Psychoanalysis vs CBT

[Smilemaker100]

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Greetings, shrinks!

I was at this news-stand tonight, doing my regular weekly perusal of various mags when I came across one which had a feature article (Freud at 150, He's Still Captivating Us) on the occasion of the upcoming 150th anniversary of Freud's birthday (May 6th, 2006) and the evolution of psychology/psychiatry since his passing. This article was featured in the March 27th edition of "Newsweek".

http://www.msnbc.msn.com/id/11904222/site/newsweek/

Just out of curiousity, I wanted to see how many psychiatrists in training are proponents of Freudian psychoanalysis versus Dr Aaron Beck's "Cognitive Behavior Therapy" . What is being taught in psychiatry these days? Which have you found more effective in clinical practice ? Is CBT a therapeutic approach which is handled mostly by psychologists or psychiatrists ?

 

[Doc Samson]

Greetings, shrinks!

I was at this news-stand tonight, doing my regular weekly perusal of various mags when I came across one which had a feature article (Freud at 150, He's Still Captivating Us) on the occasion of the upcoming 150th anniversary of Freud's birthday (May 6th, 2006) and the evolution of psychology/psychiarty since his passing. This article was featured in the March 27th edition of "Newsweek".

http://www.msnbc.msn.com/id/11904222/site/newsweek/

I was just curious to see how many psychiatrists in training are proponents of Freudian psychoanalysis versus Dr Aaron Beck's "Cognitive Behavior Therapy" . What is being taught in psychiatry these days? Which have you found more effective in clinical practice ? Is CBT a therapeutic approach which is handled mostly by psychologists or psychiatrists ?

The ACGME requires that psychiatrists receive training, and demonstrate competency in, in at least 5 forms of therapy, which specifically include both CBT and insight-oriented psychodynamic therapy (not psychoanalysis, but based on the same premise of repeated patterns of relationships). Residency programs vary widely in how seriously they take that requirement (i.e. some of them barely teach any therapy at all, and lie about it). Lots of psychiatrists, psychologists, and social workers employ either modality. Psychoanalysis requires years of additional training in a psychoanalytic institute (not least of which is undergoing you own analysis), and is similarly available to psychiatrists, psychologists, and social workers (though the composition of the trainees varies from institute to institute).

 

[Smilemaker100]

The ACGME requires that psychiatrists receive training, and demonstrate competency in, in at least 5 forms of therapy, which specifically include both CBT and insight-oriented psychodynamic therapy (not psychoanalysis, but based on the same premise of repeated patterns of relationships). Residency programs vary widely in how seriously they take that requirement (i.e. some of them barely teach any therapy at all, and lie about it). Lots of psychiatrists, psychologists, and social workers employ either modality. Psychoanalysis requires years of additional training in a psychoanalytic institute (not least of which is undergoing you own analysis), and is similarly available to psychiatrists, psychologists, and social workers (though the composition of the trainees varies from institute to institute).

I know it may seem kind of odd for a dentist to post in this forum. When I was a teen, I once contemplated a career in psychiatry. I am still fascinated by the field. As a dentist, you have to be somewhat of a psychologist/psychiatrist to deal with dental phobic patients. 🙄

What other forms of therapy (besides CBT & insight-oriented psychodynamic therapy) are psychiatrists trained in? You mentioned that there were 5 forms.

You have to undergo your own analysis if you train in psychoanalysis?! LOL!

 

[Doc Samson]

I know it may seem kind of odd for a dentist to post in this forum. When I was a teen, I once contemplated a career in psychiatry. I am still fascinated by the field. As a dentist, you have to be somewhat of a psychologist/psychiatrist to deal with dental phobic patients. 🙄

What other forms of therapy (besides CBT & insight-oriented psychodynamic therapy) are psychiatrists trained in? You mentioned that there were 5 forms.

You have to undergo your own analysis if you train in psychoanalysis?! LOL!

The other 3 are significantly more nebulous: integrated (i.e. therapy and meds combined), supportive, and brief. (I think that's right... I'm trying to do this from memory).

