Unfortunately for Freud, most of his best ideas/creations became so widely accepted people forgot he was the one who had them in the first place.
The unconscious mind, dream interpretation, importance of early childhood, psychosexual development, talk therapy as we know it today, transference, etc.
What do we remember him for? Oedipus complex. Poor guy. It's like if all we remembered about Newton was alchemy.
Yes, he's the water we're swimming in. Here's an example I've been wondering about for years:
Freud taught that early childhood experience has a profound impact on adult life. Did anyone have this perspective before Freud? Was there a precedent? If I think of literary depictions of childhood in the 19th century, for example in Dickens, there can be great pathos, but not a psychological awareness of the consequences.
This emphasis on early childhood experience is tectonic in Western culture and we still haven't caught up to it in practice. If it really was Freud's contribution, that alone makes him great.
Another dimension of Freud is that he was a taboo-breaker, and in that sense a heroic figure. Some of the steps he dared to take are still so out-there that they can't be openly discussed. That's pretty remarkable after a hundred years.
Societies have gone through waves of considering children. Proverbs 22:6 is a good example of how the Judeo-Christian worldview contrasted with those around, including regarding children: “Train up a child in the way he should go; even when he is old he will not depart from it.”
I see how my wording "early childhood experience has a profound impact on adult life" could lead to this association, but that was imprecision on my part.
Freud's insight wasn't about training children—it was about the psychological impact of early relational experience. What we now believe about developmental trauma, for example, or the idea that later relationships are patterned after what happened in one's family of origin—all of this, unless I'm mistaken, derives from Freud.
As smeeth was pointing out, it's easy to see things that Freud got wrong, and not so easy to see what he got right, because they have become so foundational that even Freud's staunchest critics take them for granted.
On one hand, society always had some puritan reflex reaction when talking about early childhood and psychosexual theories... Mixing sexuality and childhood feels wrong even on the most honest educational environments.
On the other hand, Pavlov became famous for the positive reinforcement study he developed to optimize a brutal methodo to extract dog drool, but somehow the animal abuse part was mostly ignored for a long time.
You can't choose what part of your work will become more popular or the most common association with your name...
> It's like if all we remembered about Newton was alchemy.
It’s ironic you say this. Like Freud, and unlike Newton, alchemists did not use scientific methodology. Also like Freud, alchemists get an unfair treatment by modern society, being remembered only for their mistakes. Medieval alchemists developed and refined distillation and crystallization, discovered acids and minerals, and developed metallurgy through the extraction of metals from ore. Just like psychology after Freud, the scientific field of chemistry grew rather naturally out of the advances made in alchemy.
Considering the fact that he lifted the concept of the unconscious mind from Eduard von Hartmann, I’d say it’s just desserts. Maybe this time around the actual originator of the idea will get credit, but I wouldn’t hold my breath.
If Freud is coming back, how about Jung? He was equally unfalsifiable. While his ideas of the collective unconscious and archetypes may be very Eurocentric, and his talk about spiritual alchemy ahistorical hooey, they are entertaining and perhaps even useful to some. At the very least, it feels like therapy, while CBT feels like homework, complete with xeroxed worksheets.
I haven't experienced CBT but it sounds like what you're talking about is the relational aspect of therapy, which is certainly something that Freud and Jung were deeply aware of, and which the cognitive schools perhaps emphasize less.
Popper recognizes that on any knowledge, there may be an unfalsified basis. After all, science is not the basis of our assumptions, science must begin from philosophical assumptions (like materialism, empirism, none of them can be falsified). If not mistaken, he calls these things metaphisics.
How is it not unfalsifiable? It’s a logical framework. You can argue it isn’t a good model but I’m confused how it is unfalsifiable as that doesn’t really seem to fit. However I don’t know much about it beyond the basic concept.
What do you mean? It sounds perfectly falsifiable to me: you just need to show a well accepted scientific theory that cannot be falsified even in principle.
The problem with this is that Popper wanted the criterion to function normatively. So for example, he argued that Marxism and Darwin's evolutionary theory were not falsifiable and hence not scientific. Since at least the latter was a well accepted scientific theory, it's clear that Popper didn't put forward falsificationism as an empirical generalization about which scientific theories are well accepted. (Popper later changed his mind about evolution.)
