Listening To You - Psychoanalysis and Psychotherapy in North West London
  • Welcome
  • Listening
  • Psychoanalysis
  • The Therapist
  • Beginning therapy
  • Code Of Practice
  • Contact Details
  • Links
  • A Psychoanalyst's Blog

Randomized Control Trials, part 2

19/8/2009

 
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?
That's just a methodological problem, the proponents of RCTs would say. You must design your experiment in such a way that there are no variations of treatment within the control and within the experimental group.

Is this the same, then, for psychotherapeutic or psychoanalytic treatments?

Hmmm. That would be a bit more tricky.

Eliminating treatment variation can only be possible when the treatment in question is structured and does not allow for any improvisation.

For example, one can design a "psychotherapeutic" treatment consisting of set questionnaires, exercises, tasks etc. Such treatment can "easily" be the subject of a Randomized Control Trial.

What about psychoanalysis?

Unfortunately, psychoanalysis is never structured. The only rule in a psychoanalytic session is that of free association. One patient might decide to speak about the events of the day, while another might prefer to speak about his or her worries for the future. A third might decide to recite a recent dream, or an event from his or her childhood. The variation is infinite.

Please, bear in mind that this is an intrinsic characteristic of psychoanalysis –it is not a problem.

How can we use RCTs to assess psychoanalysis then?

I am afraid we cannot. Apparently psychoanalysis is a treatment that cannot be “tested” via RCTs.

Does it mean that it is worthless?

Some people feel inclined to believe so. They are satisfied in their conclusion that whatever claims psychoanalysis makes, they cannot be tested.

This is their argument broken down:
  • RCTs can be used to collect evidence that a treatment works
  • Psychoanalysis cannot be tested with a RCT methodology
  • Therefore Psychoanalysis is an unproven (and possibly worthless) treatment

I hope you can see that he are having a fallacious argument here.

Without our consent RCTs have been elevated from being just one of all possible means to collect evidence, to be the one and only means to collect evidence. They clearly are not.

What do we do then? How do we test psychoanalysis?

That's a very different question, and, admittedly, not an easy one. But we should not do like the drunken guy, in John Searle's metaphor, who, having lost his car's keys under the dark bushes, tries to find them under the street lamp because it was brighter there.

In short, as far as evidence is concerned, the question regarding the effectiveness of psychoanalysis, remains open.

I will return to this.

Comments are closed.

    About

    This is the blog of
    Christos Tombras
    a psychoanalyst practising
    in North West London.

    For more information,
    please click here.

    For a list of all posts,
    please click here.

    Archives

    January 2020
    May 2019
    March 2016
    October 2014
    April 2014
    May 2013
    October 2012
    February 2012
    July 2011
    June 2011
    February 2011
    September 2010
    March 2010
    February 2010
    January 2010
    December 2009
    November 2009
    October 2009
    September 2009
    August 2009


    RSS Feed


    Categories

    All
    Body Mind Dichotomy
    Books
    Brain Initiative
    Cfar
    Descartes
    Discourse Ontology
    Dsm
    Event
    Evidence
    Falsification Criterion
    Films
    Free Will
    Hard Sciences
    Health Professions Council
    History
    Immanuel Kant
    Jacques Lacan
    Jouissance
    Lanzmann
    Lecture
    Martin Heidegger
    Measuring Effectiveness
    Medical Model
    Mental Illness
    Nimh
    Oedipus Complex
    Phantasy
    Psychoanalysis
    Psychosis
    Randomized Control Trials
    Reality
    Regulation Of Psychotherapy
    Resistance
    Reviews
    Scientific Research
    Sexuality
    Shoah
    Sigmund Freud
    Signifier
    Stigma
    Symptoms
    Teaching
    Therapy
    The Unconscious
    Truth
    Ukcp


Listening To You • An Invitation to Talk • Lacanian Psychoanalysis • London     © 2009 - 2021