Why is psychoanlaysis still around?

February 3, 2008 7:22 PM

Freud and his followers have been thoroughly discredited for quite a while now. Our scientific understanding of the brain has grown by leaps and bounds since their heyday, and we now have treatment methods that are cheaper, quicker, and more effective than anything psychoanalysis had to offer. So why is psychoanalysis still practiced?

Paraphrasing Peter Watson, when all is said and done, it's hard to avoid the conclusion that Freud, et al. simply "made everything up." So why are there still practicing psychoanalysts, many of whom hold academic positions on the medical faculties at places like Columbia and Yale? Why are there still psychoanalytic training institutes? And above all, why do people continue to subject themselves to psychoanalysis, in light of the fact that it's expensive, time-consuming, and ineffective?

I'm just curious how this pseudo-science has managed to stick around for so long when everything I know about it seems to indicate that it should be about as commonly practiced as alchemy these days. I realize that it's not exactly thriving, but I find its continuing presence in the major cities, among the intelligentsia, and it's refusal to completely disappear from psychiatry a bit strange.

Can anyone who knows more about it and the present state of psychiatry and psychology help me out here?

posted by decoherence to science & nature (41 answers total)

There are plenty of people who would disagree with your basic premise here. Neuroscience has certainly grown by great leaps but there is an awful lot of inner brain cognition that remains pretty occluded, and certainly there are many people who benefit from talk therapy type help. Not sure if calling it a pseudo-science is going to get you meaningful answers as it is awfully pejorative.

Your question is a bit broad and seems to be a set up for a discussion rather than an answer, which generally isn't the best use of an AskMe.
posted by edgeways at 7:34 PM on February 3, 2008

(and are you referring to Peter Watson the historian? If so, how does that credential allow him to be an authority on psychology?)
posted by edgeways at 7:35 PM on February 3, 2008

Considering that mainstream knowledge about psychology is littered with Freudian concepts, including ego, influence of the unconscious mind on one's actions, Oedipus complex, defense mechanisms, and dream analysis, I wouldn't exactly call it pseudo-science. You could call it outdated however.

Psychoanalysis as a field is pretty uncommon for someone to study now, but perhaps it is because many current psychological concepts have roots in psychoanalysis that it is slow to die out as a field entirely. Maybe it'll be like alchemy in a century.
posted by fan_of_all_things_small at 7:42 PM on February 3, 2008

Your assumptions here are pretty wrong. Neuroscience isnt therapy. Describing action on the cellular level isnt the same as helping someone cope with grief. It turns out that talk therapy does work even if its founder and popularizer's theories on why it works don't hold up. Its like how Pythagoras was a pretty crazy cult leader in his time. Turns out he was right about a few things.
posted by damn dirty ape at 7:44 PM on February 3, 2008 [1 favorite]

Mark,

I probably should've made it clearer -- part of what I'm wondering about is just to what extent psychoanalysis *is* a pseudo-science. Everything I've seen says the consensus is that it's largely unfounded and has been supplanted by other theories and methods. If this is the case then, why is it still around? I feel like there must be something in it, or else it would've disappeared by now. I'm wondering what that something is. Something's not squaring between what I understand the popular consensus to be and what I see educated people, many with MD's, still espousing.
posted by decoherence at 7:51 PM on February 3, 2008

Inertia.
posted by ibmcginty at 7:52 PM on February 3, 2008 [2 favorites]

I'm wondering to what extent you might be conflating Freudian psychoanalysis with other kinds of talking cures & therapies.

As far as I know (and I'm mainly guessing) Freudian psychoanalysis is pretty much extinct, but there are all kinds of other psychiatric techniques that laymen commonly refer to as "psychoanalysis".
posted by UbuRoivas at 7:59 PM on February 3, 2008 [1 favorite]

Inertia is normally the result of holding on to an oral or anal fixation, btw, but castration anxiety shouldn't be ruled out as a possible cause.
posted by UbuRoivas at 8:02 PM on February 3, 2008 [2 favorites]

You should check out this paper:

Smith, M.L. and Glass, G.V. (1977). Meta-analysis of psychotherapy outcome studies. American Psychologist, 32, 752-760.

