Reflections on Psychoanalytic Interpretation

Psychoanalytic interpretation, though subject to the analyst’s own biases and limitations, should not be dismissed as merely subjective or arbitrary. While interpretations inevitably arise within the context of specific psychoanalytic traditions—such as Freudian, Kleinian, or relational theories—they are not devoid of epistemic value. Rather, these interpretations can be understood as provisional efforts to track psychological truths, albeit imperfectly and always open to revision. This view aligns with the philosophical stance of critical realism, which holds that reality exists independently of our perceptions, and as Margaret Archer and Roy Bhaskur suggest, our understanding of it is mediated through theory, language, and social context. Applied to psychoanalysis, this implies that while interpretations are never final or infallible, they can be evaluated and refined over time in light of clinical experience, internal coherence, and therapeutic efficacy. Interpretations thus occupy a middle ground: neither purely objective “discoveries” nor wholly constructed “narratives,” but tentative approximations of deeper truths about the patient’s mind and its workings.

This perspective on psychoanalytic interpretation contrasts starkly with the views of many relational and intersubjective theorists who rely heavily on a postmodern worldview that is inherently skeptical of science and truth as found in the writings of Robert Stolorow and his colleagues. For these theorists, meaning is co-constructed in the analytic dyad without appeal to any deeper, mind-independent reality, thereby shifting the focus from discovering psychological truth to negotiating intersubjective experience. While this view underscores the ethical importance of mutual recognition and co-authorship, it risks eroding the epistemic ambition of psychoanalysis as a discipline committed to understanding the unconscious processes that shape thought, feeling, and behavior.

Previously, Nassir Ghaemi and Jon Mills have leveled critiques of contemporary mental health practices on this basis. Ghaemi, a psychiatrist, has argued that postmodernism has led to a gross expansion of the psychiatric diagnostic system, which since the 1980s has prioritized reliability of diagnosis over validity. To Ghaemi, psychiatry—and, by extension, psychoanalysis—have been infiltrated by a postmodern belief system that is largely unconscious but widespread. He contends that this epistemic shift has undermined psychiatry’s capacity to seek truth, replacing it with a relativism that favors consensus and utility over ontological clarity.

Mills, a formally trained philosopher, psychologist, and psychoanalyst, has offered his own views on postmodern influences on psychoanalysis, concluding that much of modern relational and intersubjective theory is philosophically unsound and scientifically illiterate.

He writes, for instance, that “postmodernism has become very fashionable with some relationalists because it may be used selectively to advocate for certain contemporary positions, such as the co-construction of meaning and the disenfranchisement of epistemic analytic authority, but it does so at the expense of introducing anti-metaphysical propositions into psychoanalytic theory that are replete with massive contradictions and inconsistencies.” Mills’ comments on relational theory’s rejection of the individual self are particularly relevant to discussions about psychopathology.

I wish here to add some thoughts on these trends, arguing for a critical realist orientation that neither retreats into the naive objectivism of classical positivism, nor succumbs to the epistemic nihilism of postmodernism. Such a position allows psychoanalysis to retain its interpretive depth while preserving a commitment to truth-seeking as a core value. It acknowledges the hermeneutic and contextual nature of all knowledge while affirming that some interpretations, through sustained clinical engagement and theoretical refinement, bring us closer to understanding the enduring structures of the human mind.

Critical Realism and Psychopathology

Critical realism provides a robust philosophical foundation for the psychoanalytic understanding and treatment of psychopathology. Take, for instance, borderline personality disorder (BPD), which object relations theory frames as a disturbance partly rooted in early relational trauma and developmental arrest. From this standpoint, BPD is not merely a discursive construct or a social convention, but a genuine, structured pattern of affective dysregulation, identity diffusion, and interpersonal turbulence. Simultaneously, critical realism recognizes that our knowledge of BPD is mediated by theoretical lenses and clinical judgment—rendering psychoanalytic interpretation both necessary and fallible.

