Is there any scientific support for psychoanalysis?

Question

I listened to episode 140 of the The Psych Files podcast where the host, Michael Britt, tried to psychoanalyze Jack Lalanne and was left wondering whether there's any validity to it.

I am under the impression that psychoanalysis is a pseudoscience and is not used by psychologists anymore. Is there any scientific validity to psychoanalysis? Or was the podcast host just having fun with it?

Answer 1

Psychoanalysis isn't used in the form that Sigmund Freud once designed by educated psychologists. Many present-day psychotherapists still use techniques that bear Freud's imprint, but they have modified the treatment in various ways. The intensity of Freud 's design has been deminished, Freud insisted on at least three sessions of psychotherapy according to his own psychoanalysis.

Also, the typical couch on which patients could relax while the psychologist sat outside of the patients' view is no longer used. Modern Neo-Freudian practitioners more commonly known as psychodynamic, ego-analytic and object-relations therapists, emphasize current interpersonal and cultural factors, where classical psychoanalysis emphasizes on past factors mainly.

Another change in modern psychoanalysis-based therapies is that patients are encouraged to apply what they have learned in their sessions with a therapist, whereas classical psychoanalysis therapy was thought to only be effective if no major life changes were made. (Like getting married, divorced, having children, etc.) So the patients life should be stable during the psychoanalysis therapy.

Although psychoanalysis has been the foundation of many therapies that have been scientifically proven to work, it's original form is no longer used in modern day psychological treatments.

So, concluding, as stated by Scott Mitchell's comment:

Yes, classical Freudian psychoanalysis is pseudoscience, but modern psychoanalytical techniques are evidence-based. Here's a paper published in American Psychologist that presents research that "supports the efficacy and effectiveness of psychodynamic therapy" - apsa.org/portals/1/docs/news/JonathanShedlerStudy20100202.pdf

Answer 2

I think the accepted answer is in some ways misleading. There are still a good number of psychoanalysts who practice therapy in a way that is fairly orthodox to Freud (or interpretation of his work) and even among those who deviate from the orthodox a lot of work is not grounded in empirical science.

I also think it is important to differentiate between effectiveness, efficience and validity.

Effectiveness - Does it help the psychologically ill?

Yes, there is research to support the notion that psychodynamic therapy helps against some psychological illnesses. There is considerably more research done on cognitive behavioural therapy (the academically most accepted paradigm). When they are compared, the effect is often equivalent. There is less evidence, the stronger the research paradigm (few RCTs with long follow-ups). For schizophrenia for example, psychodynamic therapy is inferior:

The lack of evidence for the efficacy of psychodynamic therapies in schizophrenia has also been confirmed by a recent meta-analysis of Malmberg and Fenton. Therefore, the findings of meta-analyses seem to confirm the theoretical assumptions provided by the vulnerability-stress-coping models.

Efficiency - Is it good use of therapists' and patients' time?

No, psychoanalytic therapy usually takes much longer. For now here's a link to what German insurances pay for (more hours for psychodynamic treatment and many more for psychoanalysis). A more international source would probably be nice, sorry.

Validity - Is it grounded in reality?

A lot of the theory is made up and some of it sounds plainly ridiculous today. To me this is the biggest problem - why build on theories that have been proven wrong in empirical science?

References:

A bit dusty maybe, but we're talking about the old school anyway: http://pss.sagepub.com/content/5/4/190

Perhaps the most appropriate retrospective view on Hilgard's lectures on psychoanalysis comes from Hilgard himself and helps to explain why, in the face of such poor science, the field of psychodynamics continues to claim scientific interest. "A sense of wonder before the unknown," he wrote, "appeals to me more than the confidence that comes from always having something to say that dissolves the mystery. To say, 'It couldn't have been otherwise,' does not itself move us very far along" (Hilgard, 1974, p. 153).

and for friends of strong language: http://www.springerlink.com/content/m315h57407544l26/

In therapy you could argue "anything that works and I'll take the placebo effect too, thanks", but why stick with PA when it's clearly not superior & takes more time.

I'm interested in a comparison with homeopathy and whether there is a lobby at work here, too, or if ignorance can just prevail for so long.

