Society for Psychotherapy Research
Sezione Italiana

Psychoanalytic Therapy Research: 
An Overview

Robert S. Wallerstein (2002)

Nota introduttiva di Paolo Migone

In questo articolo Bob Wallerstein riassume brevemente la storia della ricerca empirica sulla terapia psicoanalitica e la divide in quattro generazioni di ricercatori, ciascuna caratterizzata da proprie esigenze metodologiche. Wallerstein, che nel corso della sua vita si è occupato dei problemi più diversi e sempre con passione e precisione, ha dato importanti contributi anche alla ricerca in psicoanalisi. Fin dalla metł del secolo alla Menninger Foundation di Topeka con Kernberg e altri iniziò a lavorare al noto "Psychotherapy Research Project" (Wallerstein et al., 1956; Kernberg et al., 1972), di cui poi seguì 42 pazienti in un follow-up di 30 anni, contribuendo a fare chiarezza su importanti questioni teoriche e cliniche della identitł della psicoanalisi rispetto ad altre tecniche "espressive" o "psicoanaliticamente orientate" (questo follow-up è stato riportato nel suo libro del 1986 Forty-two Lives in Treatmemt: A Study of Psychoanalysis and Psychotherapy). Ha ricoperto anche importanti incarichi, tra cui quello di presidente della International Psychoanalytic Association (IPA), di analista didatta e supervisore emerito del San Francisco Psychoanalytic Institute, di professore emerito e direttore del Dipartimento di Psichiatria della University of California-San Francisco School of Medicine, e così via. Questo articolo è stato pubblicato in The American Psychoanalyst (Quarterly Newsletter of the American Psychoanalytic Association), 2002, 36, 1: 10-13; ringraziamo la American Psychoanalytic Association per il permesso di pubblicazione. L'articolo non conteneva una bibliografia, per cui abbiamo aggiunto alcuni riferimenti bibliografici, necessariamente incompleti.

It is clearly of central importance to psychoanalysis as a professional activity to sustain a vigorous program of empirical research. We need to learn more about (1) what changes actually take place in psychoanalytic therapy (the outcome question) and (2) how those changes come about, through the interactions of what factors in the patient, the therapist, the therapy, and the evolving life situation (the process question). I divide the history of psychoanalytic therapy research into four successive generations, each marked by increasing conceptual sophistication and methodological advance.

First Generation: Logging Outcomes, 1917-1967

The first generation began as early as 1917, spread over half a century and consisted of simple retrospective enumerations of percentage improved outcomes (by unspecified criteria) gathered by individuals or from treatment centers in the early psychoanalytic institutes.

The 1917 study was from the private practice of Isador Coriat in Boston and was followed by Otto Fenichel's 1930 report from the Berlin Institute, Ernest Jones' 1936 report from the London Institute, and Franz Alexander's 1937 report from the Chicago Institute. In 1941, Robert Knight at the Menninger Clinic combined all the previous reports and added 100 patients from Menninger, making an overall tabulation of 952 patients.

The overall therapeutic benefit rate was adjudged high for the neurotic and psychosomatic patients and poor for those diagnosed psychotic. Knight elaborated the pitfalls of these simple statistical summaries: the absence of consensually agreed-upon definitions and criteria, the crudeness of the nomenclature and diagnostic classification, and the failure to address issues of therapeutic skill in relation to cases of varying severity.

The most ambitious study of this genre was a report from the Central Fact-Gathering Committee of the American Psychoanalytic Association in 1967, presenting data on 10,000 initial questionnaire responses from 800 analysts, together with 3,000 completed termination questionnaires. This was followed a year later by Fred Feldman's report from the Southern California Institute. All these studies reported completely comparable improvement rates, but all of them were beset with the difficulties Knight had specified.