Surely a meaningful and true statement that most Popperians would accept. Popper’s demarcation criterion, correctly understood, may not ultimately be undermined by the fact that it is not itself a scientific theory that can be corroborated according to its own lights, but it’s perfectly meaningful to point out this feature of it.
That's not exactly what the incompleteness theorem entails.
I pointed out that the statement is not 'meaningless'. You now argue that it's trivial. That entails that it at least means something, so I don't think we disagree in a relevant way.
Having been a psychotherapists for 25 years I have heard all the negatives about Freud.
I was once told by my supervisor that the only way to fully understand Freud was to read his works in German.
For me he is an absolute genius. Who else could have discovered the unconscious mind?
For those non-psychotherapeutic people, your negative views and naive understandings are like me being negative about Timothy Berners-Lee when I dont know the first thing about coding or the difference between Python and Rust. Of course I know about aliases and small python scripts that make using linux easier but someone else has taken the time to write them. Does this alone make me qualified to question his work or claim I know more than him?
You are of course entitiled to your negative views and that is all they are, a view.
Every form, method and modality of psychotherapy in use today, from CBT to Psychosynthesis, begun with Freud.
The old man's back again! what a rubbish headline!
what should we make of his return? WHAT? He has not even left the building!
The use of the word "should" says it all. Parental, introject, super-ego.
Freud definitely didn't discover the unconscious mind - that idea was in the air in the late 19th century, with many people writing about it. There's a great book about this—I think it's https://en.wikipedia.org/wiki/The_Discovery_of_the_Unconscio.... What Freud did do was create the most influential theory about it.
It's similar to how the idea of evolution was in the air before Darwin (whose grandfather even had written a book about it), but Darwin's theory became so influential that we now identify the idea of evolution with him.
And every form of modern physics began (more or less) with Galileo.
But if physicists suddenly decided Galileo was back because Galilean physics was somehow an ideal to aspire to, many brows would be furrowed with scepticism.
Leave the corpse alone. There's enough death drive around for everyone at the moment without adding yet more ancestor worship.
Fuck Freud.
I say this every year, and as a PhD in Psychology and research professor.
Freud is not making a resurgence among scientists because Freud didn't conduct science. He wrote stories that sounded interesting. Literature majors, reporters, etc tend to love Freud. He wrote well, created vivid titillating accounts, but he did not empirically test these accounts. So Fuck Freud. He isn't relevant, and he isn't making a resurgence...not with anyone that knows something about the brain.
And people who give him credit for coming up with the idea that we have inner psychological self/child etc etc etc, just please, the brilliant minds of centuries past deserve more credit than that.
Here in Canada, you basically can't say "Fuck Freud" if you're a practicing psychotherapist, as there is something in the ethics code about respecting your peers. I can say it as I didn't make it to the PHD, but it's a bit frustrating to realize the field is self-regulating and at least 25% of its members basically don't believe in the power of... evidence.
Not unrelated, epistemology classes are not mandatory, despite the field being in the rare position of accepting (or at least tolerating) several vastly different epistemological viewpoints. Kind of like studying homeopathy and epidemiology in the same program.
>> and at least 25% of its members basically don't believe in the power of... evidence.
> Why do you say that?
Because saying the actual figure of 99% will make too many people dismiss the statement as hyperbole /s ...
In all seriousness, we're talking about psychology/psychotherapy here, not psychiatry.
The majority of trials in psychology is characterised by the phrase "non-repeatable", and all the practicing therapies boil down to "this makes a nice narrative".
Using people's self-reported feelings of mental health as an indicator of the efficacy of psychotherapy is no different from asking religious people if prayer helps them and using the answers as proof of the existence of god.
If therapy makes a difference regardless of whether or not the subject believes it does and we can measure that difference then, sure, that's evidence. Until then all we have is "evidence".
This is a cheap response.
The so called replication "crisis" is multifaceted in cause, the biggest of which is complexity of the brain, and the inherent variability of the brain and behaviors of subjects from person to person, moment to moment. It is a difficult science, but the field is improving. Better methods, larger samples, converging evidence accross levels of description, etc etc, none of which are relevant, btw to my criticisms of Freud, the literary phenom non-scientist.
An lot of my scepsis comes from seeing how Freud's theories are still applied very dogmatically in France. One terrible example from the article above is autistic children being taken away from autistic mothers, since autism, according to these psychoanalysts, is caused by the lack of maternal emotional warmth.