In a nutshell, all forms of talk therapy (psychoanalysis, CBT, etc) have roughly the same effectiveness, regardless of theoretical basis.
posted by nasreddin at 8:05 PM on February 3, 2008 [2 favorites]

You have an incomplete (at best) understanding of the state of outcome research in psychotherapy. If you're interested, you should read Bruce Wampold (The Great Psychotherapy Debate) or Michael Lambert. Both demonstrate that, in fact, in addition to psychotherapy working very well (an average effect size of 0.80) it also works through non-specific means. What this means in practice is that all forms of psychotherapy (including psychoanalysis) work about equally well. There are, indeed, some differences in what and how things are addressed in different treatment modalities, but those differences are often precisely what draws some people to different forms of therapy. Some people may find that a model that privileges conscious thoughts makes the most sense for them, others may find that one that focuses on childhood experiences and fantasy works best for them. Since they both work the same, and we don't live in a society where treatment decisions are mandated by fiat, people are free to make their own choice about how to spend their time and money.

So, as a treatment, you're incorrect. Psychoanalysis works, as do most psychotherapies, quite well at relieving patient distress. The question of the precisely Freudian model of the mind is a more nuanced one, but there, too, I think you're mis-informed. If one takes the Freudian model as a precise description, then it's bound to fail. However, there is plenty of evidence from neuroscience that the broad outlines are not so far off. We know, for instance, that most of the mind's activities take place below the level of consciousness. We know memory functions associatively, we know that feelings and memories and body states are all linked. Those are all Freudian notions, too. I always find it interesting that no one suggests that CBT should be abandoned because the model of the mind it proposes is somehow bankrupt, and yet, at the same time, no one is willing to argue that CBT works because it accurately describe how the mind works. This is because both CBT and psychoanalysis are primarily treatments, and their usefulness is predicated on how well they accord with how people experience their mental lives. The fact is that many many people find the concepts advanced by psychoanalysis to be persuasive.

You also appear to be operating under a mis-perception about the state of current knowledge about mental illness in general, and in psychiatry. There are currently no physiological tests for mental illness, and the medicalized treatments that we have for mental illnesses are not really all that much better than placebos in many many cases. That's when we can get people to take the meds in the face of crushing side-effects. The notion that mental illness or distress is biological in origin is just a notion, not currently borne out by the research, and the consistently confirmed effectiveness of psychotherapy suggests that a medical model is probably a poor way to conceive of these illnesses. That there is an ongoing debate about the causes and proper treatments for mental disorders is completely consistent with the state of the science, despite what advertisements from pharmaceutical companies would lead one to believe.

This recent FPP has a bunch of links from both sides of the issue, although on the question of the state of the science you might be most interested in the second link of the FPP on the problems with the serotonin hypothesis.
posted by OmieWise at 8:06 PM on February 3, 2008 [30 favorites]

UbuRoivas,

I'm talking about psychoanalysis, as distinct from psychotherapy in general -- the sort of thing practiced and taught at places like the Columbia Center for Psychoanalytic Training and Research, the NYU Psychoanalytic Institute (both affiliated with the medical schools), and the Chicago Institute for Psychoanalysis. One of the curious things is that psychoanalysis today only seems to have any kind of presence in a handful of major American cities. I don't think they're still hung on on Freud at these places, but the stuff they're practicing (as I understand it) is a direct continuation of the tradition founded by him.
posted by decoherence at 8:08 PM on February 3, 2008

decoherence: that's ok; i was just wondering, for the purposes of clarifying the question.
posted by UbuRoivas at 8:18 PM on February 3, 2008

So why is psychoanalysis still practiced?

Because it works?
posted by jdroth at 8:19 PM on February 3, 2008

The psychology you speak of is generally meant in the context of experiments, objectively read results, and identifiable evidence, yes? Because you seem to have disregarded a large amount of people who seem to have found "talking therapies" effective. Psychoanalysis (obviously) places a large emphasis on the subjective experience. So yes, science wouldn't particularly have a use for it, since subjective experiences usually don't apply to people at large.

When you say "cheaper, quicker, and more effective", I generally assume you mean pills. There are many people who distrust psychiatric medication, for obvious reasons, so I don't think medication has necessarily proved itself to be more effective. How can it be, if you refuse to take it? They may be convinced that medication takes away their identity, smothers their behavior, or alters their moods in a way they can't predict and don't like...These people are skeptical of medication, and may be only slightly less skeptical of therapy. Or at least enough to try it out.

