Psychoanalytic Research in Latin America: Challenges

By Ricardo Bernardi

During the last decades there has been in Latin America an increasing interest in research in psychoanalysis and, at the same time, passionate controversies about the validity and usefulness of this kind of research for psychoanalysts. Both the way in which clinicians have become interested in research as well as the objections that have been posed are partly similar to those which took place in other regions but they also present characteristics that respond to the peculiarities of Latin American tradition, which helps to understand the difficulties and crises of the marriage between research and psychoanalysis.

Latin American psychoanalysis is increasingly pluralistic regarding its theoretical and technical orientations (Freudian, Kleinian, Freudo-Lacanian, Bionian, Winnicottian, etc.). These diverse approaches coexist in the societies and also in the analysts’ minds, in their implicit theories, and in their operative models. Latin America has always been open to external influences from Europe and North America, and local traditions have been strongly influenced by new ideas coming from overseas. These external influences have sometimes led in the history of psychoanalytic ideas to very marked shifts, some kind of “geological” gaps in the dominant theoretical orientations. The theoretical landscape presented marked changes without a clear discussion of the reasons for it. For example, the hegemonic predominance of Kleinian thought in Argentina and Uruguay before 1970, later gave place to a pluralism with an increasing influence of French thought, and especially Lacanian, in the following years up to today (Bernardi, 2002).

The interest in research did not follow this pattern. It has never been a dominant trend; it is shared by analysts with diverse theoretical orientations; and it has been present from the very beginnings of Latin American psychoanalysis. Some pioneers, like José Bleger or David Liberman, have had a keen interest in combining different methodologies to complement classical psychoanalytic inquiry. Liberman started recording patients and analysed the tapes with diverse approaches as early as the 1960s and 1970s. However, this trend did not become widely accepted and in the following decades the mainstream favoured a strongly speculative metapsychological thought. The attempts to complement this kind of thought with empirical research of different kinds were often resisted. These resistances are present in all Latin American region, from Mexico up to Chile. Ramonet, Cuevas, Lartigue, Mendoza and López Garza state that in Mexico, psychoanalysis has on one side to face the scientific community’s claim for a more rigorous proof of its effectivity, and, on the other side, the resistance of the analyst to this kind of empirical studies (Ramonet, S., Cuevas, P., Lartigue, T., Mendoza, J., & López Garza, D., 2005).

Sometimes there is an overt aggression towards the ideas that come from the empirical research field, such as the one narrated by Juan Pablo Jiménez in FEPAL Latin American congress, in 1990. When he proposed the complementation of psychoanalytical clinical knowledge with other methodologies and systematic research, he felt surprised by the hostile answer from the audience (Jiménez, J.P., 2008). However, this rejection was not unanimous. Analysts from different parts of Latin America were also interested in the research advances and some societies created research groups. This step towards a wider pluralism, that includes research contributions, was successful in many places and in several psychoanalytical societies there is a sustained interest in discussing diverse kinds of research. The IPA activities during the last decades favourably influenced this direction. 

When Horacio Etchegoyen was President, the IPA supported an Argentinian proposal to develop a multicentric study in several countries of Latin America, in order to study process and outcomes of analyses in progress, with the assistance of Horst Kächele. Although this study had a short life, due to financial difficulties and lack of interest from analysts to participate in it-by answering the questionnaires that were part of the research - it showed that this kind of studies was feasible.

Less ambitious projects were successfully done in different places of the region and, especially, strengthening what Marta Nieto (unpublished) called a “research attitude” of analysts. This attitude leads to focus to the degree of adequacy of theoretical ideas to clinical facts, favouring the suspicion when discrepancies occur. In a similar direction, Juan Pablo Jiménez noted the positive effect of research, not only through its specific contributions, but also in promoting the need of a greater clarification of clinical concepts in relation to the metapsychological assumptions of ideological type (Jiménez, 2007). In the field of clinical research, H. Etchegoyen underlines the role of the testing of interpretation,(Etchegoyen, 2001, 2002). How interpretations changed through time in a given psychoanalytic society was also studied (Bernardi et al., 1997), as well as what kind of evidence leads analysts to change their theoretical and technical models (Bernardi, 2003). There are studies about the characteristics of clinical inference (Leibovich de Duarte, 2010). Papers like the one by Ramonet et al. sought to establish bridges between clinical practice and research (Ramonet et al., 2005). Other research fields were explored, especially regarding child development (Altmann de Litvan, , 2007; Schejtman, et al., 2014); underlying structures of mother-infant interaction at brief psychotherapeutic processes (Altmann de Litvan, 2015); depression (Botto,, Acuña & Jiménez, 2014); the efficiency of psychoanalysis and psychotherapy (Mantilla Lagos & Sologuren De La Fuente, 2006); the relation between frequency and analytic process(Altmann et al., 2002).

