New Thread: Psychoanalysis. Psychodynamics, EBT, and the Science of Psychology

[AcronymAllergy]

No, what I might do is design a study, gather and manipulate enough statistical data to support my hypothesis that Angel Therapy is effective in the treatment of a particular mental illness. I would get some of my friends working at universities to tell their graduate students to work on replicating Angel Therapy research. I would then have the confidence and authority to tell my patient that Angel Therapy has been "clinically shown" to be effective in relieving his symptoms (my patient hears the words "clinically shown" and is already putting his faith in what I have to offer). We would schedule 30 sessions, which works out because that is what insurance or some other government-based healthcare network is willing to pay for.

After 30 sessions, my patient is feeling better! We don't really fully understand why. It may very well be because it's the first time in this person's life that someone gave him or her their full, undivided attention, treated them with kindness and respect. Maybe I remind him of a teacher or neighbor who was caring and supportive. We just say that Angel Theray has been clinically proven to be effective.

The nice thing is, I can still charge 200 dollars, but the patient doesn't feel it as too much of a financial burden because a third party will cover some of it.

So you're going to cast the entire crowd of researchers conducting RCTs and development studies of CBT techniques in the light of individuals who would all eschew ethical principles, manipulate statistical and methodological techniques, and then adhere strictly to ONLY their developed manualized treatment in an attempt to concurrently self-aggrandize and look down their nose at other forms of treatment? That's a broad, and honestly insulting, generalization to make.

I don't know of a single EBT-practicing therapist who would, after the initially-estimated/proposed number of sessions, terminate treatment with a client simply because the "prescribed" limit was reached. EBT practitioners are NOT non-thinking, non-hypothesizing, non-empathizing individuals. Quite the opposite, actually.

Psychologists are scientists, plain and simple. It's what we do, it's how we're trained, and it's how we treat our clients and inform our professional decision making.

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[PETRAN]

No, what I might do is design a study, gather and manipulate enough statistical data to support my hypothesis that Angel Therapy is effective in the treatment of a particular mental illness. I would get some of my friends working at universities to tell their graduate students to work on replicating Angel Therapy research. I would then have the confidence and authority to tell my patient that Angel Therapy has been "clinically shown" to be effective in relieving his symptoms (my patient hears the words "clinically shown" and is already putting his faith in what I have to offer). We would schedule 30 sessions, which works out because that is what insurance or some other government-based healthcare network is willing to pay for.

After 30 sessions, my patient is feeling better! We don't really fully understand why. It may very well be because it's the first time in this person's life that someone gave him or her their full, undivided attention, treated them with kindness and respect. Maybe I remind him of a teacher or neighbor who was caring and supportive. We just say that Angel Theray has been clinically proven to be effective.

The nice thing is, I can still charge 200 dollars, but the patient doesn't feel it as too much of a financial burden because a third party will cover some of it.

So to sum up

1) All research is a conspiracy and "made-up statistics". Nothing is legit

2) All types of therapy have similar results regardless of method used. All that sufferer (from panic disorder or obsessions-compulsions) needs is attention, empathy and compassion from his therapist...


3)which probably follows that all applied psychology is crackpot since a shaman, a priest or some kind of mentalist can do similar stuff.


So why bother obtaining an academic degree when all thay you need is some empathy and the psychotherapeutic bond?

Why do you use psychodynamic PRINCIPLES and post about Bion, when all that stuff have literally (according to your view) nothing more to offer in comparison to ANY placebo treatment? Why don't you just use aromatherapy/quark-crystals/angels with your empathy to obtain identical results? Would you?

 

[AcronymAllergy]

So to sum up

1) All research is a conspiracy and "made-up statistics". Nothing is legit

2) All types of therapy have similar results regardless of method used. All that sufferer (from panic disorder or obsessions-compulsions) needs is attention, empathy and compassion from his therapist...


3)which probably follows that all applied psychology is crackpot since a shaman, a priest or some kind of mentalist can do similar stuff.


So why bother obtaining an academic degree when all thay you need is some empathy and the psychotherapeutic bond?

Why do you use psychodynamic PRINCIPLES and post about Bion, when all that stuff have literally (according to your view) nothing more to offer in comparison to ANY placebo treatment? Why don't you just use aromatherapy/quark-crystals/angels with your empathy to obtain identical results? Would you?

Agreed. If you don't like the current research, for whatever reason, more power to you. Go out and conduct some of your own. But to say that it's patronizing to humanity to try and "reduce the human condition" down to scientifically-observable and operationalized characteristics, and to then essentially disregard the entire scientific process with respect to mental health, is--in my opinion--counter-productive to the heart of psychology itself.

 

[Therapist4Chnge]

Holy Tin Foil Hat Batman! This discussion has taken yet another large detour. I think the crux of the matter is that when all of the strawmen and fun philosophical stuff is stripped away, there are two groups of clinicians: Those who believe in and utilize empirically supported methods...and those who don't.

 

[DreamInterpret]

Holy Tin Foil Hat Batman! This discussion has taken yet another large detour. I think the crux of the matter is that when all of the strawmen and fun philosophical stuff is stripped away, there are two groups of clinicians: Those who believe in and utilize empirically supported methods...and those who don't.

Exactly. The only detail I would add is this:

Those who utilize empirically supported methods claim the advantage of scientific method, which is limited, limiting, and a product of a discourse, constructed in nature as any other discourse, that is heavily influenced by Western culture and a preference for linear logic. Therefore, empirically-supported methods need not be privileged over all others.

 

[PETRAN]

Exactly. The only detail I would add is this:

Those who utilize empirically supported methods claim the advantage of scientific method, which is limited, limiting, and a product of a discourse, constructed in nature as any other discourse, that is heavily influenced by Western culture and a preference for linear logic. Therefore, empirically-supported methods need not be privileged over all others.

So, why did you go to the university to obtain a degree!? Why do you use linear scientific psychodynamic principles and theories of the western psychological culture!??

 

[roubs]

Exactly. The only detail I would add is this:

Those who utilize empirically supported methods claim the advantage of scientific method, which is limited, limiting, and a product of a discourse, constructed in nature as any other discourse, that is heavily influenced by Western culture and a preference for linear logic. Therefore, empirically-supported methods need not be privileged over all others.

