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?

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?