I wanted to share a note about a recent project of mine that might be of interest. My new book, False Negatives: Tilted Takes on a World in Flux (L2U Publishing, 2025), brings together a series of short essays written between 2019 and 2021. While it is not a psychoanalytic or clinical book, it approaches questions of truth, evidence, and meaning in ways that I think will resonate with anyone interested in the psychoanalytic view of subjectivity and culture.
The book will be available in paperback and ePub formats.
I attach below the press release
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Listening To You - Lacanian Psychoanalysis and Psychotherapy in London
Listening to You
Lacanian Psychoanalysis
London
London
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I’m sharing transcripts from a discussion I had with Derek Hook in December 2021 for his YouTube Channel. We discussed Heidegger, Lacanian psychoanalysis and my book, Discourse Ontology . What follows is the transcript of our conversation, very slightly edited for clarity. ”‹ For the actual video (part 1), see here : For part 2 and 3 of the transcription click here and here . Part 1: What are the benefits of reading Lacan alongside Heidegger, and Heidegger alongside Lacan? Christos Tombras, Lacanian psychoanalyst and author of Discourse Ontology (Palgrave, 2019), offers his reflections on this question. Further questions emerge. How are we to use Heidegger today, given his association with the Nazi regime? Are Lacan and Heidegger not incompatible given Lacan's commitment to a kind of (psychoanalytic) ethics as opposed to Heidegger's commitment to ontology? Furthermore: might Heidegger's value to psychoanalysis be in part the result of the critical questions he directs at Freudian psychoanalysis? (DH) Derek Hook:
Okay, hello everyone. It's a great pleasure today to speak to Christos Tombras, who's a colleague of mine from my time in London. And what Christos is going to be talking to us about particularly is his fantastic book, which is Discourse Ontology, Body and the Construction of a World from Heidegger through Lacan . So it's great to have the opportunity to enter into a dialogue about certain of these topics, because one of the questions that sometimes emerges, for me at least, where I'm teaching in an institution which is friendly to phenomenology, is why should people who are well-versed in, say, Heidegger's philosophy, be at all interested in Lacan? And I think we'd be right in saying that it doesn't always seem to be the case that there are that many Heideggerians who would be interested in Lacan, so maybe our first question for Christos today then would be something like, why these two? Why this pairing? Why do we bring Heidegger to Lacan or Lacan to Heidegger? What motivated that for you in the book? Christos, if you could give us your thoughts. Christos Tombras: Thank you Derek. I think what one notices, reading Lacan, is that Heidegger is always present, either by name, he mentions him, or by terminology, in conventions he is using in his writing, you can see Heideggerian features all around Lacan. That creates a first question to me. Why is Lacan interested in Heidegger? And then I went into Heidegger himself, into his work, and I found that Heidegger was very critical of psychoanalysis, extremely critical actually. So this was a challenge for me to understand how Heidegger is so against psychoanalysis, and if that is the case, why is Lacan interested in Heidegger? And what made it more important for me personally, a practitioner of psychoanalysis, is that Heidegger's arguments against basic Freudian concepts are very strong, are arguments that you cannot really ignore. So it was a challenge for me to actually see how can these criticisms of Heidegger be responded to. And of course, I would call Lacan, who provides either directly or indirectly a kind of answer. So this was the starting point for me.