Yeah, do be an analyst, you do have to be analyzed. Lots of non-analyst psych residents get psychotherapy of some sort... I'd actually highly recommend it, it's very helpful in lots of ways (and tax deductable for psych residents).

 

[Smilemaker100]

The other 3 are significantly more nebulous: integrated (i.e. therapy and meds combined), supportive, and brief. (I think that's right... I'm trying to do this from memory).

Yeah, do be an analyst, you do have to be analyzed. Lots of non-analyst psych residents get psychotherapy of some sort... I'd actually highly recommend it, it's very helpful in lots of ways (and tax deductable for psych residents).

I am fascinated by the concept of psychiatrists being obliged to undergo psychotherapy in order to study psychoanalysis. I think it's a great approach because then you can more or less understand the process from a patient's point of view.

From all the collegues you have met in psychiatry, how many of them have confessed to having a personal/family history of psychiatric illness ?

I've heard of a number of psychiatrists and/psychologists who have personally battled a mental illness of some sort and have written memoirs dealing with it. One good example that comes to mind is Dr Kay Redfield Jamison, who is not only internationally renown as an expert in bipolar disorder, but personally was afflicted by the illness herself and had a father who had it as well and committed suicide. I am sure her name rings a bell for most on this forum.

Jamison has written bestseller books and earned a number of accolades in her profession including that of being one of the "Best Doctors in the United States", was selected as one of five individuals featured for the public television series "Great Minds in Medicine" and Time Magazine named her a "Hero in Medicine":

More on Jamison:

http://myhero.com/myhero/hero.asp?hero=Kay_Jamison

http://www.med.umich.edu/depression/bio/jamison_bio.htm

 

[Doc Samson]

I am fascinated by the concept of psychiatrists being obliged to undergo psychotherapy in order to study psychoanalysis. I think it's a great approach because then you can more or less understand the process from a patient's point of view.

From all the collegues you have met in psychiatry, how many of them have confessed to having a personal/family history of psychiatric illness ?

I've heard of a number of psychiatrists and/psychologists who have personally battled a mental illness of some sort and have written memoirs dealing with it. One good example that comes to mind is Dr Kay Redfield Jamison, who is not only internationally renown as an expert in bipolar disorder, but personally was afflicted by the illness herself and had a father who had it as well and committed suicide. I am sure her name rings a bell for most on this forum.

Jamison has written bestseller books and earned a number of accolades in her profession including that of being one of the "Best Doctors in the United States", was selected as one of five individuals featured for the public television series "Great Minds in Medicine" and Time Magazine named her a "Hero in Medicine":

More on Jamison:

http://myhero.com/myhero/hero.asp?hero=Kay_Jamison

http://www.med.umich.edu/depression/bio/jamison_bio.htm

In terms of personal history, none of my colleagues have fessed up to an Axis I diagnosis outside of ADHD. In terms of family history, I've heard some stories over the years, but I don't think any more than you'd hear from any segment of the population. If anything, I think psychiatry residents may be a little guilty of overdiagnosing their families... especially on Axis II. 😉

 

[Smilemaker100]

In terms of personal history, none of my colleagues have fessed up to an Axis I diagnosis outside of ADHD. In terms of family history, I've heard some stories over the years, but I don't think any more than you'd hear from any segment of the population. If anything, I think psychiatry residents may be a little guilty of overdiagnosing their families... especially on Axis II. 😉

Thanks for your replies.

On a lighter note...some psychiatric jokes:

Why is psychoanalysis a lot quicker for a man than for a woman?
Because when it's time to go back to childhood, a man is already there.
-----------------------------------------------
What is the difference between a psychiatrist and a psychologist?
If you say to a psychiatrist "I hate my mother," he will ask "Why do you say that?" while a psychologist will say "Thank you for sharing that with us."
-----------------------------------------------------------
Two psychiatrists pass in the hall. The first says, "Hello." The other thinks,
"I wonder what he meant by that."
-----------------------------------------------------
A fact that makes you go hmmmm...

