Validity of Psychoanalysis?

[maranatha]

I know there are a lot of good articles on the validity of CBT, but what about psychoanalysis???? I've tried doing literature searches on it and haven't had very good luck. As a student going into psychiatry (as long as I match!), I'm fully sold on CBT and will undoubtedly use it in practice. However, I've heard so many mixed things about psychoanalysis that I'm not sure what to think about it....Any thoughts?....As a famous poster once said, "I WANT TO BELIEVE."

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[Quix]

Good luck finding efficacy data. Freud himself began to doubts its efficacy towards the end of his life, and the only data he published were case studies, not experiments. Psychoanalysis doesn't lend itself to experimental studies like CBT does, so there has been very little (relatively) put out, and the length of analysis makes it almost prohibitive (and, consequently, generally not covered by third-party payers).

Personally, when I run group therapies I focus on CBT and Adlerian approaches (IIRC, there are efficacy studies with Adlerian psychotherapy in dual patients).

EDIT: I almost forgot - I do still use concepts like Freudian defense mechanisms, but even the idea of "the unconscious" has taken on an entirely different meaning in light of what cognitive psychology and neuroscience tell us.

 

[50960]

I agree. Not to nitpick, but the term validity has a very specific meaning in the psych sciences literature, and it does not equal efficacy. CBT lends itself to efficacy study because it is highly reliable in the statistical sense, (IE. it can be done very similarly by every practitioner). Psychoanalysis can not show reliability because it is highly dynamic and is done differently by nearly everyone who uses it. Validity has to do with if we are really treating what we think we are treating with our treatment, so No, psychoanalysis has little validity or reliability, but that does not mean it is not effective. Because it is nearly impossible to show effectiveness in a scientific way (outside of case-studies).

 

[solumanculver]

EDIT: I almost forgot - I do still use concepts like Freudian defense mechanisms, but even the idea of "the unconscious" has taken on an entirely different meaning in light of what cognitive psychology and neuroscience tell us.[/QUOTE]

What do Cognitive pyschology and neuroscience have to tell us about the unconscious?

 

[nortomaso]

EDIT: I almost forgot - I do still use concepts like Freudian defense mechanisms, but even the idea of "the unconscious" has taken on an entirely different meaning in light of what cognitive psychology and neuroscience tell us.

What do Cognitive pyschology and neuroscience have to tell us about the unconscious?[/QUOTE]

Psychological experimentation has shown by inference that much of our decision-making, calculations, and emotional stances are arrived at unconsciously. This is where Freud's genius rings true: "consciousness" (whatever that is) really is just the tip of an iceberg. However, the rest of the iceberg is a conglomerate of unconscious processes, not "the unconscious", i.e. a unitary primal drive. Classical psychoanalysis strives to expose and resolve the conflict between the unconscious and the conscious. This approach assumes one overriding struggle between 2 or 3 partitions of the mind as the cause of an individual's psychological distress.

More modest therapies such as CBT, behavioral therapy, and mindfulness are more task oriented. They hijack particular circuits in the brain and sometimes this effect is enough to alleviate suffering considerably. I still don't know much about what is loosely termed "psychodynamic psychotherapy", but from what what I've observed so far its not so unlike CBT. They both seem to focus on identifying self-damaging patterns of behavior, thought, and perceptions. Psychodynamic psychotherapy allows more digging into the past to do this, is less explicit about this, and tends to use a confusing Freudian vocabulary, many of whose words have lost their original psychoanalytic meaning and/or mean different things to diffrent practitioners.

 

[Quix]

I agree. Not to nitpick, but the term validity has a very specific meaning in the psych sciences literature, and it does not equal efficacy. CBT lends itself to efficacy study because it is highly reliable in the statistical sense, (IE. it can be done very similarly by every practitioner). Psychoanalysis can not show reliability because it is highly dynamic and is done differently by nearly everyone who uses it. Validity has to do with if we are really treating what we think we are treating with our treatment, so No, psychoanalysis has little validity or reliability, but that does not mean it is not effective. Because it is nearly impossible to show effectiveness in a scientific way (outside of case-studies).

Yeah, I came back later and realized I was responding to the wrong thing.

 

[Quix]

EDIT: I almost forgot - I do still use concepts like Freudian defense mechanisms, but even the idea of "the unconscious" has taken on an entirely different meaning in light of what cognitive psychology and neuroscience tell us.

What do Cognitive pyschology and neuroscience have to tell us about the unconscious?[/QUOTE]

On top of what nortomaso wrote, there is also data indicating that we are only perceptually aware of making decisions well after (relatively speaking) the underlying neural pathways have fired (so the perception of choice occurs only *after* the biology of choice has occurred). Cognitive psych has shown that we make decisions based on cognitive heuristics (quick "rules of thumb"), rather than algorithmic processes, employing concepts like automaticity and backstage cognition. Some argue that these heuristics are adaptive (e.g., Gigerenzer), others that they introduce systematic error into cognition (e.g., Kahneman and Tversky).

The upshot is that while unconscious processes certainly exist (and, in fact, are what determines our conscious perception and understanding), they are a far, *far* cry from the model proposed and explored in psychoanalysis.

 

[positivepsych]

Jacques Barber at UPenn has done studies on the efficacy of brief dynamic psychotherapy. Do a search for "dynamic" on his publications site and find the full articles in PsychINFO or PubMed:

http://www.uphs.upenn.edu/psycther/barber.publications.html