Journals/Research

[Adam Blatner]

Hi Paola,
    Ah, thank you for identifying the issues more clearly. In the history of psychology in America, Gordon Allport described two approaches to research: nomothetic and ideographic, the former being more statistical, making generalizations about larger groups, trends, and using more replicable research instruments, tests, etc. The latter, ideographic, reveals the depths of complexity that can be learned from a single case study, the patterns of interactions among many variables or factors that may not be addressed in more conventional nomothetic research. That is, a general statistical research approach may consider perhaps one, maybe even four or five variables, but each further variable considered exponentially complexifies the project. A real person's story, though, involves many---hundreds!--- of variables, perhaps thousands. 

    The problem with ideographic research is that case studies are vulnerable to premature or shallow interpretation, many different interpretations of the same phenomenon depending on the observer/interpreter's bias, theoretically, or personal-socially. For example, if we feel that we have been traumatized in a certain way, we'll be extra-alert to that dynamic operating in the story of the client. 

     One way to temper this vulnerability is to consider many alternative interpretations, and better, to be in a context, such as an actual case conference in which people feel free to speak up---which, alas, rarely happens because of power gradients among those attending--- so that all can learn from these alternative observations and hypotheses. Again, to make good use of such a setting, the high status participants should be truly open to considering that they may have overlooked something, that their own perspective might be lacking or even mistaken. This is closer to the ideal of true dialogue, also. 

    A useful offshoot of case studies is the way Dr. X would read case study of Ms. Y being treated by Dr. Z and, later, in Dr. X's practice, she encounters another patient, Mr A with certain features shown by Ms. Y. Based on having read this case, Dr. X asks this new patient (A) about certain bits of symptom, history, etc. If positive, it enriches the understanding and may point to some guidelines. It turns out that in the case study, Treatment G didn't work, but Treatment H did. Dr X in effect learns from Dr. Z's experience and foregoes trying treatment G, starting instead with treatment H  (either a medicine or a therapeutic ploy or approach. Sometimes it's just a matter of asking about certain issues that might have otherwise been ignored).   This is the way a good deal of medicine was practiced in the 17th through the early 20th century, and still applies in some cases. 

    A negative problem is that outside groups are dubious about the effectiveness of Treatment G. How can we find out if it indeed works? It turns out it does work, but might Treatment G with modification G' work even better, and/or at lest cost, less time spent? So research is sometimes comparative, weighing not only effectiveness, but also the possibility that if done well, or more with this or that modification, it might be improved in terms of cost, patient compliance, further preventive or protective care, and so forth. 

    As you and Michael say, and I agree, both approaches have value. Part of the question is who wants to read the article and who would care. For articles to be read by "true believers," papers about new techniques or differential therapeutics are often most helprful. (Differential therapeutics is the field that explores which signs, lab tests, other indicators suggest that treatment G or treatment H should be used or at least tried first.)  

A problem I've found with many case studies in the literature is that they seem to lack quite a number of what I think are essential facts, so I can't really evaluate what gets said further on. Maybe so, maybe no. Maybe this is a report of what I may consider to be misleading tactics based on inadequate understanding. But there isn't a chance for me to dialogue openly with the article writer.

   Speaking of that, consider this suggestion for all journals (and certainly including psychodrama journals) established a norm from the editor's committe that said: We won't publish this unless you'll be willing to field and aswer questions sent by email from the readership to your email address. So you need to supply an email address with your report. We may even publish further dialogue as follow-up if we feel it would be informative for our readers.  (or this could happen online on some listserve. As we move towards e-journals, this potential becomes more plausible). 

Finally, part of the problem is that of establishing our work as valid for other professionals outside of our own field. Sometimes this is essential if we want third-party payers, government insurance, other sources, to consider that our work is valid rather than "fringy." The claim that we've been around for 70 years won't help. This is part of the "evidence-based" approach that calls into questions a variety of procedures in medicine, surgery, and so forth. It's awkward, but it's not altogether bad. 

