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Lindfors O, Knekt P, Lehtonen J, Virtala E, Maljanen T, Härkänen T. Effectiveness of psychoanalysis and long-term psychodynamic psychotherapy on personality and social functioning 10 years after start of treatment. Psychiatry Res 2019; 272:774-783. [PMID: 30832198 DOI: 10.1016/j.psychres.2018.12.082] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 11/30/2018] [Accepted: 12/16/2018] [Indexed: 11/18/2022]
Abstract
The evidence on potentially greater benefits of psychoanalysis (PA) vs. long-term psychodynamic psychotherapy (LPP) is scarce. This study compared the effectiveness of PA and LPP on personality and social functioning during a 10-year follow-up from the beginning of the treatments. The eligible patients, 41 self-selected for PA and 128 assigned to LPP, were 20-45 years of age and had anxiety or mood disorder. Outcomes were analyzed using ten standard measures of personality and social functioning, carried out 5-9 times during the follow-up. Different change patterns by time in PA and LPP emerged, suggesting less benefit of PA during the first years of follow-up and more benefit in most outcomes thereafter. Greater post-treatment improvement in PA than in LPP was seen up to 1-2 years after PA had ended in more mature defense style (DSQ), level of personality organization (LPO), more positive self-concept (SASB), more improved social adjustment (SAS-SR) and sense of coherence (SOC). However, at the 10-year follow-up the differences were non-significant. In conclusion, PA may give some additional benefits when long-term aims are linked to personality and social functioning. The relatively small differences and higher costs in comparison to LPP may restrict the feasibility of PA.
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Affiliation(s)
- Olavi Lindfors
- National Institute for Health and Welfare, P. O. Box 30, 00271, Helsinki, Finland; University of Helsinki, Helsinki, Finland.
| | - Paul Knekt
- National Institute for Health and Welfare, P. O. Box 30, 00271, Helsinki, Finland; Biomedicum Helsinki, Helsinki, Finland
| | - Johannes Lehtonen
- National Institute for Health and Welfare, P. O. Box 30, 00271, Helsinki, Finland; University of Eastern Finland, Kuopio, Finland
| | - Esa Virtala
- National Institute for Health and Welfare, P. O. Box 30, 00271, Helsinki, Finland
| | - Timo Maljanen
- The Social Insurance Institution, Helsinki, Finland; National Institute for Health and Welfare, P. O. Box 30, 00271, Helsinki, Finland
| | - Tommi Härkänen
- National Institute for Health and Welfare, P. O. Box 30, 00271, Helsinki, Finland
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Westenberger‐Breuer H. The goals of psychoanalytic treatment: Conceptual considerations and follow‐up interview evaluation with a former analysand. THE INTERNATIONAL JOURNAL OF PSYCHOANALYSIS 2017. [DOI: 10.1516/c563-520q-1k76-9056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Leuzinger‐Bohleber M, Stuhr U, Rüger B, Beutel M. How to study the ‘quality of psychoanalytic treatments’ and their long‐term effects on patients' well‐being: A representative, multi‐perspective follow‐up study. THE INTERNATIONAL JOURNAL OF PSYCHOANALYSIS 2017. [DOI: 10.1516/c387-0afm-4p34-m4bt] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Levine HB. Creating analysts, creating analytic patients. THE INTERNATIONAL JOURNAL OF PSYCHOANALYSIS 2017; 91:1385-404. [PMID: 21133904 DOI: 10.1111/j.1745-8315.2010.00336.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Jacobson JG. Developmental Observation, Multiple Models of the Mind, and the Therapeutic Relationship in Psychoanalysis. THE PSYCHOANALYTIC QUARTERLY 2017. [DOI: 10.1080/21674086.1993.11927392] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Zepf S. Psychoanalytic treatments and empirical research on their efficacy: A commentary. INTERNATIONAL FORUM OF PSYCHOANALYSIS 2017. [DOI: 10.1080/0803706x.2017.1346386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Lilienfeld SO, Ritschel LA, Lynn SJ, Cautin RL, Latzman RD. Why Ineffective Psychotherapies Appear to Work: A Taxonomy of Causes of Spurious Therapeutic Effectiveness. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2015; 9:355-87. [PMID: 26173271 DOI: 10.1177/1745691614535216] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The past 40 years have generated numerous insights regarding errors in human reasoning. Arguably, clinical practice is the domain of applied psychology in which acknowledging and mitigating these errors is most crucial. We address one such set of errors here, namely, the tendency of some psychologists and other mental health professionals to assume that they can rely on informal clinical observations to infer whether treatments are effective. We delineate four broad, underlying cognitive impediments to accurately evaluating improvement in psychotherapy-naive realism, confirmation bias, illusory causation, and the illusion of control. We then describe 26 causes of spurious therapeutic effectiveness (CSTEs), organized into a taxonomy of three overarching categories: (a) the perception of client change in its actual absence, (b) misinterpretations of actual client change stemming from extratherapeutic factors, and (c) misinterpretations of actual client change stemming from nonspecific treatment factors. These inferential errors can lead clinicians, clients, and researchers to misperceive useless or even harmful psychotherapies as effective. We (a) examine how methodological safeguards help to control for different CSTEs, (b) delineate fruitful directions for research on CSTEs, and (c) consider the implications of CSTEs for everyday clinical practice. An enhanced appreciation of the inferential problems posed by CSTEs may narrow the science-practice gap and foster a heightened appreciation of the need for the methodological safeguards afforded by evidence-based practice.
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Affiliation(s)
| | - Lorie A Ritschel
- Department of Psychiatry, University of North Carolina at Chapel Hill 3C Institute, Cary, NC
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Waldron S, Gazzillo F, Stukenberg K. Do the Processes of Psychoanalytic Work Lead to Benefit? Studies by the APS Research Group and the Psychoanalytic Research Consortium. PSYCHOANALYTIC INQUIRY 2015. [DOI: 10.1080/07351690.2015.987602] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Crick P. Selecting a patient or initiating a psychoanalytic process? THE INTERNATIONAL JOURNAL OF PSYCHOANALYSIS 2014; 95:465-84. [PMID: 24660869 DOI: 10.1111/1745-8315.12142] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2013] [Indexed: 11/26/2022]
Abstract
The defences provoked in the analyst by the anxieties associated with the difficult tasks of 'assessment' and 'selection' for psychoanalysis can result in a tendency to think in terms of 'hurdles to be cleared' by potential psychoanalytic patients, rather than 'opening the gates'. This can result in a diminution of the analyst's capacity to enlist and sustain a psychoanalytic stance. Only within a psychoanalytic frame can a meaningful psychoanalytic process unfold, at all stages of a potential patient's movement from their first contact through to, possibly, entering into an analysis. The author illustrates the value of this thinking by describing the work of the London Clinic of Psychoanalysis where there has been a shift of emphasis in psychoanalytic consultation towards working with individuals on their potential to initiate a psychoanalytic process, and away from the sole aim of 'selection of a suitable patient'. In this paper, the author notes that when institutional culture and practice supports psychoanalytic identity, this makes it more possible to recognize and articulate the anxieties provoked by the 'emotional storm' inevitable in psychoanalytic consultation, and the draw towards unhelpful enactment that may otherwise obscure the initiation of a psychoanalytic process that may or may not result in analytic treatment. Illustrative case material from the Clinic is presented.
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Affiliation(s)
- Penny Crick
- London Clinic of Psychoanalysis, Byron House, 112a-114 Shirland Road, London, W9 2BT, UK.