Second Generation: More Systematic Study, 1959-1984

All this spurred second-generation research, the effort at more formal and systematic outcome study geared toward overcoming the glaring methodological simplicity that marked the first generation. Second-generation studies were of two kinds. One comprised prospectively organized, group-aggregated studies from psychoanalytic treatment centers, with specified definitions and operationalized criteria and predictions to expected outcomes. The other comprised in-depth, individually studied outcomes in a succession of patients.

The major examples of the first type come from three psychoanalytic clinics. In 1960 Peter Knapp et al., and in 1975 Jerome Sashin et al., reported on 100 and 183 patients, respectively, from the Boston Institute. Together, they found only fair prediction to analyzability, as assessed at the one-year mark, and that no effective prediction to outcomes could be made judging from the patient's characteristics at initial evaluation.

In 1985, John Weber et al. published the Columbia University Center for Psychoanalytic Training and Research studies, which reported almost 1,600 patients, 40 percent in psychoanalysis and 60 percent in psychoanalytic psychotherapy. They stated that all previous studies had been limited in at least one of the following ways: small sample size, inadequate information about outcomes, not based on terminated cases, or restricted to retrospective data. The Columbia studies had comparative data on large numbers of terminated analyses and psychotherapies conducted by the same therapists, and established criteria for therapeutic benefit distinct from criteria for an analytic process.

The most striking finding of the Columbia studies was that across every patient category, measured therapeutic benefit always substantially exceeded measured evolved analytic process. However, as with the Boston study, the outcomes, in terms of both therapeutic benefit and analyzability, were only marginally predictable from initial evaluation.

The third of these group-aggregated studies, by Joan Erle and David Goldberg (1979-84) from the New York Institute, only added to the Boston and Columbia observations that the results obtained with their sample of experienced analysts were no different than those from their own (and all earlier) studies of clinic patients treated by candidates.

Individually focused studies were being conducted along parallel lines during the same period. The first of these, in 1959-63, was conducted by Arnold Pfeffer from the New York Institute. Nine patients were intensively interviewed by a "follow-up analyst" after completion of their analyses. The chief finding, in all cases, was a rapid reactivation of the characteristic treatment transferences, even including symptom flare-ups as if in relation to the treating analysts; these subsided rapidly, at times aided by interpretations, and in a manner that indicated the new ways of conflict management that had been analytically achieved. This "Pfeffer phenomenon" was essentially replicated by two other studies, by Haskell Norman et al. (1976) and Jerome Oremland et al. (1975) in San Francisco and by Nathan Schlessinger and Fred Robbins in Chicago from 1974 to 1983.

Third Generation: Charting Both Groups and Individuals, 1954-1986

Third-generation studies, contemporaneous with the second generation, combined both kinds of second-generation studies. These projects attempted both to assess analytic outcomes across a significant array of cases and to examine the processes through which these outcomes were achieved in the intensive longitudinal study of each case. Unlike the second-generation studies, they carefully separated outcomes at termination from functioning at a specified follow-up point, attempting to account for changes in this "post-analytic phase."

The 1986-90 Boston Institute studies of Judy Kantrowitz et al. and the 1956-88 Menninger Foundation project of Robert Wallerstein et al. are third-generation exemplars.

The Boston studies followed twenty-two supervised analytic cases with interviews and projective tests. They also found that the majority of patients received therapeutic benefit in excess of what could be accounted for by the interpretive resolution of the analytic transferences. Again, successful outcomes could not be foretold from any of the predictor variables. The Boston studies also focused on the therapist-patient match in shaping the two-person analytic interaction. They found that with the majority of patients, the kind of match - facilitating vs. impeding - significantly affected the outcome.

The Psychotherapy Research Project of the Menninger Foundation was a thirty-year study of the treatment careers and subsequent life careers of forty-two patients, half in psychoanalysis and half in (supportive-expressive) psychoanalytic psychotherapies. The aim of the project was to study both outcome and process, specifying in detail the particular reach and limitation of therapeutic outcomes for each kind of patient treated within the indicated modality. The researchers were particularly interested in the empirical elaboration of change mechanism operative within both the uncovering (analytic-expressive) and the "ego-strengthening" (supportive) therapeutic modes.

