Feet of clay 26/10/2009
 
You must have heard it by now. Contrary to current belief, antidepressants work much faster what previously thought, in fact within hours of taking the drug. This is, according to BBC, what Oxford University researchers found. " Although patients may not notice the effects until months into the therapy, the team say they work subconsciously", writes  BBC Health reporter Michelle Roberts.

I have to say that I found this reference to subconscious work intriguing, given that of all Freudian concepts, the concept of the Unconscious mind is the one that is contested the most, both "scientifically" and philosophically (you can read some comments on the subject here). But this is not the reason I am posting this. What I was more interested in learning was how did they do it exactly, how did the researchers manage to observe the possible "subconscious" effects of a treatment?

I read, for example, lead researcher Psychiatrist Dr Catherine Harmer quoted as saying the following: "We found the antidepressants target the negative thoughts before the patient is aware of any change in feeling subjectively." Does this really mean that the researchers were able to measure changes in the negative thoughts of patients objectively and before the patients themselves knew of any changes?
 
 
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?