These examples do not expect to be a systematic revision but only a fragmentary illustration of some papers written in the psychoanalytic research field from different Latin American countries. There is also a variety of papers related to conceptual research and to discussions of epistemological nature about the role of research in psychoanalysis which I do not mention here due to space reasons.

The creation of an exchange net among analysts interested in research in Latin America was strengthened by the activities organized by the IPA Research Committee and the Society for Psychotherapy Research (SPR) in the region. The Research Training Programme (RTP), developed by the IPA Research Committee, chaired by Peter Fonagy, allowed researchers from different countries to share and compare their research projects, to receive counselling from a faculty of experts, and to later keep an exchange among them through an electronic e-mail list (ipa.researchtraining@lists.uni-ulm.de). It is the opinion of those who participated in this program that the RTP experience left an indelible mark that significantly enriched their vision of research and also of psychoanalysis. This was also helped by the possibility to receive IPA grants for research projects, managed by the research committee. This has been an important incentive for a greater development of research in Latin America.  

Another important factor that strengthened the net of analysts interested in research was the creation of the South American Chapter of the Society for Psychotherapy Research, which took place in Mendoza, Argentina, in year 1992, fostered by Horst Kächele and Ken Howard. Juan Pablo Jiménez was the first Latin American Vice-President of the SPR, which helped psychoanalyst researchers to have a fluent dialogue among themselves and with psychotherapists from other approaches. Universities have also a crucial role facilitating research, e.g. through research grants and doctoral theses, but unfortunately the presence of analysts in universities has decreased in the last years.

Comments about psychotherapy research by Guillermo de la Parra, Past President of the SPR, are also valid for psychoanalysis (De la Parra, 2013):  “In short, Latin America’s production is slowly growing at an international level, although it is still small in scale” (p. 612). He states that difficulties and weakness of research in Latin America are linked to the lack of research culture, lack of training, scarcity of resources and the little time to devote to research and the need of English translation (p. 618).

Although the number of scientific papers is scarce, the effects of research on psychoanalytic thinking are meaningful and promote new orientations for psychoanalytic thinking. These effects can be seen in the conceptual, clinical and interdisciplinary fields.

Research questions force us to clarify theoretical terms. This, in turn, forwards the discussion of epistemological questions about evidence and truth in psychoanalysis. Sometimes psychoanalytic theories are considered as a priori unquestionable truths. Instead, a research attitude promotes their consideration as alternative hypotheses and underline the need to observe their consequences in the clinical and extra-clinical field. For example, what kind of approach benefits what kind of patients, and how? This kind of questions favour a clinically-guided metapsychological reflection that complements the speculation starting from only theoretical and historical psychoanalytic principles.

We can only expect that a small number of analysts devote a great part of their time to research, which is favoured by their belonging to a university. However, the benefits of the “research attitude” mentioned above are spread to a greater number of analysts’ thinking. It tends to favour psychoanalysis not to enclose in a discourse of demonstrative kind, while assuming certain unchangeable truths, by confronting them at different levels, favouring a reflective, critical thought. Current controversies about research in the different regions shed light on many of these problems in different fields. They allow a better confrontation and debate of theoretical ideas (Bernardi, R., in press). It also stimulates the development of clinical research.

The present interest in Clinical Working Parties and Working groups is a proof of the interest in clinical research. The Clinical Observation Committee, chaired by Marina Altmann, has elaborated a clinical observation model (Three Level Model for Observing Patient Transformations), and many clinical observation groups have applied it to the observation of clinical materials. The 3-LM opens bridges with other kind of research about what benefits do patients obtain from psychoanalysis, and facilitates to study the predictive and clinical validity of clinical judgements comparing them with other assessment methodologies.