I’m sharing transcripts from a discussion I had with Derek Hook in December 2021 for his YouTube Channel. We discussed Heidegger, Lacanian psychoanalysis and my book, Discourse Ontology . What follows is the transcript of our conversation, very slightly edited for clarity. For the actual video (part 2), see here: For part 1 and 3 of the transcription click here and here . Part 2:
How should we position both Lacan and Heidegger in relation to the project of ontology? Is it the case that ontology might play a crucial role in furthering a Lacanian agenda, despite Lacan's own rejection of ontology? Stressing both incompatibilities and prospective overlaps between these two thinkers, Christos Tombras offers illuminating perspectives on these questions. Tombras also discusses the concept of discourse in Lacan's thought, before moving on to emphasize the role of truth ( aletheia ) in Heidegger's philosophy alongside the role of primal affirmation ( Bejahung ) in Freud. Can we claim that there are moments where Freud is a Heideggerian without knowing it? (DH)
I’m sharing transcripts from a discussion I had with Derek Hook in December 2021 for his YouTube Channel. We discussed Heidegger, Lacanian psychoanalysis and my book, Discourse Ontology . What follows is the transcript of our conversation, very slightly edited for clarity. For the actual video (part 3), see here: For part 1 and 2 of the transcription click here and here. Part 3:
Heidegger's concept of ' das Man' (the They) can be both compared to - and contrasted with - Lacan's idea of the big Other. One crucial related idea, as Christos Tombras notes, is that the distinction between the ontic and the ontological (which is of course so crucial to Heidegger), is rejected by Lacan. The project of a Discourse Ontology, as outlined by Tombras, includes the attempt to formalize Lacanian concepts, to formulate the philosophical background of the account of the human subject as developed by Lacan. (DH)
Dr Vanessa Sinclair, the welcoming host of the podcast Rendering Unconscious , has invited me to talk about my book, Discourse Ontology.
Of course we don't stay at that. It's a good opportunity to discuss more generally about language, philosophy, mathematics, and psychoanalysis, as well as about Heidegger, Husserl, Freud, and Lacan. For the specific episode click here. It is also available on SoundCloud, as well as at all the usual podcast streaming platforms. Links here. Vanessa's main website page is at Rendering Unconsious.
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.
What follows is an edited version of a talk delivered on July 12, 2014, at the annual CFAR Conference. The theme this year was: ”Sexuality: Phantasy, Discourse and Practice”. I participated in a panel on the general subject of ”Sexuality and Phantasy”. My presentation was not prepared beforehand. This here is an edited transcription of a recording. As such, it tries, but fails in many ways, to capture the spontaneity and informality of what was said. But then, that’s the best I could do.
There you go. Good morning. I was wondering how to start today. I was considering the title of the panel, ”Sexuality and Phantasy”, and struggled to think. What, if anything, could I add to the subject? I realised this. I realised that whenever I find myself thinking about Sexuality, I find myself thinking of Descartes --you know, René Descartes, the philosopher. Of course Descartes did not, as far as I know, write about sexuality as such --or about phantasy for that matter. But he did write about the mind-body problem. This will be my starting point today.
This is a slightly edited transcription of a talk I delivered on April 5, 2014, at the ”Workshop in preparation of the WAP Congress” of the London Society of the NLS. The theme of the congress is " A Real for the 21st Century ". The Workshop, organised by Janet Haney, was structured around four entries from the upcoming English version of Scilicet . Each was presented by a member or friend of the London Society who participated in the process of translation and editing. My talk was in connection to ”Shoah”, a paper by French psychoanalyst Philippe Benichou .
Dear friends and colleagues, Thank you for giving me the opportunity to speak today here about some of the questions I found myself struggling with, while reading and translating ”Shoah” by Philippe Benichou. Benichou’s paper talks about the Shoah. You cannot wonder , Benichou writes, what a "real for the twenty-first century" could be, without mentioning that event beyond meaning, real, all too real, the Shoah. I was captivated but also puzzled by the power of this depiction of the Shoah as an ”event beyond meaning, real, all too real”. I asked myself, what could this mean? Attempting to formulate an answer, I found myself faced with further questions: What is an event? What is history? What is a historical event? And then: What is real in a historical event? This is how I will begin.
It has been dubbed the ”bible” of psychiatry, and indeed the Diagnostic and Statistical Manual of Mental Disorders (DSM) is taken by many as exactly that. Every new version of this publication, prepared by the American Psychiatric Association, is considered to contain the latest and more advanced criteria for the classification and diagnosis of mental disorders.
