psychotherapy and research

STIJN VANHEULE 105discussion. No definitive theory, no final definition of fundamental conceptscan be found in Lacan’s work. There is only work in progress (Miller 2007),and this is a very good attitude to foster when considering research. Lacan’sapproach to psychoanalysis is like Rimbaud’s attitude to love: it is somethingto be reinvented. Only upon this condition can it strike root (Vanheule,forthcoming). Exactly this critical attitude is to be cultivated when we thinkabout implementing research in clinical practice.There are many other ways of doing research in psychotherapy beyondthe RCT methodology; ways of research that do not mould psychotherapy tothe format of a manualized medical technique which, as I have tried todemonstrate, is inherently problematic. I advocate research that starts fromthe complexity of clinical practice, that focuses on therapeutic processes, thattakes a broader perspective on outcome, and that is guided by theoreticalideas (Hofmann & Weinberger 2007; Persons & Silberschatz 1998;Westen & Bradley 2005; Westen, Novotny & Thompson-Brenner 2004). Inthe UK, noteworthy examples of alternative forms of psychotherapyresearch can be found in, for instance, work from people affiliated to theTavistock Clinic (e.g. Briggs et al. 2006) and to the Anna Freud Centre (e.g.Fonagy et al. 2002).If we want research to be relevant and ethical for our therapeutic practices,then we should take care that patients are not filtered out as is happeningwithin RCTs. Research designs should, on the contrary, be such thatthey fit the complexity of clinical practice. In this context, more attentioncould be paid to the use of single-case research (e.g. Allison, Franklin &Gorman 1997; Borckardt et al. 2008; Molloy, Murphy & King 2007) and tothe systematic use of clinical judgement (e.g. Goldfried & Eubanks-Carter2004; Pachankis & Goldfried 2007; Westen, Novotny & Thompson-Brenner2004) in the study of naturalistic patient samples. Researchers and cliniciansshould work together much more closely than is usually the case in designing,executing and publishing studies. Alliances of this type will guaranteethat research information is circulating more easily to clinical practice andthat issues which clinically matter are scientifically studied. Furthermore, thesystematic study of unsuccessful treatments should be used more explicitlyto refine clinical work. All clinicians know about their own unsuccessfultreatments, yet very few of these treatments are examined in a systematicway, let alone published. Freud published a number of these cases andthey proved to be informative for the development of psychoanalysis as adiscipline.More attention should also be paid to the process of successful and unsuccessfultherapies. Detailed inquiries about patients’ functioning, therapists’actions and the interaction between both are in this respect most relevant.An unsatisfying characteristic of RCT psychotherapy is that it treats psychotherapyitself rather as if it were a ‘black box’. Something is put into it: aperson with a disorder; and something comes out of it: a person, this time