Think of psychoanalysis as the Latin of disciplines. It's pretty much extinct, but it informs the roots of many other fields. Many people who have a background in psychoanalytic theory actually do so for other reasons -- to apply to literary analysis, postmodern criticism (another field that is generally disregarded by science), Continental philosophy, etc. And there are very few schools of thought in psychology that haven't been touched by it, even though they wouldn't exactly call themselves "psychoanalysts".

Discrediting Freud for a lot of practicing therapists or would sort of be like telling evolutionary biologists Darwin got his basic stuff wrong.
posted by twins named Lugubrious and Salubrious at 8:21 PM on February 3, 2008 [1 favorite]

As far as I know (and I'm mainly guessing) Freudian psychoanalysis is pretty much extinct,

Not really. While the discipline has obviously developed since Freud, his model, particularly the relationship between the id, ego, and superego is still useful in an analytical setting, as are others. Furthermore, a number of later analysts used this model as the basis for their own theories.

Psychoanalysis isn't a science, nor does it purport to be. The purpose of psychoanalytic therapy is to teach the patient to recognize their own psychological patterns and to intervene on their own behalf in the moment to move beyond their problems. It's still around, because for some people, it works. In Freudian analysis, the analyst does virtually no talking, no prompting. The patient is supposed to speak, and in the process of speaking reveals their internal patterns. The analyst is trained to recognize patterns in the patients presentation (e.g. overwhelming focus on one parent, or one stage of life, in ability to articulate the viewpoint of others, etc). and over time, they gently push in one direction or another, eventually fencing in the patients own dialogue until it becomes obvious to the patient what they are doing. Freud is a component of this, but so are others. You choose the theoretical model which best suits the patient in front of you, but Freud generally is still a valid model.


What survives of Freud is his model in the abstract. Oedipal complex does not literally mean the child wants to have sex with his mother and kill his father, but instead means that the child is not yet aware that mother is different from them, and assumes that their affection for her is mutual, and all others, including father but not exclusively, are perceived as a threat. (anyone with more than one young child can attest to children becoming jealous of mom's affection towards another).

The problem with neuroscience is that it can't completely explain the physical basis for though propagation and memory on the macro level, let alone how behavior develops, or how emotional development can become stunted. I hate this analogy, but neuroscience is like a 19th century scientist trying to figure out how a desktop computer operates. The psychologist/psychoanalyst watches what the computer is doing, and over time notices patterns and tries to define or categorize what can influence them. (though I hate the computer-brain analogy).

And the reason psychoanalysis is not studied is because it takes a long time. Psychiatrists become psychiatrists by going to medical school, where they study no psychology, and then going through a residency for a few years where they get a bit of psychology and a lot of on the job training writing scripts.

Psychoanalysis requires a Ph.D in psychology, and years of clinical training. Here's an example of a curriculum at GWU.
posted by Pastabagel at 8:34 PM on February 3, 2008 [2 favorites]

I should probably clarify. I'm not skeptical of "talking therapies" in general, nor do I believe that all mental disorders are necessarily biological in origin (I know that the "chemical imbalance theory" is just that). I recognize that much of the effectiveness of therapy is probably due to the therapist/patient relationship, more than any particular modality.

But what I find especially strange about psychoanalysis is all the extra metaphysical baggage that comes with it. Dip into a psychoanalytic journal and read something by a Lacanian psychoanalyst, and the whole thing is largely indecipherable, appearing closer to something written by Heidegger than by a straight-talking scientist or therapist. Contrast this with the literature on CBT, which seems much more direct and practical-minded.

Even if the various approaches are equally effectiveness, why would anyone prefer one with such an elaborate and seemingly groundless metaphysical framework? Or is this framework actually as groundless as I've been led to believe?
posted by decoherence at 8:37 PM on February 3, 2008

He did make everything up. But one of the things that he made up is at the foundation of psychology--the idea that everything we do isn't just the logical outcome of conscious thought processes.

That's a pretty big thing. So I think that his techniques for trying to divine out what it is that is driving certain behaviors still have some value. His theory of mind has been thoroughly discredited now and I think few practitioners still use it unadultrated.
posted by Ironmouth at 9:20 PM on February 3, 2008

"I recognize that much of the effectiveness of therapy is probably due to the therapist/patient relationship, more than any particular modality."

So then why are you asking? You just acknowledged that it works. That therapist was trained, pure and simple. Maybe the terms have changed, but that therapist learned psychoanalysis as part of their training. They did so because it often solves the patient's problems.

