[ExI] Long-term Psychodynamic Psychotherapy turns out to beeffective...

Stathis Papaioannou stathisp at gmail.com
Fri Oct 3 07:59:29 UTC 2008

2008/10/3 Lee Corbin <lcorbin at rawbw.com>:

> But I'm very glad this came up, because I distinctly remember (from
> perhaps 25 years ago or so) a study in which four sets of randomly
> chosen patients were treated by
>  1.  psychotherapists
>  2.  doctors
>  3.  nurses, or social workers, or some such (don't recall)
>  4.  left alone
> The results were that the patients improved directly in the opposite
> order! Has anyone ever heard or read about such a study? Or
> one that would disconfirm it?

I don't know that particular study, but most of the studies done tend
to show that the different types of psychotherapies are equally
effective, which implies that they are equally ineffective, i.e. it's
just the reassurance of talking to someone and the placebo effect of
believing that they have special powers to heal the mind that helps.
There are particular situations where intensive psychotherapy can make
people worse, such as when they are psychotic or have certain kinds of
personality disorders. Just as it is up to the judgment of the doctor
when not to prescribe medication, it is up to the judgment of the
therapist when avoid or limit psychotherapy.

In my own practice in public mental health I mainly deal with people
who are profoundly disturbed and require medication, which is
dramatically effective in about 1/3 of cases, partly effective in
another 1/3, and only minimally effective in the rest. The "supportive
psychotherapy" given these people involves common sense things such as
providing reality testing, monitoring their mental state to detect
early signs of relapse, assessing risk to self or others, determining
if there is some stressor responsible for a deterioration and helping
them do something about it, and so on. We try to discharge as many
people as possible from the public system, which means only the worst
cases where it is clear that this sort of intensive support is helpful
(because when it's withdrawn they end up readmitted to hospital, lose
their jobs, accommodation or relationships) get kept on the books long

This is very different from private psychiatry, which deals with what
is sometimes disparagingly (and perhaps not entirely fairly) called
the "worried well".

Stathis Papaioannou

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