Freud, like all philosophers, said some pretty dope stuff and some pretty weird stuff. The mental model he provided us is quite easy to understand and even if we don't have an explicit ego, superego, or id, the subjective ideas those concepts represent can help us with things like acknowledging we have turbulence under the water of our psyche which we can't control most of the time and can direct our willful choices if unprocessed and given power.
As a critical theorist, Freud was rejected alongside many old white dudes in an understandable reactionary reflex for many decades. One had to turn to Fanon to access thinking about the unconscious. I would argue that currents in philosophy to us Lacan and Freud to read capitalist subjectivity alongside new interpretations of Hegel have shifted the field tremendously, starting with the 1989 work of Zizek Sublime Object of Ideology. Over the decades this work has increased in relevance as a way of understanding a way out of our current predicament.
The appeal of Freud is that there's clearly something true about it. It's not all true, not even close, and as a predictive model it is extremely weak; the ways it's not true is really important and everyone figured out that it's there so they moved on to other models. But it's got (I believe) true parts, even though you can't really call them "science", and those parts appeal to people like me who are looking for something... more than therapy, I guess.
>there's clearly something true about it. It's not all true, not even close, and as a predictive model it is extremely weak; the ways it's not true is really important
In what way is it clear that there's something true there?
A lot of his basic ideas are so enmeshed into our public conception of how people work that we don't even realize they come from him, the main example being the basic ideas of "subconsciousness" and "repression". The interpretation of dreams stuff is definitely not as predictive as he claimed, but it's definitely got something to it; compared to "thinking dreams are random and meaningless" it's definitely a better theory to guess that they involve repressed stuff. Etc.
Some things, e.g. id/ego/super-ego seem truish, but only because they package up already accepted things. It's like a "theory" in the Arts: a way of thinking, of analysing, a framework. It's neither true nor false, but may be convenient terminology.
Neither is Popper's Falsification Theory. The only thing that pointing this out demonstrates is that a theory does not fit under Popper's specific definition of normative science... which in the philosophy of science itself is not held in particularly high regard.
So what you're basically pointing out is that, according to one very specific philosopher of science, Freud is more philosophy than he is normative science. Which is something that I think virtually all advocates of Freud would uncontroversially agree with.
Sounds perfectly falsifiable to me: you just need to show a well accepted scientific theory that cannot be falsified even in principle.
However, Popper's seems more a principle or a criterion than a theory. By which I mean, you're free to refuse it and incorporate any amount of non-falsifiable statements in your "science". I just suspect it won't have much predictive power.
The problem with this philosophy is that we have brain scan studies, phylogenetic, developmental, neuroscience, and thousands of pages from established experts on psychology that document these three systems of learning and memory.
Who give a hoot we live in Descartes' demon and anything could be not real? The elephant is in the room. Id/ego/superego is clearly a thing, either that or you're not familiar with the field, or you're not living in shared reality! Malignant egalitarians who think everyone's opinions are just should really learn to push back harder on things that have, like, one in a trillion odds on being false.
The only thing up for debate are the definitions, functions, and boundaries of these three.
I don't know how familiar you are with Freud, but it's not something that can be made piecemeal. The Oedipal complex is not "true" or "false," it describes the universal process of socialization that children enter into (even Aristotle said somewhere, that children begin by calling all men "dad" and all women "mom," until they learn to differentiate via naming). But the various conditions of the Oedipal complex are diverse: it boils down to, in the end, not the simple conventional "mommy, daddy, me," but a triadic formulation: the child only understands themselves as individual, insofar as they have lost the mother's affection (i.e. they're being weaned), and thereby gains an object of desire (originally, the love of the mother) which is always already lost, and a process whereby they can return to a state of pre-subjectivity i.e. where their desires would have always already been fulfilled; a return to a position whereby that affection (of the mother) can be returned, by assuming the role of whatever it is that took the object of desire away, in order to get it back, thereby gaining subjectivity in seeing themselves as that which they desire to replace. This is termed identification, which is a repression of that drive towards pre-subjectivity, a drive which Freud entitles the "death drive." For Freud, there is always something that precedes all theorizing or origination, some excess towards which desire aims--towards, precisely, a state before desiring itself--but which it never fulfills.
