WHERE DO WE GO FROM HERE?
I have just returned from the Division 39 Spring Meeting that took place in San Antonio in late April. The Co-chairs, JoAnn Ponder and Stacey Rubin, and their conference committee expended countless hours to ensure that the conference would be an educational and enlivening experience for all of us. Particularly notable was their desire to give those of us who were not residents of the Southwest the opportunity to partake of the cultures and traditions that make this part of the world so special. The conference title, “Viva Psychoanalysis: Finding Connections from Couch to Culture,” reflected its upbeat focus on the interface between psychoanalysis and the cultural milieu in which we live and work. The presenters applied the principles of psychoanalytic theory to better understand how cultural traditions are handed down from one generation to another and yet are shaped and changed by new learning and experience. The enthusiastic responses from the conference attendees affirmed that the conference achieved its goal of exploring issues of immigration, exposure to trauma and war, and differences of culture and ethnic background from psychoanalytic perspectives.
I found the phrase “Viva Psychoanalysis” in the title of the conference to be particularly felicitous. “Viva” is colloquially used to express good will or approval. However, it is most literally translated as “long live”. The wish that psychoanalysis should have a long life coincides with my own desire as President to support the profession of psychoanalysis to ensure its long life and vitality. It causes me to hope that, much as Mark Twain so humorously declared about himself, the reports of the death of psychoanalysis are quite premature.
I am sure that you have been as heartened as I have been by some of the signs of vitality in our profession. We have had the pleasure of reading in the Journal of the American Medical Association that a recent meta-analysis by Leichsenring and Rabung (2008) of 23 psychotherapy outcome studies has shown that long-term psychodynamic psychotherapy produced more long-lasting personality change in patients with complex mental disorders than short-term non-psychodynamic treatments. Another recently published meta-analysis of 27 psychotherapy studies in the Harvard Review of Psychiatry (de Maat, de Jonghe, Schoevers, and Dekker, 2009) has shown that there is considerable improvement in both symptoms and personality change with the use of long-term psychoanalytic therapy and psychoanalysis. These studies suggest that psychoanalysis and psychoanalytic psychotherapy can demonstrate their effectiveness using rigorous research standards. In this era when advocates of evidence-based treatment question the effectiveness of psychoanalysis and psychoanalytic psychotherapy, such results are very heartening.
In addition to research studies pointing to the effectiveness of psychoanalytic therapy, the theory and practice of psychoanalysis have been re-vitalized by advances in our theoretical world and in related scientific fields. New understanding of brain functioning advanced by neuroscientists has pointed to the emotional underpinnings of our thought processes, the significance of unconscious thought, and the ways in which our brain functioning can be affected by the therapy process (Schore, 2003; Solms and Turnbull, 2002). We have been heartened by new theories that suggest that mentalization is a means to undo the influence of past trauma on our current lives and that psychoanalysis facilitates this process (Fonagy, et. al, 2002). Psychoanalysts (Wallin, 2007) have begun to apply attachment theory, originally a theory of infant development, to determine the attachment styles of adults. By exploring the patient’s attachment style and his or her own attachment style, the analyst can better understand the therapist-patient relationship and the impact the patient and analyst are having on each other. As the analyst and patient bring these experiences into focus, the patient is better able to recognize destructive expectations in relationships, develop healthier attachments, and have a more positive sense of self. As we incorporate findings such as these from related fields into our understanding of psychoanalysis, we gain a better appreciation of how psychoanalysis produces the changes in personality that we see in our work. We no longer have to rely on faith and personal experience alone to justify the efficacy and value of what we do. Thus, in many ways, this is an exciting time to be a psychoanalyst and a psychoanalytic researcher.
It has taken many years for psychoanalysts to become comfortable with the theoretical pluralism that is psychoanalysis today. We may have our preferred orientation within the spectrum of psychoanalytic thought, but today we have more respect for different perspectives, an appreciation of the varied traditions that encompass psychoanalytic thought, and an understanding that we have much in common regardless of differences in theoretical approach.
We have also been successful in joining with psychoanalysts of various mental health disciplines to establish the Psychoanalytic Consortium and agree on common principles of psychoanalytic education and training. While this umbrella organization may not be as wide and accommodating as some would like, it has enabled the four major professional organizations that represent psychoanalysts from a variety of mental health disciplines to come together and agree on reasonable guidelines for training psychoanalysts. The Consortium continues to provide us with a forum to coordinate our advocacy for agreed-upon principles of psychoanalytic practice, such as the importance of protecting our patients’ confidentiality and privacy.