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Bastos AG, Trentini CM. Psicoterapia psicodinâmica e tratamento biológico com fluoxetina: comparação de resposta cognitiva em pacientes deprimidos. PSICOLOGIA: TEORIA E PESQUISA 2013. [DOI: 10.1590/s0102-37722013000400010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A depressão é uma doença grave, com repercussões importantes no humor e na cognição. Tratamentos farmacológicos e/ou psicoterápicos estão comumente indicados. O presente estudo objetivou avaliar e comparar a cognição de pacientes deprimidos antes e após 12 meses de tratamento com fluoxetina ou psicoterapia psicodinâmica. Cento e oitenta pacientes foram divididos em dois grupos, e avaliados por meio da WAIS-III. Os resultados mostraram uma melhora significativa em diferentes subtestes da WAIS-III. A MANOVA indicou que há uma diferença significativa entre os grupos nas pontuações médias obtidas na reavaliação 12 meses após o início dos tratamentos. Os resultados sugerem que a psicoterapia psicodinâmica e a terapia com fluoxetina agem de forma diferente na cognição de pacientes deprimidos.
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Crick P. Thinking about judgement in psychoanalytic assessment and consultation. PSYCHOANALYTIC PSYCHOTHERAPY 2013. [DOI: 10.1080/02668734.2013.804864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Zepf S. Naturalistic studies of psychoanalytic treatments: some epistemological and methodological remarks. ACTA ACUST UNITED AC 2013. [DOI: 10.1080/01062301.2008.10592828] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Siegfried Zepf
- a Narzissenstraße 5, D-66119 , Saarbrücken , Germany E-mail:
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Huber D, Henrich G, Clarkin J, Klug G. Psychoanalytic versus psychodynamic therapy for depression: a three-year follow-up study. Psychiatry 2013; 76:132-49. [PMID: 23631544 DOI: 10.1521/psyc.2013.76.2.132] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aim of this study was to investigate the effectiveness of long-term psychoanalytic and psychodynamic psychotherapies. In a prospective, randomized outcome study, psychoanalytic (mean duration: 39 months, mean dose: 234 sessions) and psychodynamic (mean duration: 34 months, mean dose: 88 sessions) therapy were compared at post-treatment and at one-, two-, and three-year follow-up in the treatment of patients with a primary diagnosis of unipolar depression. All treatments were carried out by experienced psychotherapists. Primary outcome measures were the Beck Depression Inventory and the Scales of Psychological Capacities, and secondary outcome measures were the Global Severity Index of the Symptom Checklist 90-R, the Inventory of Interpersonal Problems, the Social Support Questionnaire, and the INTREX Introject Questionnaire. Interviewers at pre- and post-treatment and at one-year follow-up were blinded; at two- and three-year follow-up, all self-report instruments were mailed to the patients. Analyses of covariance, effect sizes, and clinical significances were calculated to contrast the groups. We found significant outcome differences between treatments in terms of depressive and global psychiatric symptoms, personality functioning, and social relations at three-year follow-up, with psychoanalytic therapy being more effective. No outcome differences were found in terms of interpersonal problems. We concluded that psychoanalytic therapy associated with its higher treatment dose shows longer-lasting effects.
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Affiliation(s)
- Dorothea Huber
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Klinikum rechts der Isar, Technische Universität München, Germany.
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de Jonghe F, de Maat S, Barber JP, Abbas A, Luyten P, Gomperts W, Swinkels J, Dekker J. Designs for studying the effectiveness of long-term psychoanalytic treatments: balancing level of evidence and acceptability to patients. J Am Psychoanal Assoc 2012; 60:361-87. [PMID: 22582323 DOI: 10.1177/0003065112441971] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Long-Term Psychoanalytic Treatments (LTPT) include both long-term psychoanalytic psychotherapy (LTPP) and psychoanalysis (PsAn). Current opinion seems to be that there is some evidence for the effectiveness of LTPP, but none for that of PsAn. This may be due in part to researchers not balancing the level of evidence of randomized controlled studies (RCTs), cohort studies, and pre-post studies with patients' acceptance of these various research designs used in studying the effectiveness of LTPT. After a review of the merits of eight possible control conditions for LTPT in RCTs and cohort studies, and a consideration of the limitations and merits of pre-post studies, it was found that RCTs pair high levels of evidence with limited degrees of patient acceptance, especially where PsAn is concerned. Cohort studies appear to provide at most a moderate level of evidence. Their acceptability is hardly better than that of RCTs, as it depends on the acceptability of control conditions similar to those of RCTs. The acceptability of pre-post studies is much better, but they can provide, at most, a moderate level of evidence. Apart from randomization, they can meet all methodological criteria for high-quality research (often they do not, but there are ways to correct this). In summary, in the long-term treatment of complex mental disorders with LTPT, RCTs often pair a high level of evidence with limited patient acceptance of the method. Compared to RCTs, cohort studies show a lower level of evidence without much gain in acceptability. Pre-post studies pair the highest level of acceptability with the lowest level of evidence of the three designs. Limited acceptability is not to be confused with no acceptability, nor moderate level of evidence with none.