Acceptance has not been unanimous, though. For many of its critics, the DSM has been too unreliable, far too prescriptive and yet quite vague, very much geared towards the compartmentalization of human behaviour, very much conforming to the wishes of the big Pharmaceutical companies –in short: very problematic. The news, then, that after more than sixty years of near hegemony –at least in the U.S.– the DSM is pushed aside by the US National Institute of Mental Health (NIMH), cannot but be welcome. A research framework is being introduced for collecting data for a new understanding of mental disorders, a "new nosology", away from DSM. Is there, at last, room for optimism? Are we finally about to enter an era of scientific psychiatry which will (hopefully) settle all disagreements and clear out all ambiguities for good?
It has been some time since I last posted something to this blog, but I guess you know how it is. Time --or rather, lack thereof-- has taken the upper hand recently.
I hope I will be able to post something soon, but in the meantime, t his is just a short note about two lectures I will be giving in October and November, as part of Autumn 2012 Public Lectures Programme of CFAR. I was reading something on the BBC today, regarding the ”decoding” by science of people’s ”internal voices”. The article was about a new technique, whereby researchers are said to be able to reconstruct words, based on the brain waves of patients thinking of those words . I was reminded of an anecdote about Lacan, one of the most important post-Freudian psychoanalysts.
In 1975, during a lecture tour in the United States, Jacques Lacan spoke at MIT before an audience of mathematicians, linguists, and philosophers. Noam Chomsky, the already famous by then American linguist philosopher and activist, attending the lecture, asked Lacan a question on thought. Lacan's reply was possibly not what Chomsky expected: ”We think we think with our brains”, Lacan said. ”Personally, I think with my feet. That's the only way I really come into contact with anything, solid. I do occasionally think with my forehead, when I bang into something. But I've seen enough electroencephalograms to know there's not the slightest trace of a thought in the brain.” Last week I wrote about a scientific paper that claimed that ”most published research findings are false”. I identified the three slightly different conceptions of truth that the abstract of that paper was alluding to, and suggested, as a work hypothesis, that we differentiate between ”real truth” and ”scientific truth”.
I ended that post rather abruptly and at a somewhat provocative point. I claimed that science does not have anything to do with reality . I acknowledged, however, that this would need to be clarified. This is what I shall attempt to do today: to clarify. So science ”does not have anything to do with reality”. How did we get to this conclusion? What does it mean?
Last week I wrote about a scientific paper that claimed that ”most published research findings are false”. I identified the three slightly different conceptions of truth that the abstract of that paper was alluding to, and suggested, as a work hypothesis, that we differentiate between ”real truth” and ”scientific truth”.
I ended that post rather abruptly and at a somewhat provocative point. I claimed that science does not have anything to do with reality . I acknowledged, however, that this would need to be clarified. This is what I shall attempt to do today: to clarify. So science ”does not have anything to do with reality”. How did we get to this conclusion? What does it mean? The other day I came across a very intriguing research paper, bearing a very provocative title: ” Why Most Published Research Findings are False ”. Published in 2005, this paper was written by John P.A. Ioannidis, a medical professor specializing in epidemiology. His claim is simple (I quote from the abstract of the paper):
The probability that a research claim is true may depend on study power and bias, the number of other studies on the same question, and, importantly, the ratio of true to no relationships among the relationships probed in each scientific field. In this framework, a research finding is less likely to be true when the studies conducted in a field are smaller; when effect sizes are smaller; when there is a greater number and lesser preselection of tested relationships; where there is greater flexibility in designs, definitions, outcomes, and analytical modes; when there is greater financial and other interest and prejudice; and when more teams are involved in a scientific field in chase of statistical significance. Now, as you might imagine, a scientific paper with such a subject matter would be sure to attract a lot of attention, both positive and negative, and that was indeed the case. But I do not intend to participate in the debate, and this is not the reason I am bringing up this paper here. I am more interested in the concept of truth, especially in the way it is employed in papers such as Ioannidis’, i.e. in current scientific research. The other day I came across a very intriguing research paper, bearing a very provocative title: ” Why Most Published Research Findings are False ”. Published in 2005, this paper was written by John P.A. Ioannidis, a medical professor specializing in epidemiology. His claim is simple (I quote from the abstract of the paper):
The probability that a research claim is true may depend on study power and bias, the number of other studies on the same question, and, importantly, the ratio of true to no relationships among the relationships probed in each scientific field. In this framework, a research finding is less likely to be true when the studies conducted in a field are smaller; when effect sizes are smaller; when there is a greater number and lesser preselection of tested relationships; where there is greater flexibility in designs, definitions, outcomes, and analytical modes; when there is greater financial and other interest and prejudice; and when more teams are involved in a scientific field in chase of statistical significance. Now, as you might imagine, a scientific paper with such a subject matter would be sure to attract a lot of attention, both positive and negative, and that was indeed the case. But I do not intend to participate in the debate, and this is not the reason I am bringing up this paper here. I am more interested in the concept of truth, especially in the way it is employed in papers such as Ioannidis’, i.e. in current scientific research. In my previous post I commented upon two experiments that attempted to address the question of free will from the point of view of modern neuroscience. I ended my post by suggesting a thought experiment to the reader. If a scientist informed you that he or she knows with scientific certainty the numbers you are going to play in the lottery, what would you do?