Overall results of the project can be generalized as follows:

1. The treatment results in psychoanalysis and in varying mixes of expressive-supportive psychotherapies tend to converge, rather than diverge.

2. Across the whole spectrum of treatment courses, the treatments carried more supportive elements than originally projected. These elements accounted for substantially more of the changes achieved than had been originally anticipated.

3. From the study of the kinds of changes achieved by the patients, the changes themselves - separate from how they were brought about - often seemed indistinguishable in terms of being so-called structural changes in personality functioning.

Fourth Generation: Detailed Study of New Data Since the 1970s

The fourth and current generation of studies includes microanalytic detailed process studies, made possible by recent technological advances - audiotapes of entire treatments, combined with programmed computer searches. Programs are currently being fashioned to combine various ongoing process studies (each using its own conceptual framework and its own devised instruments) with the best established outcome measures, all (hopefully) on the same shared database of recorded and transcribed analytic hours. The goal is to realize the principle of "Patient-Treatment-Outcome Congruence" - representation, theoretically and operationally, of the patient's character functioning, the treatment process, and the achieved outcome in comparable terms.

At this point, such process and outcome therapy research, like that being attempted under the auspices of the American Psychoanalytic Association by its Collaborative Analytic Multisite Program, can promise to have significant impact upon, and become a major component of, the evolving development of psychoanalysis as a science.


Bachrach H.M. (1983). On the concept of analyzability. Psychoanal. Q., 52: 180-203.

Bachrach H.M. (1987). Transference in brief psychotherapy: am approach to the study of the psychoanalytic process. Psychoanal. Q., 56: 396-399.

Bachrach H.M. & Leaff L.A. (1978). "Analyzability": a systematic review of the clinical and quantitative literature. Journal of the American Psychoanalytic Association, 26: 881-902.

Bachrach H.M., Weber J. & Solomon M. (1985). Factors associated with the outcome of psychoanalysis (clinical and methodological considerations): Report of the Columbia Psychoanalytic Center Research Project (IV). International Review of Psycho-Analysis, 12, 4: 379-389.

Bachrach H.M., Galatzer-Levy R., Skolnikoff A., Waldron S. (1991). On the efficacy of psychoanalysis. Journal of the American Psychoanalytic Association, 39: 871-915.

Bellak L. (1961). Research in psychoanalysis. Psychoanal. Q., 30: 519-548.

Blatt S.J. (1992). The differential effect of psychotherapy and psychoanalysis with anaclitic and introjective patients: the Menninger psychotherapy research project revisited. Journal of the American Psychoanalytic Association, 40: 691-725.

Bucci W. (1997). Psychoanalysis and Cognitive Science: A Multiple Code Theory. New York: Guilford (trad. it.: Psicoanalisi e scienza cognitiva. Una teoria del codice multiplo. Roma: Giovanni Fioriti Editore, 1999).

Dahl H.A. (1972). A quantitative study of psychoanalysis. In: Holt R.R. & Peterfreund E., editors, Psychoanalysis and Contemporary Science, vol. 1. New York: McMillan, 1972.

Dahl H.A. (1974). The measurement of meaning in psychoanalysis by computer analysis of verbal context. Journal of the American Psychoanalytic Association, 22: 37-57 (trad. it.: La misurazione del significato in psicoanalisi attraverso l'analisi del calcolatore di contesti verbali. In Conte & Dazzi, 1988, pp. 267-288).

Dahl H.A., KŐchele H. & ThomŐ H., editors (1988). Psychoanalytic Process Research Strategies. Berlin-Heidelberg: Springer Verlag.

Dorpat T.L. (1973). Research on the therapeutic process in psychoanalysis. Journal of the American Psychoanalytic Association, 21: 168-181.

Erle J.B. (1979). An approach to the study of analyzability and analysis: the course of forty consecutive cases selected for supervised analysis. Psychoanal. Q., 48: 198-228.