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Fred Busch’s response to H. Kächele and D. Widlöcher. THE INTERNATIONAL JOURNAL OF PSYCHOANALYSIS 2010. [DOI: 10.1111/j.1745-8315.2009.00234.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Zepf S. Psychoanalysis and Qualitative Psychotherapy Research—Some Epistemological Remarks. ACTA ACUST UNITED AC 2009; 37:645-64. [DOI: 10.1521/jaap.2009.37.4.645] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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de Maat S, de Jonghe F, Schoevers R, Dekker J. The effectiveness of long-term psychoanalytic therapy: a systematic review of empirical studies. Harv Rev Psychiatry 2009; 17:1-23. [PMID: 19205963 DOI: 10.1080/10673220902742476] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND There is a gap in the research literature on the effectiveness of long-term psychoanalytic therapies (LPT). AIM To present a systematic review of studies dealing with LPT effectiveness and published from 1970 onward. METHODS A systematic literature search for studies dealing with the effectiveness of individual LPT in ambulatory, adult patients. Data about the overall effectiveness of LPT, its impact on symptom reduction, and its effect on personality changes were pooled both at treatment termination and at follow-up, using effect sizes (ESs) and success rates. RESULTS We found 27 studies (n = 5063). Psychotherapy yielded large mean ESs (0.78 at termination; 0.94 at follow-up) and high mean overall success rates (64% at termination; 55% at follow-up) in moderate/mixed pathology. The mean ES was larger for symptom reduction (1.03) than for personality change (0.54). In severe pathology, the results were similar. Psychoanalysis achieved large mean ESs (0.87 at termination; 1.18 at follow-up) and high mean overall success rates (71% at termination; 54% at follow-up) in moderate pathology. The mean ES for symptom reduction was larger (1.38) than for personality change (0.76). CONCLUSION Our data suggest that LPT is effective treatment for a large range of pathologies, with moderate to large effects.
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Affiliation(s)
- Saskia de Maat
- Mentrum Institute for Mental Health, Amsterdam, The Netherlands
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Freddi J. Dodo birds, doctors and the evidence of evidence. INTERNATIONAL JOURNAL OF APPLIED PSYCHOANALYTIC STUDIES 2008. [DOI: 10.1002/aps.174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Psychoanalyse und qualitative Psychotherapieforschung. FORUM DER PSYCHOANALYSE 2008. [DOI: 10.1007/s00451-008-0355-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Haase M, Frommer J, Franke GH, Hoffmann T, Schulze-Muetzel J, Jäger S, Grabe HJ, Spitzer C, Schmitz N. From symptom relief to interpersonal change: Treatment outcome and effectiveness in inpatient psychotherapy. Psychother Res 2008; 18:615-24. [DOI: 10.1080/10503300802192158] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Kochiras H. Freud Said--or Simon Says? Informed consent and the advancement of psychoanalysis as a science. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2006; 9:227-41. [PMID: 16850202 DOI: 10.1007/s11019-005-5513-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Is it ever permissible to publish a patient's confidences without permission? I investigate this question for the field of psychoanalysis. Whereas most medical fields adopted a 1995 recommendation for consent requirements, psychoanalysis continues to defend the traditional practice of nonconsensual publication. Both the hermeneutic and the scientific branches of the field justify the practice, arguing that it provides data needed to help future patients, and both branches advance generalizations and causal claims. However the hermeneutic branch embraces methods tending to undermine the reliability of such claims, while the scientific branch aims to improve the field's empirical base - in their words, to advance psychoanalysis as a science. The scientific branch therefore has the stronger claim to the traditional practice, and it their claim that I consider. An immediate concern arises. We seem unable to answer the applied ethical question without first determining which ethical theory is correct; for defenders of the practice appeal variously to therapeutic privilege, principlism, and utilitarianism, while opponents wage autonomy-based arguments. The concern turns out to be unfounded, however, because all of these ethical approaches fail to justify the traditional practice. The more promising defenses fail partly because even the scientific branch of the field lacks empirically sound methods for establishing its causal claims and generalizations, often appealing to authority instead. I conclude that it is currently unethical for analysts to continue publishing their patients' confidences without permission, and I suggest that the field help future patients by attending to its methodological problems.
