Clinical experience vs. systematic observation

“Psychoanalytic practice has limitations as a form of research. A physician practising internal medicine learns from clinical observations but is not under the illusion of being engaged in research. The physician’s work, we hope (if we are the patient, that is), is however influenced by the results of research, and his or her reasoning will have been disciplined by scientific training. The problem of using clinical experience as research is well known to be one of induction. Mostly, we tend to confirm our theory-based expectations from our patient’s material. Our memory for material is biased, even our perception is impure. We cannot be pre-Kantian objective observers. Our own discovery of the pervasiveness of countertransference denies us this possibility, even in principle.


“In a paper that I wrote, longer ago than I care to remember (Fonagy, 1982), I put forward the argument that research studies could not and should not be used to test psychoanalytic ideas. If a clinical observation cannot be replicated in the laboratory, there are a host of good reasons why this might be so. Rather, systematic observations could be used to inform us about the psychological processes underpinning clinical phenomena…”

—Peter Fonagy, Grasping the Nettle: or Why Psychoanalytic Research is such an Irritant. Paper presented at the Annual Research Lecture of The British Psychoanalytical Society on 1st March, 2000.