Ridicule is an attempt to enforce social norms by taking advantage of the natural human desire for respect from their peers. Such an attempt ought to have no place in an academic discussion. If my professors were to model that sort of behaviour, I would run, not walk, away from that training program.

I do not say this to bring doubt about your credentials. I say this because I am confused. You appeared to cite this ridicule approvingly while simultaneously decrying other people’s failure to use evidence-based methods. Where is the evidence in ridicule? To accept your argument as valid I would simply be relying on the supposed authority of your professors. Argument from authority went out with the middle ages (long before Freud!)

Physician: heal thyself.

Raymond Bokenkamp
My Blog
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That sentence is hyperbole to make a point, and here’s my point. If a human wants to dump, pour, or invest tens or hundreds of thousands of dollars into a psychoanalysis or long-long-long term therapeutic relationship, that is the person’s prerogative. I could see where for some folks, with a brilliant analyst and a probing analysand mind, that could be a fantastic intellectual and emotional exercise. I can even see where anecdotally (as opposed to statistically) it could provide a “cure.”

The problem is, where does insurance and government funding via Medicaid enter into it? Especially with the 2010 advent of mental health parity, what is the responsibility of the larger insurance pool participants to pay for such an analysis or relationship? Freud said that the point of psychotherapy is to turn neurosis into ordinary human misery. How much misery should be tolerable, and how much of your misery should I be responsible for paying for to alleviate? How miserable ought I be before I ask you to help fund my care?

No answers here, just questions. Great post and excellent comments.

My main diagnosis was GAD. Now, in PD therapy, I don’t really have one (except when one must be chosen to submit to the insurance co.). I found psychodynamic therapists (can only speak for the ones I have known) do not use the DSM diagnosis in terms of formulating a person’s needs or categorize people into those narrow labels. Diagnoses change all the time, but how they overlap heavily adds much more complexity, which I think is another factor that leads to difficulties with making valid conclusions from comparing therapies.

I wonder if those who end up in psychodynamic therapy have more complex problems to begin with? Not in studies, but in the non-study world?

What has really helped me in terms of psychodynamic therapy was the opportunity to access and work through emotions that have been repressed all my life. This was the missing element from years of other therapies. I’m middle aged now, and am very saddened I was so clueless all those years about the different types of therapy, while I was engaged in those that made not one iota of difference in my life (even though the therapists were supportive and nice to talk to).

I really wish one of my psychiatrists would have suggested psychodynamic therapy (I had never heard of it prior to one year ago). People should be educated as to what their options are. Not one P-Doc suggested I try a different therapeutic approach than CBT. Now, with the information on the internet, it is so much easier to investigate your options. Before I had internet access-I did not even know there were so many different types of therapeutic approaches! Not everyone uses the internet for medical information..and even so, P-Docs should inform patients of these options at some point during one of our 15 minute medication appointments.

But I do think experience makes a huge difference. A therapist may be taught a certain method and realize it doesn’t work and change their approach. My current PD therapist/MD told me that long ago, he revised his techniques originally taught through psychoanalytic training. I weigh a therapist’s 30 plus years of experience with the nature of human relationships much greater than what a student might learn from a graduate program. That’s just my personal belief and preference though. Converting the many theories to clinical practice is primarily how I see the art in it all…..a skill acquired through experience. The downside is mistakes are likely to be made through some of these learning experiences…

At any rate, I’m glad to see studies comparing therapies, pleased to see others reporting on them and welcome the chance to discuss them…so thanks for your article!

http://psychcentral.com/blog/archives/2007/04/03/intensive-psychotherapy-helps-bipolar/

Someone posted a comment in the PC forum about medicare only allowing cbt or interpersonal therapy. Because of the source, i’m not sure if this is fact, but i see turning therapy into a science-in terms of basing treatments on statistics-as problematic. People who would greatly benefit from psychoanalysis would be left out in the cold and never experience recovery because of some statistic/empirical evidence that classifies people in groups instead of individuals.