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Affiliation(s)
- Hylarie Kochiras
- Philosophy Department, Caldwell Hall, University of North Carolina at Chapel Hill, CB #3125, Chapel Hill, NC 27599-3125, USA.
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Peebles-Kleiger MJ, Horwitz L, Kleiger JH, Waugaman RM. Psychological testing and analyzability: Breathing new life into an old issue. PSYCHOANALYTIC PSYCHOLOGY 2006. [DOI: 10.1037/0736-9735.23.3.504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Wallerstein RS. The relevance of Freud's psychoanalysis in the 21st century: Its science and its research. PSYCHOANALYTIC PSYCHOLOGY 2006. [DOI: 10.1037/0736-9735.23.2.302] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
OBJECTIVE To present a critique of the ideas of Karl Popper, the philosopher of science, whose depiction of psychoanalysis as a pseudoscience is often used to justify attacks on psychoanalysis. METHOD Published sources are used to provide a brief intellectual biography of Popper, a summary of his concept of science and a summary of criticisms of Popper's view of science. His depiction of psychoanalysis and Freud's reply are presented. Clinical, experimental and neurobiological research which refutes Popper's view is summarized. RESULTS There is a vast scholarly published work critical of Popper's falsifiability criterion of science. Less recognized is Popper's misunderstanding and misrepresentation of psychoanalysis; his argument against it is logically flawed and empirically false. Even if Popper's theory of science is accepted, there is considerable clinical, experimental and neurobiological research in psychoanalysis which meets Popper's criterion of science. CONCLUSION Attacks on psychoanalysis based on Popper's theory of science are ill-founded and reflect inadequate scholarship.
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Affiliation(s)
- Don C Grant
- St. Vincents Hospital Area Mental Health Service, Melbourne, Australia.
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Abstract
O presente trabalho examina as bases da pesquisa psicanalítica. Parte das marcas deixadas nas investigações psicanalíticas pelos procedimentos científicos de disciplinas como a neurologia e a neurofisiologia no século XIX. Em seguida, acompanha o surgimento de um novo objeto, o sujeito do inconsciente, o qual, ainda que requeira operações que mantenham o rigor e a precisão característicos do pensamento científico, implica formas de investigação mais apropriadas ao campo recém-constituído. Por fim, conclui que, ao contrário de emular os procedimentos das ciências naturais, a pesquisa em psicanálise tem de reconhecer a especificidade de seu objeto, pois este só se deixa circunscrever em análise, na qual analista e analisante estão implicados nas próprias produções inconscientes sob investigação. Essa é a particularidade da nova forma de saber que marca de modo indelével o pensamento do século XX em diante.