There's a lot of stuff here I don't feel like wading through, but it seems to me that you are attempting to associate psychology with psychiatry. Though they often work well together, they are not the same thing or interchangable. In my own mental health experience, I have dealt with both psychologists who recommend psychiatric treatment, and psychiatrists that recommend psychological treatment.
posted by lester's sock puppet at 9:23 PM on February 3, 2008

Even if the various approaches are equally effectiveness, why would anyone prefer one with such an elaborate and seemingly groundless metaphysical framework?


It's no more groundless that anyone that claims to know how the mind exactly works, it's just a model. Part of the draw is tradition, it's the oldest of psychology therapy methods and has the largest amount of history / casework / research.

Or is this framework actually as groundless as I've been led to believe?

No one is really a straight Freudian anymore, the framework has been in development for the century. There is some evidence that neuroscience and the Freudian framework do line up very well, some might think that they line up well enough for integration. Of course people hate Freud, and some love him. So people are going to argue about it forever. One of the main researchers looking at Freudian thought afresh is Solms.
posted by bigmusic at 9:29 PM on February 3, 2008 [1 favorite]

Oh and for most people in France therapy IS psychoanalysis.
posted by bigmusic at 9:41 PM on February 3, 2008

What is there about Freud's vision that has made his monumental work a limiting factor rather than a scaffolding on which others can stand? Put less metaphorically, why has psychoanalysis not become a cumulative discipline? I believe the answer to this question will tell us something about where psychoanalysis will survive. The answer which I think all of you who have reached the hermeneutic cross-roads know, is that psychoanalysis, both as a theory and as a practice, is an art form that belongs to the humanities and not to the sciences. It is closer to literature than to science and therefore although it may be a hermeneutic discipline as Schafer says it is not a cumulative discipline.

From a Keynote Address by Alan A. Stone, M.D.
to the American Academy of Psychoanalysis
December 9, 1995
posted by vacapinta at 10:00 PM on February 3, 2008 [3 favorites]

..and later in the address:

I certainly have not given up on psychotherapy but my focus is almost entirely on the here and now, on problem solving, and on helping patients find new strategies and new ways of interacting with the important people in their lives. I still believe that a traditional psychoanalytic experience is the best way to explore the mysterious otherness of one's self. But I do not think psychoanalysis is an adequate form of treatment. There is certainly no reason for psychoanalysts to withhold medication from their patients. If I can call on Freud after criticizing him so harshly as a moral authority. I would suggest that he would have welcomed Prozac, Ativan, and all the rest. Despite his disclaimer, he himself tried to find such substances that would relieve human suffering.
posted by vacapinta at 10:03 PM on February 3, 2008 [2 favorites]

It is closer to literature than to science and therefore although it may be a hermeneutic discipline as Schafer says it is not a cumulative discipline.

vacapinta, fantastic quote; thanks for posting that link.
posted by fan_of_all_things_small at 10:12 PM on February 3, 2008

I saw this question and that old article came to mind. The reason is that it sparked a lot of controversy. It was published in Harvard Magazine, Harvard's alum mag. The following issue was packed with an extended letters to the editor. They appear to be online as well.:

"...As co-editors of the Journal of Clinical Psychoanalysis and as psychoanalytic practitioners for 30 years, we dispute the assertions that psychoanalysis is a failure as science and useless as therapy. Stone presents his case in the one-sided fashion of a lawyer: he just omits evidence to the contrary. Readers who wish a more balanced appraisal of psychoanalysis will find it in "Why Freud Isn't Dead," in the December 1996 Scientific American..."

and so on...
posted by vacapinta at 10:24 PM on February 3, 2008

One of the curious things is that psychoanalysis today only seems to have any kind of presence in a handful of major American cities.

It's quite popular in Argentina.
posted by iviken at 11:28 PM on February 3, 2008

Even if the various approaches are equally effectiveness, why would anyone prefer one with such an elaborate and seemingly groundless metaphysical framework? Or is this framework actually as groundless as I've been led to believe?

Well, as several of the other answers here have pointed out, it isn't quite as groundless as all that. Not only does it work, a fundamental pragmatic indication of groundedness, it also isn't as divorced from current neuro-science understandings of the mind as you seem to think that it is.