The Oedipal triad, therefore, is the first and most basic articulation of this drive towards death in its social function, even if it is made particular for the time and place where Freud lived, it is necessary as a part within the larger system: a part which relies on the regular function of others, like the death drive, like repression, like the unconscious. Each part of the system is defined in relation to all the others, and defined in relation to its appearance in a symbolic system and its authorization at the level of discourse; that is, at the level at which one speaks, since it is only within symbolic exchange that one first enters into a social world. One gains language through the word "mama," not because mama, the most basic, repetitive sound that any child can make, has any significance, but because the very appearance of a word that has come in place of the "actual" object of desire implies an infinite separation already from that object in its full sensuous reality: the object, once announced, is already lost, on account of the fact that it can be announced as separate from the very thing it supposedly describes. And from then on, the child is "castrated," i.e. cut off from the source of pleasure through their very entrance into the world of symbolic structures; through, more simply put, their entrance into language.
This implicates all other systems of thought, giving to all other discourses a biological, material explanation for the formation of language itself, but one which is always permanently separated from the very biological origin by that very excess towards which it aims--the drive towards death, which, for Freud, always points to a pre-animated, pre-vivified world. A world before language and the psyche that would come to describe it. So that the materiality, and the relation to the material world of every discourse, is always established as a permanent site of loss, to which (very fortunately for itself) psychoanalysis always has a method to prepare a way forward despite this loss, through the rigorous analysis of its own development.
> The Oedipal complex is not "true" or "false," it describes the universal process of socialization
A description of a universal process is either false (the universal process does not exist as a universal process), or false (the universal process does exist but the description is inaccurate), or true (the universal process exists and the description is accurate).
It's universal only insofar as it is based on empirical evidence. Psychoanalysis always begins from empirical claims. There is nothing transcendental or purely intelligible here.
I'd love to hear you explain how your essay supports the statement that Freud's ideas "not something that can be made piecemeal."
As a single example, I'm pretty happy with his concept of psychological projection, despite the fact that I'm pretty critical of his ideas on cocaine. How does your essay show my position here is untenable?
I mean I can see where you're coming from, even if it's a bad example (derivatives of cocaine are extremely common today in medicine--procaine, lidocaine, etc.--but Freud worked with what he had at the time). Though its true that the entire psychological apparatus stands behind everything anyone ever says, writes, signs, for Freud, so it's impossible to read one part separated from any other, or to value one part more than another absolutely, instead of seeing it instead in a complex network of interwoven--as the French say--signifiers.
What your valuation (of projection over the use of cocaine in medical treatment) describes has more to do with the social and psychological economy from which you have received Freud as a body of texts and paratexts, than anything about Freud as a total system. What I've argued prior is that on account of the way Freud constructs psychoanalysis, and sets psychoanalysis as the means by which one can track their own place in discourse, means that everything is mediated psychologically, and therefore everything written by an author must be connected for that author. To take Freud, then, not as Freud as such, but as Freud as a body of disconnected texts, would be a disingenuous reading: still, possible, but not at that point Freudian. At that point, you'd be developing your own theory with reference to Freud.
Freud’s thinking was dynamic and dialectical. I think you’re acknowledging that when you say he has to be taken as a whole. There are parts of that whole that are inconsistent, parts that were added and removed, a ship of Theseus grand theory of personality. His seduction theory is a good example of the dialectical aspect of his theorizing, but there are many others. So I agree, it is the process that describes the Freudian “analytic” approach, moreso than a specific construct or summation of his theory (theories?) as it (they) existed at any particular point during or after his lifetime.
In that case, here are two words for you: "shallow dismissal." More to the point, there's no "there" there in your comment. And, it's against the guidelines (which we all know are really "rules" here, and not actual guidelines, but that's a different post):
> Please don't post shallow dismissals, especially of other people's work. A good critical comment teaches us something.
I don't know about anyone else, but your four words taught me nothing about the subject matter.
Pretty much totally disagree. You can take all the parts piecemeal. You can use the underlying concepts of his model without buying the dubious narrative of the Oedipus complex. And you can say there's something that "rings true" about the Oedipus complex without interpreting it as a literal predictive theory, aka, accept it in part while rejecting it in the whole. Easily. It's a model, and taking it piecemeal can consist either of borrowing its nouns without its story, or taking part of its story but saying it's not the full picture, or not completely right, etc.
