I magine being contacted by a television journalist who is producing a half-hour national program on the usefulness of psychotherapy. As the conversation develops, you indicate that you have been trained as a psychoanalyst and that your psychodynamic orientation differentiates much of your work from that of your biologically or cognitively oriented colleagues.
Your interlocutor, impressed by your appreciation of the complexity and subtleties of how minds work, has carefully listened to your impressions of how psychoanalysis helps. He asks for “objective data” to support your expressed belief that psychoanalysis is effective in the treatment of certain mental disorders. With what kind of information would you substantiate your claim that psychoanalysis is a valuable method for the alleviation of neurotic misery?
Until recently, you might have found such queries troublesome and been hard-pressed to reply unequivocally. Unless you had an idiosyncratic psychoanalytic education, it is unlikely that your institute training exposed you to the psychotherapy outcome literature, in which such questions are routinely examined, albeit with varying degrees of success.
Thanks to a recent report from the Research Committee of the International Psychoanalytical Association that summarizes the procedures and results of the world's major psychoanalytic outcome research programs, you can now reply to questions about psychoanalytic outcomes by directing questioners to this new publication or using the data it contains as a basis for composing your own answers.
Aptly titled “An Open Door Review of Outcome Studies in Psychoanalysis,” the downloadable version (ipa.org.uk), edited by Research Committee chair Peter Fonagy, is intended as a “resource to those who wish to further their knowledge of the area.” Although the report intentionally does not draw conclusions about psychoanalytic efficacy based on the material reviewed, it nevertheless allows the reader to become familiar with the methods and results of past and present psychoanalytic outcome research.
Here are some of the highlights among the 330 pages of this valuable document.
The published research tends to support the idea that psychoanalysis “has a beneficial effect for neurotic and some other groups of patients.”
“Completed analyses [are] invariably associated with greater benefits.”
“Longer treatment has a better outcome.”
“Psychoanalysis can bring the functioning of a clinical group to the level of the normal population.”
“Long term psychoanalytic psychotherapy can reduce borderline symptom[s] in the long run … and these improvements are maintained.”
“Psychoanalysis can lead to a reduction in health care–related use and expenditure and this is maintained for a number of years after therapy ends.”
“Intensive psychoanalytic treatment is generally more effective than psychoanalytic psychotherapy. [However, the] superiority of psychoanalysis [is] sometimes not maintained at long term follow up.”
Stephen H. Portuges, Ph.D., writes a regular column for TAP on psychoanalytic science. To let him know of interesting research for this column, e-mail him at .
“More severe disturbance specifically benefits from psychoanalysis rather than psychotherapy.”
Important caveats emerge from this excellent compilation of research findings. For example, one result, found in two separate studies, indicates that “psychoanalytic therapy at subclinical dose may have negative outcomes.”
In addition to methodological descriptions that tell the reader how these results were achieved, “An Open Door Review of Outcome Studies in Psychoanalysis” includes a thoughtful presentation of opposing philosophical perspectives on the value of objective research methods in the study of psychoanalytic treatment. What makes me even keener on this important review of the world's major psychoanalytic research programs is the fact that its format is an “open door”: New studies will be added and made available as they are reviewed, and readers are encouraged to contact the editor about research that ought to be included.