When it comes to evaluating psychodynamic therapy, the devil is in the details

Comments on the original article, "The efficacy of psychodynamic psychotherapy," by J. Shedler (see record 2010-02208-012). As Shedler noted, some researchers have reflexively and stridently dismissed psychodynamic therapy (PT) as ineffective without granting outcome studies on this modality a fair hearing. We applaud Shedler's efforts to bring PT into the scientific mainstream and hope that his article encourages investigators to evaluate claims regarding PT's efficacy with a more objective eye. Nevertheless, as Shedler also observed, one reason for the scientific community's premature dismissal of PT is traceable to some psychodynamic practitioners' historical antipathy toward controlled research and propensity to overstate PT's efficacy. Regrettably, Shedler falls prey to the latter error by glossing over key methodological details, ignoring crucial findings that run counter to his position, and overstating the quality and quantity of the evidence base for PT. Because of space constraints, we focus only on a handful of the more serious shortcomings of Shedler's analysis (a more complete review of these issues is available from the first author on request).     

Analyst Envy in Working With an Artist: Four Scenes

The paper describes a rich analytic relationship with an artist patient in which countertransference feelings of envy surfaced. The analyst's examination of her envy led to a review and reassessment of the concept of envy in psychoanalysis. I propose here that envy is a complex affect that moves on a continuum from a fairly benign combination of admiration and desire to more malignant emotional states, described by Melanie Klein and her followers. Malignant envy may lead to anger, fury, and murderous rage. A more benign form of envy, which emerged for the analyst in the treatment, resulted in psychic support for and validation of the patient as well as a shift in personal identifications and new motivational directions for the analyst.     

A Response to Carolyn Ellman and Meira Likierman: Reply to Commentaries

In my reply to Likierman and Ellman, I remark on the difficulty of responding accurately to written case material. I underline some problems resulting from the necessarily abbreviated information contained in even the most carefully constructed and detailed presentations. Using the responses to my Richard paper, I attempt to show that in the absence of complete information, respondents tend to substitute their own imaginative assumptions for missed or incomplete information. They also tend to borrow from preferred theory to organize these assumptions as well as the conclusions that follow. Like unmarked wind currents, these tendencies can carry discussions far off the author's intended course.     

Multiple Cultures,Multiple Selves,and Analytic Influence: A Response to Goldin’s “The Storied Self”

Using a dynamic systems contextual model, I expand Daniel Goldin’s ideas about narrative and the “storied self.” I identify two issues that are key to the development of a coherent life story: first, the identification and integration of the multiple psychic self-states and external cultures with which and in which people live, and second, the meeting and melding of important minds in the person’s environment.