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Doidge N, Simon B, Brauer L, Grant DC, First M, Brunshaw J, Lancee WJ, Stevens A, Oldham JM, Mosher P. Psychoanalytic patients in the U.S., CANADA, and Australia: I. DSM-III-R disorders, indications, previous treatment, medications, and length of treatment. J Am Psychoanal Assoc 2002; 50:575-614. [PMID: 12206544 DOI: 10.1177/00030651020500021201] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To determine the demographics, DSM-III-R disorders diagnosed, indications used in recommending psychoanalysis, previous treatment histories, use of medication, and length of treatment in patients in psychoanalysis in the U.S., Canada, and Australia, a mail survey of practice was sent to every other active member of the American Psychoanalytic Association and every member of the Australian Psychoanalytical Society. This supplemented an earlier survey sent to all Ontario psychoanalysts. The response rates were 40.1 % (n = 342) for the U.S., 67.2% (n = 117) for Canada, and 73.9% (n = 51) for Australia. Respondents supplied data on 1,718 patients. The employment rate for patients increases as analysis progresses (p < .0001). The mean number of concurrent categories of disorders (Axis I, Axis II, and Disorders First Evident in Childhood) per patient at the start of treatment is 5.01 (SD = 3.66; median = 4; mode = 3). There are no statistically significant differences across countries. Mood, anxiety, sexual dysfunction, and personality disorders are most common. American Psychiatric Association / American Psychoanalytic Association peer review criteria for indicating psychoanalysis are followed for 86.5% of patients. Over 80% of patients in all three countries had undergone previous treatments prior to analysis. In the U.S., 18.2% of analysands are on concurrent psychoactive medication; in Australia, 9.6%. The mean length of analyses conducted in the U.S. is 5.7 years, in Australia 6.6, and in Canada 4.8. Psychoanalytic patients in all three countries have similar rates of DSM-III-R psychopathology, and many indications of chronicity.
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Affiliation(s)
- Norman Doidge
- Canadian Institute of Psychoanalysis, Toronto Branch, Ontario.
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La biologie et le futur de la psychanalyse : un nouveau cadre conceptuel de travail pour une psychiatrie revisitée. EVOLUTION PSYCHIATRIQUE 2002. [DOI: 10.1016/s0014-3855(02)00105-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Macmillan M. AUTHOR'S RESPONSE: The Reliability and Validity of Freud's Methods of Free Association and Interpretation. PSYCHOLOGICAL INQUIRY 2001. [DOI: 10.1207/s15327965pli1203_03] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Abstract
Two sorts of subjectivity problems are discussed. The 1st concerns the characterization of psychotherapy as an attempt to alter clients' meanings. The 2nd concerns the seemingly subjective nature of value judgments about psychotherapy outcomes. It is argued that despite initial appearances, neither of these problems poses an insuperable difficulty for transforming the discipline of psychotherapy into a genuine science.
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Affiliation(s)
- E Erwin
- Department of Philosophy, University of Miami, Coral Gables, FL 33214, USA.
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Corvin A, Fitzgerald M. Evidence-based medicine, psychoanalysis and psychotherapy. PSYCHOANALYTIC PSYCHOTHERAPY 2000. [DOI: 10.1080/02668730000700141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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MacKenzie KR, Leszcz M, Abbass A, Hollander Y, Kleinman I, Livesley J, Pinard G, Seeman MV. Guidelines for the psychotherapies in comprehensive psychiatric care: a discussion paper. Working Group 2 of the Canadian Psychiatric Association Psychotherapies Steering Committee. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 1999; 44 Suppl 1:4S-17S. [PMID: 10390651 DOI: 10.1177/07067437990440s102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- K R MacKenzie
- Department of Psychiatry, University of British Columbia, Vancouver.
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Kandel ER. Biology and the future of psychoanalysis: a new intellectual framework for psychiatry revisited. Am J Psychiatry 1999; 156:505-24. [PMID: 10200728 DOI: 10.1176/ajp.156.4.505] [Citation(s) in RCA: 94] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The American Journal of Psychiatry has received a number of letters in response to my earlier "Framework" article (1). Some of these are reprinted elsewhere in this issue, and I have answered them briefly there. However, one issue raised by some letters deserves a more detailed answer, and that relates to whether biology is at all relevant to psychoanalysis. To my mind, this issue is so central to the future of psychoanalysis that it cannot be addressed with a brief comment. I therefore have written this article in an attempt to outline the importance of biology for the future of psychoanalysis.