Properly applied, the scientific method is freeing from superstition and authority-based opinion. The origins of science can as easily be traced to India and China as they can to the Western world. Does that mean what works in the US can just be carelessly exported to other cultures? Of course not.

Empirically-supported methods represent what works best. Clients deserve our best effort across all the domains discussed--building a relationship, tailoring treatments to the patients individual circumstances, paying attention to environment/family/cultural variables AND using methods that have been shown to be effective. Leaving off the last one should be considered malpractice.

 

[DreamInterpret]

So, why did you go to the university to obtain a degree!? Why do you use linear scientific psychodynamic principles and theories of the western psychological culture!??

Because in the United States that is how it is set up. In Europe and parts of South America, one need not have a doctorate in psychology to study or practice psychoanalysis. Many analysts come from fields as diverse as mathematical theory, comparative literature, art history, anthropology...

And, also, psychodynamic principles, while they have a foundation in Western thought, lend themselves to expanding beyond.

 

[PsychBrownBag]

Exactly. The only detail I would add is this:

Those who utilize empirically supported methods claim the advantage of scientific method, which is limited, limiting, and a product of a discourse, constructed in nature as any other discourse, that is heavily influenced by Western culture and a preference for linear logic. Therefore, empirically-supported methods need not be privileged over all others.

I would argue that empirically supported methods prioritize accountability on the part of the clinician. In other words, instead of simply telling me how great your methods are, give me some evidence that you're actually correct. Given Lilienfeld's findings on iatrogenic treatments and their frequent use in clinical practice, that's a very legitimate perspective. If people out there are frequently utilizing iatrogenic methods (e.g., critical incident stress debriefing), either they're evil and twisting their mustaches in anticipation of inflicting harm, or they're ability to intuitively assess the utility of a treatment approach is as flawed as any other person and they (and more importantly, their patients) could stand to benefit from a bit more objectivity rather than philosophy.

 

[PsychBrownBag]

And, also, psychodynamic principles, while they have a foundation in Western thought, lend themselves to expanding beyond.

That's an often repeated talking-point, but it's not really based upon anything. Anything can "expand" upon the scientific method or "Western thought" by pushing forth an unfalsifiable philosophical idea. Simply because psychodynamic folks attempt to do so more often doesn't mean they've cornered the market on making claims unsupported by fact - it simply means they've chosen to exercise that option more often. Proclaiming that tendency to be an asset is a questionable approach.

The most recent issue of the American Psychologist includes a number of responses to the unfortunately influential Shedler (2010) piece that highlight a number of these issues.

 

[cara susanna]

If it were that easy to fake results that support Angel Therapy, it wouldn't be on the list of empirically unsupported treatments.

 

[nononora]

The most recent issue of the American Psychologist includes a number of responses to the unfortunately influential Shedler (2010) piece that highlight a number of these issues.

The Feb-Mar 2011 issue of the American Psychologist also includes Shedler's responses to several critics.

Psychoanalysis is not angel therapy, nor does it include the use of the supernatural. Where is this perception coming from?

If you believe that psychoanalysts purposely refrain from teaching breathing techniques to patients suffering from panic attacks, or let irrational thoughts fester in depressed patients without challenging them, then perhaps you need to re-assess your understanding of psychoanalysis. Contrary to popular belief, we also do not make random oedipal interpretations and suggest that patients are stuck in some oral/anal stage.

If a couple were to come to you asking for parent training, would you provide it to them and immediately terminate despite knowing that the latent message is that they are having trouble connecting with their child? If yes, then I believe you are doing the couple a huge disservice.

What new CBT therapists seem averse to is the reality that the therapeutic relationship is a real relationship. You see the patient simply as someone who needs to learn better skills, and yourself as someone with the training to provide what the patient is looking for. While that may be true and will probably result in significant improvement on outcome measures, merely focusing on skills training is, again, a huge disservice. It is akin to treating severe headaches without considering the possibility of a tumor.

What does the "evidence" tell you to do when a patient falls in love with you? The CBT supervision I've received around a situation like this is laughable - I was told to ignore it so the patient could be put on extinction. No prizes for guessing how that worked out.

Again, and it bears repeating, why are we thinking in black and white terms? I'd like to think of it as a lack of insight but I'd be glad to be proven wrong.

Perhaps an appropriate thread title for this detour would be "Addressing Anti-Psychoanalytic Sentiments"

 

[Eivuwan]

I don't think that making this a CBT vs. Psychoanalysis debate is very helpful (I tend to use psychoanalysis and psychodynamic interchangeably). Psychodynamic theories and Cognitive Behavioral theories on treatment are not incompatible.

While it is true that many CBT practitioners speak derisively of psychodynamic therapy without having a real understanding of what it is, painting CBT practitioners as being inadequate does not help our cause. Some psychoanalytic therapists that I have spoken to acknowledge that psychoanalysis is not helpful to all populations. On the other hand, CBT may not be useful for those who want more insight into how their past relationships affect their current interactions with others. It seems to me that the best course of action is to continue promoting research on the effectiveness and efficacy of CBT, psychodynamic and other therapies rather than to pit one against the other.

The Feb-Mar 2011 issue of the American Psychologist also includes Shedler's responses to several critics.


If a couple were to come to you asking for parent training, would you provide it to them and immediately terminate despite knowing that the latent message is that they are having trouble connecting with their child? If yes, then I believe you are doing the couple a huge disservice.

What new CBT therapists seem averse to is the reality that the therapeutic relationship is a real relationship. You see the patient simply as someone who needs to learn better skills, and yourself as someone with the training to provide what the patient is looking for. While that may be true and will probably result in significant improvement on outcome measures, merely focusing on skills training is, again, a huge disservice. It is akin to treating severe headaches without considering the possibility of a tumor.

What does the "evidence" tell you to do when a patient falls in love with you? The CBT supervision I've received around a situation like this is laughable - I was told to ignore it so the patient could be put on extinction. No prizes for guessing how that worked out.

Again, and it bears repeating, why are we thinking in black and white terms? I'd like to think of it as a lack of insight but I'd be glad to be proven wrong.