But if your question really is "why choose psychoanalysis?" the answer is that many people find its description of mental life to be compelling. This shouldn't be a surprise, surely it's obvious to any intelligent observer that the Freudian model of mental life is the dominant explanation of its kind in American (and probably Western) culture at the moment. Not everyone may identify their version of how individual history affects life and how unconscious processes influence our choices and actions as Freudian, but it certainly is rooted in the ideas that Freud worked hard to popularize.
posted by OmieWise at 4:40 AM on February 4, 2008

As I understand it, Freud pioneered the idea of the unconscious, or, that we all have an inner psychic life (thoughts, feelings, memories, emotion) that lays beneath the surface of what we access regularly and on a daily basis. The idea is that with some thought, some talking and someone guiding you through the process, we can access these motivations and thoughts and feelings and make some sense of them.

This is the basic premise for psychoanalysis and has in no way been discredited. Yes, much of Freud's other "findings" were best guesses that were often, well, pretty ridiculous and later given up for dead/stupid. However, if you throw a bunch of stuff at a wall some of it is going to stick. The idea of the unconscious has stuck.
posted by sneakin at 4:51 AM on February 4, 2008

This is kind of a nutshell answer, and even though I am rather strongly anti-Freudian it needs saying.

What Freud and his followers (and fellow thinkers of his era about mind) produced was *actually* a very good theory of "culture" and not "mind" per se. Freud's was an especially good account of the psychodynamics of Western cultural norms, in fact. (It's all about the repression.)

So Freudian theory lives on, big time, in sociological disciplines (esp. as mediated through the feminist and post-structuralist critiques) like anthropology. It tells us little about the brain. But a whole lot about how brains get filled with crazy ideas.
posted by fourcheesemac at 6:12 AM on February 4, 2008 [1 favorite]

Including, btw, Freudian ideas becoming the dominant cultural metaphors for the mind in the West.
posted by fourcheesemac at 6:13 AM on February 4, 2008

... thoroughly discredited ?

It may come as a surprise to you that the heliocentric model of the solar system was around in the days of Archimedes, long before Copernicus. Some ancient someone made the observations and explained planetary motions in a fashion that made more sense than perhaps, planets mounted on individual glass globes with earth as their center. Have you any appreciation of what an accomplishment that was in the absence of things you take for granted, such as zero and positional notation for representation of numbers, let alone pocket calculators?

Freud, similarly, moved the comprehension of the mind from a similar state of ignorance toward one which embraced an analytic approach... one which attempted to explain our self-modifying brains and the consciousness they enable in terms other than evil spirirts and/or the sins of our ancestors.

Darwin, Einstein, Crick and Watson, Newton, Freud ALL qualify as nearly inhuman in their accomplishments. They didn't have the comfortable security of being critics; they were orginators.

Just because one can use Prozac to defer depression doesn't mean it's a perfect replacement for techniques that can permanently modify the offending organ. Hell, we don't even know HOW some of the prescription drugs we use even WORK!

No one understands the mind, and perhaps, no one will. "If the mind were simple enough to understand, we'd be too simple to understand it" is a quote that immediately comes to mind. Freud may have had some aspects of his model discarded by superior and or more elegant descriptions, but 'thoroughly discredited'? Please have some respect for your betters!
posted by FauxScot at 6:33 AM on February 4, 2008 [1 favorite]

I don't think the evidence in favour of psychoanalysis is nearly as good as omiewise suggests. From Cochrane:

Over the past 40 years, short-term psychodynamic psychotherapies (STPP) for a broad range of psychological and somatic disorders have been developed and studied. Four published meta-analyses of STPP, using different methods and samples, have found conflicting results.

23 studies of 1431 randomised patients with common mental disorders were included. These studies evaluated STPP for general, somatic, anxiety, and depressive symptom reduction, as well as social adjustment. Outcomes for most categories of disorder suggested significantly greater improvement in the treatment versus the control groups, which were generally maintained in medium and long term follow-up. However, only a small number of studies contributed data for each category of disorder, there was significant heterogeneity between studies, and results were not always maintained in sensitivity analyses.

Authors' conclusions
STPP shows promise, with modest to moderate, often sustained gains for a variety of patients. However, given the limited data and heterogeneity between studies, these findings should be interpreted with caution. Furthermore, variability in treatment delivery and treatment quality may limit the reliability of estimates of effect for STPP. Larger studies of higher quality and with specific diagnoses are warranted.

The evidence for efficacy for the kind of therapy that let's you "find yourself", or "work through issues", as is frequently suggested in AskMe, is completely lacking. As an additional caveat it is impossible to conduct a genuine double blind trial of psychotherapy in any context.

