Psyche, Science, and Society

New York Times letters on psychoanalysis and research

The New York Times published eight letters today in response to Adam Phillips’ Sunday piece criticizing attempts to research psychotherapy. Alas, mine was not among those published. The letters are interesting in showing the range of thinking on this important, yet difficult, relationship.

The Letters:

March 2, 2006
Beyond Data: Does Therapy Work? (8 Letters)
To the Editor:

Re “A Mind Is a Terrible Thing to Measure” (Op-Ed, Feb. 26):

Adam Phillips revives the old and worn argument that the effects of
psychotherapy are so ineffable that they cannot, or perhaps should not, be
quantified.

In fact, hundreds of carefully controlled studies now demonstrate that
several psychotherapeutic modalities, especially behavioral,
cognitive-behavioral, interpersonal and perhaps short-term psychodynamic
treatments, exert positive and measurable effects on the symptoms of
depression, anxiety, bulimia, insomnia, sexual dysfunction and other
conditions.

Mr. Phillips’s claim to the contrary, the primary impetus underlying the
increasing pressure to assess psychotherapy outcomes is not the desire to
appear scientific. It is the laudable desire to hold psychotherapists
accountable for their claims to alleviate mental suffering.

Mr. Phillips cannot have things both ways. If he charges his clients for
his therapy hours, which I assume that as a psychoanalyst he does, he must
presumably be offering a legitimate service with measurable effects.

If he is not offering such a service, then it is not clear what benefit he
is offering beyond that of an empathic or perceptive friend who is surely
less expensive.

Scott O. Lilienfeld, Ph.D.
Atlanta, Feb. 26, 2006
The writer is an associate professor of psychology at Emory University and
editor of the Scientific Review of Mental Health Practice.

To the Editor:

As a psychiatrist and psychoanalyst, I applaud Adam Phillips’s excellent
overview of the struggles that psychotherapy faces in America today.

Psychoanalysts and psychotherapists do have a “marketing” problem in this
society. We have the only “product” in America that is all natural, has sex
and aggression in it, with no additives, and is difficult to sell. In our
fast-paced, quick-fix culture, we not only value empirical science but
often overvalue it.

Of course, the notion to sit still with someone over an unspecified length
of time to discuss private feelings and secrets is quite foreign. But when
a person has finally suffered enough with neurotic problems, usually after
exhausting other less extreme measures to get help, he or she takes a
radical step and finds a way to our doors.

We should respect the fact that people often have a way of measuring their
internal psychological pain without the need for external empirical
measurements.

Bruce J. Levin, M.D.
Plymouth Meeting, Pa.
Feb. 26, 2006

To the Editor:

Adam Phillips questions efforts to transform psychotherapy into an
evidence-based science, but he ignores the main reason for doing so.

Most of the hundreds of psychotherapies have no credible empirical support
for their effectiveness. The cure for this epistemological sickness is to
insist on the use of randomized clinical trials before a therapy is judged
to be effective. There is no other way.

Ed Erwin, Ph.D.
Miami, Feb. 27, 2006
The writer, a philosophy professor at the University of Miami, is the
editor of The Freud Encyclopedia: Theory, Therapy and Culture.

To the Editor:

Adam Phillips is to be applauded for highlighting the idea that
psychological growth and transformation often occur not in spite of but
rather because of what occurs when two people meet in a psychotherapeutic
encounter that defies scientific rigor.

It is against the backdrop of what cannot be quantified in the
psychotherapeutic relationship that so many come to feel a genuine and
meaningful connection to another person in a world in which isolation too
readily replaces two people talking with each other about the profoundly
personal.

Such is the immeasurable beauty and power of psychotherapy.

Janet Plotkin Bornstein, Ph.D.
New York, Feb. 26, 2006
The writer is a psychoanalyst.

To the Editor:

Adam Phillips makes some very good points about psychotherapy, but the fact
remains that as long as we count on health insurers to pay for the
treatment we provide, we must demonstrate its effectiveness. And there are
studies that do that, without robbing psychotherapy of its artistic and
unpredictable elements.

There are new studies by Alan N. Schore demonstrating actual structural
changes in brain anatomy as a result of psychotherapy and the large study
published in Consumer Reports in the 1990’s, among others.

Andrew Roth, Ph.D.
South Orange, N.J., Feb. 28, 2006
The writer is a psychologist and psychotherapist.

To the Editor:

Adam Phillips maintains that psychotherapy should not be held to standards
of predictability or measurement of outcome. Yet he speaks of good and bad
consequences, and the possibility that psychotherapy has something to
offer. In other words, that the patient will be helped.

The implication is that if psychotherapy is justified, it is by the
probability that it will usually do more good than harm, and furthermore,
that there are criteria against which to measure these good and bad
outcomes.

Without such probabilities and definition, there could be no justification
for the practice of psychotherapy.

The distinction between hard science and psychotherapy is one of degree.
Outcomes in hard science are easier to define, and predictions more
certain. But prediction and definition of outcomes are essential in either
case.

Robert J. Sullivan
Alpharetta, Ga., Feb. 26, 2006

To the Editor:

Modern psychotherapists seek to heal their patients’ suffering effectively
and reliably, not to “legitimize themselves as scientists.”

When they say their method is effective, they provide evidence for this
claim.

Adam Phillips writes that “as a treatment, psychotherapy is a risk.” In
fact, modern time-limited, focused and evidence-based treatments help most,
fail to help some, but never harm.

Baruch Fishman, Ph.D.
New York, Feb. 26, 2006
The writer is director of Cornell Cognitive Therapy Clinic, Weill Medical
College.

To the Editor:

I have been to a psychiatrist a couple of times in my life, each time
because I stopped functioning. This last time, at age 51, the situation was
serious indeed.

I went to two therapists, each very good. There is certainly some science
involved in what is wrong with me and what we try to do to work around it,
although we have all tended to agree that there is a lot more to learn
about depression and similar mental disorders.

Still, the therapy has been working, along with other treatment and the
passage of time. And when all else fails, my therapist has these wonderful
little hard candies I am quite fond of.

Bruce Neuman
East Hampton, N.Y., Feb. 26, 2006

Add comment March 2nd, 2006