It wasn’t meant as an insult— the modern-lens defense of Freud just sounded remarkably like Peterson in a way that I found entertaining! I’m not particularly anti-Peterson, though I guess that might be the common view here so I can see how it might have sounded negative.
By the way thanks for all your great work! I’m honored to have been scolded by dang!
From an empirical perspective, the theories of psychotherapy are profoundly uninteresting. Debate has raged for decades about the dodo bird verdict - the hypothesis that all psychotherapies have equivalent outcomes - but the data has rendered that debate moot.
Psychotherapy is effective, but only marginally better than placebo. The differences in efficacy between various modes of psychotherapy are statistically insignificant and undoubtedly clinically insignificant. People receiving psychoanalysis improve at basically the same rate as people receiving CBT or IPT or ACT or a raft of other interventions that loosely resemble psychotherapy. In the most basic sense, it doesn't matter whether Freud was a genius or a fraud; entertaining his theories, even if only to criticise them, is a distraction at best.
The bottom line is that people tend to feel a bit better when they talk about their problems with someone who is attentive, supportive and non-judgemental. That's a valuable insight, but it's inherently limited and it's never going to yield the kind of treatments that we want and need.
I'm pretty familiar with that literature for professional reasons and the linked paper provides a pretty fair assessment, or at least it's consistent with my impressions overall.
One thing worth noting that's been skimmed over, maybe because of the target article, is that second-order meta-analysis and review concludes that psychotherapy and pharmacotherapy efficacy have both been overestimated or overstated, and that the combination of both is more effective on average than either alone. This is also consistent with my impressions.
There's a lot that could be said about it.
First, like a lot of academics, there's a lot of inflated hype and publication bias. It applies to behavioral and mental intervention research as well as other things, so you end up with overstated effects of interventions.
Second, both psychiatry and clinical psychology suffer from a certain amount of insecurity about being seen as "real sciences." As a result, I think (this is just my personal opinion) there's a certain tendency to apply poorly-fitting models from other fields to treatment research, sort of blindly, and it results in poor investigation of underlying mechanisms. Writing this out, it might not be obvious what I mean by this to someone outside the field, but one way of explaining it is that intervention research in psychopathology (pharmacology or psychotherapy) has historically been distracted by concerns about emulating "real scientific disciplines", and as a result a certain amount of self-criticism that might have resulted in faster improvements (by shedding actual dead ends) were not pursued, and research into methods and approaches (for approaching interventions in general) that are more uniquely suited to behavior and psychological phenomena were kind of neglected. I think this trend continues. Basically people in a lot of very high-profile institutions are afraid to say their grade A "empirically supported" interventions aren't so great, or not actually better than other, supposedly "grade B" interventions, because they're afraid it will be jumped on as a sign of weakness of the discipline, rather than of rigorous attempts at improvements. To be fair to these people, a lot of the time that is what happens to these fields: instead of saying "well that was a good idea that didn't work out, good people in the field are looking at this closely", some critics will tend to target the entire field as being incompetent. This is counterproductive, really, and sometimes it looks like a lose-lose position for those in the field.
Third, there is fairly strong evidence that different treatments work well for some people but not others, but that we don't really have a good way to predict what will work for whom. So, for example, the efficacy for drug A might be sort of small to modest overall, but high for one subset of people, and low for another subset of people; the efficacy for psychotherapy B follows similar patterns. This is one reason why combination treatments work: you're kind of applying a shotgun approach with the idea that one thing will stick. People have tried to predict what works for whom but it doesn't work out so well in a replicable sense. As someone else noted, a more accurate way of understanding things is that there's little evidence for the general differential efficacy of one intervention over another in most cases (most things tend to have about the same probability of "working" on their own, and that probability is lower than you might think based on the way they're sometimes discussed in the literature).