Perhaps an appropriate thread title for this detour would be "Addressing Anti-Psychoanalytic Sentiments"

 

[PsychBrownBag]

The Feb-Mar 2011 issue of the American Psychologist also includes Shedler's responses to several critics.

Psychoanalysis is not angel therapy, nor does it include the use of the supernatural. Where is this perception coming from?

What new CBT therapists seem averse to is the reality that the therapeutic relationship is a real relationship. You see the patient simply as someone who needs to learn better skills, and yourself as someone with the training to provide what the patient is looking for. While that may be true and will probably result in significant improvement on outcome measures, merely focusing on skills training is, again, a huge disservice. It is akin to treating severe headaches without considering the possibility of a tumor.

Perhaps an appropriate thread title for this detour would be "Addressing Anti-Psychoanalytic Sentiments"

Two points here:

(1) I don't think critics of psychoanalysis equate that treatment modality with angel therapy or the supernatural. I certainly don't, anyway, and Shedler's original article did a great job of clarifying misunderstandings about the nature of current psychoanalytic treatment techniques. That being said, the comments in the American Psychologist issue were not critiquing psychoanalysis on these terms. They were critiquing the evidence put forth to claim that this treatment approach is not only equivalent to evidence-based treatments, but superior to them and that, when CBT in particular is effective, it's because effective CBT therapists utilize psychodynamic approaches. This might not be directly relevant to the topic at hand, but wanted to at least clarify where I was coming from in my earlier post.

(2) CBT therapists don't view their patients as any less of a person than psychodynamic therapists do or view the therapeutic relationship as unimportant. Here again we have an oft-repeated talking point completely lacking in substance.

In discussing the therapeutic relationship, however, it's important to look at the entirety of the literature on the topic. No doubt, some studies find a positive correlation between therapeutic alliance and treatment outcome (e.g., Horvath et al., 1991 (r = .26); Martin et al., 2000 (r = .22)). These studies, however, tend to be cross-sectional, so there's no evidence indicating that a better alliance led to a better outcome and the size of the effect tends to be quite small. Taking this a step further, a number of studies (e.g., DeRubeis & Feeley, 1990; Feeley et al., 1999) have demonstrated that early therapeutic alliance did not predict symptom change but symptom change predicted alliance later in therapy. Going even further, in a study of cognitive therapy for depression, Tang and DeRubeis (1999) found that sudden gains in treatment were not predicted by stronger levels of alliance, but alliance was stronger in sessions immediately following sudden gains (e.g., alliance is strong because the patient is getting better....not the other way around). At the same time, in brief dynamic therapy, results have demonstrated that a strong alliance precedes symptom improvement (Barber et al., 2000).

So yeah, ignoring the therapeutic relationship and showing no empathy towards your patient would be ridiculous, but the degree to which alliance impacts outcome may depend on the treatment being used (and the degree to which the relationship is a central topic of the treatment) and, in fact, the outcome may be the ultimate determinant of the relationship in some treatments. All this being said, I think the idea that CBT therapists ignore the relationship is absurd, but I also think an emphasis on the relationship as a central component of CBT would be ineffective.

 

[Ollie123]

If a couple were to come to you asking for parent training, would you provide it to them and immediately terminate despite knowing that the latent message is that they are having trouble connecting with their child? If yes, then I believe you are doing the couple a huge disservice.

What new CBT therapists seem averse to is the reality that the therapeutic relationship is a real relationship. You see the patient simply as someone who needs to learn better skills, and yourself as someone with the training to provide what the patient is looking for. While that may be true and will probably result in significant improvement on outcome measures, merely focusing on skills training is, again, a huge disservice. It is akin to treating severe headaches without considering the possibility of a tumor.

What does the "evidence" tell you to do when a patient falls in love with you? The CBT supervision I've received around a situation like this is laughable - I was told to ignore it so the patient could be put on extinction. No prizes for guessing how that worked out.

Again, and it bears repeating, why are we thinking in black and white terms? I'd like to think of it as a lack of insight but I'd be glad to be proven wrong.

Perhaps an appropriate thread title for this detour would be "Addressing Anti-Psychoanalytic Sentiments"

Thread has definitely derailed but I think its an interesting discussion.


RE: The couple, of course you don't terminate if other important problems aren't resolved. Assessment is an ongoing process these situations emerge routinely (in fact, I can only think of one case I've seen where the original goal DID stay continuous throughout therapy). My point is simply that the implicit assumption is that a psychodynamic approach will improve their ability to connect with the child. Don't just assume it works, prove it. Show that the parent-child relationship is improved. Parenting work is way outside my scope, so maybe it has been shown but I have my doubts given the lack of evidence in more thoroughly studied areas. If the assumption is that CBT cannot address these issue (though I would argue it can), compare them and see. In the event there aren't any supported techniques to address the issue than yeah, absolutely try one of the untested approaches, whatever it may be. My issue is not when people are seeing refractory cases or attempting to deal with a very nuanced set of circumstances where there really is no evidence available to guide them. My issue is when someone presents with what is clearly OCD and no attempt is made at doing exposure and response prevention, but they are kept in therapy for months doing things like discussing dreams, etc.

You make a fair point regarding the role of the therapeutic relationship. Though that particular example speaks more of the supervisor than CBT since there are certainly ways it can be addressed within that framework - one of my supervisors had that very scenario come into place when he was working at the Beck Institute and he reports it actually became a highly effective talking point that fit in well with the cognitive framework they were using. Either way, the dynamic literature may serve a clear function in those scenarios. I'm not suggesting it not be used, ever, for any reason, and it be abandoned. I am suggesting that with 100+ years to prove itself (if we're talking traditional analysis), if it has yet to do so it certainly shouldn't be the starting point unless we have a client-centered and/or literature-guided reason to believe it will be the better choice.

 

[nononora]

@PBB: You had called Shedler's article "unfortunately influential", which I read as a blanket statement. Perhaps it would be helpful if you could tell us what you meant.

Certainly, blanket statements are unhelpful and it's too bad that mine was interpreted as such. I was, in fact, speaking to structure and how a more rigid therapeutic structure lends itself to easier understanding in newer therapists. However, there is significant depth that one will miss if treatment or training stops there.

