Evidence-based medicine,psychoanalysis and psychotherapy

SUMMARY

The scientific status of psychoanalysis is a matter of importance to both theorists and clinicians in psychiatry. The empirical evidence for both the theory and the practice of psychodynamic practice is much greater than is generally recognised. There is strong evidence for the effectiveness of psychoanalysis and psychoanalytically oriented therapy. the future of psychoanalysis depends on this evidence. We will discuss both the evidence and reasons why it is overlooked in certain quarters, and review the developing neuro-cognitive understanding of the mechanisms that underlie psychoanalytical processes.     

Wilhelm Reich and Anna Freud: His expulsion from psychoanalysis

This article describes the growth of hostility towards Wilhelm Reich in the psychoanalytic community over his Marxist ideology and activism as well as disagreements over the death instinct. It brings to the fore the behind the scenes political manipulations between Ernest Jones and Anna Freud to effect the expulsion of Reich both from the Vienna and Berlin local psychoanalytic societies and from the International Psychoanalytic Association (IPA). It describes Reich's reactions to these events and the pressure placed on other psychoanalysts to stop supporting him and also the revision of history about the expulsion. It discusses the use of the term "crazy" as it was used in the psychoanalytic movement. Further the article discusses personality attributes of Anna Freud leading to counter-transference possessiveness to children and women, especially patients. It briefly touches on the attitudes of both Sigmund and Anna Freud toward sex and how this furthered the clash with Reich. It discusses the similarity between Anna's actions toward the Burlingham children and what happened to the children of Reich.     

Psychiatry, psychoanalysis, and politics during the First World War.

This article compares the therapeutic power used by psychiatrists and psychoanalysts serving in the German and Austro-Hungarian armies during World War I, and the ways in which their therapeutic techniques were related to governmental and military authority. When treating "shell shocked" soldiers, army psychiatrists were guided by nationalist commitment rather than concern for their patients. Whatever theoretical approach they took, they defined their therapeutic task as administrative intervention aimed to increase the docility of soldiers to the state and its military purposes. But violent means of coercion, designed to force neurotic soldiers back into duty, remained inefficient. Drawing from an alternative body of knowledge, army physicians influenced by Freud's writings, or trained in psychoanalysis, applied cathartic methods to treat the Central Powers' soldiers. Their approach was not only more humane, but also proved to be therapeutically more efficient.     

Time and timekeeping in psychoanalysis and psychotherapy

The American Journal of Psychoanalysis -     

Dream frequency in psychoanalysis and psychoanalytic psychotherapy

The authors examine data on dream frequency from 50 patients, half of whom were seen in psychoanalysis and half in psychoanalytic psychotherapy. Frequency, defined as the proportion of sessions where at least one dream is related, is analyzed statistically as a function of sex, age, and type of treatment. Also, treatment outcome is examined as a function of sex, type of treatment, diagnosis, and dream frequency. Psychoanalytic patients are found to have higher dream frequency than the patients in the psychotherapy group. Higher average dream frequency is correlated with a better treatment outcome in both patient groups.     

Understanding the Moral Phenomenology of the Third Reich

This paper discusses the issue of German moral responsibility for the Holocaust in the light of the thesis of Daniel Goldhagen and others that inherited negative stereotypes of Jews and Jewishness were prime causal factors contributing to the genocide. It is argued that in so far as the Germans of the Third Reich were dupes of an 'hallucinatory ideology,' they strikingly exemplify the 'paradox of moral luck' outlined by Thomas Nagel, that people are not morally responsible for what they are and are not responsible for. The implications of this paradox for the appraisal of German guilt are explored in relation to the views of a number of recent writers on the Holocaust.     

Therapeutic technique in psychoanalysis and psychoanalytic psychotherapy.

As the distinctions between what we consider to be psychoanalysis and what we consider to be psychoanalytic psychotherapy have become more uncertain and more blurred, it follows that it is equally difficult to designate the techniques that would be appropriate and specific for each modality. The problem has been compounded by the fact that in recent years psychoanalysis in the United States has become considerably less homogeneous than in the past and the ego-psychological structural model is no longer the only point of view in the psychoanalytic marketplace. Further, with alterations in the criteria for analyzability, cases which, generally, had not been viewed as suitable for analysis, have been appearing with increasing frequency on psychoanalysts' couches. We have also recognized that the degree of congruence between our expectations from and the results of psychoanalytic treatment was often less than anticipated. It appears that analysts have become considerably less arbitrary about what psychoanalysis is and how a psychoanalysis can be carried out. The author is unable to delineate one technique that is intrinsic to and limited to psychoanalysis. There are, however, differences in degree and emphasis in the ways in which various techniques are applied in the therapy of psychoanalysis as compared to the therapy of psychoanalytic psychotherapy. Special attention is given to the role of a psychoanalytic process and the central place the analysis of resistance plays in psychoanalytic therapy.