Another thing that is missing is for the field to adopt decision theory properly. At the moment it's usually left to the patient to decide that a treatment is not working for them and pick a different therapist. If we can't predict which treatment will work, we should at least have some research into how long to try each one, and in what order, and any indicators that might allow us to switch early from one that is not working. At the moment I think a huge amount of suffering is endured because therapists don't have good incentives to give up when their treatment isn't working. (At least in my country in the private sector. The public sector has different issues - they are incentivised to declare victory early - and I don't know how it works in the US)
> methods and approaches (for approaching interventions in general) that are more uniquely suited to behavior and psychological phenomena were kind of neglected
Can you give some examples and expand on this? I realize it's speculative but I'd like to hear your speculations :)
> we don't really have a good way to predict what will work for whom. So, for example, the efficacy for drug A might be sort of small to modest overall, but high for one subset of people, and low for another subset of people; the efficacy for psychotherapy B follows similar patterns
In the case of psychotherapy my feeling is that there's an additional complication, which is that efficacy depends not only on what (is it psychotherapy B1, B2, etc.) but also on who - because efficacy has also to do with the quality of relationship between therapist and client, this varies a lot, and it is not a function of modality*. Do you agree? and if yes, what methods do you think would be best suited to studying this?
(* I dislike that word "modality" but it's what people use to describe the different therapeutic methods, so it's at least clear in this context.)
> Can you give some examples and expand on this? I realize it's speculative but I'd like to hear your speculations :)
That's a big topic, probably something you could write many papers about, or a book. I probably also overstated things a bit. But it does come up in important ways.
I don't know I had anything in particular in mind although for example:
Defining a behavioral or psychological "placebo" or control becomes very complex really quickly. There's ways to approach it, such as a waitlist control, or a psychoeducational control (where clients get education but not therapy per se), or even, say, a pharmacological control for a psychotherapy study, but none of them are quite the same, and there's really no way to do true blinding. I think for a long time, people would just try to import this notion of a waitlist control or something without tackling the question of "what's an appropriate control", or trying to decide it if it's even possible. I think some of these issues have resolved but I suspect that approaching RCTs without trying to emulate drug trials so closely might have resulted in more progress faster, by honing in on what are particular components of controls versus therapies.
Another example I've discussed with my colleagues is related to our lack of understanding of the nature of psychological interventions. So for example, with a medication, it's pretty clear for the most part what the molecules involved are, their proportions, and so forth, even if we don't understand mechanisms well. But with something like, say, CBT, even if you accept its superiority in terms of efficacy (which isn't really the case), where are the boundaries? What exactly is a "cognition" and what components of it are key to understanding progress or lack thereof? A lot of psychological variables have boundaries that are fuzzy to us, and if you think about it, the notion of causality itself is a little murky (what does it mean to say that a cognitive bias "causes" negative mood?). There's some philosophical and scientific answers to these things but in general we just kind of take them for granted, and I think some of it is associated with a very operational, protocol-driven approach to intervention research influenced by other areas of medicine.
> In the case of psychotherapy my feeling is that there's an additional complication, which is that efficacy depends not only on what (is it psychotherapy B1, B2, etc.) but also on who - because efficacy has also to do with the quality of relationship between therapist and client, this varies a lot, and it is not a function of modality*. Do you agree? and if yes, what methods do you think would be best suited to studying this?
Yes there's a lot of evidence for client, therapist, and relationship factors. The nature or quality of the therapeutic relationship is one of the "common factors" posited to be shared across different therapies that have demonstrated efficacy, in the sense that you can define it for a variety of types of therapies and it predicts outcomes.
As for how to study it in a "matching" sense is tricky. It's easier to identify background characteristics of clients and therapists that predict outcomes, or to predict that, say, a given therapist is associated with better outcomes without understanding why, and you can ask clients and therapists basically some variant of "how comfortable do you feel? how is this going?" and it predicts outcomes well, but in terms of matching clients and therapists a priori is less certain. It's a bit like predicting dating outcomes, which are also tricky.
I actually have some hope for the use of LLMs and related methods in this space, with videos and whatnot. My guess is ideally there would be some kind of intake assessment of some sort; traditionally these are aimed at assessing problem areas for a client and strengths, but shifting that more to finding out who they might work well with, or what approach might work, probably would show a lot of benefits. Kind of like speed dating but maybe instead with some standard initial contact with therapy method and therapist match in mind (maybe even in some kind of online videorecording format?).
It may be there's some inherent level of unpredictability in the sense that clients don't always disclose everything intially, or aren't aware of what is relevant, so don't provide in that regard, or circumstances shift over the course of therapy (e.g., a relationship goes sour, or improves over the course of therapy) that becomes critical to the therapy match process itself. There's a kind of dynamic, self-organizing quality in that way.