Consider a case example: a woman in her late twenties, diagnosed with BPD, seeks treatment after a cycle of stormy relationships characterized by rapid idealization and devaluation. She vacillates between clingy dependency and explosive withdrawal whenever the therapist enforces limits or plans time away. For instance, in one session, her reaction to the therapist’s upcoming vacation erupts into accusations of abandonment and betrayal. Rather than dismissing this response as merely capricious, the analyst, drawing on object relations theory, interprets it as the activation of split internal objects—“good” nurturing figures versus “bad” persecutory ones—echoing an early maternal rejection schema.

This interpretive move does not claim to unearth an immutable historical fact, but offers a provisional hypothesis: that the patient’s intense rage and despair stem from reactivated internal dynamics forged in childhood. In critical realist terms, the clinician’s account approximates the underlying mechanisms sustaining her borderline pathology. Over successive sessions, such interpretations can be tested against emerging clinical evidence—shifts in the patient’s capacity for affect regulation, moments of self-reflection, or changes in relational patterns—and refined accordingly.

By affirming BPD as a real psychological phenomenon while treating interpretations as revisable approximations, critical realism steers a path between naïve positivism and radical constructivism. It validates diagnostic categories as pointers to enduring disturbances in mental organization yet insists that every analytic formulation remains open to revision in light of new data, theoretical scrutiny, and therapeutic outcomes. In contrast to postmodern and constructivist approaches that reduce diagnoses to social artifacts or co-created narratives, this stance upholds both the ontological reality of BPD and the epistemic value of psychoanalytic interpretation in illuminating—and gradually transforming—the structures of the mind.  

A Path Forward for Psychoanalysis

While postmodern approaches have rightly emphasized the importance of subjectivity and the therapeutic relationship, they risk, according to Mills, collapsing interpretation into narrative relativism, thereby undermining psychoanalysis’s commitment to exploring unconscious processes and enduring mental structures. Without a regulative ideal of truth, interpretation can devolve into rhetorical improvisation rather than a disciplined inquiry into the patient’s internal world. A critical realist stance retains the epistemological humility of relational theory—acknowledging that all knowledge is mediated and provisional—without relinquishing the pursuit of deeper understanding. It provides a framework in which psychoanalytic interpretations can still aim to track truths about the patient’s inner life, even if those truths are partial, revisable, and influenced by context. This philosophical grounding affirms the possibility of shared understanding and therapeutic change, grounded in the recognition of the patient’s psychic reality.

Moreover, critical realism may serve as a vital philosophical bridge between psychoanalysis and the broader domains of psychiatry and scientific psychology.

A longstanding critique of psychoanalysis is its epistemic isolation from empirical science, particularly its perceived resistance to diagnostic standardization or outcome-based measures. While this critique often oversimplifies psychodynamic epistemology, it underscores real tensions between hermeneutic and positivist models of mind. Critical realism offers a reframing of these tensions by supporting a layered ontology, where psychological phenomena can be real and causally efficacious even if not directly measurable.

In this view, constructs such as internal objects, splitting, and projective identification are understood as real mechanisms operating at the psychological level of analysis, even if they are not reducible to biological correlates or behavioral metrics. This allows psychoanalysis to retain its interpretive richness and depth while remaining engaged with scientific standards of explanation, coherence, and progress. It supports a pluralistic science in which meaning-based and empirically grounded approaches work in tandem to illuminate the complexity of human suffering.

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In sum, a critical realist framework offers a productive middle path. Psychoanalytic interpretations, including those applied to complex psychiatric disorders like BPD, are shaped by theoretical models and clinical subjectivity, but they are not arbitrary constructions. They represent serious, good-faith efforts to make sense of unconscious dynamics and to promote psychological transformation. In this light, critical realism not only supports the epistemological integrity of psychoanalysis but also repositions it within the larger landscape of scientific psychology and psychiatry. It allows psychoanalysis to reclaim its rightful place as a discipline committed both to meaning and to truth. 

File under: Musings and Reflections