Presentation is loading. Please wait.

Presentation is loading. Please wait.

The Enduring Significance of Psychoanalytic Theory and Practice

Similar presentations


Presentation on theme: "The Enduring Significance of Psychoanalytic Theory and Practice"— Presentation transcript:

1 The Enduring Significance of Psychoanalytic Theory and Practice
Gregory Lowder The New York Psychoanalytic Institute James Hansell University of Michigan Nancy McWilliams Rutgers University The Enduring Significance of Psychoanalytic Theory and Practice Greg Lowder The New York Psychoanalytic Institute James Hansell University of Michigan Nancy McWilliams Rutgers University

2 As a general theory of the mind As a theory of psychopathology
There is much current misunderstanding about contemporary psychoanalytic theory: As a general theory of the mind As a theory of psychopathology As a theory of social and group phenomena As the basis for psychotherapeutic treatments There is much current misunderstanding about contemporary psychoanalytic theory: -As a general theory of the mind -As a theory of psychopathology -As a theory of social and group phenomena -As the basis for psychotherapeutic treatments

3 Newsweek - March 27 2006 Cover story: “Freud in Our Midst”
Psychoanalysis permeates our culture 2006 poll shows that 18% of Americans have been in talk therapy Terms such as “passive-aggressive,” “anal,” and “Freudian slip” are widely used The influence of sexual and aggressive impulses is widespread, and conflict and ambivalence are ubiquitous Although there have been repeated attempts over the past decades to discount the merits of psychoanalytic theory, and to definitively declare that “Freud is dead,” it is clear, from many sources, that psychoanalytic theory and treatment have been assimilated into all aspects of our culture (see, for example, the March 27, 2006, Newsweek story, “Freud in Our Midst,” where the cover declared, “Freud is Not Dead” Some points from the Newsweek article: -2006 poll shows that 18 percent of Americans have been in therapy -Terms such as passive-aggressive and anal are widely used -The influence of sexual and aggressive impulses is widespread, and conflicting feelings and ambivalence are ubiquitous

4 Psychoanalytic/Psychodynamic Empirical Treatment Research
There is substantial research that supports psychoanalytic theory and treatment

5 Profiled in the New York Times on February 7, 2007
Milrod, et al (2007). A randomized controlled clinical trial of psychoanalytic psychotherapy for panic disorder. American Journal of Psychiatry, 164(2): Profiled in the New York Times on February 7, 2007 21 patients with Panic Disorder in twice-weekly psychodynamic psychotherapy for 12 weeks 16 of 21 patients experienced remission of panic and agoraphobia, along with remission of depression in treatment completers who were depressed American Journal of Psychiatry’s conclusion: Psychodynamic psychotherapy appears to be a promising non-pharmacological treatment for Panic Disorder A study conducted by Milrod, et al (2007). A randomized controlled clinical trial of psychoanalytic psychotherapy for panic diosrder. American Journal of Psychiatry, 164(2): Profiled in the New York Times on February 7, 2007 21 patients with Panic Disorder in twice-weekly psychodynamic psychotherapy 16 of 21 experienced remission of panic and agoraphobia, along with remission of depression in treatment completers who were depressed Conclusion: Psychodynamic psychotherapy appears to be a promising nonpharmacological treatment for Panic Disorder

6 Leichsenring, F. (2005). Are psychodynamic and psychoanalytic therapies effective? International Journal of Psychoanalysis, 86, At least one RCT providing evidence for the efficacy of psychodynamic psychotherapy was identified for: Leichsenring, F. (2005). Are psychodynamic and psychoanalytic therapies effective? International Journal of Psychoanalysis. 86: -This is a review of the evidence for the efficacy of psychodynamic psychotherapy in specific psychiatric disorders. For the following psychiatric disorders at least one Randomized Controlled Trial (RCT) providing evidence for the efficacy of psychodynamic psychotherapy (7 to 46 sessions) was identified: -depressive disorders (4 RCTs) -anxiety disorders (1 RCT) -post-traumatic stress disorder (1 RCT) -somatoform disorder (4 RCTs) -bulimia nervosa (3 RCTs) -anorexia nervosa (2 RCTs) -borderline personality disorder (2 RCTs) -cluster C Personality disorder (1 RCT) -substance-related disorders (4 RCTs) Depressive disorders (4) Anxiety disorders (1) Post-traumatic stress disorder (1) Somatoform disorder (4) Bulimia nervosa (3) Anorexia nervosa (2) Borderline personality disorder (2) Cluster C Personality disorder (1) Substance-related disorders (4)