More than 20 percent of the nation's psychotherapists work in the New York area.
---------------------------------------------------------
After twelve years of psychoanalysis, my analyst said something that brought tears to my eyes. He said: "No hablo inglés."
--------------------------------------------------------
Q: How do two psychiatrists greet each other? A: You are fine. How am I?
----------------------------------------------------------------------
Q: How many psychiatrists does it take to change a light bulb? A: Only one, but the light bulb has to WANT to change.

 

[pschmom1]

I have yet to employ or have training on CBT or psychoanalysis, but from what I have learned so far, I love both and think the two together is a perfect combination for excellent therapy and a hopeful outcome for the patient in care. But, I've said before, and will continue to say until I have the education and training to back me up, what do I know?!

Two psychiatrists pass in the hall. The first says, "Hello." The other thinks,
"I wonder what he meant by that."

That is sooo funny and sooo me!

 

[Smilemaker100]

I have yet to employ or have training on CBT or psychoanalysis, but from what I have learned so far, I love both and think the two together is a perfect combination for excellent therapy and a hopeful outcome for the patient in care. But, I've said before, and will continue to say until I have the education and training to back me up, what do I know?!

From what I can gather, psychoanalysis doesn't seem "à la mode" (trendy) right now. CBT seems more effective. Like we all know, blaming our problems on the past isn't going to solve anything. What matters is what your thoughts are right at this moment and how you deal with them. Over the last years,nearly all the pop psychology literature revolves around the concept of "positive thinking" which seems to more or less follow the ideas of CBT .

I have a doctor friend who knows a psychiatrist. According to him, psychoanalysis really isn't taught as much to psychiatrists in Canada anymore . It seems more prevalent in the US. I wonder why that is?

 

[Psyclops]

Smilemaker,

There is a similar thread on the Clinical Psychology board. I suggest you check it out if you haven't already. Although full blown psychoanalysis has lost its luster, psychodynamic therapy, which draws on similar theories and history, is alive, well, and being empirically validated. Pop psychology (exuce me I have to puke) certainly is celebrating the CBT and its affiliates, and for the most part with good reason. However, in terms of being effective, I wouldn't necessarily concede the victory to CBT. But, to quote Lavar Burton "don't take my word for it". Check out the other thread.

 

[Doc Samson]

Smilemaker,

There is a similar thread on the Clinical Psychology board. I suggest you check it out if you haven't already. Although full blown psychoanalysis has lost its luster, psychodynamic therapy, which draws on similar theories and history, is alive, well, and being empirically validated. Pop psychology (exuce me I have to puke) certainly is celebrating the CBT and its affiliates, and for the most part with good reason. However, in terms of being effective, I wouldn't necessarily concede the victory to CBT. But, to quote Lavar Burton "don't take my word for it". Check out the other thread.

????... What's going on... I agree with Psyclops 😱 . I'm going to lie down for a while now.

 

[Smilemaker100]

Smilemaker,

There is a similar thread on the Clinical Psychology board. I suggest you check it out if you haven't already. Although full blown psychoanalysis has lost its luster, psychodynamic therapy, which draws on similar theories and history, is alive, well, and being empirically validated. Pop psychology (exuce me I have to puke) certainly is celebrating the CBT and its affiliates, and for the most part with good reason. However, in terms of being effective, I wouldn't necessarily concede the victory to CBT. But, to quote Lavar Burton "don't take my word for it". Check out the other thread.

I don't know much about psychodynamic therapy. 😕 Please enlighten this ignorant "Tooth Puller".

I LOVE 😍 pop psychology. One of my favorite gurus is Dr Wayne W. Dyer. I have read most of his books. However, I don't dig Dr Phil that much.

http://www.drwaynedyer.com/

 

[Psyclops]

Oh man, where to begin. Psychodynamic theory and therapy is a result of a long progression begining with Freud, and continuing through other theorists/psychiatrists and now psychologists who believe there are dynamic forces working in our psyche. Some of the more notable were Sullivan, Winnicot, Kohut, Fairbairn, Klein, Horney, Anna Freud, etc. These days the work is alive and well, object relations theory is a psychodynamic theory, and to a certain extent so is interpersonal theory. Otto Kernberg is a big name in the field of dynamic work these days, and there is a myriad of other psychologists and psychiatrists continuing the trends. Yalom is anoither name that comes to mind. There is even a brief psychodynamic therapy, and it has not escaped the scrutany of the empiracists. The best part is is that it holds up, it works. Essentially, those continuuing in this vein have gotten rid of all of the stuff that freud was wrong about (e.g., penis envy) and kept and built on that which worked (we are affected by unconcious processes, etc.). For a lay review please see two weeks or so ago's issue of newsweek, the one with freud on the cover.

I realize that this is a hodgepodge of a post but I hope it helps. Doc Samson can fill in the blanks and correct me where I went wrong.

 

[Doc Samson]

Oh man, where to begin. Psychodynamic theory and therapy is a result of a long progression begining with Freud, and continuing through other theorists/psychiatrists and now psychologists who believe there are dynamic forces working in our psyche. Some of the more notable were Sullivan, Winnicot, Kohut, Fairbairn, Klein, Horney, Anna Freud, etc. These days the work is alive and well, object relations theory is a psychodynamic theory, and to a certain extent so is interpersonal theory. Otto Kernberg is a big name in the field of dynamic work these days, and there is a myriad of other psychologists and psychiatrists continuing the trends. Yalom is anoither name that comes to mind. There is even a brief psychodynamic therapy, and it has not escaped the scrutany of the empiracists. The best part is is that it holds up, it works. Essentially, those continuuing in this vein have gotten rid of all of the stuff that freud was wrong about (e.g., penis envy) and kept and built on that which worked (we are affected by unconcious processes, etc.). For a lay review please see two weeks or so ago's issue of newsweek, the one with freud on the cover.

I realize that this is a hodgepodge of a post but I hope it helps. Doc Samson can fill in the blanks and correct me where I went wrong.

Nothing I'd change about that description (other than adding Peter Fonagy's name as one of the current major figures in psychodynamic theory - evidence based even!). Again... we're in agreement.

 

[Smilemaker100]

Oh man, where to begin. Psychodynamic theory and therapy is a result of a long progression begining with Freud, and continuing through other theorists/psychiatrists and now psychologists who believe there are dynamic forces working in our psyche. Some of the more notable were Sullivan, Winnicot, Kohut, Fairbairn, Klein, Horney, Anna Freud, etc. These days the work is alive and well, object relations theory is a psychodynamic theory, and to a certain extent so is interpersonal theory. Otto Kernberg is a big name in the field of dynamic work these days, and there is a myriad of other psychologists and psychiatrists continuing the trends. Yalom is anoither name that comes to mind. There is even a brief psychodynamic therapy, and it has not escaped the scrutany of the empiracists. The best part is is that it holds up, it works. Essentially, those continuuing in this vein have gotten rid of all of the stuff that freud was wrong about (e.g., penis envy) and kept and built on that which worked (we are affected by unconcious processes, etc.). For a lay review please see two weeks or so ago's issue of newsweek, the one with freud on the cover.

I realize that this is a hodgepodge of a post but I hope it helps. Doc Samson can fill in the blanks and correct me where I went wrong.

Thanks 🙂

 

[deuist]

I've heard of a number of psychiatrists and/psychologists who have personally battled a mental illness of some sort and have written memoirs dealing with it.

The First Law of Misery is that psychiatrists specialize in their defects.

 

[Solideliquid]

The First Law of Misery is that psychiatrists specialize in their defects.

I loved that book, and also the other, The House of God .

 

[deuist]

I loved that book, and also the other, The House of God .

Everything you need to know about practicing medicine can be gathered from watching Scrubs and reading The House of God.