Photograph: Professor Mark Solms, by Jürgen Frank
Psychoanalysis in Ireland
Although CBT is particularly popular nowadays as the most recent arrival on the psychotherapy scene, the original talking therapy, Freudian psychoanalysis, has been around for much longer, over one hundred and thirty years. In Freud’s time, a group of European intellectuals rapidly gathered around him and psychoanalysis spread throughout the developed world, becoming very fashionable. Today Freud’s many followers continue to work at and refine his ideas and techniques – psychoanalysis has a major presence at the cutting edge of human psychology and psychotherapy worldwide.
It may not be widely known that psychoanalysis is active in Ireland. Psychoanalysis is currently studied in most Irish Universities, with several clinical and academic Masters qualifications available as well as study at Doctorate level. In Ireland alone, there are no fewer than five peer-reviewed academic psychoanalytic journals currently published. Psychoanalysis also thrives in the rest of Europe, in North and South America, Australia and New Zealand. There has been more written about Freud than any other single figure in the entire history of psychology. His theories have been hugely influential globally in the study of the human psyche and its maladies.
The scientific research
There is a growing body of scientific support for psychoanalysis in both its guises, as a therapeutic practice and as a theory of the human psyche.
The evidence base for Psychoanalytic Psychotherapy
The study of the effectiveness of psychotherapy is fraught with difficulty because of the large and indeterminate range of diagnoses, and the complexity of measuring what might count as a cure. It’s not clear cut, like tonsillitis. Despite this, there has been a substantial amount of scientific research into the efficacy of psychoanalytically informed psychotherapy with children, adolescents and adults.
The basis of scientific research into therapeutic interventions of all types is the randomised controlled trial (RTC). Subjects are randomly assigned to waiting list, control and treatment groups. Data is usually collected before and after treatment. The metric used is effect size which is the pre-treatment /post-treatment difference between control and treatment groups. An effect size of 1.0 represents one standard deviation on a normal distribution curve. In medical and psychological research an effect size of 0.8 is considered large, 0.5 moderate, and 0.2 small. Recent research into anti-depressant medication efficacy ranges from 0.31 to 0.17, whereas the research into the effectiveness of psychoanalytic psychotherapy cited in the attached review* are in excess of 0.5. There is a large body of research supporting the efficacy of psychoanalytic psychotherapy and in its long term effects, called the sleeper effect. In long term follow up studies specific to psychoanalytic psychotherapy, it has been shown that improvement continues long after the therapy has finished.
The evidence base for psychoanalysis as a theory of the human psyche
Freud, originally trained as a medical doctor and neuroanatomist, always sought to connect mind and brain. He understood that mental processes must have a physical manifestation in the brain. As a result of advances in contemporary neuroscience there is now a collaboration between neuroscience and psychoanalysis under the aegis of the International Neuropsychoanalysis Society. This has enabled the pairing of psychoanalytic concepts with neurological activity. Psychoanalysis offers a rich framework within which to generate testable hypotheses about the subjective aspects of the human brain. Professor Mark Solms (watch his video below: Neuro Psychoanalysis – Where Mind meets Brain) is a major figure in this area. His groundbreaking works are The Neurospsychology of Dreams and The Brain and the Inner World (with Oliver Turnbull). As well as offering support for psychoanalytic concepts, neuroscience demonstrates that there is also evidence of normalisation of medial temporal lobe activity post therapy.
It looks likely that research into the effectiveness of psychoanalytic psychotherapy will increase. In a climate where cost-effectiveness is the most important consideration, and since there is a growing body of evidence that medication alone is much less effective than medication and psychotherapy, it seems that psychotherapy is a sensible response to psychological suffering.