Love By Numbers cover
The book I am reading these days is "Love By Numbers" by Dr Luisa Dillner. It's a very interesting book, "essential and entertaining reading for anyone who is, has been or wants to be in a relationship", according to what is written on the back cover.

Of course such a broad description covers just about everyone, but Dillner's book has an originality. She is using scientific research that can answer questions such as:
  • How do I know if he's the one?
  • Are office romances doomed?
  • What's the best way to mend a broken heart?
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As I have tried to show in previous posts, psychoanalysts do not have a set of tools to apply. Contrary to what a clinician would do, psychoanalysts will not treat your symptom, let's say your eating disorder, in the same way that they will treat the eating disorder of the next person. Psychoanalysts do not work with disorders, they work with people, real people who have real histories.

We have reached a crucial point in our investigation. We have seen that Randomized Control Trials are not really suitable for testing the effectiveness of psychotherapy and psychoanalysis. We have also seen that when focusing on psychoanalysis our standard methodologies for collecting evidence do no justice to it. So, what do we do?

First we need to understand (and accept) that the approach of a psychoanalyst is fundamentally different to the approach of the clinician; it's not better or worse, it's different.

(In fact it's because of this difference that many feel inclined to argue that psychoanalysis is not a health profession for all intents and purposes of the Health Professions Council. But that's another story.)
 
 
In previous posts I have managed, I believe, to cast some doubt on whether Randomized Control Trials are really suitable for measuring the effectiveness of treatments such as psychotherapy or psychoanalysis.

That leaves us with an important question unanswered.

If the effectiveness or the efficacy of many psychotherapies or psychoanalysis cannot be measured with RCTs, how can it be measured? Can it be measured at all?

To attempt at answering the question we first need to think about what we mean by the term effectiveness. It might look self-evident but I am afraid it is not.

(Please note that what follows applies only to psychoanalysis, or psychoanalytic psychotherapy.)

Let’s take the following hypothetical example.

A young woman presents herself to a psychoanalyst. She has a specific problem which she complaints about, severe insomnia; could the analyst please help her?
 
 
I continue here with my thoughts about Randomized Control Trials (RCTs). RCTs are considered to be a tool that would help us determine the effectiveness of a treatment, by comparing the outcome of this treatment (called experiment) to a treatment that we already know about (called control).

One of the most fundamental tenets of RCTs is that members of the control group receive identical (control) treatment. Similarly members of the experimental group must receive identical (experimental) treatment, as well. It’s only when this happens that you can collect statistically useful data.

That's is not so difficult to ensure when considering RCTs for pharmacological or other similar “medical” treatments. Making sure that identical amounts of some substance are administered is rather easy.

But how do you do it when considering other types of treatment, which are not easily measurable?
 
 
I was planning to write about Evidence Based Practice, but stumbled upon the question of Randomized Control Trials (RCTs).

I think that complex questions can be rendered a bit more manageable when broken down to their constitutive parts. RCTs form a constitutive part of any Evidence Based Practice, so I will start from them.

Let’s see.

In the literature we read: “Randomized control trials are the most rigorous way of determining whether a cause-effect relation exists between treatment and outcome and for assessing the cost effectiveness of a treatment”.
 
 
It has been already some weeks that the Consultation on the statutory regulation of psychotherapists and counsellors has begun. This is, no doubt, one of the most pressing and important issues for all professionals working in this "industry".

While no-one would seriously argue that therapists, counsellors and psychoanalysts should be left alone, practicing with no external regulation, the case for statutory regulation by the HPC (Health Professions Council) is, in my opinion seriously flawed.

I will present my full argument in the next couple of days or so, but let me outline it here in the form of a number of questions.
 
 
A blog by a psychoanalyst? Another blog by a psychoanalyst? What would be the point of something like that?

Well, these questions are rather reasonable. After all, isn't it the case that psychoanalysts are supposed to be listening? They are not supposed to be talking, let alone bloging...

I had such questions myself. But then the answer came to me, an answer, which was not so unexpected, and not so unreasonable either.