Erle J.B. & Goldberg D.A. (1979). Problems in the assessment of analyzability. Psychoanal. Q., 47: 48-84.

Erle J.B. & Goldberg D.A. (1984). Observations on assessment of analyzability by experienced analysts J. Amer. Psychoanal. Ass., 32: 715-739.

Feldman F. (1968). Results of psychoanalysis in clinic case assignments. Joournal of the American Psychoanalytic Association, 16: 274-300.

Fonagy P. & Moran G.S. (1990). Studies on the efficacy of child psychoanalysis. Journal of Consulting and Clinical Psychology, 58: 684-695.

Fonagy P. & Moran G.S. (1991). Understanding psychic change in child psychoanalysis. International Journal of Psycho-Analysis, 72, 1: 15-22 (trad. it.: La comprensione del cambiamento psichico nella psicoanalisi infantile. Prospettive psicoanalitiche nel lavoro istituzionale, XI, 2: 195-208).

Gill M.M. & Hoffman I.Z. (1982). A method of studying the analysis of aspects of the patient's experience of the relationship in psychoanalysis and psychotherapy. Journal of the American Psychoanalytic Association, 30: 137-167.

Gill M.M., Simon J., Fink G., Endicott N.A. & Paul I.H. (1968). Studies in audiorecorded psychoanalysis: 1. General considerations. Journal of the American Psychoanalytic Association, 16: 230-244.

Henry W.P., Strupp H.H., Schacht T.E. & Gaston L. (1994). Psychodynamic approaches. In: Bergin & Garfield, editors, Handbook of Psychotherapy and Behavior Change: An Empirical Analysis, 4th ed. New York: Wiley, 1994 (I ed., 1971; II ed., 1978, III ed., 1986), chapter 11, pp. 467-508.

Hoch P. H. & Zubin J., editors (1964). The Evaluation of Psychiatric Treatment. New York: Grune & Stratton.

Jones E.E., Caston J., Skolnikoff A. (1992). Research on the Efficacy of Psychoanalysis. Bull. American Psychoanal. Ass., 40: 625-627.

KŐchele H. (1992). Psychoanalytische Therapieforschung, 1930-1990. Psyche, 46: 259-285 (trad. it.: La ricerca sulla terapia psicoanalitica, 1930-1990. Quaderni. Associazione di Studi Psicoanalitici, 1993, IV, 7: 9-35).

Kantrowitz J., Singer J.G. & Knapp P.H. (1975). Methodology for a prospective study of psychoanalysis: the role of psychological tests. Psychoanalytic Quarterly, 44: 371-391.

Kantrowitz J., Katz A.L. & Paolitto F. (1990a). Follow up of psychoanalysis five to ten years after termination: I. Stability of change. Journal of the American Psychoanalytic Association, 38: 471-496.

Kantrowitz J., Katz A.L. & Paolitto F. (1990b). Follow up of psychoanalysis five to ten years after termination: II. Development of the Self-analytic function. Journal of the American Psychoanalytic Association, 38: 637-654.

Kantrowitz J., Katz A.L. & Paolitto F. (1990c). Follow up of psychoanalysis five to ten years after termination: III. The relation between the resolution of the transference and the patient-analyst match. Journal of the American Psychoanalytic Association, 38: 655-678.

Kernberg O.F., Burnstein E., Coyne L., Appelbaum A., Horowitz L., Voth H. (1972). Psychotherapy and psychoanalysis: final report of the Menninger Foundation's Psychotherapy Research Project. Bull. Menninger Clinic, 36: 1-275.

Klein H.R. (1960). A study of changes occurring in patients during and after psychoanalytic treatment. In: Hoch P. H. & Zubin J., editors, Current Approaches to Psychoanalysis. New York: Grune & Stratton, 1960, pp. 151-175.

Knapp P.H., Levin S., McCarter R.H., Wermer H., Zetzel E. (1960). Suitability for psychoanalysis: a review of one hundred supervised analytic cases. Psychoanal. Quart., 29: 459-477.