I don't think CBT therapists ignore the importance of a therapeutic relationship. If anything, it's one of the few things the two orientations can agree on. Rather, the real relationship I am talking about refers to the acknowledgment of the therapist that he/she is part of the process, and that how the therapist reacts to the patient is in large part due to the therapist's past. When a client continuously does not do the assigned homework, it is natural for a therapist to get frustrated (counter-transference). Do we ignore this frustration or try to understand it in a larger context? Patient-wise, depending on what got in the patient's way of doing the homework (resistance), we may be more flexible and assign easier homework or do the homework together (working around the resistance) which is fine and dandy. However, what is ultimately curative or effective may not be the homework itself but the therapist's self-reflection of the decision to assign homework in the first place, and how it may play into his/her prior schemas of power/authority and how that is related to your view of the client as needing to "try harder". Therefore, the frustration at the client is now no longer simply the client being "difficult" but is frustration around the client's rejection of your expertise which may serve to bring up feelings of inadequacy in the therapist. This is the "real relationship" that I believe CBT has trouble addressing. It is a two-person psychology after all.

Unfortunately, it is difficult to measure these phenomenon. Does that make it not evidence-based? Perhaps. But if you refrain from self-reflection and considering your past as affecting the therapy, one ends up not providing effective treatment.

I'm not of the opinion that one is better than the other - it'd be nice if people could see that the two orientations are more similar than they are different. But the general discourse has been anti-psychoanalytic for a long time. How do we right this wrong?

 

[DreamInterpret]

@PBB: You had called Shedler's article "unfortunately influential", which I read as a blanket statement. Perhaps it would be helpful if you could tell us what you meant.

Certainly, blanket statements are unhelpful and it's too bad that mine was interpreted as such. I was, in fact, speaking to structure and how a more rigid therapeutic structure lends itself to easier understanding in newer therapists. However, there is significant depth that one will miss if treatment or training stops there.

I don't think CBT therapists ignore the importance of a therapeutic relationship. If anything, it's one of the few things the two orientations can agree on. Rather, the real relationship I am talking about refers to the acknowledgment of the therapist that he/she is part of the process, and that how the therapist reacts to the patient is in large part due to the therapist's past. When a client continuously does not do the assigned homework, it is natural for a therapist to get frustrated (counter-transference). Do we ignore this frustration or try to understand it in a larger context? Patient-wise, depending on what got in the patient's way of doing the homework (resistance), we may be more flexible and assign easier homework or do the homework together (working around the resistance) which is fine and dandy. However, what is ultimately curative or effective may not be the homework itself but the therapist's self-reflection of the decision to assign homework in the first place, and how it may play into his/her prior schemas of power/authority and how that is related to your view of the client as needing to "try harder". Therefore, the frustration at the client is now no longer simply the client being "difficult" but is frustration around the client's rejection of your expertise which may serve to bring up feelings of inadequacy in the therapist. This is the "real relationship" that I believe CBT has trouble addressing. It is a two-person psychology after all.

Unfortunately, it is difficult to measure these phenomenon. Does that make it not evidence-based? Perhaps. But if you refrain from self-reflection and considering your past as affecting the therapy, one ends up not providing effective treatment.

I'm not of the opinion that one is better than the other - it'd be nice if people could see that the two orientations are more similar than they are different. But the general discourse has been anti-psychoanalytic for a long time. How do we right this wrong?

Maybe we should each talk about why we are drawn to practice in a particular way. I think a combination of personal attributes, experiences, and motivations are what lead each psychologist to the particular modality that dominates their work.

 

[PsychBrownBag]

@PBB: You had called Shedler's article "unfortunately influential", which I read as a blanket statement. Perhaps it would be helpful if you could tell us what you meant.

...

I'm not of the opinion that one is better than the other - it'd be nice if people could see that the two orientations are more similar than they are different. But the general discourse has been anti-psychoanalytic for a long time. How do we right this wrong?

Happy to clarify. I mean it was unfortunately influential in the sense that the author drew conclusions about the efficacy of psychodynamic psychotherapy that were inconsistent with the data he cited and then his document was trumpeted as a source of vindication and is now being cited by other authors. More specifically, the studies that comprised the meta-analyses cited in the Shedler piece painted a different picture of the situation than the authors of the meta-analyses and, subsequently, Shedler indicated. As such, there was a game of telephone that took place. The data said one thing...the authors of the meta-analyses said something inaccurate about those data...Shedler cited those meta-analyses and repeated their erroneous interpretations of the data...media outlets and listservs then declared the piece to be evidence of the efficacy of psychodynamic psychotherapy and other researchers subsequently have come to cite the Shedler piece as evidence supporting a point that it, in fact, fails to support.

To further clarify, I am not anti-psychoanalysis. I'm against making statements that are inconsistent with evidence and I'm against the implementation of non-evidence based treatments when evidence-based treatments exist for a client's presenting complaints and have not yet been attempted.

Also, given that evidence-based treatments are so rarely implemented in real world practice, I'm not certain I understand the argument that the general consensus is anti-psychoanalysis or pro-evidence-based treatments. Scientifically-minded psychologists may fall into those camps quite a bit, but we mostly just talk to one another in forums that have no impact on what happens in therapy rooms and, in that sense, I think the bulk of the world - both in terms of consumers and practitioners - are decidedly open to psychoanalysis and generally non-evidence-based treatments.

I definitely agree that a more civil back and forth between camps would be beneficial. I'm not entirely optimistic, however, that any resolution is likely to occur there, as the disagreements that do exist are fundamentally incompatible (e.g., the importance of falsifiability and the relative value of empirical data). Hope I'm wrong.

 

[erg923]

I'm against the implementation of non-evidence based treatments when evidence-based treatments exist for a client's presenting complaints and have not yet been attempted.

This is the issue I have been harping on this whole time. They're there, but you're choosing not to use them. Why not just start there?

How/why have you become so mistrustful of the research? My ph.d program taught to us to critically evaluate things and to think for ourselves too, but when everybody is telling you (and showing you the evidence for) one thing and you stubbornly wont listen (or just think everybody is making it up), that your issue, not ours. To take a quote from Meehl, "think again, Jack." As Cara said, if the data could be made-up or minipulated that easily...I'm sure someone would have demonstrated the superior efficacy of angel therapy or whatever already.

