider and more developed set of grounded hypotheses can be developed, intended to illuminate what seem to be the core issues that arise over time and the core problems suffered by the patient. Often such hypotheses will only be in the form of working orientations. If they can be conceptualised more precisely into specific hypotheses explaining sets of observed events and predicting consequences, they can be better evaluated--either by the analyst working alone, or in group discussion through the achievement of genuine consensus. A process of building up a 'grounded' hypothesis, by making comparisons in the process of trying to solve a clinical problem, is described using detailed clinical material. This is also intended to illustrate the argument that it can be useful to consider the basic occurrences reported from sessions as data, distinct from the theory put forward to explain them.

Some thoughts on the presentation and discussion of the clinical material of psychoanalysis.

This paper is intended to stimulate consideration of the problems we face as psychoanalysts in attempting to discuss our basic data: the material from the clinical setting. Some brief comments are made about the importance of this issue for progress in our field, in the context of several attempts by the author to present and discuss process material from psychoanalytical treatment, and also in the light of discussion at psychoanalytical conferences and congresses, such as the Amsterdam sessions devoted to the clinical papers by Jacobs and Duncan. The question of what is going when psychoanalysts present clinical material to each other and discuss it is approached: firstly, by drawing attention to some features of the context in which discussion of that report takes place; secondly, by considering what it is we are doing when we select what we report of a psychoanalytic session; and, thirdly, by exploring certain inherent features of the psychoanalytic situation itself and their impact on the construction of a report and the response to it of an audience. Taken together, it is argued, these three elements have quite far-reaching implications for how presenter and audience might usefully play their parts in clinical discussion, and on the nature of the culture of enquiry we need to develop if we are to have hopes of building psychoanalytic theory and technique grounded in observations of practice.

A brief view of Herbert Rosenfeld's contribution to the theory of psychoanalytical technique.

This paper aims to highlight some of the contributions Herbert Rosenfeld made to the theory of how psychoanalysis works. Taking Rosenfeld's first psychoanalytic paper as a starting point the author suggests that his technique was rooted in trying to make the patient aware by verbal interpretation of his psychic reality as he experienced it in the session with his analyst. Four of Rosenfeld's theoretical contributions for helping clearly to conceptualize the patient's psychic reality are then outlined: his ideas about narcissism, projective identification, the role of history and external reality and his optimistic insistence that no matter how different it may seem the patient is always trying to communicate his predicament.

Approaches to the measurement of explanation and information-giving in medical consultations: a review of empirical studies.

Many 'sociological' and 'medical' reasons for informing and not informing patients in medical consultations have been given. This paper reviews and evaluates various empirical attempts to support arguments about the relationship between information-giving and outcomes. It suggests that more attention has been paid to examining the way information is given than to the information itself. When information has been examined this has been in relatively 'empiricist' ways, ignoring the issue as to how illuminating it might be. The paper concludes both that we know very little about the causes and consequences of information exchanged in medical consultations and that we are unlikely to do so unless different approaches are attempted.