Skip to main content Accessibility help
×
Home

There is no place for the psychoanalytic case report in the British Journal of Psychiatry

  • Lewis Wolpert (a1) and Peter Fonagy (a2)

Summary

As evidence-based mental health and the randomised controlled trial come to dominate the content of major psychiatric journals, the status and clinical utility of single case reports have been increasingly questioned. Arguably, owing to their subjective, anecdotal nature and unsuitability for rigorous scientific testing, this is particularly true of psychoanalytic case studies. Professor Peter Fonagy and Professor Lewis Wolpert debate here whether or not there is a place for such case reports in the British Journal of Psychiatry.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      There is no place for the psychoanalytic case report in the British Journal of Psychiatry
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      There is no place for the psychoanalytic case report in the British Journal of Psychiatry
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      There is no place for the psychoanalytic case report in the British Journal of Psychiatry
      Available formats
      ×

Copyright

References

Hide All
1 Cooper, AM. American psychoanalysis today: a plurality of orthodoxies. Am Acad Psychoanal Dyn Psychiatry 2008; 36: 235–53.
2 Phillips, A. Side Effects. Penguin, 2007.
3 Chiesa, M. Pathological organisations of the personality: a clinical case study. Br J Psychother 2007; 23: 395410.
4 Clarke, NA, Williams, AJ, Kopelman, MD. Rapid eye movement sleep behaviour disorder, depression and cognitive impairment. Case study. Br J Psychiatry 2000; 176: 189–92.
5 Robertshaw, BA, MacPherson, J. Scope for more genetic testing in learning disability. Case report of an inherited duplication on the X-chromosome. Br J Psychiatry 2006; 189: 99101.
6 Fonagy, P, Wolpert, L. Has Freudian psychoanalysis been killed by pills? [Debate]. Prospect 1999; November: 1620.
7 Freud, S. Three essays on the theory of sexuality. In The Standard Edition of the Complete Psychological Works of Sigmund Freud (volume 7) (ed Strachey, J): 123230. Hogarth Press, 1937.
8 Haddad, SK, Reiss, D, Spotts, EL, Ganiban, J, Lichtenstein, P, Neiderhiser, JM. Depression and internally directed aggression: genetic and environmental contributions. J Am Psychoanal Assoc 2008; 56: 515–50.
9 Neubauer, PB. Nature's Thumbprint: The New Genetics of Personality (2nd edn). Columbia University Press, 1996.
10 Fonagy, P. The development of psychopathology from infancy to adulthood: the mysterious unfolding of disturbance in time. Infant Ment Health J 2003; 24: 212–39.
11 Reiss, D, Cederblad, M, Pedersen, NL, Lichtenstein, P, Ethammar, O, Neiderhiser, JM, et al. Genetic probes of three theories of maternal adjustment: II. Genetic and environmental influences. Fam Process 2007; 40: 261–72.
12 Reiss, D, Leve, L. Genetic expression outside the skin: clues to mechanisms of Genotype Environment interaction. Dev Psychopathol 2007; 19: 1005–27.
13 Luyten, P, Blatt, SJ. Looking back towards the future: is it time to change the DSM approach to psychiatric disorders? The case of depression. Psychiatry 2007; 70: 8599.
14 Russ, E, Shedler, J, Bradley, R, Westen, D. Refining the construct of narcissistic personality disorder: diagnostic criteria and subtypes. Am J Psychiatry 2008; 165: 1473–81.
15 Westen, D, Shedler, J. Personality diagnosis with the Shedler-Westen Assessment Procedure (SWAP): integrating clinical and statistical measurement and prediction. J Abnorm Psychol 2007; 116: 810–22.
16 National Institute for Health and Clinical Excellence. Depression: Management of Depression in Primary and Secondary Care. NICE, 2004.
17 Alliance of Psychoanalytic Organizations. Psychodynamic Diagnostic Manual (PDM). Interdisciplinary Council on Developmental & Learning Disorders, 2006.
18 Arbeitkreis, OPD (ed). Operationalisierte Psychodynamische Diagnostik: Grundlagen und Manual. Hans Huber, 1996.
19 Luyten, P, Blatt, SJ, Corveleyn, J. Minding the gap between positivism and hermeneutics in psychoanalytic research. J Am Psychoanal Assoc 2006; 54: 571610.