Answer 3

For the theory it's based upon - very, very little.

For the act of "talking therapy" itself there is some evidence of benefit from studies and meta analysis to suggest it helps but this in itself does not indidcate that psychodynamic theory is valid.

In short it's nonsense. But it is nonsense that in some cases can work.

ETA: Apologies for lack of sources, it's just these things seem so remarkably trivial as I am so familiar with them.

For instance see: The efficacy of psychodynamic psychotherapy. Shedler, Jonathan American Psychologist, Vol 65(2), Feb-Mar 2010, 98-109. http://www.apa.org/pubs/journals/releases/amp-65-2-shedler.pdf

Abstract: Empirical evidence supports the efficacy of psychodynamic therapy. Effect sizes for >psychodynamic therapy are as large as those reported for other therapies that have been >actively promoted as “empirically supported” and “evidence based.” In addition, patients >who receive psychodynamic therapy maintain therapeutic gains and appear to continue to >improve after treatment ends. Finally, nonpsychodynamic therapies may be effective in part >because the more skilled practitioners utilize techniques that have long been central to >psychodynamic theory and practice. The perception that psychodynamic approaches lack >empirical support does not accord with available scientific evidence and may reflect >selective dissemination of research findings. (PsycINFO Database Record (c) 2010 APA, all >rights reserved)

and in comparison with pharmacological interventions: Relative efficacy of psychotherapy and pharmacotherapy in the treatment of depression: A meta-analysis Psychotherapy Research Volume 16, Issue 5, 2006, Pages 566 - 578 Authors: Saskia De Maata; Jack Dekkera; Robert Schoeversa; Frans De Jonghea DOI: 10.1080/10503300600756402 http://www.informaworld.com/smpp/content~db=all?content=10.1080/10503300600756402

Abstract:

We investigated the efficacy of pharmacotherapy and psychotherapy for depression by >searching for RCT's. Studies were classified according to chronicity and severity and a >meta-analysis was applied. Ten studies were included. Remission did not differ between >psychotherapy (38%) and pharmacotherapy (35%). No differences were found in chronic, or in >non-chronic depression, and in mild or in moderate depression. Both treatments performed >better in mild than in moderate depression. Dropout was larger in pharmacotherapy (28%) >than in psychotherapy (24%). At follow-up relapse in pharmacotherapy (57%) was higher than >in psychotherapy (27%). Psychotherapy and pharmacotherapy appear equally efficacious in >depression. Both treatments have larger effects in mild than in moderate depression, but >similar effects in chronic and non-chronic depression and at follow-up psychotherapy >outperforms pharmacotherapy.

As for the assertion that theoretically it's nonsense:

Efficacy of treatment depends on therapist not school of psychoanalysis The alliance. Horvath, Adam O. Current issue feed Psychotherapy: Theory, Research, Practice, Training, Vol 38(4), Win 2001, 365-372. http://psycnet.apa.org/?&fa=main.doiLanding&doi=10.1037/0033-3204.38.4.365

Also psychoanalytic therapies have, by and large - anorexia is a notable exception, been abandoned by psychologists in favour of CBT and mindfulness treatments.

Some of Freud, and other early psychoanalysts, theories influenced the direction of psychology and you can see some vestiges of psychoanlytic ideas in some mainstream psychological theories. But I would say vestiges only and that psychology, for the main has abandoned psychodynamic theory as valid or having any explanatory power.

That it was built on unfalsifiable case studies doesn't help it's cause either

Answer 4

Although there are still some Freudian loyalists about (few clinicians, even fewer researchers), the influence of psychodynamic theories is not large in modern psychology, and it is continuing to decline. See Bornstein RF (2001) The impending death of psychoanalysis. Psychoanalytic Psychology 18:3. for a discussion of the issues from within the field.

There is very little high-quality research into the efficacy of psychoanalysis, and what does exist is largely negative. See The Cochrane Library (which, incidentally, should be your #1 reference for just about any question to do with evidence-based medicine; Cochrane are the gold standard on such matters) for an example of a meta-analysis reviewing the impact of psychoanalytic treatment on severe mental illness.