Reaction formation in New York City

My latest Beyond Boundaries column is about psychodynamic revolutionaries in New York and is in the December edition of The Psychologist.

Jonathan Shedler is recounting an anecdote. ‘So when the patient says “I’m frustrated”, you say “Tell me more about that” and then you shut up!’ We’ve just bustled in from a crisp Manhattan evening and the story gets an appreciative laugh. City University of New York is home to one of the most psychodynamically oriented clinical psychology courses in the US, and Shedler is here to fire up the audience. He’s presenting his research on the effectiveness of psychodynamic therapy, but the underlying message heralds a fight back. His data is mixed with tales of naive cognitive therapy trainees and disdain for ‘manualised CBT’ (there is, it seems, no other sort) and the audience are firmly behind him.

New York City was famous for its Freudian émigrés and became a leading centre for psychoanalysis during the 20th century, but the rising influence of drug treatment began to erode both the popularity of the couch and the therapeutic eminence of the Big Apple. Shorter therapies, validated using the techniques of academic research, have pressured both psychodynamic therapy, the younger relation of psychoanalysis, and its community of practice, who traditionally eschewed the systematic collection of data for the introspective gaze.

Psychoanalysis never gripped the UK’s psychology and psychiatry departments as it did in the US, and so the division between clinicians and researchers has traditionally been much less acute. In the New York lecture hall, this divide is reflected in the post-presentation discussion, driven by the split rhetoric of ‘practitioners’ and ‘researchers’ and how the latter don’t understand the former, despite the fact that we’re here to discuss research evidence. But most striking is the sense of revolt against the perceived oppression towards the psychodynamic approach, which, in the US, is additionally fuelled by the insurance companies desire for the most evidence-based bang for their buck.

The audience speak out. Person after person stands up, vociferously thanking the speaker, decrying the lack of respect afforded to psychodynamic treatment and promising to spread the word about this new evidence to colleagues, managers and patients. But beyond the fight back, there is a distinct culture change in the air. In an area famously divided by internecine feuding and bitter theoretical differences there is unity. And perhaps more significantly, the tools of clinical trials, systematic data collection and evidence-based practice are now being taken up as essential allies. New York City may yet be home to psychodynamic revolutionaries once more.

Many thanks to @Zleeoga for inviting me along to see the New York psychoanalytic scene in action. Greatly appreciated!

And many thanks to Jon Sutton, editor of The Psychologist, who has kindly agreed for me to publish my column on Mind Hacks as long as I include the following text:

The Psychologist is sent free to all members of the British Psychological Society (you can join here), or you can subscribe as a non-member by going here.
 

Link to December’s Beyond Boundaries column.

2 Comments

  1. Bronson
    Posted November 24, 2011 at 12:43 pm | Permalink

    Bah! We have a publicly funded mental health service here in Australia and once you throw tax payers money into the mix the idea of spending resources on an unvalidated, lengthy and inefficient therapy is ridiculous. If anything the British social worker system is a far better alternative to mainstream clinical psychology.

  2. Oren
    Posted December 11, 2011 at 6:00 am | Permalink

    @Bronson,

    You have to spend some resources on any therapy to get the initial validation, no?
    Also, what’s your goal with therapy?


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