7 Leichsenring, F. (2001). Comparative effects of short-term psychodynamic psychotherapy and cognitive-behavioral therapy in depression: A meta-analytic approach. Clinical Psychology Review, 21(3), 6 RCTs contrasting manualized CBT and short-term psychodynamic psychotherapy (STPP) No substantial difference - only one of the studies suggested a possible superiority of CBT Leichsenring, F. (2001). Comparative effects of short-term psychodynamic psychotherapy and cognitive-behavioral therapy in depression: A meta-analytic approach. Clinical Psychology Review. 21(3): -This review identified 6 RCTs that contrasted manualized short-term psychodynamic psychotherapy (STPP) and CBT -The review concludes that the two forms of therapy are not substantially different, as only one of the studies reviewed suggests a possible superiority of CBT

8 Fonagy, P. , Roth, A. , & Higgitt, A. (2005)
Fonagy, P., Roth, A., & Higgitt, A. (2005). The outcome of psychodynamic psychotherapy for psychological disorders. Clinical Neuroscience Research, 4, 20 published trials in which depressive and anxiety disorder symptoms were treated with psychodynamic psychotherapy Psychodynamic psychotherapy has better effectiveness in open trials or compared to waiting list or outpatient treatment in general Fonagy, P., Roth, A., & Higgins, A. (2005). The outcome of psychodynamic psychotherapy for psychological disorders. Clinical Neuroscience Research. 4: -In another review, Fonagy et al., reviewing 20 published trials in which depressive and anxiety disorder symptoms were treated with psychodynamic psychotherapy -Concluded that psychodynamic psychotherapy has better effectiveness in open trials or compared to waiting list or outpatient treatment in general

9 Beutel, M. , Rasting, M. , Stuhr, U. , Ruger, B
Beutel, M., Rasting, M., Stuhr, U., Ruger, B., & Leuzinger-Bohleber, M. (2004). Assessing the impact of psychoanalyses and long-term psychoanalytic psychotherapies on health care utilization and cost. Psychotherapy Research, 14, Looked at 255 patients who had terminated their treatments with members of the German Psychoanalytic Association 70-80% of patients achieved good and stable psychic changes (average 6.5 years after ending) Qualitative analysis pointed to the value that patients continued to attach to their respective analytic experiences Beutel, M., Rasting, M., Stuhr, U., Ruger, B., & Leuzinger-Bohleber, M. (2004). Assessing the impact of psychoanalyses and long-term psychoanalytic psychotherapies on health care utilization and cost. Psychotherapy Research. 14: -The German Psychoanalytic Association (GPA) undertook a study of 255 patients who had terminated their psychoanalytic treatments with members of the GPA - According to the evaluations of the patients themselves, their analysts, independent psychoanalytic and non-psychoanalytic experts, and questionnaires commonly applied in psychotherapy research, 70-80% of the patients achieved good and stable psychic changes (average 6.5 years after the end of treatment) -Qualitative analysis of the data also pointed to the value that patients continued to attach to their respective analytic experiences

10 Sandell. R., et al. (2000). Varieties of long-term outcome among patients in psychoanalysis and long-term psychotherapy: A review of findings in The Stockholm Outcome of Psychoanalysis and Psychotherapy Project (STOPP). International Journal of Psychoanalysis, 81, 331 patients in psychoanalytic psychotherapy and 74 patients in various phases of psychoanalysis Improvement 3 years after treatment was positively related to treatment frequency and duration In follow-up, psychotherapy patients did not change but those who had psychoanalysis continued to improve Sandell. R., Blomberg, J., Lazar, A., Carleson, J., Broberg, J., & Schubert J. (2000). Varieties of long-term outcome among patients in psychoanalysis and long-term psychotherapy: a review of findings in The Stockholm Outcome of Psychoanalysis and Psychotherapy Project (STOPP). International Journal of Psychoanalysis. 81: -This pre-post design study followed 756 people who received national insurance-funded treatment for up to 3 years in psychoanalysis or psychoanalytic psychotherapy -Because some patients refused to be randomly assigned to treatments, random assignment was unsuccessfully attempted -Complete data was obtained from a group of 331 patients in various phases of long-term psychoanalytic psychotherapy (1-2 times per week) and from a group of 74 patients in various phases of psychoanalysis (4-5 times per week) -In measurements of symptomatic outcome using the Symptom Checklist 90, improvement during the 3 years after treatment was positively related to treatment frequency and duration -Of note, during the follow-up period, psychotherapy patients did not change, but those who had had psychoanalysis continued to improve, almost to the point where their scores were indistinguishable from those obtained from a non-clinical Swedish population

