Is Psycho-analysis dead?

In what way is this a good place to start? The only thing that article tells you is that Darian Leader is clearly a complete loon.

On psychotherapy:
"Therapy is about the encounter of two people, and the real work is done not by the therapist but by the patient."

Well that's how CBT works.

"Unlike CBT, traditional therapies do not aim to give access to a common, scientific reality but to take the patient's own reality seriously: to explore it, to define it, to elaborate it and to see where it will go. No outcome can be predicted in advance: the patient may go back to work but equally they may give up a well-paid job to pursue another path."

Wrong - that's exactly like CBT.

All this huffing and puffing about science and what works just suggests that psychotherapy is unscientific and doesn't work. If (noting the emphasis on 'if') that's the best defence of psychotherapy then it should be classified with all the other weird and wacky 'alternative' therapies.

No Blagsta, you misunderstand the nature of scientific debate.

What you need is for your words and arguments to make sense, not to try to pull some kind of "Listen To Me I'm An Authority" schtick.

In what way does it do that?

You're having a scientific debate are you?

I'm trying to, but you won't engage.

It's like trying to debate with astrologers, or cultists, or Gorski.

Blagsta, could you perhaps explain more about what you mean by difficulties with evidence based practice?

Because I come across this argument a lot - but TBH I don't really get it.

I can see that mental health has by its nature a lot of subjective elements. But lots of things have strong subjective elements and nonetheless are able to be studied by objective methods including RCTs: pain & pain reduction; other psychological therapies; the effects of meditation...

Sure, RCTs by themselves don't tell you everything you need to know - you need real-world information too. In my experience even the staunchest defender of RCTs would agree with that.

But I do think that RCTs tell you one crucial thing: does this therapy actually do anything OVER AND ABOVE what happens to people in the absence of the therapy.

What's so bad about that?

(BTW - I don't think Jonti is unaware of the controversies or disagreements - just taking a position on one side of the argument.)

Why else is he obsessing about it?

Two things to note:

1) Its a strawman argument and a ludicrously crass one at that.

2) Its an utterly weird strawman. The problem with things working is that they can sold? What!! That's the problem with medicine that works - its just so market oriented. I must remember to take more placebos in the future. The alternative medicine crowd - now they're not just in it for the money.

It's distasteful that the generality of frauds, pseuds and charlatans really don't (can't!) care about evidence. That rejection of the need for evidence is explicit in the defence of Freudian Psychoanlysis we're seeing on this thead.

It's deeply immoral. It means these methods may cause real harm, but practitioners will systematically try to escape being seen as responsible, perhaps by blaming their victims, perhaps by attacking the whole idea of evidence!

And worse, given that underlying attitude, devotees will have no qualms about making up slurs and general shit about folks who criticise their methods.

If I hadn't read that Leader article, I would have been shocked by your vehemence. If he's typical of psychoanalysts, then its shocking that these people are given the time of day.

Leader is a Lacanian analyst, sometime media pundit and hangs around with an arty crowd. Whether he's typical of psychoanalysts or not - dunno!

Sure, you could argue that Leader was being defensive about his professional territory - but why would critics like Oliver James want to concur, if it was just about that?

I think this line:

is the giveaway

Useful for what? The answer to this is virtually always "to adapt to ordinary life and play a useful role in society" ie, get back to doing a day's graft you slacker. No wonder New Labour with their "welfare to work" are championing CBT.

I went through a course of CBT on the NHS. I'd already read a lot of psychoanalytical theory so of course I was somewhat sceptical, but I tried to give it a chance. To her credit, the analysts finished up by saying that I'd probably find psychoanalysis more "useful" Can't afford it though

There's a nice example of this in that Leader article, actually - the 2nd and 3rd to last paras:

What Leader is completely ignoring here is that the 'little book' being talked about is actually a notebook the person created themselves. It's hardly a dogmatic 'red book' drawn up by some sinister CBT-pushing organisation, it's the person's OWN record of what they find helpful to do in various situations, which they carry round as an aide-memoire.

Most therapists would have recognised this as a standard 'relapse-prevention' technique - get your patient to make some sort of record of what they've figured out in therapy, that they can refer to if they have problems again. It's certainly not unique to CBT.

To compare this technique to what happened in the Cultural Revolution is absurd beyond words. And surely a deliberate misunderstanding of the original anecdote - unless Leader has never heard of this (as I say, extremely common) technique?

The point about Layard and the CBTers is that it places the onus of responsibility for ones own well being entirely back on the individual - what if the individual's problems are a perfectly reasonable response to utterly insane social structures?

I think this is a big give away on your behalf. You think people with mental/cognitive problems don't want to work. There is nothing romantic or rebelious about being on the dole.

CBT isn't very good in my experience. Its not particularly useful. The idea that it is something sinister is just conspiraloonacy. You've got to get over this ridiculous thing you have about instrumental reason.

See, when I did CBT, the answer to 'useful for what?' was always 'useful for making you happier'.

No therapist I've come across (CBT and otherwise) has ever suggested to me that I should 'adapt to ordinary life' or 'play a useful role in society' - they've variously encouraged me to consider working less hard, to tell people about the problems I had, to be kind to myself... but certainly not to stop being so slack.