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Affiliation(s)
- E R Kandel
- Howard Hughes Medical Institute, Columbia University College of Physicians and Surgeons, New York, NY, USA
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Freedman N, Hoffenberg JD, Vorus N, Frosch A. The effectiveness of psychoanalytic psychotherapy: the role of treatment duration, frequency of sessions, and the therapeutic relationship. J Am Psychoanal Assoc 1999; 47:741-72. [PMID: 10586399 DOI: 10.1177/00030651990470031001] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This is an effectiveness study of treatment outcome that relies on patients' perception of their mental health during and after psychoanalytic psychotherapy. Ninety-nine outpatients attending the IPTAR Clinical Center (ICC) responded to the Effectiveness Questionnaire (EQ) adapted from that developed by Consumer Reports. Effectiveness is studied from various perspectives. Findings indicated (1) an incremental gain in effectiveness scores from six to over twenty-four months of therapy; (2) an incremental gain with greater session frequency from one to two or three weekly sessions; (3) facilitation of effectiveness by the experience of a positive relationship with the therapist; (4) an interplay between clinical syndrome and treatment conditions. A method giving clinical validity to the quantitative findings is described. Brief summaries of two recorded interviews reveal differential reconstruction of events that had occurred during treatment. The findings are discussed from the vantage point of two hypotheses: cognitive dissonance and internalization of therapeutic experience.
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Affiliation(s)
- N Freedman
- SUNY Health Science Center, Downstate, NY, USA
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Doidge N. Empirical evidence for the efficacy of psychoanalytic psychotherapies and psychoanalysis: An overview. PSYCHOANALYTIC INQUIRY 1997. [DOI: 10.1080/07351699709534161] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Fonagy P, Target M. Predictors of outcome in child psychoanalysis: a retrospective study of 763 cases at the Anna Freud Centre. J Am Psychoanal Assoc 1996; 44:27-77. [PMID: 8717478 DOI: 10.1177/000306519604400104] [Citation(s) in RCA: 118] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Under Anna Freud's guidance, the Anna Freud Centre developed a rigorous approach to the collection of child psychoanalytic data. Material contained in detailed diagnostic assessments and weekly written reports of 763 cases treated in intensive and nonintensive therapy has now been subjected to systematic study. This is the first, retrospective stage of a major investigation of child psychoanalytic outcome, carried out in collaboration with Yale University Child Study Center, New Haven, CT. The main findings of the work are reviewed. The study showed child analysis to be particularly effective for seriously disturbed children under 12 years suffering from a variety of psychiatric disorders, particularly those which involve anxiety.
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Marshall RD, Vaughan SC, MacKinnon RA, Mellman LA, Roose SP. Assessing outcome in psychoanalysis and long-term dynamic psychotherapy. THE JOURNAL OF THE AMERICAN ACADEMY OF PSYCHOANALYSIS 1996; 24:575-604. [PMID: 9220374 DOI: 10.1521/jaap.1.1996.24.4.575] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The efficacy of psychoanalysis and long-term psychotherapy remains a fundamentally unresolved issue for lack of methodologically sound studies. This article reviews the shortcomings of prior long-term treatment research, and presents a rationale and justification of the importance of more rigorous outcome studies. An emphasis on process research is premature when efficacy remains uncertain. The modern reconceptualization of psychotherapy in terms of hermeneutic theory is discussed in relation to the empirical model. Although historically the hermeneutic perspective has served to repudiate positivism, the hermeneutic and empirical (but not positivistic) approaches to understanding information actually share common priorities. The clearest of these is that the process is ultimately evaluated and validated by the produced effect. It is argued that the recasting of psychoanalytic technique and theory according to aesthetic and pragmatic principles is not inconsistent with contemporary outcome research paradigms so long as the professed treatment objective is clearly specified in verifiable terms. The specific methodologic problems involved in extending the successful short-term psychotherapy research model to psychoanalysis are discussed. An overview of the major components of the Columbia feasibility study currently underway is presented. Finally, a number of assessment domains-for which reliable and validated instruments exist-that are thought to be relevant to outcome are reviewed.