As pastabagel points out "psychoanalysis requires a Ph.D in psychology, and years of clinical training", and that heavy educational investment by analysts in a limited therapeutic modality, may contribute to the fact that we still don't have really credible evidence, almost 70 years after Freud's death.
posted by roofus at 7:00 AM on February 4, 2008

Quite a few research psychologists don't really regard clinical psychologists as scientists either. Make of that what you will.
posted by electroboy at 7:19 AM on February 4, 2008

But what I find especially strange about psychoanalysis is all the extra metaphysical baggage that comes with it. Dip into a psychoanalytic journal and read something by a Lacanian psychoanalyst, and the whole thing is largely indecipherable, appearing closer to something written by Heidegger than by a straight-talking scientist or therapist. Contrast this with the literature on CBT, which seems much more direct and practical-minded.

I think part of the problem you are having understanding Freud's continued influence is that in the 20th century Freudian thought took two different routes. One, as Fourcheesemac pointed out upthread, was that Freudian analysis was used as a tool for cultural critique, largely by people doing "continental" philosophy and later feminists and post-structuralists. This is were a lot of the stuff comes from that looks like it was "written by Heidegger."

The other path it took was as a clinical tool for treating people. Modern day psychoanalysts are more practically minded than the cultural critics and have largely abandoned Freud's ridiculous theories of sexual repression. See the "Current" section of the wikipedia article on Psychodynamics. Personally, I think a lot of psychodynamics is bullshit, but it works as well as other talking therapies for most cases, (there are some glaring exceptions, the psychodynamic treatment for autism was an ugly regime of blaming the mother, for example). At least it is interesting bullshit, while a lot of Freud's theories were more or less obvious bullshit.

Also Freud introduced the idea that there is a difference between the conscious and unconscious mind. Which is accepted dogmatically by almost everyone, (as seen in this thread), even though there is no coherent theory of how to separate higher brain functions in to strict conscious and unconscious categories.
posted by afu at 7:35 AM on February 4, 2008

Even if the various approaches are equally effectiveness, why would anyone prefer one with such an elaborate and seemingly groundless metaphysical framework?

The fact that different approaches are equally effective overall does not mean they are equally effective for a particular individual.
posted by DevilsAdvocate at 8:00 AM on February 4, 2008

We're going to have a very old argument here in a moment. We could cut to the chase.

It is perfectly possible for some -- many -- people to experience and claim a significant psychological benefit from psychoanalytic treatment, and for that benefit to be unmeasurable in a clinical trial setting. Mental illness (let alone ordinary neurosis) is a very complex phenomenon, with individual and cultural as well as neurobiological dimensions. The problem is that if you can't prove something "works" better than something else for some specific set of symptoms, you can't get it paid for in a rationing economy of scarce medical resources, which is what we've got. It certainly can't *hurt* in most cases to talk to a professional therapist every day if you are mentally ill, as long as you are also getting your meds. But psychoanalysis is not just designed for mentally ill people, or even primarily for them. It is a distinctively cultural discourse, and its cultural context is shifting and fading fast.

I'm a non-believer, just to be clear, in the therapeutic use of analysis. But it doesn't offend me the way dangerous quackery does. Just don't ask me to pay for it.

As a body of ethnotheory about the western mind the psychoanalytic literature is an extraordinary resource for anthropologists, just saying.
posted by fourcheesemac at 8:37 AM on February 4, 2008

This isn't a question. It's a bunch of dubious assertions with a half-assed "change my mind about it if you dare" appended to it.

Psychoanalytic theory has assisted me to help hundreds of patients, and to understand the problems plaguing hundreds more patients whom I wasn't able to help very much at all. The idea that psychoanalytic theory is somehow worthless, bankrupt, irrelevant, or proven useless is a foolish idea without any basis.
posted by ikkyu2 at 11:54 PM on February 4, 2008

Sorry, I meant to get back to this, but was too busy over the past couple of days.

The evidence for the effectiveness of psychotherapy is, in fact, quite well established. As cited in Wampold's book: Meta-analysis by Lipsey & Wilson 1993 mean effect size for 13 metaanlyses=0.81; 1994 Lambert & Bergin after reviewing 25 meta-analyses concluded "the average effect associated with psychological treatment approaches one standard deviation [!!!]; Grissom 1996 reviewed 68 meta-analyses and found an aggregate effect size of 0.75; Smith & Glass 1977 average effect size of 0.68. All of those are measures of absolute efficacy.

