The American Psychoanalytic Association, in conjunction with Division 39 of the American Psychological Association, has made available “The Enduring Significance of Psychoanalytic Theory and Practice,” a free-use PowerPoint presentation intended to disabuse audiences of misconceptions about psychoanalytic theories and treatments. Although dozens of studies have shown the efficacy and effectiveness of psychoanalytic treatments, and many more have substantiated various psychoanalytic tenets, some psychoanalytic practitioners and many non-psychoanalytic clinicians are not familiar with this body of research.
The presentation was created by Greg Lowder, in collaboration with Nancy McWilliams, James Hansell, the Board of Directors of Division 39, and the “10,000 Minds” Project of the American Psychoanalytic Association. Numerous empirical studies, both clinical and experimental, are covered that either specifically investigate psychoanalytic treatments and concepts or focus on psychological phenomena that have immediate relevance to psychoanalytic theory.
This is the first presentation to cull and make accessible these important studies. It may be used as a teaching and outreach tool for audiences such as insurers, undergraduates, non-psychoanalytic clinicians, academic book publishers, administrators, and individuals in the humanities.
The presentation may be accessed and adapted for any setting at apsa.org by clicking on “Recommended Resources.” Two formats are provided to accommodate diverse needs and levels of computer savvy: (1) a PowerPoint presentation with attendant notes and (2) a word processing document comprised of the PowerPoint slides and notes that can be handheld for presentation. Both formats are user-friendly and require minimal preparation time. A reference list of the studies addressed is also available.
A unique aspect of this project is that the presentation is an “open document,” meaning that any ideas for improvement will be duly considered by the authors. Please send suggestions to .
The studies presented include clinical trials that found similar outcomes for psychoanalytic psychotherapy and cognitive behavioral therapy, research demonstrating the cost-effectiveness of brief psychodynamic psychotherapy, and a study supporting the commonly reported clinical observation that patients in psychoanalysis continue to experience gains after their treatment has terminated.
In addition to research highlighting the efficacy of psychoanalytic treatments, the presentation includes studies in other areas of psychology that provide support for several aspects of psychoanalytic theory; for example, a compelling word-priming experiment demonstrating the impact of unconscious processes on motivation, a study that found an association between conflicted personal goals and an increase in somatic complaints, and an investigation that shows how affect-laden thoughts may continue to have an affective press when kept from consciousness.
The presentation also addresses more general, fundamental issues about the culture in which psychoanalysis now finds itself. It summarizes popular myths about psychoanalytic theory and suggests reasons why the theory has attracted such criticism. It points to many psychoanalytic concepts that have been adopted by other therapeutic modalities without proper credit to their psychoanalytic roots. Finally, the presentation proposes several ideas about the role of psychoanalytic treatments in contemporary mental health practice.
Psychoanalytically informed treatments and psychoanalytic concepts predominated in the mental health field well into the 1970s. Freestanding psychiatric hospitals were commonly psychoanalytic in their approach to treatment, insurance companies reimbursed for psychoanalysis, and both DSM I and DSM II were heavily informed by psychoanalytic theory. As reported in the March 26, 2006 Newsweek cover story, psychoanalytic ideas and treatments constitute a much more intrinsic and important part of our culture and communities than their current general reputation would suggest.
As this readership knows, over the last few decades psychoanalytic theory and practice have been severely criticized in both academic and popular circles. Some of the criticism reflects legitimate concerns, such as the insularity of psychoanalytic institutes, the damage done by misguided or misapplied theorizing, and the documentation of a handful of cases in which treatment was wildly inappropriate. Some reflect stereotypes, however, that have little to do with psychoanalytic therapy as it is actually practiced.
Most of us are painfully aware of the current status of psychoanalysis: Almost all the psychoanalytically oriented hospitals have either gone bankrupt or changed theoretical orientations, few insurance plans will reimburse for more than one session per week,
Greg Lowder, L.C.S.W., is in private practice in Manhattan. He is also a fourth-year candidate at the New York Psychoanalytic Institute, an advanced clinical psychology Ph.D. candidate at the Adelphi University Derner Institute, and adjunct psychiatry faculty at Weill Cornell Medical School.
Nancy McWilliams, Ph.D., is president of Division 39 of the American Psychological Association and associate editor of the Psychoanalytic Diagnostic Manual.
some psychoanalysts have been denied academic and clinical positions on the basis of their theoretical orientation, and most curricula in psychiatry, psychology, and social work programs pay little attention to psychoanalytic ideas or treatments (other than to claim that they are passé or not “evidence-based”).
If our opponents are correct, and psychoanalysis really is an ineffective and misguided undertaking, then there would not be much we could do about the matter. But as the empirical research in the PowerPoint presentation attests, psychoanalytic ideas and treatment are demonstrably helpful and viable. Public education efforts by members of this organization could help dismantle the misinformation that is currently ubiquitous. Public opinion can have a large bearing on whether or not a particular treatment is deemed legitimate and sought out, and whether it is covered by insurance.
Twenty years ago, alternative medicine was on the fringes of the health care scene, but in response to a number of popular publications, some charismatic leaders, and convincing research, the general public began to seek and demand reimbursement for alternative interventions. A 2004 study showed that more than 50 percent of adults in the United States have utilized at least one form of these treatments. Most schools of medicine currently offer courses on alternative medicine. In Sweden a few years ago, psychoanalysis was removed from a list of government-supported treatments, only to be restored by popular demand. In Germany, where there is good funding for research on psychoanalysis and the analytic therapies, such treatment is also covered by national policy.
While many American psychoanalysts prefer not to associate themselves with insurance companies, those who do wish to obtain insurance reimbursement are often thwarted by policies that discriminate against psychoanalytic therapies. Partly because psychoanalysts have not done a good job of communicating the value and legitimacy of their work, the general public has not been informed of the effectiveness of analytic treatments. Meanwhile, drug company employees, biological psychiatrists, and advocates of non-psychoanalytic therapeutic modalities have championed their work in academic journals and have participated in political lobbying and marketing campaigns that have convinced many clinicians and lay people that their treatments are the gold standard.
We need to challenge these assumptions by means of the empirical studies that expose their fallacies. We hope that members will use this resource to the full extent of its potential. For anyone who is interested in gaining funding for outreach efforts, the American Psychoanalytic Association has some generous grant monies available; for details, visit the American Psychoanalytic Foundation site on APsaA's home Web site, .