 

[PETRAN]

Because in the United States that is how it is set up. In Europe and parts of South America, one need not have a doctorate in psychology to study or practice psychoanalysis. Many analysts come from fields as diverse as mathematical theory, comparative literature, art history, anthropology...

And, also, psychodynamic principles, while they have a foundation in Western thought, lend themselves to expanding beyond.

According to you, ALL treatments are relative and framed in the context of a culture yes? This is what you seem to have said in your previous posts, correct me if i'm wrong. According to your view, all therapeutic methods are totally equal and have stronger or weaker results depending on the context and individual right? Would you say that psychoanalysis is equivalent to ANY treatment? Can someone obtain identical therapeutic results by using quark crystals, snake oil and bio-energy in the context of empathy, therapeutic relationship and interpersonal support? If yes, why study all that psychodynamic principles, methods and interpretations? According to you, they are are just the creation of a specific culture at a specific place which has nothing real or valid to say about human nature other than the time and place that it was/is created and applied (Vienna to modern western civilization). It is no more "deeper" or "valid" or "true" in comparison to ANY other type of psychological theory or method, such as angel therapy or CBT for that matter.


If ANYTHING can work, your studies of psychoanalysis and degrees are just a waste of time, since i can-at any time- come with my angel therapy and obtain the same outcomes with my clients.

According to this (your?) line of thought, religion can have the exact SAME effects on panic attacks, OCD and major depression. All you need is jesus or st. mary and none of your psychoanalytic mumbo-jumbo. They are identical in the end no? This is your view, am i wrong?


On the contrary, if you think that psychoanalysis is "some kind" of a systematic study (aka "science") of human nature and not just a cultural narrative or a placebo/crackpot thing (e.g. "angel therapy", "religion") then you would probably contradict yourself, since you would actually accept/endorse the scientific process. Psychoanalysis is (or wants to be) a science no? It has clear principles that apply to a specific group of situations, linear relations between causes and effects, systematic categorizations of phenomena and abstractions and makes some strong claims in the process.

So if it is-or wants to be a science- why not compare it to other "scientific lines of thought" about the psyche? Last time i checked this was called science. If it is religion, why bother studying psychology in the first place? It would just become a matter of belief and nothing more.

 

[DreamInterpret]

@PETRAN,

Why are you interpreting my reluctance to accept EBT's as superior as a desire to go backwards?

It's unfortunate that training programs out there aren't encouraging students to study psychoanalysis in its present-day iteration, or to rotate through at least a brief psychodynamically-oriented training, so that they know what it is they are criticizing and rejecting. Rather, it seems that a new generation of psychologists are stuck on outdated caricatures of psychoanalysis. It's the gaps in your knowledge and experience base, not mine, that are preventing us from having a productive debate.

 

[PsychBrownBag]

@PETRAN,

Why are you interpreting my reluctance to accept EBT's as superior as a desire to go backwards?

It's unfortunate that training programs out there aren't encouraging students to study psychoanalysis in its present-day iteration, or to rotate through at least a brief psychodynamically-oriented training, so that they know what it is they are criticizing and rejecting. Rather, it seems that a new generation of psychologists are stuck on outdated caricatures of psychoanalysis. It's the gaps in your knowledge and experience base, not mine, that are preventing us from having a productive debate.

I do think it makes sense to learn about treatments as we critique them; however, I'm not sure I see the logic in the idea that individuals have to receiving training in a treatment to reject it and that if they reject a treatment without training in it, that rejection was due to their lack of training. The reason many - and I certainly can not speak for all - scientifically-minded psychologists reject psychoanalysis is due to its inability to produce empirical evidence supporting the case that it should be considered an EBT. If I received 20 years of training in psychoanalysis prior to this moment, the evidence base for that approach would be no different. Understanding a treatment has no impact on its overall efficacy and effectiveness.

Besides which, wouldn't this then be true of all treatments that proclaim themselves to be effective in the absence of evidence? Would we need to complete rotations in equine assisted psychotherapy to critique the lack of evidence supporting that approach? Where would we draw the line?

 

[erg923]

Were you trained to reject the importance of science (and the utility of psychotherapy research) by your program... or did this come later?

 

[roubs]

Thus far, you are presenting as the poster child for why we need more science education in psychology.

 

[nitemagi]

Fun thread.

Throwing some other ideas into the mix, I'd quote an old supervisor of mine--
"Theory is what therapists create to make ourselves feel like we know what we're doing."
A lot of treatments work before we understand why they work. Though it's useful to show that they work at least. My point being not everything effective in the world is first constructed on a theory. In fact quite the opposite. And yet that doesn't make them less effective. There are plenty of treatments in the world that lack a theoretical basis AND evidence of effectiveness. But that's a distinction.

I don't think anything is outside the reach of science, but there's a helluva lot we haven't figured out how to measure yet.

 

[reluctantPhd01]

I've enjoyed reading this thread.
The trouble I have with many empirically supported treatments is that many times they are based on RCTs which have been poorly done. I have no doubt that treatments like CBT and DBT are very useful for some types of patients. A big problem I have with RCTs is that they typically exclude difficult-to-treat patients. Also, a patient that is participating in a research study is different from one that comes into an office---and I feel like these are huge differences. Also, I feel that RCTs don't really inform clinical work ultimately because they are so far removed actual mechanisms of clinical change. Questions I think we need better answers to are: how do we treat patients with multiple co-morbid disorders? How do we treat Axis II disorders that confound treatment outcome? How do we deliver effective services to patients with Axis III/IV issues. How do we resolve clinical impasses?

Martin Seligman wrote a great piece on this (1995 or 1996 I think) arguging that the very properties that make an RCT rigorous also make it the wrong method for empirically validating therapy.

Also, I think some of this argument is being confused because people are confusing EST with EBP. ESTs are one type of evidence that should inform EBP.

