Tuesday, January 20, 2009

Surveying the Therapy Landscape

By Kevin Murphy, M.Sc.,
Psychoanalytic Psychotherapist
Dublin, Ireland.

One of the big questions for any therapy is, does it work? And in this regard, surveys backing up the success or otherwise of psychoanalytic psychotherapy have been very thin on the ground. In fact, most of the running has been done by the ‘newer’ therapies, those that offer short term, quick solutions, ones with ‘evidence-based’ data behind them. And, you have to include drug-based treatments that have been around since the 1950s that also take the limelight with the promise of a pill for every ill, not to mention reams of data to support their position.
By contrast, the longer term psychoanalytic approach, the one that invests time in each individual client, the one that goes behind the symptoms and looks for causes, the one that refuses to accept the simple answer or the short cut, the one that is based on a speaking relationship between client and therapist and that is the oldest, original form of psychotherapy; this is the one that has had very few surveys carried out. As a result it has seemed much like a sleeping giant for many years.
There is a change of attitude on this, however, and the current debate now within the psychoanalytic field internationally is why not research and survey? Why not let the world now that a) psychoanalsyis is not dead but very much alive in both practice and education and b) it has enormous benefits to offer. But the debate hinges on finding a way of researching and surveying that respects client confidentiality and does not impinge in any way on the all-important relationship between client and analyst.
In this context it was interesting, therefore, to see new research in the prestigious Journal of the American Medical Association (JAMA) that supports the effectiveness of the psychoanalytic approach in glowing terms. The research was published in the October edition and, interestingly, this is the first such review to appear in a major medical journal.
In a comment on the findings, the New York Times said the studies on which it was based are probably not widely known among US doctors. And presumably that also applies to Europe and beyond.
Essentially, it gathered together 23 separate studies that used the psychodynamic approach (psychodynamic is another word used for psychoanalytic) covering over 1,000 patients who were in analysis for anything from over a year up to many years. It put these studies through a rigorous further analysis or 'meta-analysis' and came up with the following findings.
Intensive psychoanalytic therapy, or the ‘talking cure’ as it was named by Freud, when it is given three times a week relieved symptoms more than did short term therapies. Commenting on this, the same newspaper quoted Bruce Wampold, chairman of the department of counselling psychology at Wisconsin University as saying that although the study prompts the need for further study, it now contradicts the notion that cognitive or other short-term therapies are better than any others.
The studies that the investigators examined tracked patients with a variety of problems, among them severe depression, anorexia nervoxa and personality disorders. Psychoanalytic therapy showed significant, large and stable treatment effects which actually increased from the end of therapy until follow-up assessments were made some time later. In effect, the study is saying that the positive changes that can result are so stable and effective that they continue working even after the therapy has finished. That’s probably not going to come as a surprise to psychoanalytic psychotherapists but it is quite a claim to make publicly and one that hasn’t been highlighted in the past.
The New York Times report quoted Dr Andrew Gerber, a psychiatrist at Columbia University as saying that the research suggests that if you want to make lasting improvements you’ve got to use longer-term therapy.
The study compared the psychoanalytic treatment of personality, eating, and other disorders with therapeutic treatments that included cognitive-behavioural therapy, cognitive-analytic therapy, dialectical-behavioural therapy, family therapy, supportive therapy, short-term psychodynamic therapy, and psychiatric treatment.
The results indicated that after treatment with long term psychoanalytic psychotherapy patients on average were better off than 96% of the patients in the comparison groups.
In 5 studies of analytic therapy alone, the majority of patients had complex depressive and anxiety disorders and the majority of patients were also classified with chronic mental disorders. According to the results, long term analysis on its own yielded significantly large effects in overall outcome, general psychiatric symptoms, and social functioning in follow-up testing in all outcome areas.
Its a long study and quite complex from a statistical analysis point of view but in their conclusion, the authors suggest that further studies of psychoanlytic treatment are now required in order to unearth more hidden facts about this sleeping giant of the therapy world.
They also suggest further surveys be carried out that might compare costs of long term versus short term therapy because in spite its long term nature, analysis and the psychodynamic/psychoanalytic approach was found to be cost-effective in some of the studies they looked at. Even though it took longer and cost more, the positive effects lasted longer and kept on going after the therapy ended. Which is another thing you rarely hear being mentioned.

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