Commentary on "Making the Case for Psychoanalytic Therapies in the Current Psychiatric Environment" by John G. Gunderson and Glen O. Gabbard

Gunderson and Gabbard make three important claims: (1) empirical evidence is needed concerning the efficacy of psychoanalytic treatment; (2) randomized controlled trials comparing psychoanalytic treatment to other treatments and placebo equivalents are not feasible, at least as yet; (3) other sources of evidence are available but need to be used in a systematic way. The first two points appear relatively uncontroversial.

I am also in partial agreement with the third. I would, however, make a different case for each of the three claims than is presented here.

Empirical evidence is needed. The authors, concerned with the diminished role of psychoanalytic treatment in psychiatry, attempt to make a case for locating psychoanalysis within proper psychiatric practices for major disorders. This would involve developing guidelines for factors such as diagnostic indications, dosage (frequency and duration), and expectable benefits for specific disorders.

There are two related issues that I would like to raise here. First, the paper seems to be driven more by the need to make a case to policy makers and third-party reimbursers than by the need to develop and improve the treatments that are offered.

It is clear that the absence of empirical evidence has contributed significantly to the declining professional—and economic—status of psychoanalysis, and this should be corrected. It is also the case that the lack of systematic data has limited treatment development in a more intrinsic way, which may even have contributed to the professional decline. It is the responsibility of psychoanalysis, as of any treatment field, to carry out scientific studies to improve treatment techniques, and that need is neglected here. It would be useful to systematize findings that have already been developed, as the authors note. When this is done, however, the inadequacy of the existing data and the need for new research will emerge in sharp relief, as I will discuss below. It may even be that many