Knapp P.H., Greenbreg R., Pearlman C., Cohen M., Kantrowitz J., Sashin J. (1975). Clinical measurement in psychoanalysis: an approach. Psychoanal. Q., 44: 404-428.

Luborsky L. (1984) Principles of Psychoanalytic Psychotherapy. A Manual for Supportive-Expressive Treatment. New York: Basic Books (trad. it.: Princôpi di psicoterapia psicoanalitica. Manuale per il trattamento supportivo-espressivo. Torino: Bollati Boringhieri, 1989). Dattiloscrito del manuale con copyright del 1976.

Luborsky L. & Crits-Christoph P. (1988). Measures of psychoanalytic concepts: the last decade of research from "The Penn Studies". International Journal of Psycho-Analysis, 69: 75-86.

Luborsky L., Crits-Christoph P., Mintz J. & Auerbach A. (1988). Who Will Benefit from Psychotherapy? Predicting Therapeutic Outcomes. New York: Basic Books.

Luborsky L. & Crits-Christoph P. (1990). Understanding Transference: The CCRT Method. New York: Basic Books (trad. it.: Capire il transfert. Milano: Cortina, 1992).

Luborsky L., Barber J.P. & Crits-Christoph P. (1990). La comprensione del processo della psicoterapia ad orientamento dinamico: la ricerca a base teorica. Rivista di Psicologia Clinica, 2: 126-141.

Luborsky L. Diguer L., Luborsky E., Singer B., Dickter B. & Schmidt K.A. (1993). The efficacy of dynamic psychotherapies: is it true that "everyone has won and all must have prizes"? In: Miller et al., 1993, cap. 24, pp. 497-516.

Miller N., Luborsky L., Barber J.P. & Docherty J., editors (1993). Psychodynamic Treatment Research. A Handbook for Clinical Practice. New York: Basic Books.

Nishizono M., Docherty J.P. & Butler S.F. (1993). Evaluation of psychodynamic psychotherapy. In: Sartorius N., de Girolamo G., Andrews G., German G.A. & Eisenberg L., editors, Treatment of Mental Disorders. A Review of Effectiveness. Washington, D.C.: American Psychiatric Press, 1993, cap. 5, pp. 131-148.

Oremland J.D., Blacker K.H., Norman H.F. (1975). Incompleteness in "Successful" Psychoanalyses: A Follow-up Study. J. Amer. Psychoanal.. Ass., 23: 819-844.

Pfeffer A.Z. (1959). A procedure for evaluating the results of psychoanalysis: a preliminary report. J. Amer. Psychoanal.. Ass., 7: 418-444.

Pfeffer A.Z. (1961). Research in psychoanalysis. J. Amer. Psychoanal.. Ass., 9: 562-570.

Pfeffer A.Z. (1961). Follow-up study of a successful analysis J. Amer. Psychoanal.. Ass., 9: 698-718.

Pfeffer A.Z. (1963). The meaning of the analyst after analysis. A contribution to the theory of therapeutic results. J. Amer. Psychoanal.. Ass., 11: 229-244.

Robbins F.P. (1965). Results of first control case assignments. Report to the Committee on Membership of the American Psychoanalytic Association, December 1965.

Sashin J.I, Eldred S.H. & Amerongen S.T. (1975). A search for predictive factors in institute supervised cases. A retrospective study of 183 cases from 1959-1966 at the Boston Psychoanalytic Society and Institute. International Journal of Psycho-Analysis, 56: 343-359.

Schlessinger N. & Robbins F. (1974). Assessment and follow-up in psychoanalysis. J. Amer. Psychoanal.. Ass., 22: 542-567.

Schlessinger N. & Robbins F. (1975). The psychoanalytic process: recurrent patterns of conflict and changes in Ego functions. J. Amer. Psychoanal.. Ass., 23: 761-782.

Shapiro D., Jaffe D., Brauer L. Leaf P. (1980). Final report of the survey of psychoanalytic practice, 1976, Report to Executive Council of the American Psychoanalytic Association (mimeo, 90 pages).

