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Commentary on: “Functional Neuroimaging—Can It Contribute to Our Understanding of Processes of Change?”

If psychodynamic concepts are to be tested using functional neuroimaging (fMRI), they must be quantified. This is not a metaphor; rather, it is a literal requirement. To enter a psychological hypothesis into fMRI analysis software is to use the number keys. The general linear model can’t read prose. With a patient, in my office, I may ask “Are you experiencing my silence as though I were against you?” But of the same patient lying in an fMRI scanner, I must ask “010203?” In my office, the patient may respond “Not at all! When you did not speak I worried that you do not care for me, that I bore you.” But in the scanner she must reply “121350.” In my office I may consider her answer and think “My interpretation seems off base; perhaps my countertransference is leading me astray.” But analyzing my fMRI findings, I must think “The correlation coefficient between my a priori model and the BOLD signal is .126 and insignificant; I must reanalyze the data or choose a new task.” Are my two questions the same? Are her two answers? In short, can analytic ideas be quantified—can words become numbers? Beutel and Huber ask an important question: what is the “potential of functional neuroimaging [to aid] in the understanding and evaluation of psychotherapy?” Their answer, though a qualified “yes,” gives short shrift to three fundamental methodological questions that need attention. They are: