Law & Medicine & Intellectuals (was Re: geels)

Chris Burford cburford at gn.apc.org
Sun Sep 17 13:56:12 PDT 2000


At 07:49 17/09/00 -0400, Jim F wrote:


>On Sun, 17 Sep 2000 00:05:27 EDT JKSCHW at aol.com writes:
> > In a message dated 9/16/00 2:16:11 PM Eastern Daylight Time,
> > dhenwood at panix.com writes:
> >
> > << Ever seen an analytically oriented shrink? Ineffective is not a
> > word
> > I'd use to describe the experience. >>
>
>I suppose one can cite the case of Woody Allen as a testimonial to
>the effectivenss of psychoanalysis. -:)
>
> >
> > I was interested in this years ago, and have forgotten the
> > references, except
> > for Adolf Grunbaum's Founations of Psychoanalysis. However, I do
> > recall that
> > statitsical clinical studies showed pretty consistently that the
> > rate of
> > recovery of people teated by psychoanalysis was no greater than the
> > control
> > group, i.e., that there wasn't persuasive evidence that
> > psychoanalysis made a
> > statistically measurable difference.
>
>As I recall it was Hans Eyesenck who first published such studies back in
>the
>late 1940s. It is said that British psychoanalysts organized pickets to
>protest
>his claims.
>
> >I recall discuss this with one
> > of my
> > phil science teachers, Larry Sklar at Michigan, a very hard headed
> > philosopher of physics who was also being treated by a
> > psychoanalyst. He said
> > that he avoided reading about that sort of thing because he thought
> > it might
> > have a bad effect on his own analysis. --jks
>
>The behaviorist John B. Watson in his book *Behaviorism*, after debunking
>the
>mentalist assumptions upon which psychoanalysis is built and in general
>casting doubt on psychoanalysis' scientific basis, nevertheless, admitted
>that there situations in which he would consider consulting a
>psychoanalyst.
>Of course at the time that he wrote that book (1930s) there were not too
>many
>viable alternatives to psychoanalytic therapy.
>
>Jim F.

Cognitive Behavioural Therapy (CBT) is clearly proved as an effective treatment for depression in controlled trials.

CBT is now proved to reduce the degree of distress from the chonic symptoms of psychosis.

Information-giving and problem-solving family therapy is proved effective in reducing the relapse rate from psychosis.

None of these are psychoanalytic as such, and the research evidence is less clear for this form of therapy. Nevetheless I thought I ought to interject some comments from what I can see of the scene in England, where a more modulated and less sectarian perspective is perhaps emerging.

Psychodynamic psychotherapists do see patients free under the National Health Service, where they are appointed to these posts, and are adapting IMO intelligently to government pressure to demonstrate the effectiveness of their treatment. This is resulting in more structured approaches of perhaps 12 to 16 sessions, with some effort to define target psychodynamic problems.

It is not clear that transference-based psychotherapy is effective but there is more evidence that the therapeutic alliance between patient and therapist is important, and this holds true across a range of therapies. That said, transference is a common phenomenon in any therapy and therapists need to be aware of it, and increasingly, of their own countertransference reactions to the patient.

Psychodynamic psychotherapy still does not have the research evidence that CBT has. On the other hand the model behind CBT - that patients should be drawn into a polite dialogue as if they are objective scientists, into what their underlying mental schema are - is too rationalist. It is almost certain that cognitive schema develop in the human mind associated with affect (emotion) and in particular, affect towards people with whom one is in relationship. Certainly parents, but not just them.

The enemy, as with biological psychiatry, is reductionism. Psychoanalysis can be violently reductionist, too. Nevertheless I suggest it is realistic, and realist in the philosophical sense, to assume that when a mind is in turmoil, that turmoil is often about the person in the context of their relationships.

I would suggest talking therapies may be useful and appreciated by individuals where they give a space to reflect on important emotional issues in their lives, and perhaps achieve some reconciliation with them. Other therapies might provide the same function.

It is also difficult to prove that group therapy is effective, but subjectively people may feel that a course of group therapy over several months may give them new insights and strengths about how they interact with other people. From an ideological point of view I would suggest this is less inherently individualistic than individual therapy.

Very overtly ego-centric forms of therapy as favoured in the USA, may appear more immediately relevant to a patient, but may lack subtlety and shading - and therefore an ability to live with amibivalence (contradiction??) that is necessary to be reconciled with life.

These at any rate are my impressions form England, in which the NHS does not favour psychotherapy but it does provide some shape to a market in therapy which sounds in the USA quite chaotic and disorientating.

Chris Burford

London



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