I also think in general there probably isn't enough research into why clients feel like things aren't working when they feel that way, and trying to rectify it (or conversely, when a therapist is frustrated about something with a client's progress). A study to do that correctly would be really expensive and necessitate having the right diversity of therapists. Therapy studies also often tend to be organized around grand therapeutic approaches too, like CBT versus psychodynamic versus interpersonal, and less focused on specific relational questions like "what are problem areas identified by a client in therapy, with the thereapeutic relationship". It certainly happens, but probably not as often as it should.
The metastudy compares against "placebo or treatment as usual" which means the placebo group is getting some kind of therapy, just not the specific kind tested.
If this metastudy is accurate, it means that therapy is effective but your choice of therapy method doesn't matter very much.
The study compares types of psychotherapy and commonly used medication. Both work about equally well, but neither has a large effect. This mostly shows that the effect size of psychological interventions in general is small.
But it sometimes helps, and as someone who has benefitted from psychotherapy I'm deeply grateful.
The fact that psychotherapy works about as well as medication is pretty impressive, considering some of these medications have serious side effects.
This is a very limited perspective, reducing Freud and the development of psychotherapy theory to, as you put it, feeling “a bit better”.
Freud was as much a mystic, philosopher, and literary genius as he was a psychiatrist. I've found his ideas to be extraordinarily deep and they have influenced my life and thinking in profound ways.
I see your point, but honestly, the only way I can respond to your question is with more questions.
Why do we expect deep psychological or philosophical insights to make things better for us, or lead to “improvements”? Why do we think that a profound revelation will bring clarity and resolution to our lives? It could just as well make us more crazy.
There’s the famous case of the “Rat Man”. Whether Freud cured him is up for debate, though he most likely didn’t. But it’s a deep mediation on neurosis, obsession, cognitive dissonance, love, hate. It raises more questions than it answers but it's incredibly insightful. It gets at the heart of human fragility and I think that's something to take seriously.
> Why do we expect deep psychological or philosophical insights to make things better for us, or lead to “improvements”?
That's a fair point. We shouldn't necessarily expect them to.
However, we do need some way to evaluate if they are real deep insights or just an interesting fantasy. IF Freud's ideas are just not true, if our psyche is not really divided in id, ego, and super-ego, if our early childhood experiences are not so formative etc - is it really fair to call it a deep insight? I'd say that, IF that turns out to be the case, then no, it wasn't a deep insight, it was just an interesting fantasy, no different from the deep lore of the Elves of Tolkien. Not without value, but lacking in philosophical or psychological value.
So, the big question is how we should tell if his insights are true or not, before using them to change our way of thinking about ourselves and others. And evaluating how they are successful or not at their stated purpose, while not proof, is at least evidence in this direction.
It is nice to see some renewed interest in psychoanalysis.
Sure, Cognitive Behavior Theory can work really well for some people but I fear the phrase "evidence based" is a bit of over-hyped in a field with a major reproducibility crisis. Again, it can be perfect for the right person but it is not a silver bullet.
Especially for some people with PTSD it might not work that well or even be contra-productive.
So if you feels like CBT is not working for you, maybe give psychoanalysis a shot. There is more to it than Freud anyway.
There is no silver bullet, but if we're going to talk reproducibility, CBT blows any psychoanalysis-based approach out of the water, even once we account for all the outright fraud.
It's true however that psychoanalysis has evolved a lot over time and bringing it back to Freud every time is not really fair to modern approaches.
Yeah, go see psychanalysts when you have a real mental issue, give them your money, every weeks for 15 years. To 4 different ones, with only one response 'psychoanalysis is a lifelong work' when you don't see improvement.
Then, if you're lucky, you'll meet a psychiatrist, who within 5 minutes will say 'I think I know your issue, do you consent to a blood test?' and discover within half a day you're bipolar.
Too bad, your bipolarity already estranged you from your daughter and old friends. Hopefully you'll work on reconnecting since now, a real doctor actually found the issue.
DBT is basically a category of CBT. "It’s based on cognitive behavioral therapy (CBT), but it’s specially adapted for people who experience emotions very intensely."
This is why it's often recommended to people with PTSD who fit this (or similar) criteria, among others.
(I've never heard of IFS, but I studied in Canada so some things don't cross over.)
IFS = Internal Family Systems. I don't think it's very big at least right now. I think it's also recommended for PTSD. To me it feels more in line with psychotherapy in that it looks at root causes, whereas CBT is more of a surface level thing. DBT seems somewhere in between.
