Since psychoanalysis is a long-term, intensive, and expensive treatment, some degree of certainty about its effectiveness is helpful for those who are considering pursuing psychoanalytic treatment.
What to Expect
Recently, a thorough and detailed meta-analysis of 14 good-quality studies of psychoanalysis has been conducted with the basic results reported here. The psychoanalytic treatment lasted from 2.
- The Bloomsbury Companion to Kant;
- White Mischief.
- Search form.
- Psychoanalytic psychotherapy and difficult-to-treat depression: towards an integrative model.
Only a few studies presented information about the long-term benefit of psychoanalysis with follow-up periods ranging from 1 to 3. Other diagnoses included eating disorders, sexual and relational disorders, work problems, obsessive-compulsive disorders, psychosomatic complaints, and substance abuse. While four of the studies defined psychoanalysis as meeting times per week on the couch, the majority defined psychoanalysis as sessions or more per week on the couch.
At the end of treatment psychoanalysis was found to have an effect size of 1. The effect size was even higher for 5 studies that followed-up patients for at least a year after the end of treatment 1. In recent years she said she had been incapable of being with her family. She said that her conjugal relationship wore her out, that she couldn't stand the difficulties of caring for children aged 4, 9 and 16 and that her parents were intrusive and critical.
She also saw herself as incapable of assuming her professional responsibilities. The depressive symptoms had taken form after the birth of her youngest child, She had been going through a wearing period of higher education and physical disease which had caused her serious problems due to complications resulting from the use of corticoids, when she got pregnant, itself unplanned and with her marriage already in conflict.
She tells how, at the time, with her children more grown up, she had intended to live her own life, get more satisfaction from relationships etc.
Her puerpurium had been complicated, the baby had clinical problems that made feeding and sleeping difficult. She felt overloaded and incapable of dealing with the tasks of motherhood. She had tried a number of different pharmaceuticals to treat the depressive symptoms and had been hospitalized at services of known technical and academic prowess. At the time of presentation she was taking venlafaxine. Her family, professional and social lives were all in total disorder, she was living apart from her family and was on leave from work.
She had been living away from home for the previous 2 years, living with a female cousin and was involved in an extramarital relationship, which she considered to be her only good moments. Her hospital admissions coincided with this period. Her husband traveled for his job, her adolescent son remained at home trying to look after himself and the two younger children were being cared for by relatives.
Initially we combined a detailed evaluation, which was prolonged due to the chaotic characteristics of her family and support context. Precautions were necessary in order to establish resources in cases of risk and arrangements were made to ensure the treatment was maintained, including help to organize a limitation to her financial resources, which demanded the presence of a relative from outside of the primary group, but available.
During this period, Ana showed herself to be determined to be treated, appearing to believe in the treatment proposal and, despite her difficulties, collaborated with the organization of the therapeutic contract. The medication was maintained in the belief that this was a suitable prescription, taking into account the previous attempts, focusing at this point of the treatment on the psychodynamic issues. As treatment progressed, Ana began to bring up material relating to her interpersonal relations and life history, describing her mother as someone extremely invasive and her father as cold, distant and highly critical.
Her aggressive sentiments with relation to her family members became evident, to their expectations of attention and care and her sense of being drained and uncomfortable with the demands of the maternal function and her recriminatory worries. Ana's depression already long-term and seriously prejudicial to her familiar, social and professional functioning, presented only limited improvement, characterizing a difficult to treat case.
The presence of psychological factors influencing her progress suggested the psychodynamic approach. Among the variety of different factors that were possibly involved in the case of Ana, some became more evident at the start of the process. Her inability to think, the result of a kidnap, was perhaps a defensive strategy to abolish the mental function, since the realization of her desire could not be achieved. The desire in this case may be only an ideal, an abstraction that remains in the place of an object. Her ego, identified with the absent object, became impoverished and empty.
There is evidence of devaluation and impotence in the face of the unattainable. Perhaps a repetition of the unattainable desire for the love of her father, a figure she describes as cold and extremely critical. Her thoughts of death represent the desire to kill her object. The sadism is here represented both in the aggression directed at the introjected object and in the impact that the suicidal attitudes have on her family members. Ana abandons relations with her object and feels lost in the world, as she put it.
In fact she has expectations of attention and care and seeks a substitute for this in the figure of the lover. She recriminates herself for abandoning her children, but, more than anything else, perhaps she recriminates herself, questioned by her superego, for the intensity of her aggressive feelings, which make her feel guilty. As she progresses, Ana still mentions themes of death, but less frequently.
