Psychiatry and Freud

[Eivuwan]

These types of debates are a pet peeve of mine because there is always black and white thinking and oversimplification of the theoretical orientation that one does like. Having been trained by excellent supervisors in both CBT and psychoanalytic therapy, the truth is that in practice a good therapist will monitor progress and tailor their treatment to the patients' needs. Both CBT and analysts do this. The style may be different, but the core is the same.

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[Liquid8]

I wasn't referring to the old pervert doctors, irrespective of specialty (though they mostly end up being surgeons) who hit on residents/med students/nurses, etc, though none of my "biological" (whatever that means) older attendings to that, though they have their fair amount of lovable quirks)

I was referring to the well known practice of analysts sleeping with patients (https://www.psychologytoday.com/blog/impromptu-man/201206/sex-patients-revisited ), and I seriously doubt that this practice has been completely abandoned, especially in the blueblood private practice market in NYC. It's probably harder to get away with it in an academic setting, but I'm guessing for the older analysts who have been following patients for decades, it's still not uncommon.

On the subject of the horny psychiatrist, I was reminded of a psychiatrist from South Africa who had been working as a staff specialist in Australia while studying for the exemption exams. One day over lunch, one of the more juniors asked her why she'd made the move overseas, which led to a discussion about how she'd first thought about going to the UK, US, Canada or New Zealand instead, but decided that she had too many ex-partners from each of these countries and wanted a fresh start. The junior then asked about how she met all these different partners, which then led to a discussion about the swingers scene at psychiatric conferences.

 

[erg923]

The junior then asked about how she met all these different partners, which then to a discussion about the swingers scene at psychiatric conferences.

gross

 

[OldPsychDoc]

On the subject of the horny psychiatrist, I was reminded of a psychiatrist from South Africa who had been working as a staff specialist in Australia while studying for the exemption exams. One day over lunch, one of the more juniors asked her why she'd made the move overseas, which led to a discussion about how she'd first thought about going to the UK, US, Canada or New Zealand instead, but decided that she had too many ex-partners from each of these countries and wanted a fresh start. The junior then asked about how she met all these different partners, which then to a discussion about the swingers scene at psychiatric conferences.

If that's what you're looking for, you'll be sorely disappointed...

 

[Nasrudin]

On the subject of the horny psychiatrist, I was reminded of a psychiatrist from South Africa who had been working as a staff specialist in Australia while studying for the exemption exams. One day over lunch, one of the more juniors asked her why she'd made the move overseas, which led to a discussion about how she'd first thought about going to the UK, US, Canada or New Zealand instead, but decided that she had too many ex-partners from each of these countries and wanted a fresh start. The junior then asked about how she met all these different partners, which then to a discussion about the swingers scene at psychiatric conferences.

Hey! Clearly you and your colleague are not familiar with the first rule of fight club. And that! Is certifiably unprofessional.

Haha. Seriously though, what?!

 

[HarryMTieboutMD]

The article you linked does not support your implication that these therapists slept with their patient because they are analysts.

Every famous person (or nearly) mentioned in that article was an analyst.

These types of debates are a pet peeve of mine because there is always black and white thinking and oversimplification of the theoretical orientation that one does like. Having been trained by excellent supervisors in both CBT and psychoanalytic therapy, the truth is that in practice a good therapist will monitor progress and tailor their treatment to the patients' needs. Both CBT and analysts do this. The style may be different, but the core is the same.

This is the same platitude proffered by every therapist with decent training and not the point of the above thread

 

[Eivuwan]

Every famous person (or nearly) mentioned in that article was an analyst.



This is the same platitude proffered by every therapist with decent training and not the point of the above thread

If you think that is enough evidence to make such comments about a whole group of professionals then I don't know what to say. Regardless of what the point of the original post was, this thread turned into one of those endless arguments about CBT vs psychoanalytic and that was what I was responding to. This is my last comment on this topic.

 

[Amygdarya]

I think this paper is relevant to the thread:
http://journals.sagepub.com/doi/pdf/10.1177/000306519904700404
And in case you don't have access to the above PDF article: http://www.psychomedia.it/rapaport-klein/westen99.htm

Tl;dr: cognitive neuroscience research supports many of the main psychoanalytic concepts.

 

[deleted736562]

I think this paper is relevant to the thread:
http://journals.sagepub.com/doi/pdf/10.1177/000306519904700404
And in case you don't have access to the above PDF article: http://www.psychomedia.it/rapaport-klein/westen99.htm

Tl;dr: cognitive neuroscience research supports many of the main psychoanalytic concepts.

So basically the very general evidence this article cites relates the importance of the "unconscious" to thought, emotion and behavior. Duh. And it's not like Freud came up with that concept, either. That does not necessarily translate to psychoanalytic techniques or what the psychoanalyst does or assumes about the patient in a psychoanalytic session.

 

[Amygdarya]

That does not necessarily translate to psychoanalytic techniques or what the psychoanalyst does or assumes about the patient in a psychoanalytic session.

Just to make sure we're talking about the same thing, what do you think psychoanalysts do? Or, since it's a lot more commonly used but ultimately rooted in psychoanalysis, what do you think psychodynamic therapists do?

 

[deleted736562]

Just to make sure we're talking about the same thing, what do you think psychoanalysts do? Or, since it's a lot more commonly used but ultimately rooted in psychoanalysis, what do you think psychodynamic therapists do?

It's one thing to acknowledge the unconscious and quite another to claim you can figure out unconscious motives of an individual by sitting there and talking to them. Or interpreting their dreams. Seriously. Your question is kinda irrelevant as I'm sure we are both aware what psychoanalysts do. If psychoanalysts want to cite the evidence in the article as validating, then it says more about their field than anything else.