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Affiliation(s)
- R D Marshall
- Anxiety Disorders Clinic, New York State Psychiatric Institute (NYSPI), USA
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Mohl PC. What is a balanced program? ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 1995; 19:94-100. [PMID: 24442525 DOI: 10.1007/bf03341537] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
"Balance" has become the watchword of psychiatry programs. It seems that almost all residency training programs claim to be balanced. But what do we mean by this term? This article summarizes the author's evolving thinking about what makes for a balanced program and suggests that diversity may be a better term. The author advocates that balance is not as simple as teaching both psychodynamics and biological psychiatry. Instead, it entails a considered, intellectual approach that involves long-term vs. other psychotherapies, neuro-science vs. psychopharmacology, theoretical pharmacology vs. practical pharmacology, social psychiatry vs. treating minority patients, representing all viewpoints in psychiatry vs. integrating them.
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Affiliation(s)
- P C Mohl
- Department of Psychiatry, Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd., Dallas, TX, 75235-9070, USA
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Affiliation(s)
- E Harari
- Department of Psychiatry, St Vincent's Hospital, Fitzroy, Victoria
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Abstract
OBJECTIVE This paper describes a chart review of 763 cases of child psychoanalysis and psychotherapy at the Anna Freud Centre, and illustrates its usefulness by examining predictors of treatment outcome in children with disruptive disorders. METHOD 135 children and adolescents with a principal diagnosis of disruptive disorder were individually matched with others suffering from emotional disorders. Outcome was indicated by diagnostic change and change in overall adaptation (clinically significant improvement or return to normal functioning). RESULTS Improvement rates were significantly higher for the emotional than for the disruptive group. Within the disruptive group, significant improvement was more frequent among children with oppositional defiant disorder (56%) than those with attention deficit hyperactivity disorder (36%) or conduct disorder (23%). However, 31% of the children terminated treatment within 1 year. Of those disruptive children who remained in treatment more than 1 year, 69% were no longer diagnosable on termination. Fifty-eight percent of the variance in outcome ratings could be accounted for within this group. The crucial variables in predicting attrition and symptomatic improvement were found to be quite different in the disruptive and emotional groups. CONCLUSION Although the study has several methodological limitations, it does suggest demographic, clinical, and diagnostic characteristics of those disruptive children most likely to benefit from intensive and nonintensive psychodynamic treatment.
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Affiliation(s)
- P Fonagy
- Freud Memorial Professor of Psychoanalysis, University College London, U.K
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Allison GH. On the homogenization of psychoanalysis and psychoanalytic psychotherapy: a review of some of the issues. J Am Psychoanal Assoc 1994; 42:341-62. [PMID: 8040546 DOI: 10.1177/000306519404200201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Concepts of the psychoanalytic process and of the various modes of therapeutic action are allied to the similarities and differences between psychoanalysis and psychoanalytic psychotherapy. Lack of clarity about these concepts calls for a concerted effort toward outcome studies that can provide a scientific basis for and elucidate the relation of process and mode of therapeutic action to efficacy. Clinical concepts such as the development and resolution of transference or of a transference neurosis can then be compared scientifically with others which emphasize the interactive models. The thesis is held that the development of a psychoanalytic process typically requires thorough immersion through frequent sessions which permits greater resolution of the transference or transference neurosis, with insight and greater opportunity for the achievement of autonomy. Other modes of therapeutic action also play into the process as in psychotherapy, but the interpretive mode with progressive insight distinguishes psychoanalysis proper.
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