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Depth-Psychological Understanding: The Methodologic Grounding of Clinical Interpretations

Gerald P. Perman, M.D.

Key Words: Books Reviewed

How do we know that what we interpret to our patients is valid? Is it simply because we think or feel it is? Is it because our theory tells us it should be? These are difficult and perplexing questions. In addressing them, Dr. Rubovits-Seitz brings together his decades of thinking about this knotty issue in an intellectual and philosophical tour de force, taking us on a journey to explore the methodologic underpinnings of clinical interpretation. When we have finished we are much more aware of the panoply of tools at our disposal to help us validate what we tell our patients, and we are also better able to acknowledge and assess the vast shortcomings in this endeavor.

The uncertainty involved in inferring latent meanings and determinants in clinical data has been called (by Glover) the Achilles heel of psychoanalysis. To address this uncertainty, Rubovits-Seitz examines the methodology of clinical interpretation, with a focus on the construal and justification phases of the interpretive process.

Beginning with "Trouble at the Source" (chapter 1), the author describes Freud's positivist approach in his effort to use observational data alone to arrive at absolutely certain knowledge. Freud ran into difficulty as soon as he needed to infer latent content to his patients' free associations, resulting in a host of methodologic problems that the author enumerates and proceeds to examine in detail.

By the 1960s, this positivist model came under increasing attack as scientists and philosophers recognized that logical empiricism could not provide a secure foundation for such absolutely certain knowledge. The author tells us that a radical shift, or postpositivist turn, occurred in the philosophy and conduct of science, suggesting that indirect, inferential, presumptive knowing is the best we can do. This shift resulted in a more pragmatic, eclectic, qualitative, problem-oriented (rather than method-oriented) approach to scientific inquiry, in which words (rather than numbers), empathy, context, and the polydimensionality and nonlinearity of experience assumed increased importance. And yet the "lingering ghost of positivism" still pervaded our thinking, resulting in efforts to combine positivist and postpositivist approaches, as in Harre's "New Paradigm" and Quine's "Naturalized Epistemology."

But we are told that a "methodologic lag" persists. Kohut's views, in particular on interpretation and technique, are criticized as being outdated and positivist, although the author does not spare the rod with a number of other well-known analysts as well. He also lists a number of analysts whose methods he considers postpositivist and pluralistic. Interestingly, he includes Freud in this latter group, after having previously identified him as the main contributor to the origin of many of the difficulties under consideration.

Rubovits-Seitz then begins a critical review of language-based models, relation-oriented and pattern-oriented methodologies, and language-based related disciplines as they apply to clinical interpretation. He examines the relationship of the cognitive sciences to interpretive methodology, including symbolic functioning and schema theory. In part, he uses many of these models as straw men, disassembling and knocking them down but also retrieving and applying what is applicable in them to clinical interpretation. He offers a fascinating evaluation of "commonsense" (intentional) psychology as another model of interpretive inquiry.

One full chapter is devoted to Grunbaum's ten major arguments against the validity of psychoanalysis as a science. Rubovits-Seitz then asks: "Must interpretations be justified?", "Can interpretations be justified?", and "Can interpretations be justified intraclinically?", after which he presents 14 ways to justify interpretations, in order of potency. We are next offered a case presentation to demonstrate the post-therapeutic justification of interpretations, on the basis of recurrent dynamic cycles, employing the methods of justification previously enumerated. Finally the author summarizes what he sees as the scientific status of interpretation as a method of inquiry, comments on the difficulties and the fallibility of clinical interpretive inquiry, and notes common but avoidable errors in clinical interpretation along with remedial strategies.

I found little not to like in this book. The author is a skilled wordsmith who obviously has an encyclopedic grasp of his topic. The book is extremely well written, though I did need to compile a glossary of philosophic and other terms as an aid to navigation. Kohutians and Kleinians will bristle at the treatment he affords their heroes and heroines in his effort to be brutally honest and pull no punches. The results of that effort may prove to be in the eye of the beholder, and I await with anticipation the array of reactions to his book.

With psychoanalysis and psychodynamic psychiatry presently under heavy attack by the insurance-industrial complex, Dr. Rubovits-Seitz has importantly placed the interpretive aspect of our science squarely on an equal footing with other branches of medicine and scientific endeavor.

Footnotes

Dr. Perman is Associate Clinical Professor, Department of Psychiatry and the Behavioral Sciences, The George Washington University Medical Center, Washington, DC, and president of the American Society of Psycho-analytic Physicians.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Perman, G. P. Search for Related Content PubMed Articles by Perman, G. P.