Anecdotally, I've also heard quite a few analysts who like to cite science claim that everything we do is part or say of an unconscious "association network" (the buzz word). Talk about hyperbole.

 

[Nasrudin]

Alright. Let's really try to nail down what Psychodynamic work DOES?

My early sense of it that it broadens the range of thought and behavior choices a person has because they have become more aware of the things that they were previously unaware of about themselves.

It seems to me that listening to a person talk. And maintaining a certain range of psychodynamic premises allows you to hear them differently. The patient can model a type of self-perception that resembles this and is in conversation with it and the co-exploration is on.

What is faulty about the above. Why doesn't neuroscience have something important to say about these processes? I don't think of them as separate or unrelated phenomenon. The amygdala is timeless. It does remember in ways that are different than conscious awareness. We can access those phenomenon and re-write a new narrative memory over them or in their place.

Why the hate for psychoanalysis?

 

[deleted736562]

I think the very fact that psychoanalysts are looking to cite evidence that came 100 years after tells us all we need to know about the scientificity of the field. There's really no point in proving otherwise. Scientific theories progress arm in arm with empirical evidence in a painstakingly slow process. Most of the science about unconscious processes is at its infancy and has next to no clinical applications. And to somehow validate the whole body of psychoanalytic methods based on science that shows the mere presence of unconscious thought is awfully unscientific in itself.

Why the hate for psychoanalysis?

Spending time with patients is commendable and postulating what could underlie their behavior I guess is also not entirely worthless. However, it's also useful to make the difference between the epistemological validity of such claims and their outcomes on the care of the patient. Most of the research afaik suggests anyhow that it's the quality of therapist rather than the school of thought that makes a difference, which does imply that it's all about the personal relationship and the therapeutic alliance rather than underlying theory.

 

[Nasrudin]

I think the very fact that psychoanalysts are looking to cite evidence that came 100 years after tells us all we need to know about the scientificity of the field. There's really no point in proving otherwise. Scientific theories progress arm in arm with empirical evidence in a painstakingly slow process. Most of the science about unconscious processes is at its infancy and has next to no clinical applications. And to somehow validate the whole body of psychoanalytic methods based on science that shows the mere presence of unconscious thought is awfully unscientific in itself.

I disagree. Scientific advancement can take imaginative leaps that require several centuries for empirical evidence to validate the idea. All the time.

We're also trying to answer questions that are as equally challenging as the movements of the heavens. We don't know what invisible force controls the gravity of the visible matter in the universe. People come up with all kinds theories to try to explain those things. Similarly, we don't know the nature of consciousness and yet, indirectly, we can observe it's phenomenon, and come up with ways of understanding it's invisible movements that explain what is difficult to explain.

For instance, how do you explain the neurotic consciousness acting against itself? Are we to wait for metabolic MRI's to map the neuronal networks on a neuron to neuron level. Or even then what?

I think psychodynamics can be useful for people. I don't disagree with your point about what is the real component of therapeutic value, but... how do we even explain that?

 

[smalltownpsych]

And to somehow validate the whole body of psychoanalytic methods based on science that shows the mere presence of unconscious thought is awfully unscientific in itself.

This is a great example of a straw man tactic. I don't know anyone who ascribes to current psychodynamic thought and integrates it into their practice who would "validate the whole body of psychoanalytic methods". Maybe some of the doddering old psychiatrists lurking in the dusty old hallways of the east coast hospitals, but out here in the real world we understand the roots of the theory and it's context of the time and we have moved past that. Theorists such as Winnicott, Ainsworth, Mahler, Kohut, Kohlberg, Stolorow, and Gabbard are all helpful to know about when. You could also look into the neurobiological understanding of some of these dynamics as detailed and summarized in texts by Daniel Stern, Alan Schore, and Lou Cozolino.
This doesn't mean that the theories and of Skinner leading to Beck, Elllis, and Linehan aren't essential to know as well.
I can see how unconscious internalized object relationship patterns and early childhood attachment patterns and even the content of dreams can relate to behavior just as I can see how irrational beliefs and thought patterns and principles of reinforcement can also effect behavior.

 

[deleted736562]

I disagree. Scientific advancement can take imaginative leaps that require several centuries for empirical evidence to validate the idea. All the time.

We're also trying to answer questions that are as equally challenging as the movements of the heavens. We don't know what invisible force controls the gravity of the visible matter in the universe. People come up with all kinds theories to try to explain those things. Similarly, we don't know the nature of consciousness and yet, indirectly, we can observe it's phenomenon, and come up with ways of understanding it's invisible movements that explain what is difficult to explain.

For instance, how do you explain the neurotic consciousness acting against itself? Are we to wait for metabolic MRI's to map the neuronal networks on a neuron to neuron level. Or even then what?

I think psychodynamics can be useful for people. I don't disagree with your point about what is the real component of therapeutic value, but... how do we even explain that?

Developing a model and developing a testable model are two very different things. Psychoanalysis is a whole theoretical edifice, it's not even a theory, that essentially tries to abstract subjective experience and the mind without recourse to falsifiability or empirical testing. It's not scientific and never was; and that's why when analysts refer to experiments about experience outside awareness, that barely scratch the surface, they are really reaching for validation. That analogy to physics is neither here nor there. And there really isn't any straw man argument there. Personally, I think it's fun to learn about psychoanalysis but at the end of the day it's just fancy theories with multiple schools of thought that we don't have the ability to validate or not, and they should be treated as such.