WHEN REALITY DOESNT FIT THE BLUEPRINT - DOING RESEARCH ON PSYCHOANALYSIS AND LONG-TERM PSYCHOTHERAPY IN A PUBLIC-HEALTH SERVICE PROGRAM

A public health service program in Sweden, involving the funding of ps ychoanalysis and long-term psychotherapy, seemed to offer an opportuni ty to conduct a large-scale natural experiment on long-term psychother apy and psychoanalysis. This paper describes our experiences with this project, focusing on the methodological and practical difficulties we encountered in implementing our plans, primarily because of the compl exities of patients' treatment histories and the consequent lack of co ntrol over the treatment variable. Thus, when confronted with the cond itions of reality, our experimental design had to be transformed into a quasi-experimental one. Despite the various problems, valuable data has been secured on such issues as psychometrics, health outcomes, and comparative outcome processes. We conclude that health service projec ts may provide rare opportunities for conducting long-term psychothera py outcome research, at the same time creating conflicts between exter nal and internal validity.