Many of us who are engaged in the world of psychoanalysis
and psychoanalytic therapy
feel like underdogs. We feel that our theories have been devalued, dismissed by managed care, American medicine, and are ignored by the public who increasingly want simple cures to complex problems.
In a world in which analysts and analytic clinicians can feel lonely and misunderstood, the news about empirical research supporting psychodynamic therapy can be met like the only water available in the midst of a severe drought. Indeed, psychodynamic psychotherapy has recently been viewed as vindicated, largely in response to Jonathan Shedler's 2010 American Psychologist article, The Efficacy of Psychodynamic Psychotherapy. And while any public acknowledgement of psychoanalytic (or synonymously, psychodynamic) therapy can nourish those of us who feel marginalized, research suggesting the efficacy of psychodynamic therapy is not new. I remember reading about the efficacy of psychoanalytically oriented approaches in a book published by Anthony Ross and Peter Fonagy in the 90's (though now in it's second edition), What Works for Whom? There has, in fact, been a lot of research over the last couple of decades on the efficacy of psychodynamic psychotherapy, much of which shows that it works, especially for complicated patients.
However, despite the victories of authors who have been able to communicate their ideas as well as multiple forms of scientific research to the wider academic and popular press world, there have been flags of caution raised by some of our colleagues. They have been hesitant to embrace empiricism because of the possible limitations it might bring to the understanding of the analytic process.
Of course, there are limitations to empiricism, and especially limits to traditional research methods. Revering randomized controlled trials carries many limitations, including a blind adherence to reductionism and positivism, as well as the neglect of naturalistic studies. But when advocates of psychoanalysis throw away empiricism and act as if we live in an impermeable bubble, we may have achieved a pyrrhic victory. By presuming that science does not apply to us, we have left ourselves vulnerable to a number of criticisms, including that we are not a credible or serious discipline.
Some psychoanalytic clinicians seem to possess a long-held fantasy that we operate as elite and unique fighter pilots in the wars on human suffering. We risk a lot when we act as if the gods of psychoanalysis explain everything and act enraged when others question our ideas. Although in some sense, we do offer something unique, we are still held up to the standards of science, the public, and most importantly, to the patients we treat. Shouldn't we be expected to explain what we do, using current nomenclature and cultural demands?
A collapse in thinking has occurred in relation to recent psychodynamic research publications. There is a tendency among some to say, "These articles and books make it so we don't have to justify our approach, or reach out to the public; these authors are addressing everyone's concerns." But the reality is, no matter what kind of research hero(s) we wish to rely on to disseminate the values of our work, we are still charged with the hard task of adjusting our reputation. Let's face it, somewhere along the way, we have missed the mark and let people down. From what I can tell from the popular press (i.e., Merkin, 2010, summarized by Jessica Grose) we have a lot of disgruntled patients.
What worries me most about the excitement over the recent Shedler article is that in fact, no hero can save us; we have to save ourselves.
Maybe we should take accountability for the ways that our approaches have not worked for some people. By assuming that we have all of the answers, we have failed to acknowledge that some of our non-analytic colleagues also possess some insightful ways to diminish human suffering.
Further, infighting among some psychodynamic clinicians has not helped our cause. Our arguing and jockeying for the position of the newest and most novel theorist can provide us with a great deal of satisfaction. It also gives us an outlet for venting our own frustration regarding the ways that psychoanalysis has not helped us enough when we have been patients.
On the other hand, while our debates may be meaningful to us, they do not make sense to many of those (within our field and without), who just want to know if we can alleviate suffering.
This is an excerpt of an article from the new and forthcoming publication, DIVISION/REVIEW, published by Division 39 (Psychoanalysis) of the American Psychological Association and edited by David Lichtenstein, Ph.D.