11 The role of psychoanalytic treatments
When other treatment options have failed When treatment compliance is a problem Psychoanalytic therapies have the potential to affect long-range vulnerability by altering the way the patient deals with stressors and therefore to make more enduring changes Cost-effective The role of psychoanalytic treatments -When other treatment options have failed, or the gains from other treatments have not held -When treatment compliance is a problem, as psychoanalytic theory specifically addresses the issue of ambivalence toward making gains in treatment -Psychoanalytic therapies also have the potential to affect long-range vulnerability by altering the way the patient deals with stressors and therefore to make more enduring changes -Cost-effective (study cited on next slide)

12 Guthrie et al. (1999). Cost-effectiveness of brief psychodynamic-interpersonal therapy in high utilizers of psychiatric services. Archives of General Psychiatry, 56, 519–526. 110 patients randomly placed in either 8 weekly psychodynamic psychotherapy sessions or treatment as usual Psychotherapy patients had significantly better improvement in distress and social functioning Baseline treatment costs were similar, but the therapy patients showed significant reductions in the cost of health care utilization in the 6 months after treatment, and psychotherapy costs were recouped within 6 months -Regarding cost-effectiveness Guthrie et al. (1999). Cost-effectiveness of brief psychodynamic-interpersonal therapy in high utilizers of psychiatric services. Archives of General Psychiatry. 56:519–526. -A 1999 study, Guthrie et al looked at 110 patients who randomly placed in either 8 weekly psychodynamic psychotherapy sessions or treatment as usual with psychiatric coverage -Psychotherapy patients had significantly better improvement in distress and social functioning -Baseline treatment costs were similar, but the therapy patients showed significant reductions in the cost of health care utilization in the 6 months after treatment, and psychotherapy costs were recouped within 6 months

13 Empirical studies that support key areas of psychoanalytic theory, such as:
Unconscious motivation Ambivalence and conflict Unconscious affective processes The influence of historical relationships, such as childhood experiences Empirical studies that support psychoanalytic concepts Most people within the field of psychology have encountered research in the cognitive sciences or in social psychology that substantiate many of the psychoanalytic tenants. Usually they are presented independently, but here a few of the many studies will be presented together covering the topics of: -unconscious motivation -ambivalence and conflict -unconscious affective processes -the influence of historical relationships -the influence of childhood experiences

14 The concept of unconscious motivation
Consciousness is a recent development superimposed on an information processing system that worked well for millions of years Our culture highly privileges and pays attention to consciousness and free will Our ancestors successfully navigated complicated situations and relationships using resources and abilities other than individual consciousness Unconscious motivation -Consciousness is a recent evolutionary development, superimposed on an information-processing system that worked relatively well for millions of years -Our culture highly privileges and pays attention to consciousness and free will -Our ancestors successfully navigated complicated situations and relationships using resources and abilities other than individual consciousness

15 Examples of research on unconscious motivation
The Swiss neurologist Edouard Claparede concealed a pin between his fingers and shook hands with a patient suffering from Korsakoff’s disorder Upon meeting again the patient didn’t recognize Claperede, but was unwilling to shake his hand despite not knowing why (Cowey, 1991) The Swiss neurologist Edouard Claparede, a century ago, concealed a pin between his fingers, and shook hands with a patient suffering from Korsakoff’s disorder. Upon meeting again, the patient didn’t recognize Claperede, but was unwilling to shake his hand, despite not knowing why (Cowey, 1991)

