Psychodynamic Psychotherapy - Countercultural?

In a recent New York Times Op-Ed, Brandon Gaudiano, a clinical psychologist and assistant professor at the Alpert Medical School at Brown University, makes the following statement. “But psychotherapy’s problems come as much from within as from without. Many therapists are contributing to the problem by failing to recognize and use evidence-based psychotherapies (and by sometimes proffering patently outlandish ideas). There has been a disappointing reluctance among psychotherapists to make the hard choices about which therapies are effective and which — like some old-fashioned Freudian therapies — should be abandoned.”

Jonathan Shedler, in a landmark paper published in the American Psychologist in October of 2009, states that effect sizes for psychodynamic psychotherapy are as large as those reported by other therapies. In fact, he makes a bold statement, “the perception that psychodynamic approaches lack empirical support does not accord with available scientific evidence and may reflect selective dissemination of research findings.” Shedler acknowledges that there may be a lingering distaste in the mental health professions for past psychoanalytic arrogance and authority. In decades past, he says, American psychoanalysis was dominated by a hierarchical medical establishment that denied training to non-MDs and adopted a dismissive posture toward research. This did not win friends and influence people, he writes. When empirical findings emerged that supported non-psychodynamic treatments, many educational establishments greeted this with excitement and were eager to spread the word. When evidence supported psychodynamic concepts and treatments, it was often overlooked.

Psychoanalyst Frank Summers provides an interesting discussion on this in his recent book, The Psychoanalytic Vision: The Experiencing Subject, Transcendence, and the Therapeutic Process. He writes, “Psychoanalytic insights into human experience have been attacked as invalidated speculations…” In fact, “psychology texts are unanimous in dismissing psychoanalytic ideas as empirically unverified (Munn et al, 1969; Morgan et al., 1985; Kalat, 2007).

Summers goes onto state that the dismissal of analytic theory is not based on research findings but on the fact that psychoanalysis fails to fit into the dominant objectivist ideology of the social science culture. The natural sciences have enjoyed great benefit with the objectivist method and is based on a certain stance. This stance is reflected well by a statement by E.L. Thorndike in 1918: “Whatever exists, exists in some amount, and whatever exists in some amount can be measured.” Summers’ point is that this is a certain concept of reality that tends to believe that only the measurable exits. Hence, psychology texts define the field as the study not of the psyche, but of the behavior of living organisms. An introductory psychology textbook by Morgan et al., 2005, states the following, “Behavior, rather than mind, thoughts, and feelings, is the subject of psychology because it alone can be observed, recorded, and studied.” Summers’ point is this – the application of objectivist space to humans is a theoretical prejudice that ignores the distinctively human quality of being in the world. Psychic states, while one can make attempts to understand and quantify, are difficult to measure. Approaching the complexity of the human being with a purely empirical approach misses so much of the very subject matter in question. With the ACA’s supposed emphasis on outcome measures, and the tying to financial incentives to those outcomes, it’s easy to assume that a psychodynamic sensibility will be squeezed out. Not everything that is, is measurable and if our healthcare system is continually leaning toward legitimizing only that which is measurable, the psychoanalytic worldview becomes countercultural.