It has been quite some time since my last blog entry, but I thought I'd add a quick note about this very interesting upcoming conference on Psychosis and Psychoanalysis at the Freud Museum, London.
It is organised in collaboration with the Psychosis Therapy Project, a therapy service for people experiencing psychosis, and I am honoured to have been invited to participate in a Clinical Round-table on technique.
This is a question I often get from people when they first meet me. "You are a psychoanalyst", they say. "Right..." And then, after a moment of hesitation: "Excuse my ignorance, but I am always confused. A psychoanalyst. What does it mean? You are a doctor, aren't you? Are you a psychiatrist? A psychologist? No? So, what are you? What's the difference?"
You see, all those Greek words, made up by people who were not Greeks at a time when creating "new" Greek words was fashionable, are more or less opaque for whomever does not have much familiarity with the so called Psi world. They are compound terms, sharing the first bit, "psych-" (which comes from Psyche, i.e. Soul.)
So, we have:
All this is very interesting, but did not answer the question. What's the difference?
In my latest post I wrote about how people who see that you are a therapist take it for granted that you deal with mentally ill people. I realize that this association between therapy and mental illness is not rare and goes both ways. If you are in therapy yourself many people seem to automatically believe that you are mentally impaired in some way.
Ask yourself. Imagine that you were in some kind of distress and asked your best friend for some kind of advice. What would you think if they told you that you need to see some a specialist, a psychotherapist perhaps?
Many people would take offence. They would protest that they are not ill, and cut the conversation short. If their best friend was like them, they would back down immediately and would try to suggest something else.
People ask me sometimes what I do for a living, and when I tell them, almost invariably I am met with a look of understanding and compassion. I know what this look says. It says: “Poor you, for having to have such a regular contact with those mentally ill people.”
In the early days I tried to challenge this view. (I don’t anymore).
I would explain that people who go to a psychotherapist or a psychoanalyst are not necessarily mentally ill. I would admit that some of them might be, of course, but even they, I would stress, do not go to the therapist because of their illness. They might think so, but what they really do is go to the therapist because they need help and hopefully the therapist can provide this.
This very simple truth was incomprehensible to many of my interlocutors –and, I would expect, to many of the readers of this blog. I can almost hear, loud, the objections: “If you cannot cure people, why do you invite them to come to you? Is this a joke or something?”
My argument against the state regulation of psychotherapy is still under construction so to speak; several more steps are needed. You could perhaps look at previous posts to get an idea.
But while I am at it, the world has not stood still.
It is already September; gone are already half of the three months set aside as consultation period for the regulation of psychotherapy through the Health Professions Council.
I am very well aware that any last minute arguments will not suffice to stop what has started many years ago –namely the move towards state regulation of the so called Health Professions.
But I need to make my position clear. For the record, if for nothing else. Urgently.
So, let me attempt to summarize my point of view.
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?
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.
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