16 Bargh, J. A. (1997). The automaticity of everyday life. In R. S
Bargh, J. A. (1997). The automaticity of everyday life. In R. S. Wyer, Jr. (Ed.), The automaticity of everyday life: Advances in social cognition (Vol. 10, pp. 1-61). Mahwah, NJ: Erlbaum. Participants were primed with words relating to either achievement (e.g. strive) or affiliation (e.g. friend) Participants were paired with an incompetent partner to solve a challenging puzzle Success would humiliate the partner, while not being successful would protect their partner’s self-esteem Participants who had been primed with achievement words outperformed participants primed with affiliation words Bargh, J. A. (1997). The automaticity of everyday life.(In R. S. Wyer, Jr. (Ed.), The automaticity of everyday life: Advances in social cognition (Vol. 10, pp. 1-61). Mahwah, NJ: Erlbaum. -In a 1997 study by Bargh, participants were primed with words relating to either achievement (e.g. strive) or affiliation (e.g. friend) -Then they placed participants in a situation that posed a motivational conflict – they were paired with an incompetent partner to solve a challenging puzzle -Therefore, the participant could either succeed, which would humiliate the partner, or they could not be so successful, and thus protect their partner’s self-esteem -As predicted, participants who had been primed with achievement words outperformed participants primed with affiliation words

17 The concepts of ambivalence and conflict
Freud posited that multiple psychological processes can proceed in parallel, which is similar to contemporary connectionist or parallel distributed processing (PDP) models in cognitive science Conflict and Ambivalence Freud posited that multiple psychological processes can proceed in parallel, which is similar to contemporary connectionist or parallel distributed processing (PDP) models in cognitive science

18 Emmons, R. & King, L. A. (1988). Conflict among personal strivings: Immediate and long-term implications for psychological and physical well-being. Journal of Personality and Social Psychology, 54, Students listed 15 personal goals then rated how much each goal conflicted with other goals A matrix of their ratings was used to create a mean index of level of conflict for each student Students also reported how much they thought success in attaining the goal would lead to some conflict Dependent variables included daily mood reports taken twice a day over 21 consecutive days and reports of somatic complaints Conflict and ambivalence correlated significantly with reported emotions and somatic complaints Emmons, R. & King, L. A. (1988). Conflict among personal strivings: Immediate and long-term implications for psychological and physical well-being. Journal of Personality and Social Psychology. 54: -Another example from a 1988 study by Emmons and King showed the degree to which conflict and ambivalence can affect a person’s wellbeing -Students listed 15 of their personal goals, they then rated the extent to which each individual goal conflicted with every other goal on their list -Researchers then used the matrix of their ratings to construct a mean index of level of conflict for each individual. -Participants also reported the extent to which success at the goal would lead to some conflict -Dependent variables included daily mood reports taken twice a day over 21 consecutive days, reports of somatic complaints (e.g. headaches, coughing, and acne) and visits to the health service. -Conflict and ambivalence showed significant correlations with reported emotions and ambivalence

19 The concept of unconscious affective processes
This fundamental psychoanalytic principle means that people can feel things without knowing they feel them and they can act on feelings of which they are unaware Unconscious affective processes One fundamental psychoanalytic principle is that people can feel things without knowing they feel them, and they can act on feelings of which they are unaware

20 Bruyer, R. (1991). Covert face recognition in prosopagnosia: A review
Bruyer, R. (1991). Covert face recognition in prosopagnosia: A review. Brain and Cognition, 15, Individuals with prosopagnosia, who lose the capacity to discriminate faces, consciously may show differentiated electrophysiological responses to familiar versus unfamiliar faces Bruyer, R. (1991). Covert face recognition in prosopagnosia: A review. Brain and Cognition. 15: A 1991 study by Bruyer showed that individuals with prosopagnosia, who lose the capacity to discriminate faces consciously may show differentiated electrophysiological responses to familiar versus unfamiliar faces

