Current Medical Diagnosis & Treatment in Psychiatry

Psychoanalytic Theory Applied

Psychological Testing

All psychological tests that claim to be projective derive ultimately from psychoanalysis through either Freud or his pupils, such as Jung. For example, Rorschach, originator of the famous inkblot test that bears his name, was influenced by Jung. The Rorschach Inkblot Test, Thematic Apperception Test (TAT), Draw-a-Person Test, and hundreds of other instruments all presume validity of the psychoanalytic concepts of internal psychic conflict and ego defense, especially projection and displacement. Thirty years ago projective testing fell into disrepute and seemed on the verge of collapse, but some contemporary research psychoanalysts have sought to place the Rorschach on rigorous, objective footings.

The validity and utility of projective tests are of central concern to contemporary research because Rorschach findings are often part of the test battery used to evaluate the effectiveness of particular therapies. For example, to investigate Freud’s claim that sicker patients get less benefit from psychotherapy than do healthier patients, Luborsky et al used a battery of tests that included the Barron Ego Strength Scale (derived from ego psychology), the TAT, and the Rorschach Prognostic Rating Scale. Each of these tests derives wholly or mainly from psychoanalysis. To avoid circularity, research psychologists have attempted to validate projective instruments before using them to evaluate the effectiveness of psychoanalytic treatment. For example, Blatt and Riggs examined outcomes on 90 patients undergoing intensive, long-term psychotherapy. They too used the TAT, the Rorschach, and the human figure drawings test for both pretreatment and posttreatment evaluations. In a manner typical of such research, they also used contemporary theory (ORT) to reevaluate standard Rorschach protocols. Indeed, they claim that their data support a new clinical distinction between anaclitic and introjective types of psychopathology: Anaclitic patients (those whose defenses are primarily avoidant) do better with psychotherapy, whereas introjective patients (those whose defenses are counteractive and focused on self-cohesion) do better with psychoanalysis.

Character Pathology

Psychoanalysis, having the advantage of seniority, has named and given substance to most of the major terms and concepts used to designate character pathology, or what in DSM-IV is termed personality disorder. In addition to drive theory (S. Freud), ego psychology (A. Freud), ORT, and self psychology, McWilliams (1994) notes the utility of other bodies of theory from classical authors such as Jung, Otto Rank, and Alfred Adler. Unlike the laboratory sciences, psychoanalysis and dynamic psychology cannot afford to dismiss the contributions of texts and traditions that preceded them by dozens or even hundreds of years. The great novelists, poets, and playwrights of our own and other cultures have seen deeply and wisely into human character in ways most clinicians cannot match, nor often fathom. The best trained research clinician, of any school and of any theoretical persuasion, has much to learn from Shakespeare, Goethe, and Chekhov.

Yet to remain plausible and contribute to the medical sciences as progressive enterprises, psychoanalysis must also find ways to exclude competing theories. Given the range of psychoanalytic theory and the complexity of its subject matter (the human mind in conflict), psychoanalysis needs a critical, research-based way to decide between competing theories. Happily this need is addressed in new empirical studies.

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