Tag Archives: Does psychoanalysis have a valuable place in modern mental health services?

“Does psychoanalysis have a valuable place in modern mental health services?” News tips courtesy of Ken Pope.

The new issue of *British Medical Journal* includes a debate on whether psychoanalysis has a valuable place in modern treatment.

Part 1: “Does psychoanalysis have a valuable place in modern mental health services? Yes.” The authors are Peter Fonagy and Alessandra Lemma.

Here’s an excerpt: “A growing body of studies, however, report that psychodynamic therapy is effective in the treatment of both mild and complex mental health problems. For example, a meta-analysis found substantial effect sizes in randomised controlled trials of long term psychodynamic psychotherapy, larger than those for short term therapies.1 Positive correlations were also seen between outcome and duration or dosage of therapy. Another meta-analysis found that psychotherapy in addition to antidepressants significantly reduced depressive symptoms compared with antidepressants alone.2 A third meta-analysis found that short term psychodynamic psychotherapy may be more effective than other therapies for somatic disorders.3 So evidence is on its way.”

Another excerpt: “The psychoanalytic approach makes three valuable and unique contributions to a modern healthcare economy. First, in their applied form, psychoanalytic ideas can support mental health staff to provide high quality services despite the interpersonal pressures to which they are inevitably exposed when working with disturbed and disturbing patients.”

Another excerpt: “Secondly, there are increasingly strong indications that adult mental health problems are developmental in nature; three quarters can be traced back to mental health difficulties in childhood, and 50% arise before age 14 years.8″

Another excerpt: “Thirdly, psychoanalytical ideas continue to provide the foundations for a wide range of applied interventions. Research and clinical observation show that other modalities– particularly cognitive behavioural therapy–have made use of theoretical and clinical features of the psychoanalytic approach and incorporated these into their techniques.”

Another excerpt: “Research clearly shows that there is no one size fits all approach to the treatment of mental health problems; irrespective of brand, psychotherapy only substantially helps around 50% of referred patients who complete treatment12 and medication fares no better.13 Rationally designed services should therefore provide a range of approaches for which some evidence of effectiveness exists, and should continue to broaden the research base to ensure monitoring and improvement of the effectiveness of these services.”

The article is online — but requires a subscription — at: http://www.bmj.com/content/344/bmj.e1211

Part 2: “Does psychoanalysis have a valuable place in modern mental health services? No” The authors are Paul Salkovskis and Lewis Wolpert.

Here is how the article starts: “Psychoanalysis is of historical value only and, at best, has no place in modern mental health services. Not only is there no evidence base for the treatment, but there is no empirical grounding for the key constructs underpinning it. In addition, we suggest that the theory and practice of psychoanalysis are inimical to modern mental health services and so are, at worst, counterproductive and perverse in that context.”

Here’s another excerpt: “Clearly, true paradigm shifts have occurred in terms of the understanding of human psychology and of the ways in which people experiencing psychological problems and distress can be helped. Freud himself deserves credit for establishing psychoanalysis as a new paradigm over a century ago. There is, however, an inevitability in the subsequent shift away from psychoanalysis, which began 50 years ago and which was de facto completed in the 1980s. Paradigm shifts are a form of accelerated intellectual evolution, where the explanatory and heuristic power of a particular theory are supplanted by another that better explains and predicts the key phenomena under investigation. Sometimes a supplanted idea is kept alive in some form; there is something charming and at times amusing about the continued existence of a flat earth society or the psychoanalytic approach to literary criticism. However, we propose that it is no longer defensible to continue ideas whose time has come and gone and which have been succeeded by more appropriate ones in an area as important as healthcare.”

Another excerpt: “Psychoanalysis rejected Freud’s original concept of psychoanalytic science.4 We suggest that psychoanalysis has become a pseudoscience because its claims are neither testable nor refutable. Attempts to identify evidence for constructs such as the id, ego, and superego and concepts such as the oedipal complex have sadly failed.”

Another excerpt: “Our opponents in this debate might choose to argue the usefulness of psychodynamic approaches, such as mentalisation and interpersonal therapy, given their associated research findings. They will find no argument from us. Neither, however, will they find a couch in the consulting rooms of those who practise such approaches–these methods are successors to psychoanalysis, rather than a continuation.”

The article is online — but requires a subscription — at: http://www.bmj.com/content/344/bmj.e1188