The Revenge of Freud?

Therapy wars: The Revenge of Freud

Shedler’s subsequent research and writing has played a significant role in undermining the received wisdom that there’s no hard evidence for psychoanalysis. But it’s undeniable that the early psychoanalysts were sniffy about research: they were prone to viewing themselves as embattled practitioners of a subversive art that needed nurturing in specialist institutions – which in practice meant forming cliquish private bodies, and rarely interacting with university experimenters. Research into cognitive approaches thus got a big head start – and it was the 1990s before empirical studies of psychoanalytic techniques began hinting that the cognitive consensus might be flawed. In 2004, a meta-analysis concluded that short-term psychoanalytic approaches were at least as good as other routes for many ailments, leaving recipients better off than 92% of all patients prior to therapy. In 2006, a study tracking approximately 1,400 people suffering from depression, anxiety and related conditions ruled in favour of short-term psychodynamic therapy, too. And a 2008 study into borderline personality disorder concluded that only 13% of psychodynamic patients still had the diagnosis five years after the end of treatment, compared with 87% of the others.

These studies haven’t always compared analytic therapies with cognitive ones; the comparison is often with “treatment as usual”, a phrase that covers a multitude of sins. But again and again, as Shedler has argued, the starkest differences between the two emerge some time after therapy has finished. Ask how people are doing as soon as their treatment ends, and CBT looks convincing. Return months or years later, though, and the benefits have often faded, while the effects of psychoanalytic therapies remain, or have even increased – suggesting that they may restructure the personality in a lasting way, rather than simply helping people manage their moods. In the NHS study conducted at the Tavistock clinic last year, chronically depressed patients receiving psychoanalytic therapy stood a 40% better chance of going into partial remission, during every six-month period of the research, than those receiving other treatments.

Alongside this growing body of evidence, scholars have begun to ask pointed questions about the studies that first fuelled CBT’s ascendancy. In a provocative 2004 paper, the Atlanta-based psychologist Drew Westen and his colleagues showed how researchers – motivated by the desire for an experiment with clearly interpretable results – had often excluded up to two-thirds of potential participants, typically because they had multiple psychological problems. The practice is understandable: when a patient has more than one problem, it’s harder to untangle the lines of cause and effect. But it may mean that the people who do get studied are extremely atypical. In real life, our psychological problems are intricately embedded in our personalities. The issue you bring to therapy (depression, say) may not be the one that emerges after several sessions (for example, the need to come to terms with a sexual orientation you fear your family won’t accept). Moreover, some studies have sometimes seemed to unfairly stack the deck, as when CBT has been compared with “psychodynamic therapy” delivered by graduate students who’d received only a few days’ cursory training in it, from other students.

Pretty surprising. Good find.

Just posted a potential counterpoint to this thread's article:

https://psiencequest.net/forums/thread-t...m-are-real