My guess was that very possibly you would avoid playing those numbers, if for no other reason, just to prove this arrogant scientist wrong! The point of this thought experiment was to show that, at the level that our actual decisions are being taken, we are the sole masters in the house, and, crucially, that discussions about our ”free will” and about all what science can, or cannot, claim in regards to it are a bit confused. In my previous post I commented upon two experiments that attempted to address the question of free will from the point of view of modern neuroscience. I ended my post by suggesting a thought experiment to the reader. If a scientist informed you that he or she knows with scientific certainty the numbers you are going to play in the lottery, what would you do?
My guess was that very possibly you would avoid playing those numbers, if for no other reason, just to prove this arrogant scientist wrong! The point of this thought experiment was to show that, at the level that our actual decisions are being taken, we are the sole masters in the house, and, crucially, that discussions about our ”free will” and about all what science can, or cannot, claim in regards to it are a bit confused. In a famous experiment of the 80s, neuroscientists claimed that they managed to show that what we, humans, call ”free will” simply does not exist. The setting of their experiment was rather simple. A number of volunteers were wired with electrodes and their brain activity was monitored. Then they were asked to choose whether they would flex their fingers or their wrists. They were instructed to first report when they had made their choice and then actually flex their fingers or their wrists.
The neuroscientists running the experiment identified a consistent pattern in the recorded brain activity. Signals were appearing a split second before the volunteers were able to report that they had made their choice. A split second is not much, you would think, but when a scientist is able to show that a result in an experiment cannot be attributed to chance, then this scientist might want to interpret it. This those scientists did. They explained this pattern of brain activity, observed just before an actual choice was made, as evidence that ”unconscious neural processes” determined the volunteers’ actions before they were ever aware of making a decision. They gave it the name ”readiness potential”. In a famous experiment of the 80s, neuroscientists claimed that they managed to show that what we, humans, call ”free will” simply does not exist. The setting of their experiment was rather simple. A number of volunteers were wired with electrodes and their brain activity was monitored. Then they were asked to choose whether they would flex their fingers or their wrists. They were instructed to first report when they had made their choice and then actually flex their fingers or their wrists.
The neuroscientists running the experiment identified a consistent pattern in the recorded brain activity. Signals were appearing a split second before the volunteers were able to report that they had made their choice. A split second is not much, you would think, but when a scientist is able to show that a result in an experiment cannot be attributed to chance, then this scientist might want to interpret it. This those scientists did. They explained this pattern of brain activity, observed just before an actual choice was made, as evidence that ”unconscious neural processes” determined the volunteers’ actions before they were ever aware of making a decision. They gave it the name ”readiness potential”. I was reflecting, leaving the cinema the other day, on the very clear similarity between the film I had just watched, ”Source Code” (2011), by Duncan Jones, and ”Groundhog Day” (1993), by Harold Ramis. In the latter, Bill Murray’s character, a stroppy and cynical weatherman finds himself ”trapped” inside this Groundhog Day, as it is called, by finding himself forced to relive every single moment of it, from morning till night.