 For example, is three-times-a-week on-the-couch psychoanalysis for two to five years conducted by a largely silent analyst effective? Might it be more effective or as effective if:  it were once a week? If it were face-to-face?  If the analyst would talk?  If action methods were combined?
     Might a mixture of group therapy and personal one-to-one be even more effective? How can we find out?   And so forth.

 In a way, we should recognize that sociologically and economically, what is at stake here is a trend in the last 40 years that has been challenging mainly traditional psychoanalysis, and looking at its yield, effectiveness, cost; and that psychodrama and other therapies that are not clearly short-term or able to be explained clearly are caught in the back-wash of this challenge to the authority of traditionalism.

  I'm open to further comments or questions. Warmly, Adam

January 09, 2009 re Journals/Research  

Dear Adam and David and Judith (and All),
   many wishes for a very Good Year to all of you, and thank you very much, Adam and David, for your late "two cents of dialogue"!
          Judith, you see, one major issue of underlying possible contrast between psychodramatic cultures has already come out: (empirical) reasearch or not reasearch, this is the problem. 
       Of course I recognize the importance of that question, and in a following e-mail I will try to express my thought about it. I hope that many persons will add their opinion and position to this basic subject.    

  But here I would like to point out that, when speaking in my Symposium abstract of a latent conflict between anglo-american and latin-american psychodramatic cultures, I had in mind, not simply a defective  reciprocal communication, but the different kind, style and approach of their respective scientific communication.

    I know that simplification may result into erroneous and even impolite statements, and I apologize in advance for it, but please take the following considerations of mine as a psychodramatic "contrast amplification" aimed to clarify my thought.  

    As much (that it is not much indeed!) as I try to keep myself up to date on international psychodrama literature, I note that the general trend of anglo-american psychodrama literature is largely for pragmatic, typically cognitive, utilitarian and synoptical exposition. Consequently a lot of contributions are mainly centered on methods and tecniques, and also the clinical expositions are often schematic, not rarely scanty and seemingly devoted to, and conditioned by, "objectivity".
  At the opposite, the trend of latin-american psychodramatic literature (inside which I place most of the Italian one, including the journal I am editor of) seems to me largely narrative, subjectively reflective,  mainly describing projects and interventions, and I must recognize that its clinical contributions are often not very accurate in expounding anamnesis, symptoms, condition, and so on.  

  I think that these different approaches to the scientific communication may be the cause of difficulties in dialogue and exchange between the "two cultures".
  For instance, in my editor experience, articles from anglo-american authors have more chances to be good (in my opinion) when their matter is clinical research, scientific exploration and documentation (i.e. neuroscience and psychodrama), and description of  particular tecniques. 
  Latin-american articles may be  very good in theoretical reflection, including theory of the tecnique, description of personal experience, and reporting of  stimulating interventions in a variety of contexts.  

  Supposing that what I stated above is somehow true, the reasons of that cultural difference may be either simple or complex. Anyway that difference in itself can reflect different values as well as different purposes ascribed to our psychodramatic thought and practice. And this is already a good subject to dibate. 

  To go to extremes, clinical empirical research "is better" than "open psychodrama sessions" recurring in a community? Well, I am certain that none of us would renounce to either one of the two. 
  Certainly, David, also in the Empire's province (as we use to call Europe in front of the States) we risk to have psychodramatic therapy marginalized because of lacking of empirical research, an event that we still can try to oppose. But I sincerely hope that, according to Moreno's view and intelligence, we will go on to give worth and importance to the numerous types of terapeutic as well as educational interventions that psychodrama allows us.   

  Of course, all that does not dispense us from reflecting on the poorness of the empirical research in psychodrama. Michel (Wieser), in the last years you worked a lot on this subject. Please, will you come into the dialogue and help us to clarify the matter?

  Good work and good luck! Warmly, Paola 


  Paola de Leonardis
  CENTRO STUDI DI PSICODRAMMA
  Associazione per la Formazione e la Promozione della Persona
  Via Montevideo 11
  20144 Milano
  Tel. / Fax 02.463618
  www.centrostudipsicodramma.it



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