Evidenced Based Best Practice Social Work and Psychoanalysis?
I have a good friend who likes to denigrate psychoanalysis because it is not ‘evidence based’ and does not conform to ‘best practices.’ And it’s not just my friend; many people seem to view psychoanalysis this way… especially social workers. If Rutgers School of Social Work is representative of the profession more generally, then social work’s commitment to evidence based best practices is certainly no secret. But what is evidence based best practice? And to what extent should we concern ourselves with it? I will be updating this blog post as I encounter literature that helps me answer these questions. To begin, I found Bruce Fink’s introductory comments in Reading Seminar XI: Lacan’s Four Fundamental Concepts of Psychoanalysis helpful. He offers the following on page xi:
1. In Lacan’s version of psychoanalysis, theory informs analysis’ aims and practice, and vice versa. I take this to mean that champions of evidence based practice should remember that there are no examples or evidence without a theory already in place. Evidence and examples are only recognized as evidence and examples when a theoretical paradigm is in place to recognize them as such. Consequently, attending to evidence and examples without also making making the theoretical paradigm that underpins them explicit is not just focusing on evidence and examples, it’s sloppy scholarship. Perhaps what we need isn’t evidence and examples but rather better theoretical rigor, awareness, and engagement.
2. Analysis does not insist on pragmatic aims, and this is because pragmatism often means compliance with social, economic, and political norms and realities.
3. Getting healthy can often mean getting to a place where the demands such as capitalism, health insurance companies, socialized health care, public order, and “mature adult relationships” are seen as arbitrary and oppressive structures to be opposed changed. Most would not call this kind of work practical.
4. The techniques of psychoanalysis resist, confront, and refuse to submit to ideologies of “time is money” and “professional conduct.”
5. While most therapists are expected to interact with their patients in ways that are clearly for their own good (always understood in terms of what is socially acceptable at a particular historical moment), analysts act instead for their client’s desire, their Eros.