Finally, I am dumbfounded why people are suggesting that pscyhodynamic treatments are not empirically supported. Indeed, several meta-analyses exists that show their effectiveness----there was a great article in the American Psychologist last year about the effectiveness of dynamic work by Shedler

 

[reluctantPhd01]

Were you trained to reject the importance of science (and the utility of psychotherapy research) by your program... or did this come later?

In my honest opinion, you have some great ideas to contribute here, but sometimes your tone can be a bit disconcerting and off-putting.

 

[reluctantPhd01]

I do think it makes sense to learn about treatments as we critique them; however, I'm not sure I see the logic in the idea that individuals have to receiving training in a treatment to reject it and that if they reject a treatment without training in it, that rejection was due to their lack of training. The reason many - and I certainly can not speak for all - scientifically-minded psychologists reject psychoanalysis is due to its inability to produce empirical evidence supporting the case that it should be considered an EBT. If I received 20 years of training in psychoanalysis prior to this moment, the evidence base for that approach would be no different. Understanding a treatment has no impact on its overall efficacy and effectiveness.

Besides which, wouldn't this then be true of all treatments that proclaim themselves to be effective in the absence of evidence? Would we need to complete rotations in equine assisted psychotherapy to critique the lack of evidence supporting that approach? Where would we draw the line?

Sorry, confused here. There are studies demonstrating the effectiveness of psychoanalysis and psychodynamic psychotherapy for the treatment of mood, anxiety, and personality disorders.

 

[erg923]

Sorry, confused here. There are studies demonstrating the effectiveness of psychoanalysis and psychodynamic psychotherapy for the treatment of mood, anxiety, and personality disorders.

Compared to???

PS: I'm sorry you are disconcerted. You should try living with me...

 

[reluctantPhd01]

Treatment-as-usual, therapy by expert, as well as a host of alternative treatments. I thought the article by Shedler nicely summarized some findings, as well as numerous papers by Leichsenring and Crits-Christoph. Those are just a few things that come to mind. IMO, there isn't enough studies comparing CBT to psychodynamic stuff for many disorders.

 

[Ollie123]

Finally, I am dumbfounded why people are suggesting that pscyhodynamic treatments are not empirically supported. Indeed, several meta-analyses exists that show their effectiveness----there was a great article in the American Psychologist last year about the effectiveness of dynamic work by Shedler

And subsequently torn apart I believe one of the major meta-analyses cited in his paper actually calculated the effect size incorrectly, hugely inflating their findings. It was awhile ago that I read it, but I remember coming across a number of pretty catastrophic problems with this article that weren't just philosophical differences but just pretty egregious errors in data interpretation. I applaud the goal of "more research on the topic" getting this out there, but I'm not certain the evidence is anywhere near sufficient for most things. The other reality is that I don't believe most practitioners of it are in any way limiting themselves to the areas where there is reasonable evidence for it. I take much less issue with people using psychodynamic therapies for any of a number of Axis II disorders where other areas have generally not seen much success...I have yet to see any convincing evidence it is effective in treating any anxiety disorder besides GAD (and even that isn't great at the moment). I regularly see it applied in a number of situations where there is no supporting evidence that I'm aware of (e.g. OCD - at one point I looked and could not find even a single non-case-study on the topic).

 

[aequitasveritas]

It is utterly crucial to examine the empirical assumptions beneath "evidence based" therapies.

Weston 2001 is a great meta analysis, highlighting the empirical assumptions beneath manualized and sequential therapies, the problematic flow of hypotheses from the lab to the field, and the actual (vs fantasized) effect sizes of the short and long term approaches.

 

[reluctantPhd01]

And subsequently torn apart I believe one of the major meta-analyses cited in his paper actually calculated the effect size incorrectly, hugely inflating their findings. It was awhile ago that I read it, but I remember coming across a number of pretty catastrophic problems with this article that weren't just philosophical differences but just pretty egregious errors in data interpretation. I applaud the goal of "more research on the topic" getting this out there, but I'm not certain the evidence is anywhere near sufficient for most things. The other reality is that I don't believe most practitioners of it are in any way limiting themselves to the areas where there is reasonable evidence for it. I take much less issue with people using psychodynamic therapies for any of a number of Axis II disorders where other areas have generally not seen much success...I have yet to see any convincing evidence it is effective in treating any anxiety disorder besides GAD (and even that isn't great at the moment). I regularly see it applied in a number of situations where there is no supporting evidence that I'm aware of (e.g. OCD - at one point I looked and could not find even a single non-case-study on the topic).

I wouldn't use the term "torn apart." It has some flaws, for sure but makes several valid points that I don't think can be easily dismissed. Let's give at least a little bit of credit to the editorial board at the American Psychologist.

 

[reluctantPhd01]

It is utterly crucial to examine the empirical assumptions beneath "evidence based" therapies.

Weston 2001 is a great meta analysis, highlighting the empirical assumptions beneath manualized and sequential therapies, the problematic flow of hypotheses from the lab to the field, and the actual (vs fantasized) effect sizes of the short and long term approaches.

You mean Westen?

 

[DreamInterpret]

"Psychologists are scientists, plain and simple. It's what we do, it's how we're trained, and it's how we treat our clients and inform our professional decision making."

Yes, psychologists are scientists, social scientists. Other kinds of social scientists include anthropologists, historians, sociologists... And folks in these fields do not seem as vulnerable to the same inferiority complexes that psychologists have vis a vis the "hard" sciences, and allow themselves to be informed by vast and varied sources of information. It makes their science more compelling, interesting, and nuanced.

It's interesting. Earlier I had the opportunity to speak to the DBT psychologist who is caring for a former (and perhaps future) patient of mine in a partial inpatient setting. She was very interested in what I had to offer and thought that the insights I was able to provide would be very valuable in her work with the patient. It was an utterly refreshing experience for me, and for her, also. There was no snake oil or hack science involved. There was no rejection of what she or I had to bring to the table, just a genuine interest in working together to give a highly intelligent and troubled young woman the best possible shot at a happy, productive life.

Now THAT's what I'm talking about!

 

[Ollie123]

I wouldn't use the term "torn apart." It has some flaws, for sure but makes several valid points that I don't think can be easily dismissed. Let's give at least a little bit of credit to the editorial board at the American Psychologist.