Shapiro T. & Emde R.N., editors (1994). Research in Psychoanalysis. Process, Development, Outcome. Madison, CT: International Universities Press.

Shulman D. (1990). Psychoanalysis and the quantitative research tradition. Psychoanalytic Review, 77: 245.

Simon J., Fink G., Gill M.M., Endicott N.A. & Paul I.H. (1970). Studies in audio-psychoanalysis: II. The effect of recording upon the analyst. Journal of the American Psychoanalytic Association, 18: 86-101.

Svartberg M. & Stiles T. (1991). Comparative effects of short-term psychodynamic psychotherapy: a meta-analysis. Journal of Consulting and Clinical Psychology, 59: 704-714.

Wallerstein R.S. (1986). Forty-two Lives in Treatmemt: A Study of Psychoanalysis and Psychotherapy. New York: Guilford.

Wallerstein R.S. (1987). Book review: "The Psychoanalytic Process: Theory, Clinical Observation, and Empirical Research. By Joseph Weiss, Harold Sampson, and the Mount Zion Psychotherapy Research Group. New York: Guilford, 1986". International Journal of Psychoanalysis, 68, 4: 565-567.

Wallerstein R.S. (1988). Psychoanalysis, psychoanalytic science, and psychoanalytic reseearch - 1986. Journal of the American Psychoanalytic Association, 36: 3-30.

Wallerstein R.S. (1989). Follow-up in psychoanalysis; clinical and research values. Journal of the American Psychoanalytic Association, 37: 921-941.

Wallerstein R.S. (1993). Psicoanalisi e psicoterapia. Milano: Franco Angeli.

Wallerstein R.S. et al. (1956). The psychotherapy research project of the Menninger Foundation. Bull. Menninger Clinic, 20: 221-278.

Wallerstein R.S. & Sampson H. (1971). Issues in research in the psychoanalytic process. Internat. J. Psycho-Anal., 52: 11÷51.

Weber J.J., Elinson J., Moss L. (1965). On the fate of the psychoanalytic clinic patient. Bull. Assn. Psychoanal. Med., 5: 7-10.

Weber J.J., Elinson J., Moss L. (1967). Psychoanalysis and change. Arch. Gen. Psychiatry, 17: 697÷708.

Weber J., Solomon M. & Bachrach H.M. (1985a). Characteristics of psychoanalytic clinic patients: Report of the Columbia Psychoanalytic Center Research Project (I). International Review of Psycho-Analysis, 12, 1: 13-26.

Weber J., Bachrach H.M. & Solomon M. (1985b). Factors associated with the outcome of psychoanalysis: Report of the Columbia Psychoanalytic Center Research Project (II). International Review of Psycho-Analysis, 12, 2: 127-141.

Weber J., Bachrach H.M. & Solomon M. (1985c). Factors associated with the outcome of psychoanalysis: Report of the Columbia Psychoanalytic Center Research Project (III). International Review of Psycho-Analysis, 12, 3: 251-262.

Weintraub W. & Aronson H. (1968). A survey of patients in classical psychoanalysis: some vital statistics. J. Nerv. Ment. Dis., 146: 98÷102.

Weiss J. (1993a). How Psychotherapy Works. Process and Technique. New York: Guilford (trad. it.: Come funziona la psicoterapia. Presentazione di Paolo Migone e Giovani Liotti. Torino: Bollati Boringhieri, 1999).

Weiss J., Sampson H. & the Mount Zion Psychotherapy Research Group (1986). The Psychoanalytic Process: Theory, Clinical Observation, and Empirical Research. New York: Guilford (trad. it. del cap. 1: Introduzione al lavoro del "San Francisco Psychotherapy Research Group". Psicoterapia e Scienze Umane, 1993, XXVII, 2: 47-65).

Robert S. Wallerstein, M.D.
290 Beach Road
Belvedere, California 94920
Tel. 415-389-9323