21 Wegner, D. , Shortt, J. , Blake, A. W. , & Page, M. S. (1990)
Wegner, D., Shortt, J., Blake, A. W., & Page, M. S. (1990). The suppression of exciting thoughts. Journal of Personality and Social Psychology, 58, Participants who were instructed to suppress an exciting thought about sex remained psychophysiologically aroused even while the thought was outside of their awareness They remained as aroused as participants instructed to actually think about the sexual thought Those instructed to suppress the thought did not habituate to it so that when the sexual thought returned they showed physiological arousal again This suggests that affect-laden thoughts kept from consciousness may continue to have an affective press Wegner, D., Shortt, J., Blake, A. W. & Page, M. S. (1990). The suppression of exciting thoughts. Journal of Personality and Social Psychology. 58: -Apropos of a presentation on psychoanalytic theory is this 1990 study by Wegner et al where they found that when people are instructed to suppress an exciting thought about sex, they remain psychophysiologically aroused even while the thought is outside of awareness -In fact, they remain as aroused as participants instructed to actually think about the sexual thought -Unlike the latter participants, however, those instructed to suppress the thought do not habituate to it, so that when the sexual thought returns to their consciousness, they show physiological arousal again, unlike participants who have kept it in mind the entire time -This suggests, much as Freud did, that affect-laden thoughts kept from consciousness may continue to have an affective press

22 Transference: The influence of historical (e. g
Transference: The influence of historical (e.g. childhood relationships) on current relationships One primary psychoanalytic idea is that of “transference,” which simply means that early relationship templates color how people see and interact in the world as adults. This idea is cogently captured in Wordsworth’s oft quoted phrase, “The child is the father of the man” The influence of historical relationships on current relationships (Transference) One primary idea psychoanalytic is that of “transference” -- which simply means that early relationship templates color how people see and interact in the world as adults. This idea is cogently captured in Tolstoy’s oft quoted phrase, “The child is the father of the man”

23 Attachment Theory Attachment styles are significantly influenced by early child/caregiver interactions Attachment style significantly affects social adjustment and personality The mother’s responsiveness has shown to be the greatest predictor for the child’s style of attachment The predictive power of the mother’s - as opposed to the father’s - attachment style refutes an exclusively genetic explanation Attachment Theory -Various studies conducted by researchers such as Mary Main at the University of California Berkeley and Inge Bretherton at the University of Wisconsin-Madison on attachment styles have shown the influence that early child/caregiver interactions have on later social adjustment and personality -Attachment style significantly affects social adjustment and personality -The mother’s responsiveness has shown to be the greatest predictor for the child’s style of attachment -The predictive power of the mother’s, as opposed to the father’s, attachment style refutes an exclusively genetic explanation

24 Andersen, S. , & Cole, S. W. (1990). "Do I know you
Andersen, S., & Cole, S. W. (1990). "Do I know you?” The role of significant others in social perception. Journal of Personality and Social Psychology, 59, Participants were asked to provide a description of significant others and descriptions were embedded in narratives about fictional characters The participants wrongly attributed traits to the characters that stemmed from their templates, but were not originally part of the character’s description In the words of these researchers, “The transference process is a basic mechanism by which the past comes to play a role in the present and it depends on relatively automatic social cognitive processes” Andersen, S. & Cole, S. W. (1990). "Do I know you?” The role of significant others in social perception. Journal of Personality and Social Psychology. 59: -Using a particularly shrewd research design, Andersen and Cole (1990) asked participants to provide a description of significant others, and these descriptions were then embedded in narratives about fictional characters -When asked to subsequently describe the fictional characters, the participants wrongly attributed various traits to the characters that stemmed from their template of their significant others, but were not originally part of the character’s description -In the words of these researchers “The transference process is a basic mechanism by which the past comes to play a role in the present and it depends on relatively automatic social cognitive processes”

25 Mickelson, K. D. , Kessler, R. C. & Shaver, P. R. (1997)
Mickelson, K. D., Kessler, R. C. & Shaver, P. R. (1997). Adult attachment in a nationally representative sample. Journal of Personality and Social Psychology, 73, In a non-clinical sample of 5,000 adults a history of parental loss and separation was associated with higher ratings of insecure attachment and lower attachment security Mickelson, K. D., Kessler, R. C. & Shaver, P. R. (1997). Adult attachment in a nationally representative sample. Journal of Personality and Social Psychology. 73: -In a non-clinical sample of 5,000 adults a history of parental loss and separation was associated with higher ratings of insecure attachment and lower attachment security