Fair enough - I did mention one of several valid points that I think it makes - however the resulting implications that emerged from this article certainly seem to be deeply flawed (though not sure the author is entirely responsible for this, as many people seem to push it even further beyond the point he makes). My only point was that I'm not convinced the article provides anywhere near the evidence that we would demand of other ESTs. I'll admit that I genuinely don't like American Psychologist as a journal though

Thanks for the article aequitas - I did some pretty heavy reading on the topic for a project a few years ago but somehow missed that one. Westen's work is usually thought-provoking even if I don't always agree with his conclusions.

 

[aequitasveritas]

You mean Westen?

Of course.

Here's the address of the article in case anyone would like to check it out.

http://www.psychsystems.net/Publications/2004/2.%20empirical%20status%20of%20empirically%20supported%20therapies_Westen_psych%20bulletin%202004.pdf

another one that may interest folks is below and involves construct assumptions with EST and RCTs.

http://www.psychsystems.net/lab/2005_%20EST_%20psych_bull_2ndres.pdf

 

[KillerDiller]

It's interesting. Earlier I had the opportunity to speak to the DBT psychologist who is caring for a former (and perhaps future) patient of mine in a partial inpatient setting. She was very interested in what I had to offer and thought that the insights I was able to provide would be very valuable in her work with the patient. It was an utterly refreshing experience for me, and for her, also. There was no snake oil or hack science involved. There was no rejection of what she or I had to bring to the table, just a genuine interest in working together to give a highly intelligent and troubled young woman the best possible shot at a happy, productive life.

Now THAT's what I'm talking about!

I'm still not sure what you're talking about, though. Is the fact that this psychologist was interested in your point of view supposed to demonstrate that your way of treatment planning is just as good as what science has taught us? Science is the way we find out what works and what doesn't. It's that simple. To eschew science is to say you don't care whether what you are doing works. And yes, your approach (whatever it is) could be scientifically tested too, you just don't appear to be willing to, and that makes people understandably skeptical.

 

[DreamInterpret]

I'm still not sure what you're talking about, though. Is the fact that this psychologist was interested in your point of view supposed to demonstrate that your way of treatment planning is just as good as what science has taught us? Science is the way we find out what works and what doesn't. It's that simple. To eschew science is to say you don't care whether what you are doing works. And yes, your approach (whatever it is) could be scientifically tested too, you just don't appear to be willing to, and that makes people understandably skeptical.

I don't mind people scientifically testing what I do, I just don't want to waste my time testing anything. I'd rather be in there doing the work, because over time, my intuition has evolved. Similarly, I know an experienced gemologist who can see a stone from several feet away and tell you whether it is or isn't fake, and if it's real, what its characteristics are. I know a plastic surgeon who can palpate the identify even the slightest scar tissue. I know an anesthesiologist who is so seasoned that he can tell how a patient is faring just by the subtlest changes in the tones that his instruments are producing. Integrating the scientific literature, and going through graduate education and practica are just the starting points of the evolution of a clinician.

It's actually not "that simple", as many would like to believe it is. And the psychologist who is currently charged with treating my patient in the inpatient setting clearly has the actual, on the job experience to know that. And that is why she bothered to call and consult with me, because there was a lot that was not making sense to her a week into her work with that particular individual. When you have someone who is in an acute depressive state complicated by Axis II issues, layered over with the fact that she is 18 and in an intense and rapid developmental phase, there is a whole lot going on. Having worked with that patient over the course of an extended period of time, I was in a position to inform the other clinician in a way that would, ultimately, benefit the patient. I am certain that if and when the patient returns to working with me, that psychologist will have a lot to offer to advance my work with the patient.

I know a psychologist who directs an inpatient unit for low SES people with psychoses. He works from a behavioral model, integrating things such as social skills training, a token system, and other EST's, depending on a patient's presenting issues, and response to previous treatments. But, he is open-minded enough that he is also immersed in a Jungian working group. He finds that what he takes from his study of Jung sheds light on his work with individual patients.

I know of eating disordered patients who have cycled through programs like Renfrew a few times before arriving at the office of an Object-relationally oriented therapist, and who, have been able to emerge from their struggles with food and eating. Clearly, something happened there that helped consolidate what was offered in the previous Cognitive-behavioral stints.

It's a shame that graduate schools of psychology are not preparing generalists. In the end, it's the patients who need our help most, those with complex issues, who are not benefitting from what our profession has to offer.

 

[SingingCow]

I don't mind people scientifically testing what I do, I just don't want to waste my time testing anything. I'd rather be in there doing the work, because over time, my intuition has evolved. Similarly, I know an experienced gemologist who can see a stone from several feet away and tell you whether it is or isn't fake, and if it's real, what its characteristics are. I know a plastic surgeon who can palpate the identify even the slightest scar tissue. I know an anesthesiologist who is so seasoned that he can tell how a patient is faring just by the subtlest changes in the tones that his instruments are producing. Integrating the scientific literature, and going through graduate education and practica are just the starting points of the evolution of a clinician.

It's actually not "that simple", as many would like to believe it is. And the psychologist who is currently charged with treating my patient in the inpatient setting clearly has the actual, on the job experience to know that. And that is why she bothered to call and consult with me, because there was a lot that was not making sense to her a week into her work with that particular individual. When you have someone who is in an acute depressive state complicated by Axis II issues, layered over with the fact that she is 18 and in an intense and rapid developmental phase, there is a whole lot going on. Having worked with that patient over the course of an extended period of time, I was in a position to inform the other clinician in a way that would, ultimately, benefit the patient. I am certain that if and when the patient returns to working with me, that psychologist will have a lot to offer to advance my work with the patient.

I know a psychologist who directs an inpatient unit for low SES people with psychoses. He works from a behavioral model, integrating things such as social skills training, a token system, and other EST's, depending on a patient's presenting issues, and response to previous treatments. But, he is open-minded enough that he is also immersed in a Jungian working group. He finds that what he takes from his study of Jung sheds light on his work with individual patients.

I know of eating disordered patients who have cycled through programs like Renfrew a few times before arriving at the office of an Object-relationally oriented therapist, and who, have been able to emerge from their struggles with food and eating. Clearly, something happened there that helped consolidate what was offered in the previous Cognitive-behavioral stints.