In ”Source Code”, Jake Gyllenhaal’s character, an American helicopter pilot, finds himself on a commuter train, ”trapped” inside someone else’s body, during the same 8 minutes before the explosion of a bomb that will kill him and everyone else in the train. And then he lives these minutes again, and again, because, it turns out, he is on a mission. It has been a long time since I last wrote about the plans to regulate "talking therapies" through the HPC. The new Government had indicated from the beginning that they were sceptical about those plans, and had made it clear that the issue was not very high up in their agenda of priorities.
Now, finally, we have got some very good news. The Government has decided to abandon any plans to further extend statutory regulation to any further professions --and this includes psychotherapy, psychoanalysis and so on.
When I decided to begin this blog, I was very optimistic. I envisaged one or two posts every week or so, or, at least one post every month. I thought that this was feasible, as well as useful.
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?
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?
The female voice on the phone sounded very distressed. A wife, who was very worried that her husband, very depressed since having been made redundant six months ago, was getting worse and going to do something "crazy". I tried to calm her down, and asked for some more information.
This happens, from time to time. I get contacted by people who act on behalf of someone else. They are very worried about a relative, friend or significant other, and try to find some help. Sometimes they just ask me if I can prescribe medication, or want specific medical advice. If this is the case, I refer them to the person's GP. More often, however, the call is a call of concern. Like this distressed wife, they call because they are worried that someone close to them is feeling down, is neglecting themselves, is depressed or just very unhappy.
There was a very interesting article on the New Scientist website, about the question of consciousness. The author, Ray Tallis, argues that we have failed to explain how consciousness equates to neural activity inside the skull because the task is self-contradictory .
Tallis, a Professor of geriatric medicine at the University of Manchester, and Fellow of the Academy of Medical Sciences, challenges the "orthodoxy", held by most neuroscientists and philosophers of the mind , that very soon scientists will be able to explain the mystery of human consciousness in terms of the activity of the brain. He stresses, however, that his argument is not about technical limitations; rather it is about the deep philosophical confusion embedded in the assumption that if you can correlate neural activity with consciousness, then you have demonstrated they are one and the same thing, and that a physical science such as neurophysiology is able to show what consciousness truly is .
There is an article on Times On Line about state regulation of psychotherapies which I read with great interest but which at the end left me with a mixed feeling of a vague contradiction. The writer, Lucy Banneman, tried to approach the issue carefully, highlighting the arguments of both sides, on the one hand of those who claim that an unregulated world of psychotherapies and other therapies of all kinds are infested by charlatans who only look to manipulate clients and maximise their income, and on the other hand of those who claim that the HPC is too bureaucratic and costly and not really suitable to deal with what psychotherapists do.
I have made my position on the subject clear in various posts of this blog, and if I am returning to Γt is not because this article of the Times has something very new to offer to the debate. I am mentioning it because in my opinion it is flawed by something which in my view is a serious journalistic error. This is the sort of things you see in films or read in novels –"Johnny Took his Gun" by Dalton Trumbo or "The Patient" by Georges Simenon are but two of the examples that spring to mind– but the report that circulates all media since yesterday is very real. A paralysed Belgian man who doctors thought was in coma for 23 years was conscious all along. It was only recently that a scan showed that his brain was "almost entirely" functioning. You can read the BBC report here.
I cannot begin to grasp what it must have been this experience for this poor man, but I can very vaguely imagine. A recent book and film used the metaphor of a diving bell. You are inside your body as if you are inside a diving bell. It's alright when you can control your diving bell. You swim around and interact with all other beings in diving bells you encounter. Suddenly something happens and you loose control of the diving bell. Your life as such is not threatened; but you can't communicate any more, you can't interact. You are trapped inside.
I was following news from UKCP very closely these last weeks. We had elections for chair. These elections were the first in which all registrants were invited to vote, and were particular important in view of all the changes currently happening in the British "psi" world (the world of psychotherapists / psychoanalysts / counsellors). I am referring, of course to the much debated and undesired, in my opinion, but imminent, possibly, statutory regulation of the psychotherapeutic professions by the Health Professions Council. I have argued about this elsewhere in this blog.