Relative efficacy studies show that all treatments are about the same. Both Wampold et al from 1997 and Grissom from 1996 determined an upper-bound on the effect size of differences in treatment at 0.20. "an effect size of 0.20 indicates that only 1% of variance in outcomes is due to treatments." (Wampold, 2001, 96) The null hypothesis for psychological treatments is clearly that they all work about equally well. This includes psychoanalysis.

It's true that there are no true placebo controls possible with psychotherapy studies, because, surprise of surprises, talk therapy involves (at least) two people talking to each other. While no specific treatment modality is better than others, it has been demonstrated that therapists who have allegiance to a treatment modality do better with patients than those who do not. Furthermore, there's no doubt that a large part of what makes therapy effective is the placebo effect, or hope for change. This same effect operates in medicine all the time. Anyone who understands it understands that "placebo effect" IS NOT another way of saying "nothing happened." Reputable psychotherapy trials are done using non-treatment control groups of matched patients wanting care (those on a waitlist, say).

Wampold 2001 The Great Psychotherapy Debate

Wampold et al 1997 Psychological Bulletin 122, 203-215

Grissom 1996 Journal of Consulting and Clinical Psychology 64, 973-982

Lambert 1992 in Handbook of psychotherapy integration

Lambert & Bergin 1994 in Hdbk of psychotherapy and behavior change

Smith & Glass 1977 American Psychologist 32, 752-760

Smith et al 1980 The Benefits of Psychotherapy

Anyone who gives a shit can email me for more complete references.

Also, what ikkyu2 said.
posted by OmieWise at 5:50 AM on February 5, 2008

ikkyu2, I'd love to hear more about your experience using psychoanalysis, if you're still following this thread and are able to.
posted by ibmcginty at 11:35 AM on February 10, 2008

I don't use or practice psychoanalysis. I have just read a lot of psychoanalytic works. The book that I found most helpful in daily practice was Menninger's Man Against Himself, but I have read most of the classics: both Freuds, Jung, Erich Fromm, Piaget, Erik Erikson, Adler were all authors I gained by reading. Gail Sheehy's Passages. Lacan, Foucault and Barthes all have something to say about psychoanalysis and I have read what they have to say, though with varying degrees of comprehension. Dale Carnegie and Stephen Covey, to my mind, both find their roots in the analytic tradition. And of course the incomparable Vaillant and his Adaptation to Life.

Every so often I run across something in a patient's story that reminds me of something I read in one of those works, and then I think to myself, "is there a role for trying to achieve some insight into these things, here and now in the neurologist's office?" Sometimes the answer is yes, sometimes no, sometimes I don't know, sometimes the patient isn't someone who's going to be interested for a myriad of possible reasons.

It's certainly nothing like deciding to inject someone with Botox™.
posted by ikkyu2 at 9:00 PM on February 10, 2008 [1 favorite]

Thanks, ikkyu2. That's useful stuff. I would not even have realized that Piaget would be classified as a follower of Freud. That helps explain why psychoanalysis might still be relevant-- even if Freud's castration anxiety/penis envy stuff isn't particularly well-regarded today, he did come up with the idea of stages of development.

Is it fair to compare Freud to, say, Heraclitus?

Heraclitus got to philosophy first (more or less), and Freud got to psychology first (more or less). So they each have some pretty nifty, literary insights, on stepping twice into rivers, or the role of the unconscious. But they also let loose some wacky stuff, like "The sun is the breadth of a man's foot," or "All boys secretly think their dads want to cut off their wangs, so they unconsciously want to kill them." Because neither were really empiricists, and neither really had a whole lot of scholarship to draw on.
posted by ibmcginty at 7:11 AM on February 11, 2008

I think of Freud as someone in the same league as Aristotle or Darwin or Karl Marx. These are thinkers who may have been wrong in whatever particular, but the frameworks they built in order to structure their wrong ideas are frameworks that were robust and resilient enough to inspire later thinkers to be able to get at deeper truths.

I really don't think Freud was the first to get at psychology. He studied under Charcot, so from that perspective he was a neurologist, before neurologists and psychiatrists had ever thought to distinguish themselves from each other. There were a lot of (semi-) famous names around that time, interested in these and similar questions: Krafft-Ebing, Havelock Ellis, Joseph Babinski, Franz-Joseph Gall, Hughlings Jackson spring to mind, but there were many others.
posted by ikkyu2 at 9:27 PM on February 12, 2008 [1 favorite]