20 Gabbard, GO, Gunderson, JG, Fonagy, P. The place of psychoanalytic treatments within psychiatry. Arch Gen Psychiatry 2002; 59: 505–10.
21 Chiesa, M, Fonagy, P. Psychosocial treatment for severe personality disorder. 36-month follow-up. Br J Psychiatry 2003; 183: 356–62.
22 Chiesa, M, Fonagy, P, Holmes, J. Six-year follow-up of three treatment programs to personality disorder. J Personal Disord 2006; 20: 493509.
23 Chiesa, M, Fonagy, P, Holmes, J, Drahorad, C. Residential versus community treatment of personality disorders: a comparative study of three treatment programs. Am J Psychiatry 2003; 161: 1463–70.
24 Milrod, B, Busch, F, Cooper, A, Shapiro, T. Manual of Panic-Focused Psychodynamic Psychotherapy. American Psychiatric Publishing, 1997.
25 Leuzinger-Bohleber, M, Target, M, (eds). The Outcomes of Psychoanalytic Treatment. Whurr, 2002.
26 Pretorius, IM. Repeating and recalling preverbal memories through play: the psychoanalysis of a six-year-old boy who suffered trauma as an infant. Psychoanal Study Child 2007; 62: 239–62.
27 Yardino, SM. ‘Break point’: a significant moment in the transference. Int J Psychoanal 2008; 89: 241–7.
28 Fonagy, P. Some complexities in the relationship of psychoanalytic theory to technique. Psychoanal Q 2003; 72: 1347.
29 Fonagy, P. The relation of theory and practice in psychodynamic therapy. J Clin Child Psychol 1999; 28: 513–20.
30 Grünbaum, A. The Foundations of Psychoanalysis: A Philosophical Critique. University of California Press, 1984.
31 Freud, S. Analysis terminable and interminable. In The Standard Edition of the Complete Psychological Works of Sigmund Freud (volume 23) (ed Strachey, J): 209–53. Hogarth Press, 1937.
32 Fonagy, P, Target, M. Psychoanalytic Theories: Perspectives from Developmental Psychopathology. Whurr, 2003.
33 Fonagy, P, Moran, G.S. Selecting single case research designs for clinicians. In Psychodynamic Treatment Research: A Handbook for Clinical Practice (eds Miller, NE, Luborsky, L, Barber, JP et al): 6295. Basic Books, 1993.
34 Klumpner, GH, Frank, A. On methods of reporting clinical material. J Am Psychoanal Assoc 1991; 39: 537–52.
35 Horwitz, L, Gabbard, GO, Allen, JG, Frieswyk, SH, Colson, DB, Newsom, GE, et al. Borderline Personality Disorder: Tailoring the Psychotherapy to the Patient. American Psychiatric Press, 1996.
36 Elkin, I, Shea, MT, Watkins, JT, Imber, SD, Sotsky, SM, Collins, JF, et al. National Institute of Mental Health Treatment of Depression Collaborative Research Program. General effectiveness of treatment. Arch Gen Psychiatry 1989; 46: 971–82.
37 Blatt, SJ, Sanislow, CA, Zuroff, DC, Pilkonis, PA. Characteristics of effective therapists: further analyses of data from the National Institute of Mental Health Treatment of Depression Collaborative Research Program. J Consult Clin Psychol 1996; 64: 1276–84.
38 Beutler, L, Malik, M, Alimohamed, S, Harwood, M, Talchi, H, Noble, S, et al. Therapist variables. In Bergin and Garfield's Handbook of Psychotherapy and Behavior Change (ed Lambert, M): 227306. Wiley, 2004.
39 Moher, D, Schulz, KF, Altman, DG. The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials. Lancet 2001; 357: 1191–4.
40 Dobkin, RD, Allen, LD, Menza, M. A cognitive–behavioral treatment package for depression in Parkinson's disease. Psychosomatics 2006; 47: 259–63.
41 Blackburn, IM, Davidson, K. Cognitive Therapy for Depression and Anxiety. Blackwell, 1995.
42 Hampe, M. Pluralismus der Wissenschaften und die Einheit der Vernunft. In Die Erfahrungen, die wir machen, widersprechen den Erfahrungen, die wir haben. Formen der Erfahrung in den Wissenschaften (ed Hampe, M). Duncker und Humblot, 2000.
43 Lear, J. Open Minded: Working Out the Logic of the Soul. Harvard University Press, 1998.
44 Cicchetti, D, Valentino, K. An ecological-transactional perspective on child maltreatment: failure of the average expectable environment and its influence on child development. In Developmental Psychopathology, Volume 3 (2nd edn) (eds Cicchetti, D, Cohen, DJ): 129201. John Wiley & Sons, 2006.
45 Heim, C, Young, LJ, Newport, DJ, Mletzko, T, Miller, AH, Nemeroff, CB. Lower CSF oxytocin concentrations in women with a history of childhood abuse. Mol Psychiatry 2008; Epub ahead of print.