It's a pity that the therapist you had didn't refer you on to some other form of therapy, given CBT didn't do much for you - could you go back and push them for it?

And psychoanalysis would help in what way? Pointing out that they are right to be miserable, watch them crash and burn, then making a tearjerking film about the evils of capitalism?

The patient is not a convenient device for the obsessions of the therapist.

Thankyou for informing me what I think. This is not what I'm saying at all. What I'm saying is that the practitioners of CBT might think that they are interested in people's ongoing hapiness - but what they do is deliver the nicely quantifiable units of treatment with measurable short-term results that the PCT managements need for their league tables. A short, sharp programme of "therapy" to get you thinking more "productively" in a few weeks. Now you're free again to earn your crust and make the kind of life choices that make you happy like any other consumer.

That article sounds pretty reasonable to me. For example:
"A further irony is that when actually tested with "science" - sorry, science - psychoanalytically-inspired therapies of the briefer kind actually do quite well for the limited evidence that exists. This seems to be particularly the case for people diagnosed with 'personality disorder' - a vague and controversial category but one which suggests the person has pervasive problems with sustaining relationships.

Interestingly, transference is one of the genuinely important, testable and innovative ideas to come out psychoanalysis, and it specifically describes how experiences of past relationships affect how we interpret social interactions."

I don't know much about psychology, but I recognise the difference between a serious mental health professional and a crank.

Then I was right about what you think.

No, you said I thought that people with mental illness didn't want to work. I think no such thing. I'm saying that a society that obligates people to work in conditions where they are alienated from the value of their own labour will inevitably produce mental problems. A society that invests so much in a weird combination of puritanical self-denial and repressive desublimation likewise.

Rather than stop the rising tide that is seeing us start to drown, CBT would try to teach us one individual after another about better swimming techniques. This might be temporarily useful, but even the strongest swimmers get tired

OK so you've noticed that CBT is not a theory of social revolution.

But it all feeds back into this psych industry social development.

If you are unable to work due to mental health/cognitive problems, this means you are also unable to effectively take part in a trade union or in your community, or in any type of organised activity that might change society. Great. That'll show 'em.

Of course that's going by the assumption that if you are having CBT then you are not working and that's a big assumption.

There was an incident on "Super Nanny" the other night which neatly exemplifies some aspects of the debate.

Briefly, Super Nanny was dealing with a rather older child than usual, a girl who had been prevented from doing the things appropriate for her age (kids like to feel independent and capable). The child was being suppressed and made helpless. Unsurprisingly, at least to me, the kid was increasingly acting out her frustration in acts of defiance, and in raging and behaving violently towards her parents.

When Super Nanny tacked the parents about the way they (for example) cut up the girl's food, but not that of her much younger brother; the way they did so much for her that she could do for herself; the way they made her into a helpless thing, the mother tearfully explained she had lost her first baby; that she had latched onto the girl as a substitute and not let her grow up.

Super Nanny listened to this almost tearful confession. Then said (not unkindly, but not with any great sympathy either) "I can give you the tools to change the situation, if you want."

To me, this is a vignette of the debate. Psychoanalysis would want to analyse the poor woman so as to render a psychological transformation. But Mum already knew why she was smothering the girl! What Mum really needed was to learn the techniques to drop the dysfunctional smothering behaviour. That's all.

How does this relate to anything I've said? My point isn't that individuals with mental problems do or should choose to suffer rather than enter paid employment, or that there is no conceivable benefit in the short (or maybe even longer) term to the individual of undergoing CBT.

My point is that the government prioritise CBT over less instrumental forms of therapy because it encourages the view that the individual is ultimately responsible for their own happiness. This is very convenient for governments - as is the ability to point to the volume of "successful treatment episodes", patient throughput etc.

Or they might just want the treatments they're paying for to work.

Seems reasonable to me.

Well then a...

...is surely a good thing then (if it works).

CBT is not a government mind control excercise.

Ok, we can run with this. Surely the main thing here is that the loss of the infant is such that the work of mourning has not been fully realised . The living child is being treated as a substitute for the lost object. And clearly the issue is also anxiety over separation - if the child grows up she will be lost.

You would be treating the symptom, but the conditions that produce it still fester. Clearly, mum now feels that loving someone means having to behave in such a way as to guard against their being lost. Why hasn't she been able to accept the loss and move on? Clearly at one level she acknowledges her ongoing grief. But she can't put it to bed. This suggests that there is something about the experience of loss that is still too painful to confront. Would it be so surprising if the death of the infant could have evoked still earlier memories of loss, separation and anxiety?

Can all this be settled by simply teaching her a few thought techniques? It might buy her a little peace in the immediate context. But is that case solved?

[edit] - and your use of the word 'dysfunctional' suggests that you have in mind some model of what a perfectly "functional" mother-daughter relationship might look like. As though the ambivalences of dependence-resentment, love-hate, loss-power etc. could ever be wholly ironed out of such a relationship?!

Oh the ironing!

I've pointed out to you that there is a debate in mental health about evidence based practice and RCT's. I've mentioned some of the issues. I've even posted a link to a paper about it. Yet you continue to deny that such a debate exists! If you want to engage, then engage! Engage me with your views on what the issues are.