As research results confirm the effectiveness of psychoanalysis and as we are able to value the range of theory and practice within the spectrum of psychoanalysis, the question remains as to how we can more fully utilize this information to make a greater impact on our culture and our society. The message about the effectiveness of psychoanalytic treatment and the vitality of psychoanalytic theory needs to spread to people who influence public opinion and make decisions about our profession. How do we get the word out to the public and to policy makers that psychoanalysis and psychotherapy based on psychoanalytic principles are treatments that work? How do we encourage psychology and other mental health disciplines to treat psychoanalysis with respect and not as an unproved theory from a bygone era? How do we show the public the new discoveries and clinical data that prove the effectiveness and timeliness of psychoanalysis rather than allow the old stereotypes to dominate the media and cyberspace? This is the dilemma that we need to confront and solve.
Unfortunately, our Division and other psychoanalytic organizations do not have large pools of money to undertake a public education campaign. We need to find ways to refine our message and appeal to the public in an economical manner that capitalizes on the limited resources we have. Several months ago I established a Public Relations Task Force, chaired by Nina Thomas, to address these issues. Our initial discussions have focused on both the content of our message and processes for disseminating that message.
Regarding the content of our message, the task force has begun tackling the question of how to describe psychoanalysis and psychoanalytic psychotherapy to the public to emphasize its value as a treatment for troubled individuals. The APA Practice Organization has developed an evolving public education campaign over several years to highlight the interplay of psychological factors in physical health and the value of talking to a psychologist. The focus has been on the impact that psychotherapy can have on an individual’s problems rather than on specifics of the treatment situation. Similarly, we need to define our own strengths and find ways to make what we do more understandable to the public. Psychoanalysis and its derivative therapies need to be seen not as an indulgence for a limited few but as a treatment of choice for the many who want to understand themselves better, form healthier relationships, and live more productive lives. We need to emphasize that we differ from treatments that are short-term and medication-driven. We need to demonstrate that psychoanalytic therapy has long-lasting beneficial effects.
As we develop the content of our message, we also need to think about the best, most economical ways to let the public learn about the advantages of psychoanalytic therapy. It makes particular sense to explore ways to use the internet and cyberspace to spread our message. Might we, for instance, establish a companion site to our current Division website that would provide information about psychoanalysis in a form that would demonstrate its value to the public? How can we establish links with other websites where individuals go for information about health, relationships, and therapy resources? How, in other words, can we let the public know that they can derive considerable benefit from psychoanalytic therapy and that they might wish to seek out such treatment when they need professional help?
We also need to devise ways to disseminate information regarding psychoanalytic research and other recent theoretical developments to our members and fellow professionals. APA, for instance, publishes a monthly Clinician’s Research Digest, subtitled Briefings in Behavioral Science, which summarizes studies related to clinical practice from a variety of journals. The journals referenced in several volumes have not been psychoanalytic journals. On the other hand, I recently discovered on my shelves an issue of the Bulletin of the Psychoanalytic Research Society, Section VI of Division 39. This brief publication summarized the Section VI panel presentation at the Division 39 Spring Meeting in 2006. The panel was entitled “What really changes in psychoanalytic treatment? A view through the lens of the Shedler-Westen Assessment Procedure (SWAP).” The presenters described how this assessment procedure helps psychoanalytic practitioners develop better case formulations and assesses meaningful personality change in psychoanalytic treatment. Reading about this interesting research suggested to me that our members would appreciate having a digest of psychoanalytic research available online. In addition, it reaffirmed my belief that there is significant psychoanalytic research that could be included in the APA research digest. Having such material at our fingertips would make it easier for us to become convincing advocates for psychoanalytic therapy in professional and political forums.
The suggestions above only begin to explore the questions we need to answer and the stumbling blocks that we need to overcome to enable psychoanalysis to regain its preeminence as a theory of human development and an effective therapy for the mental health and interpersonal problems besetting our society. I am confident that we can all contribute to this effort and make our voices heard as practitioners, researchers, consumers, and advocates of psychoanalysis. I look forward to working with you and all members of the Division on this endeavor.
de Maat, Saskia; de Jonghe, Frans; Schoevers, Robert and Dekker, Jack (2009). The effectiveness of long-term psychoanalytic therapy: A systematic review of empirical studies. Harvard Review of Psychiatry. 17, 1-23.
Fonagy, Peter; Gergely, Gyorgy; Jurist, Elliot and Target, Mary (2002). Affect regulation, mentalization, and the development of the self. New York: Other Press.
Leichsenring, Falk and Rabung, Sven (2008). Effectiveness of long-term psychodynamic psychotherapy: A meta-analysis. Journal of the American Medical Association, 300, 1551-1555.
Schore, Allan (2003). Affect regulation and the repair of the self. New York: Norton.
Solms, Mark and Turnbull, Oliver (2002). The brain and the inner world. New York: Other Press.
Wallin, David (2007). Attachment in psychotherapy. New York: Guilford Press.
News posted: May 01, 2009