The election process took place in October and early November and the results were announced on Monday. New chair is going to be Andrew Samuels who won by a vast majority of 66%. The second candidate, Carmen Joanne Ablack, got 34%. As you can see, with a margin of 2 to 1 Andrew can call his a real victory. According to Electoral Reform Services, the independent charity commissioned to administer the voting, the turnout was "tremendous", with almost 48% of registrants voting. It appears that voters felt that something important was at stake, and decided to do their bit.
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?
There has been a lot of movement recently in relation to the proposed regulation of counseling and psychotherapy under the Health Professions Council.
In other posts of this blog I have made my personal and professional opinion clear. As I have argued, the HPC, in its attempt to create an umbrella of standards applicable (with minor adjustments) to all Health Professions, has created a Procrustean bed that works by eliminating differences and homogenizing approaches in the name of ”protection of the public”, ”scientific evidence” and ”measurable outcomes”. This, I wrote, can only be to the detriment of a discipline like psychoanalysis which as we have seen, and very clearly, does not fit on that Procrustean bed. The war is far from over, but there were some interesting developments. Instead of re-writing things that have already been written by others much better than I could ever hope to do myself, I choose to reprint below a press release by several Psychotherapy Organisations –including the ones that I belong to, CFAR and College of Psychoanalysts-UK. Here it goes.
There was a very amusing article on BBC the other day. It was about George the cat, which has been registered as a hypnotherapist with three relevant professional bodies in the UK. According to what BBC wrote, the bodies accepted credentials which were a bit dodgy –to use an understatement– such as a certificate from the "Society of Certified Advanced Mind Therapists".
Of course, such a Society does not exist, but some of the British bodies that represent Neuro-Linguistic Programmers and Hypnotherapists do not seem to run rigorous checks on their prospective registrants. This allowed Chris Jackson, presenter of "Inside Out" in the North East and Cumbria, to register George.
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?"
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?” In my previous post I have promised that I will write a bit about how one works with the Unconscious, this elusive entity that is only manifesting itself in our mental lives through its effects, such as dreams, ”insignificant” or ”accidental” errors, lapses of memory, symptoms etc.
Of course it is not in my intentions to offer an online course in psychoanalytic technique. Rather I am eager to show what sort of interventions a psychoanalyst can make, and how he or she can assess the accuracy, the effectiveness if you will, of those interventions. After all we have seen that this is what most critics of psychoanalysis see as its Achilles’ heel –that it’s "impossible" to verify or falsify a hypothesis. So I will try to show that such a claim is based on ignorance if not on bad faith. Following what I wrote in my last post about the incompatibility between psychoanalysis, as a method, and HPC's requirements for ”quality assurance” and ”improvement programmes” –to bring just two examples– I would like to attempt to clarify the reasons why such incompatibility exists.
The answer is at once simple and complicated. Simple because one only needs to remind themselves that psychoanalysts work with what is unknown in the psyche rather than what we know. Freud, who was the first to systematically work in this way, gave to what is unknown the name ”Unconscious”. So, psychoanalysts work with the Unconscious. That’s why requirements about ”quality assurance” and ”improvement programmes” are irrelevant. Simple, wasn’t it? Unfortunately, it is not so simple. Following what I wrote in my last post about the incompatibility between psychoanalysis, as a method, and HPC's requirements for ”quality assurance” and ”improvement programmes” –to bring just two examples– I would like to attempt to clarify the reasons why such incompatibility exists.
The answer is at once simple and complicated. Simple because one only needs to remind themselves that psychoanalysts work with what is unknown in the psyche rather than what we know. Freud, who was the first to systematically work in this way, gave to what is unknown the name ”Unconscious”. So, psychoanalysts work with the Unconscious. That’s why requirements about ”quality assurance” and ”improvement programmes” are irrelevant. Simple, wasn’t it? Unfortunately, it is not so simple.
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.
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.
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:
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.)
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?
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.
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 blog ing... I had such questions myself. But then the answer came to me, an answer, which was not so unexpected, and not so unreasonable either. |
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