Psychoanalytic Inquiry and the Scientific Method
When authorities in the field prematurely discard psychoanalytic inquiry, it only stifles exploration and the scientific method itself.
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In response to my recent essays on autogynephilia, more than one critic has accused my work of being unscientific and lacking an evidence-base. If that means I don’t rely on surveys and empirical data sets to write essays which are then peer-reviewed and published in academic journals, I agree with them. By their definition, my work is not scientific, and I have no obvious defense.
Such criticism reflects a logical positivist point of view, where “only empirical, publicly examinable evidence [can] furnish statements of belief with the warrant necessary for them to become truths.” Logical positivism views the scientific method as superior to all other forms of knowing. I could simply disagree and say that the scientific method represents only one way of knowing; but while I do believe that’s true, I’m instead going to argue that my clinical vignettes and papers represent earlier data points in the scientific process—observations and hypotheses rather than conclusions. My papers invite further research, and in time, a body of work might arise and be statistically analyzed for significance.
I also believe that psychodynamic psychotherapy involves its own kind of scientific method, but because it appears to be subjective and interpersonal, it won’t satisfy the naysayers. Psychodynamic psychotherapy embodies a mode of investigation where client and therapist collaborate to discover previously unforeseen patterns and to agree upon their significance. The therapist posits a meaning to the pattern (i.e., makes an interpretation) and the client confirms or disconfirms it. The decision as to what counts as true always rests with the client.
To go a little deeper, psychoanalytic investigation unfolds something like this: a client in session describes a chain of experiences–feelings, behaviors, reactions–and the therapist listens with an open mind (without memory and desire, as Bion described it). As the session goes along, a pattern impresses itself upon the therapist’s mind; he sees interconnections between apparently unrelated details and listens for echoes of the pattern in subsequent material.¹ Finally, when he feels some conviction that the pattern is real and believes he might understand it, he tells the client what he has observed and what he thinks it might mean. The client decides whether the interpretation feels true and helpful.
The “evidence” that the therapist has made an accurate or inaccurate observation emerges in subsequent material. This requires him to be humble, and not overly invested in being “right.” If the interpretation is useful, the subsequent material may open new vistas; the client will make connections to other aspects of his or her experience, or access some hitherto unnoticed emotions. The therapist must also look out for deferential assents or hostile rejections that shed light on the transference.
In this regard, the therapist, by virtue of his training, experience, and intuition, is something like a well-calibrated instrument for accessing emotional truths, but he isn’t infallible. His hypotheses must be validated by the client, who demonstrates their value/accuracy by making use of them. Or not. An inaccurate interpretation leads nowhere and won’t promote emotional growth.
Let me give an illustration from my work with several clients in my practice who struggle with autogynephilia. I began with a preconception, described in my first paper on the topic for this Substack, that AGP embodies a kind of narcissism; I soon abandoned that idea because it explained very little about these men and didn’t help me to understand them. So I listened with an open mind. Over time, I began to hear a theme, not with only one client but with several.
The nature of their autogynephilic fantasies all involved what I eventually came to think of as a kind of “psychic retreat,” to use John Steiner’s term.² For these men, envisioning themselves as women, or dressing up to “confirm” the fantasy, offered a kind of relief from the stresses of everyday life and, in particular, from the demands of “masculinity” as they conceived of it. It brought them a kind of comfort. Playing out the fantasy often, but not always, involved masturbation, bringing its own form of relief.
And sometimes deep shame.
In our work together, my clients and I try to understand the sources of stress, the perceived demands inherent in masculinity, and whether they might learn (a) other ways to comfort themselves that don’t involve a retreat from reality; and (b) how to make peace with masculinity (whatever that means to them) and feel better about themselves as men.
That doesn’t mean “curing” them of their autogynephilia since I consider it a lifelong proclivity, just as I personally am still inclined toward certain psychological defenses even though I’m able to recognize them and often find better ways of reacting before I do too much damage. Nothing in the mind ever goes away, as my analyst used to say; you just grow other capacities to compensate for them. Likewise with my clients: our ongoing work helps them to accept their lifelong tendencies and try to find more adaptive ways of coping with stress, reducing shame, and building good feelings about themselves as men.
I’ve published these accounts not to insist upon a theory but rather to tender a hypothesis, making my own insights available to other therapists who might find them useful in their own work. I don’t and can’t possibly argue that this hypothesis explains every case of autogynephilia, but based upon the number of emails I’ve since received from men who’ve read my essays, these views seem to resonate with a number of people outside my practice. This response makes me feel good, to be honest–that I’ve contributed something original that might be of use. Maybe other therapists will continue this work and validate, correct, or modify it.
I believe this is another way the scientific method can operate in its early stages: by publishing hypotheses and limited “data sets” that invite further study. Maybe someday, a researcher concerned with statistical analysis might even devise an “evidence-based” study or experiment to test it. But when authorities in the field prematurely discard psychoanalytic inquiry and dismiss anything that challenges their better-established views, it only stifles exploration and the scientific method itself.
By now, it shouldn’t be necessary to say it again, but the science is never settled.
Notes
[1] For the sake of convenience, and because I’m describing my own experience as a therapist, I’ll be using the generic “he” rather than its awkward alternatives.
[2] Steiner, J. (1993). Psychic Retreat: Pathological Organizations in Psychotic, Neurotic and Borderline Patients. (London: Routledge), p. 13.
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This article about autogynephilia adds to a theory I have. The men are escaping from the demands of masculinity. And so many of the young transitioning women are escaping from the demands of femininity. Is transgenderism the result of our strict sex roles?
I have a hard time understanding how psychotherapy is falsifiable, especially in the wake of so many people who are therapized into believing that 2+2=5.