26 Boudewyn, A., & Liem, J. (1995). Childhood sexual abuse as a precursor to depression and self-destructive behavior in adulthood. Journal of Traumatic Stress, 8, Childhood sexual abuse rendered adults susceptible to a number of mental health problems, including depression, anxiety, suicidality, and self-destructiveness Boudewyn, A. & Liem, J. (1995). Childhood sexual abuse as a precursor to depression and self-destructive behavior in adulthood. Journal of Traumatic Stress. 8: Boudewyn and Liem found, in a 1995 study, that childhood sexual abuse rendered adults susceptible to a number of mental health problems, including depression, anxiety, suicidality, and self-destructiveness

27 These are only a few of hundreds of studies, mostly in the fields of cognitive science and social psychology, that substantiate many psychoanalytic ideas *For an excellent and more complete overview see: Westen, D. (1998). The scientific legacy of Sigmund Freud: Toward a psychodynamically informed psychological science. Psychological Bulletin. 124(3): As mentioned, these are only a few of hundreds of studies, largely in the fields of cognitive science and social psychology, that substantiate many psychoanalytic tenants *For an excellent and more complete overview see: Westen, D. (1998). The scientific legacy of Sigmund Freud: Toward a psychodynamically informed psychological science. Psychological Bulletin. 124(3):

28 Other psychotherapy models have appropriated psychoanalytic theory without proper crediting. Examples: All talking therapies Trauma theories Therapeutic alliance (CBT, IPT, and others) Childhood/developmental models Defense mechanisms (social psychology, cognitive science) There are a number of issues that affect current attitudes toward psychoanalytic theory and practice -Other theoretical orientations and psychotherapy models have appropriated psychoanalytic theory without proper crediting, such is the case in: -All talking therapies -Trauma theories -Therapeutic alliance (CBT, IPT) -Childhood/developmental models -Defense mechanisms (social psychology, cognitive science)

29 Why the myths about and misunderstandings of psychoanalysis?
The dearth of affiliations between psychoanalytic institutes and universities The insularity of psychoanalytic institutes The historical under-emphasis of empirical research within psychoanalytic institutes – some legitimate challenges in collecting research, but much of it has to do with a dismissal of research Why the myths about psychoanalysis? -The dearth of affiliations between psychoanalytic institutes and universities, and the insularity of psychoanalytic institutes has kept psychoanalytic information out of the mainstream -The historical under-emphasis of empirical research within psychoanalytic institutes – some of this has to do with legitimate challenges in collecting data in psychoanalytic psychotherapies and psychoanalysis, but much of it has to do with a dismissal of the value of empirical research dating back to Freud

30 Why does psychoanalysis attract so much criticism?
Ethnocentricity of some theorists Unwavering belief, by some clinicians, in the analyst’s privileged perspective Discomfort with sexual, aggressive, and dependent aspects of human nature Historical pathologizing of diversity Concretization of theories (e.g. penis envy) Discomfort with the idea of the unconscious Feared subversive impact of psychoanalytic theory Disputes and prejudices against psychoanalysis: -Ethnocentricity of some theorists -Unwavering belief, by some clinicians, in the analyst’s privileged perspective -Discomfort with sexual, aggressive, and dependent aspects of human nature -Historical pathologizing of diversity -Concretization of theories (eg. penis envy) -Discomfort with the idea of the unconscious -Feared subversive impact of psychoanalytic theory

31 Why learn about psychoanalytic theory?
The current focus on theoretical convergence and integration “Brand name” therapies aren’t pure, and almost all contain components that may be deemed “psychoanalytic” The importance of understanding unconscious motivation to explain both clinical and social/political phenomena Psychoanalytic theory offers diagnostic alternatives Why learn about Psychoanalysis? -The dawning reality of theoretical convergence, where CBT is beginning to talk about non-conscious events and “dormant schemas” -“Brand name” therapies aren’t pure, and include various components that may be deemed “psychoanalytic” -The importance of keeping unconscious motivation in mind when evaluating the merits of self-report measures -The relevance of how unconscious affect/motivation influences political and social judgment -Psychoanalytic theory offers diagnostic alternatives, especially as the DSM does an inadequate job of addressing the complexities of how personality structure and manifest psychiatric illness overlap


Download ppt "The Enduring Significance of Psychoanalytic Theory and Practice"

Similar presentations


Ads by Google