Psychoanalysis is under attack

HEAD TO HEAD

Psychoanalysis: does it have a valuable place in modern mental health services? sizes in randomised controlled trials of long term psychodynamic psychotherapy, larger than those for short term therapies.1 Positive correlations were also seen between outcome and duration or dosage of therapy. Another meta-analysis found that psychotherapy in addition to antidepressants significantly reduced depressive symptoms compared with antidepressants alone.2 A third meta-analysis found that short term psychodynamic psychotherapy may be more effective than other therapies for somatic disorders.3 So evidence is on its way.
Convergent support for psychoanalytical approaches comes from 20 studies of brain function changes after a range of psychotherapeutic treatments, including psychodynamic ones, for several mental disorders.4 Brain changes that have been shown include a substantial increase in 5-HT1A receptor density in patients with major depressive disorder after psychodynamic therapy—this was not the case in patients who received fluoxetine5—and normalisation of neuronal activity in patients with somatoform disorders.6 Ultimately these investigations will enable us to better understand the therapeutic mechanisms of a range of approaches and provide badly needed improvements in our treatments of complex disorders.

Paul Salkovskis professor of clinical psychology and applied science, Department of Psychology, University of
Bath, Bath BA2 7AY, UK [e-mail]
Lewis Wolpert emeritus professor of biology as applied to medicine, Department of Cell and Developmental Biology,
University College London, London, UK

Peter Fonagy and
Alessandra Lemma say that the psychoanalytical approach can provide a useful and unique contribution to modern healthcare, but Paul Salkovskis and Lewis Wolpert argue that it has no place there at all

Peter Fonagy Freud memorial professor and head of research, Department of