It's a shame that graduate schools of psychology are not preparing generalists. In the end, it's the patients who need our help most, those with complex issues, who are not benefitting from what our profession has to offer.

I think it is a sweeping statement to suggest that all graduate training is the same. There are graduate programs out there that highly value the production and understanding of solid scientific research AND an openess in clinical training. To be truly ecclectic, one not only has to be well-versed in conceptualizing and/or treating from various orientations/ schools of thought/ belief systems but also be open to the possibility that even treatment options that have not undergone sufficient research can be efficacious and effective. One also must learn to integrate these concepts and skills.

I have a preference for treatment options that have been studied extensively but I am also mindful of the limitations in most RCT studies, whether psychopharmacology or psychotherapy focused. Thus, I can see why sometimes the best option may be to follow the principle of "whatever works." Good mentorship and supervision are beneficial, but even the best supervisor tends to have certain rules or "recipes" he tends to follow. It would be nice if everyone could develop an outstanding insight or intuition that guide treatment successfully, but most individuals will likely benefit from some documented guidance. Research on different treatment options and development of manualized treatments can be seen as ways to help give clinicians some rules they can choose to follow.

I see this as a way to help share knowledge. This is not to say that it is the only right way to do something. In fact, science encourages us to challenge current findings and come up with more appropriate and updated theories and practice. As a taxpayer, I may not be too thrilled to know that we are supporting services that are no more effective than placebo, but when you work at settings that serve SMI populations who are cycling through the system, I am thrilled when I am able to "use"(capitalize on?) placebo effect. What worries me about resentment towards scientific research on psychological intervention is that some iatrogenic effect may not be caught.

Even though we don't have to follow the Oath as physicians do, I think "Do no harm" needs to be our guiding principle. Whether it is snake oil, angels, IPT, CBT, object-relations, or hypnosis, if it is going to cause more harm than TAU, then it may be best if we don't offer any treatment at all.

p.s. The OP's description of confession within the Catholic Church seems to be relatively dated. Although it is highly possible that the OP has witnessed that at a more conservative parish/locale, confessions these days are quite different.

 

[erg923]

I don't mind people scientifically testing what I do, I just don't want to waste my time testing anything. I'd rather be in there doing the work, because over time, my intuition has evolved.

Nobody is gonna sit here and tell you that "clinical judgement" is not important when working with patients, but you know its only a matter of time before someone responds to that quoted part by citing Meehl's book (that clinicians never seem to pay much attention to) and studies about how bad we are at estimating our own abilities/expertise. You know that, right?

 

[DreamInterpret]

IDK. Maybe it's a geographic thing, but here in the northeast, I'm meeting lots of really "phallic" newby clinicians who are completely allergic to the notion that something other than ESTs can have any value at all, and these are the folks who I wish would start thinking a bit more critically as to why one particular form of discourse comes to dominate a field that is still evolving.

 

[DreamInterpret]

Nobody is gonna sit here and tell you that "clinical judgement" is not important when working with patients, but you know its only a matter of time before someone responds to this and starts citing Meehl's book (that clinicians never seem to pay much attention to) and studies about how bad we are at estimating our estimates own abilities/expertise. You know that, right?

If Meehl is there in the trenches actually seeing patients and making an impact for difficult to treat individuals then I want to hear what he says. Otherwise he can continue his theoretical masturbation in peace.

 

[KillerDiller]

If Meehl is there in the trenches actually seeing patients and making an impact for difficult to treat individuals then I want to hear what he says. Otherwise he can continue his theoretical masturbation in peace.

Well, he's in a trench; he's dead. May he RIP.

 

[erg923]

If Meehl is there in the trenches actually seeing patients and making an impact for difficult to treat individuals then I want to hear what he says. Otherwise he can continue his theoretical masturbation in peace.

Apparently he wasn't required reading in your program? I would think he would be everywhere. Its too bad, not only is amazing level headed, empirical and rationale, he also had a thing for Freud. He was just very vocal that he had given up trying to study the analytic hour because he just couldn't figure out to do it properly. He was also a quite humorous writer. " Why I Do Not Attend Psychiatric Case Conferences" is hilarious and so, so true.

 

[DreamInterpret]

Were you trained to reject the importance of science (and the utility of psychotherapy research) by your program... or did this come later?

I don't reject science. I reject making generalizations, and then developing treatments based on those generalizations, and then insisting those treatments are superior even though they are not more effective in the long term than other treatment approaches. Why is that so difficult to grasp?

(On a personal note, it didn't help that in my training program the professor around whom most of the EST folks congregated was the sleaziest, most characterologically effed, most chauvinistic, sociopathic individual I've ever encountered. If I say he had a huge set of moose antlers hanging above his desk in his office, those of you who attended my same program will know exactly who I am talking about. I had my first real world encounter with axis 2 psychopathology at an office hour of his. This was someone doing cutting edge research, and really important research that met all the criteria of good research. It made me wonder if all the people who do clinical research are
doing so because they don't have the foundational empathy that is demanded of them in the therapy room.)

 

[roubs]

Dammit my comment about Meehl rolling over down there is so not timely anymore!! I swear I thunk it up before I read any of your replies!

I reject making generalizations

Like you're either in the trenches or theoretically masturbating?

 

[DreamInterpret]

Apparently he wasn't required reading in your program? I would think he would be everywhere. Its too bad, not only is amazing level headed, empirical and rationale, he also had a thing for Freud. He was just very vocal that he had given up trying to study the analytic hour because he just couldn't figure out to do it properly. He was also a quite humorous writer. " Why I Do Not Attend Psychiatric Case Conferences" is hilarious and so, so true.

Duh, of course I've read Meehl. Have you read Grotstein?

 

[DreamInterpret]

Well, he's in a trench; he's dead. May he RIP.

That's actually pretty funny. I say "masturbate in peace", you say "rest in peace."

 

[DreamInterpret]

Dammit my comment about Meehl rolling over down there is so not timely anymore!! I swear I thunk it up before I read any of your replies!



Like you're either in the trenches or theoretically masturbating?

My generalizations don't impact public health policy. That's a pretty important difference.