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This introduction to the symposium explores the key features of the American Psychological Association empirically supported treatment (EST) guidelines, the forces leading to their development, and some of the potential implications of these guidelines for the future of psychoanalysis. The EST guidelines consist of (a) a set of criteria for identifying psychotherapeutic treatments that can be considered effective on the basis of research evidence and (b) a list of treatments that meet these criteria. These guidelines are an outgrowth of a more general trend in the health care system – the shift toward an evidence-based practice model. Although the EST movement clearly has important professional implications for psychoanalysis, categorizing and possibly dismissing the relevant concerns as exclusively political or territorial would be a mistake. At issue are fundamentally important epistemological and ethical concerns.
In this conclusion, I synthesize and elaborate on some of the central threads running through the contributions to the symposium on the implications of the empirically supported treatment (EST) controversy for psychoanalysis. I argue that the EST controversy brings increased urgency to discussions about the role that empirical research should play in the development of psychoanalysis and about the potential contributions of different research paradigms to the field. Different research paradigms are associated with different epistemologies and worldviews, and the dialogue between these worldviews is critical to the vitality and health of the field. On one hand, the EST movement embodies limited, mechanistic, and one-sided values, and psychoanalysis has an important role to play in challenging these values. On the other hand, the EST movement can offer an important corrective to the more insular and rarefied strands within psychoanalysis and to its tradition of argument on the basis of authority.