‘Talking Cure’ for Mental Problems

Intensive psychoanalytic therapy, the “talking cure” rooted in the ideas of Freud, has all but disappeared in the age of drug treatments and managed care.
But now researchers are reporting that the therapy can be effective against some chronic mental problems, including anxiety and borderline personality disorder.

In a review of 23 studies of such treatment involving 1,053 patients, the researchers concluded that the therapy, given as often as three times a week, in many cases for more than a year, relieved symptoms of those problems significantly more than did some shorter-term therapies.

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The authors, writing in Wednesday’s issue of the Journal of the American Medical Association, strongly urged scientists to undertake more testing of psychodynamic therapy, as it is known, before it is lost altogether as a historical curiosity. The review is the first such evaluation of psychoanalysis to appear in a major medical journal, and the studies on which the new paper was based are not widely known among doctors.

The field has resisted scientific scrutiny for years, arguing that the process of treatment is highly individualized and so does not easily lend itself to such study. It is based on Freud’s idea that symptoms are rooted in underlying, often longstanding psychological conflicts that can be discovered in part through close examination of the patient-therapist relationship.

Experts cautioned that the evidence cited in the new research was still too meager to claim clear superiority for psychoanalytic therapy over different treatments, like cognitive behavior therapy, a shorter-term approach. The studies that the authors reviewed are simply not strong enough, these experts said.

“But this review certainly does seem to contradict the notion that cognitive or other short-term therapies are better than any others,” said Bruce Wampold, chairman of the department of counseling psychology at the University of Wisconsin.

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“When it’s done well, psychodynamic therapy appears to be just as effective as any other for some patients, and this strikes me as a turning point” for such intensive therapy.

The researchers, Falk Leichsenring of the University of Giessen and Sven Rabung of the University Medical Center Hamburg-Eppendorf, both in Germany, reviewed only those studies in which the therapy had been frequent – more than once a week – and had lasted at least a year or, alternatively, had been 50 sessions long. Further, the studies had to have followed patients closely, using strict definitions of improvement.

The investigators examined studies that tracked patients with a variety of mental problems, among them severe depression, anorexia nervosa and borderline personality disorder, which is characterized by a fear of abandonment and dark squalls of despair and neediness.

Psychodynamic therapy, Leichsenring wrote in an email message, “showed significant, large and stable treatment effects which even significantly increased between the end of treatment and follow-up assessment”.

The review found no correlation between patients’ improvement and the length of treatment. But improve they did, and psychiatrists said it was clear that patients with severe, chronic emotional problems benefited from the steady, frequent, close attention that psychoanalysts provide.

The new review is encouraging, some psychoanalysts said, but also a reminder of how much more study needs to be done.

Sources: The Times Of India

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