There is a lot of talk in mental health circles these days about psychotherapy treatment outcomes. Researchers try to measure ways in which people change as a result of one psychotherapy treatment modality as opposed to another. Patients, insurance companies, and mental health providers themselves want to know what the best treatments are generally and, more specifically, what the best treatments are for particular psychological troubles (such as depression anxiety, post-traumatic stress disorder, etc). In this post, I am not so much concerned with which treatment is better than another but what positive outcomes we can expect to achieve from psychotherapy and especially from psychoanalysis.
As a basic framework, the outcomes we hope to see from any successful psychotherapy include a reduction in psychiatric symptoms, resolution of the problems that brought the person into treatment, as well as improvement in overall personality and social functioning.
In taking a step forward in this research, Dr. Scott D. Miller of the International Center for Clinical Excellence developed an ultra-brief scale to measure psychotherapy treatment outcomes. For me, Miller’s Outcome Rating Scale (ORS) helps further clarify the areas that all psychotherapies hope to impact in a positive way. The areas are: Individual (personal well-being), Interpersonal (family, close relationships), Social (work, school, friendships), and Overall (general sense of well-being).
Dr. Jonathan Shedler of the University of Colorado, Denver School of Medicine wrote an important paper in the American Psychologist in 2010 called “The Efficacy of Psychodynamic Psychotherapy.” He reviewed many available outcome studies about the effectiveness of various psychotherapies and concluded that psychodynamic psychotherapies (a broad category that would include psychoanalysis) are as effective or more effective than other kinds of psychotherapy treatments (including medication) and, notably, that the changes tend to last and even improve over time. Now, there are some criticisms of this paper that are worth consideration, but the bit that I wish to highlight is the way in which Dr. Shedler broadened the goals of psychodynamic therapy beyond the aims of many other types of psychotherapy. These goals reveal the deeper impact that psychoanalysis and other psychodynamic psychotherapies can have on an individual’s life. Shedler writes,
The goals of psychodynamic therapy include, but extend beyond, symptom remission. Successful treatment should not only relieve symptoms (i.e., get rid of something) but also foster the positive presence of psychological capacities and resources. Depending on the person and the circumstances, these might include the capacity to have more fulfilling relationships, make more effective use of one’s talents and abilities, maintain a realistically based sense of self-esteem, tolerate a wider range of affect, have more satisfying sexual experiences, understand self and others in more nuanced and sophisticated ways, and face life’s challenges with greater freedom and flexibility.
While I am not a researcher in any formal way, I resonate with Shedler’s description of the potential benefits of psychodynamic therapies. As a clinician, I have observed and thought about the ways in which my patients (and myself as a patient) change over time. I have come to believe that there are three main outcomes of a successful psychoanalysis: feeling better, doing better, and being better.
For me, these three outcomes are not limited to psychoanalysis; really, they are goals that we all might seek to achieve in whatever path of psychological growth that we may choose in life.
In my view, the three main benefits of psychoanalysis are:
- To feel better. The desire to feel better is often what motivates people to go see a therapist in the first place, or even to pick up and read a blog on Psychology Today. Patients want relief from distress. They long for their depression to be lifted, their anxiety to be quelled, or their grief to pass. I would say that feeling better is a main goal of every type of psychotherapy, including psychoanalysis. For some patients, it is a great outcome and it is enough.
- To do better. But other patients want more. Some want to develop the skills and capacity to do better in their lives over the long-term. They want to cope better and function better. They want to do better at work, in their relationships, and in their care for themselves. They want more than relief from their greatest anxieties; they want a better foundation for living. This kind of goal is better suited to longer, more in-depth treatments including psychoanalysis.
- To be better. For some patients, as life becomes more and more stable as the result of a psychotherapy treatment that is working well, a glimpse of something even greater emerges. Not only a life that works, wonderful as that is; but a life that is deeper, more satisfying, and more meaningful. If a patient wishes to go further than feeling better and doing better, a good analysis can help her go there—to develop a psychological life in which the changes she makes are not only on the outside but also on the inside.
The goal of being better is essentially an inner transformation which, I think, is one of the main reasons why treatment outcomes of psychodynamic therapies like psychoanalysis are more lasting and why improvement continues even beyond the treatment itself. Such deep work is not necessary for or desired by everyone. It requires enormous investment of time, money, and energy. But for those who choose this less-traveled road, it often yields benefits that cannot be adequately measured in the research lab but instead can be appreciated profoundly through their own experience. Such patients don’t need the benefits to be proven to them. They know the benefits to be true out of their own experience. And that is enough.
Copyright 2014 Jennifer L. Kunst, Ph.D.
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