There is no place for the psychoanalytic case report in the British Journal of Psychiatry

  • Lewis Wolpert (a1) and Peter Fonagy (a2)

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

There is no place for the psychoanalytic case report in the British Journal of Psychiatry

  • Lewis Wolpert (a1) and Peter Fonagy (a2)
Submit a response

eLetters

Battle of the Titans

jeremy a holmes, Psychiatrist
03 December 2009

Reading Wolpert & Fonagy (1) was like watching two Titans doing battle. So far apart were their worlds of discourse that neither managed to land a substantive blow. But the piece prompted the following Pythonesque imaginary consultation:

Fonagy: ‘Good morning Professor…’

Wolpert: ‘I am afraid I cannot accept that greeting, I know of no evidence that warm opening remarks to sessions improve illness outcomes…’

Fonagy: ‘What seems to be the trouble…’

Wolpert: ‘Seems sir, nay it is -- I have no truck with uncertainties, mysteries and doubts. Like Grandgrind, I demand facts, no more, no less…’

Fonagy: ‘I notice you have just unconsciously quoted from Shakespeare, Keats and Dickens. Surely you will accept their insights, despite their not having been subjected to a RCT’.

Wolpert: ‘Poor creatures all , like your Freud who never lived to seethe triumph of modern science. And how dare you accuse me of having an unconscious – that miserable, unsubstantiated, irrelevant, pseudo-hypothesis…

Fonagy (sotto voce): Methinks the Professor doth protest too much…

Wolpert: By the way I notice, rather than NICE guidelines, you appear to have a copy of a novel [contempt in voice], Middlemarch or somesuch, on your desk…it is quite clear that you will be unable to help me…(rises and leaves)

As an unashamed deployer of fictional case histories(2) , but admittedly also a habitual skipper of them when trying to get to the heartof an article, surely each psychoanalytic (or any other) case history, assuming ethical considerations are met, should be considered on its own merit – does it convincingly advance an argument, or is it no more than a tedious diversion? For BJPsych to become proscriptive in the way that Wolpert wants would be to succumb to the protocol-driven culture which psychiatrists, working in the messy multifaceted world of suffering and confusion that is our chosen milieu, must resist.

I note, incidentally, that neither of your contributors is a psychiatrist – or are ad hominem attributions also to be banned from the BJPsych, along with their case history cousins?

Jeremy Holmes, University of Exeter, UKj.a.holmes@btinternet.com

(1) Wolpert, L., Fonagy, P. There is no place for the psychoanalytic case report in the British Journal of Psychiatry .British Journal of Psychiatry 2009 195 483-487(2) Holmes, J Exploring In Security: Towards an Attachment-informed Psychoanalytic Psychotherapy. 2009 Routledge: London
... More

Conflict of interest: None Declared

Write a reply

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *