Psychoanalytic Treatment: An Evidence-Based Psychotherapy

The psychotherapeutic component of our work at the Mind-Body Clinic draws from various traditions and techniques – from mindfulness-based approaches, to biofeedback, to EMDR. But the underlying framework that informs what we do is psychoanalytic psychology. There is much debate both within and outside the world of psychoanalysis about what the defining features of this school of thought are. From our perspective, they include, at minimum, attention to the unconscious register of human experience. This means not only looking at those aspects of our inner and relational lives that we are unaware of, but also and more importantly, understanding those things that we don’t want to know, the reasons why we don’t want to know them, and, crucially, how we keep ourselves blinded.

What we prevent ourselves from fully knowing are not just facts of our biographies or the thoughts we’d rather not have, but also emotions we don’t want to experience – feelings we don’t want to name because we imagine that doing so would make them unbearably real.

While psychoanalytic therapy is most concerned with the here-and-now experience of the patient in the consulting room, that experience is deeply shaped by his or her life history – in childhood, in adulthood, by major life transitions, by the inevitable losses that accompany being alive for very long, and, for some people, by trauma. The Danish philosopher Kierkegaard once observed, “Life is lived forwards, and understood backwards.” Psychoanalytic therapy aims to reduce that lag time.

Because the self knowledge gained in psychoanalytic treatment is not simply intellectual but profoundly emotional, it has the potential to change how people live – to interrupt self-defeating patterns of behavior in work, love, and creative pursuits, to forsake our investment in unhealthy activities and relationships, and ultimately to transform a life of sleep walking into one driven by vitality, pleasure, and focus.

This description may come as a surprise to those whose only exposure to psychoanalytic treatment has been through New Yorker cartoons and bad sit-coms, in which analysts are portrayed as emotionally constipated relics of a bygone era, or worse -- incompetent purveyors of useless psychobabble clichés. One of the erroneous assumptions held by many non-psychoanalytic therapists, as well as a significant segment of the public, is that there is little if any scientific support for the effectiveness of psychoanalytic psychotherapy.

As a member of a research team at the University of California at Berkeley that studied the efficacy of different psychotherapeutic approaches to depression, I know this to be completely untrue. However, it wasn’t until a few years ago that an exhaustively thorough review of the research on the effectiveness of psychoanalytic psychotherapy appeared in a mainstream journal, The American Psychologist . Its publication was perhaps most significant in bringing the impressive body of supportive empirical literature to the attention of non-psychoanalytic clinicians. This article by Dr. Jonathan Shedler is so important that I wanted to share it with a readership, like those of you visiting this site, that is unlikely to subscribe to the generally dry journals of professional psychology.

Recently, Dr. John Thor Cornelius, a fellow alumnus of the Psychoanalytic Institute of Northern California, and an instructor in the Department of Psychiatry at the University of California Davis, recorded this very compelling lecture on the large body of psychotherapy effectiveness research. In his talk he compares the efficacy data on medication, cognitive behavioral therapy (CBT), and psychoanalytic treatments. He does not address the often debilitating and sometimes enduring side effects of psychiatric drugs because that is not the focus of his lecture. (See Robert Whitaker's book, Anatomy of an Epidemic , for a thorough discussion of that issue.)

However, the evidence he marshals shows that not only are psychoanalytic approaches as effective as the other two modalities of treatment, but also that it is the only form of mental health therapy that significantly reduces the rate of symptom relapse over the long term. And, an even more impressive finding of these studies is that the majority of patients who have undergone psychoanalytic treatments, unlike those who have received medication or CBT continue to improve years after stopping the therapy. In addition, after about 4 months or so of improvement a majority of patients who remained on psychiatric drugs lost much of the benefit they had achieved earlier.

Dr. Ducat

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