Finally, I’d like to remark that research has a key role in the opening of psychoanalysis to the dialogue with other disciplines and with other cultures from our time, thus enabling knowledge triangulation and search of consilience. Current studies in neuropsychology are an example of this crossed fertilisation among different fields.

References

Altmann, M., Gabarino, A., de Barbieri A. M., de León, B., Frioni, M., Lamónaca, J., Morató, R., Ponce de León, E., Tellería, E., Bernardi, R. Statistical consultant: Corti, A. (2002). Alta y baja frecuencia en nuestra práctica analítica actual [High and low frequency in our psychoanalytic practice today]. Revista Uruguaya de Psicoanálisis (on-line) (95).

Altmann de Litvan, M. (2007). Infant observation: A range of questions and challenges for contemporary psychoanalysis. International Journal of Psychoanalysis, 88, 713–733.

Altmann de Litvan, M. (2015,) Estructuras relacionales subyacentes en procesos psicoterapéuticos breves madre-infante [Underlying structures of mother-infant interaction at brief psychotherapeutic processes]. Buenos Aires: Biebel.

Bernardi, R. (in press). Clinical research and systematic empirical research: What can we learn about them from current controversies? International Journal of Psychoanalysis.

Bernardi, R. (2002). The need for true controversies in psychoanalysis: the debates on Melanie Klein and Jacques Lacan in the Rio de la Plata. International Jornal of Psychoanalysis, 83, 851–73.

Bernardi, R. (2003). What kind of evidence makes the analyst change his/her theoretical and technical ideas? In M. Marianne Leuzinger-Bohleber, A. U. Dreher, & J. Canestri (Eds.), Pluralism and Unity? Methods of Research in Psychoanalysis. (pp. 125–136). London: The International Psychoanalytical Association.

Bernardi, R., Altmann, M., Cavagnaro, S., de León, B., De Barbieri, A. M., Garbarino, A., Flores, M., Frioni, M., Lamonaca, J., Morató, R., Seigal, J., Schroeder, D., Tellería, E. (1997). Cambios de la interpretación en el psicoanálisis del Uruguay entre 1960 y 1990. Revista Uruguaya de Psicoanálisis, 84/85, 89–102.

Botto, A., Acuña, J., & Jiménez, J. P. (2014). La depresión como un diagnóstico complejo. Implicancias para el desarrollo de recomendaciones clínicas. A new proposal for the diagnosis of depression. Revista Médica de Chile, 142(10).

De la Parra, G. (2013). Presidential Address. Psychotherapy research in developing countries: The case of Latin America. Psychotherapy Research, 23(6), 609–632.

Etchegoyen, R. H. (2001). Algo más sobre el testeo del proceso clínico. Subjetividad Y Procesos Cognitivos, 1, 34-59.

Etchegoyen, R. H. (2002). Los Fundamentos de la Técnica Psicoanalítica (2a ed.). Buenos Aires: Amorrortu.

Jiménez, J. P. (2007). Can research influence clinical practice? International Journal of Psycho-Analysis, 88, 661–679.

Jiménez, J.P. (2008). 15 años de investigación en psicoterapia en el cono sur latinoamericano. Gaceta de Psiquiatría Universitaria, 4(1), 51–64.

Leibovich de Duarte, A. (2010). Psychotherapists at work. Exploring the construction of clinical inferences. In R. S. Frensch & A. Peter (Eds.), Personality, Human Development, and Culture: International Perspectives on Psychological Science (Vol. 2, pp. 29–43). New York: Psychology Press.

Mantilla Lagos, C. E., & Sologuren De La Fuente, M. X. (2006). Criterios para evaluar la eficiencia: hablan psicoterapeutas psicoanalíticos, conductuales cognitivos, racionales emotivos y psicoanalistas. Revista de Psicología, 24(2).

Ramonet, S., Cuevas, P., Lartigue, T., Mendoza, J., & López Garza, D. (2005). A successful trial utilizing the Leuzinger-Bohleber methodology for evaluation of psychoanalytic treatment: Preliminary report. International Journal of Psychoanalysis, 86, 1425 – 1440.

Schejtman, C., Huerin, V., Vernengo, M. P., Esteve, M. J., Silver, R.; Vardy, I.; Laplacette, J. A., Duhalde, C. (2014). Regulación afectiva, procesos de simbolización y subjetividad materna en el juego madre-niño. Revista de Psicoanálisis, 71, 283–304.