As the work progresses, she appears less cognitively prejudiced, more capable of self-observation, recovering parts of herself that had been inhibited defensively, and this appears to alleviate her. She has been speaking of how she misses her children, of how she does not feel capable of returning to her life and, as she puts it, face the blame of her parents and husband. She is better, although partially, with respect of her depressive symptoms, thinking that she should change her sessions to alternate days so that she can be with her children more often.
She remains on the same antidepressive medication. The referral of this patient for combined treatment appears to have resulted in a more all-embracing view of her disease. Although multiple factors that have not yet been understood may be involved in the psychopathology of this patient, the task continues to be the possibility of remaining alert to this amplitude of vectors, both within psychoanalytic theory and with respect of the concepts of clinical psychiatry.
Psychological Theories of Depression
With respect of psychotherapy and depression, it is worth repeating Freud's 25 warning that melancholy is not a homogenous group of conditions and that it probably involves more than one etiology, in order to then take advantage of psychoanalytic theory, amplifying our view of depressive states. While biological concepts and pharmacological approaches to difficult-to-treat depression are essential, we must think about the disease in a more open manner, with a more individualized focus.
This is a good principle for guiding our clinical practice in the face of the heterogenous group of patients with depression. It is possible that the benefits of eclecticism may be better demonstrated in the management of difficult cases, i. Indeed, if the psychiatrist lacks the flexibility to change their theoretical perspective or, even, sufficient knowledge of the alternatives, a patient may be unnecessarily treated with an inappropriate method or prematurely labeled "refractive".
Despite the limitations of our science, it is evident that psychoanalytic theory is rich in contributions to the theme, and that analysis-oriented psychotherapy can be extremely useful in dealing with cases of difficult-to-treat depression. The author believes that the patient, more than anything else, is the arbiter of what makes sense.
Thanks to Dr. Sobre os resultados das psicoterapias.
Rev Psiquiatr RS ; Lipowski ZJ. Psychiatry: mindless or brainless, both or neither? Can J Psychiatry ; Kuhn TS.
Therapy wars: the revenge of Freud
In: Kuhn TS. Drob SL. The dilemma of contemporary psychiatry. Am J Psychother ; J Bras Psiquiatr ; Albeniz A, Holmes J. Psychotherapy integration: its implications for psychiatry.
Br J Psychiatry ; Eizirik CL. Wallerstein R. Forty two lives in treatment. New York: Guilford Press; Yager J. Psychiatric eclecticism: a cognitive view. Am J Psychiatry ; Cost-effectiveness of brief psychodynamic-interpersonal therapy in high utilizers of psychiatric services. Arch Gen Psychiatry ; General effectiveness of treatments. Schestatsky S, Fleck M. Rev Bras Psiquiatr ; Elkin I. The NIMH treatment of depression collaborative research program: where we began and where we are.
Handbook of psychotherapy and behavior change. New York: John Wiley and Sons; The Newcastle chronic depression study. Patient characteristics and factors associated with chronicity. Scott J.
Is Psychoanalysis Effective? | Toronto Psychoanalytic Society & Institute
Psychological treatments for depression. An update. The prediction of major depression in women: toward an integrated etiologic model. Zavaschi MLS. Grote NK, Frank E. Difficult-to-treat depression: the role of contexts and comorbidities. Patients who receive psychoanalytic treatment retain these gains and may continue to improve even after treatment ends. A review published in American Psychologist found that the scientific evidence supports that psychodynamic therapy was as effective as other evidence-based treatments.
What makes psychoanalytic therapy different from other forms of treatment? A review of the research comparing psychodynamic approaches to cognitive-behavioral therapy CBT identified seven features that set the psychoanalytic approach apart. If psychoanalytic therapy sounds like it might be right for you, there are some things you can do to find a therapist in your area.
The first step is to begin looking for a therapist who specializes in this form of treatment. How can you find a qualified psychoanalytic therapist? Once you have identified a potential therapist, make a call to set up an initial consultation. During this consultation, you can further explore if psychoanalytic therapy is the right approach for you.
Psychoanalytic therapy is just one mental health treatment approach that you may want to consider. Have you ever wondered what your personality type means? Sign up to get these answers, and more, delivered straight to your inbox.
Related Depression as a Psychoanalytic Problem
Copyright 2019 - All Right Reserved