Talk to someone- what for?

It is becoming more and more common to hear, even amongst therapists, that old-fashioned psychoanalysis is simply too long and the results too negligible, worse, that simply “talking” doesn’t solve anything, especially deep-rooted psychological ailments. This is made worse by the fact that many “old-school” psychoanalysts, especially in Europe, see the word “healing” as an almost dirty word. There have been a number of times at conferences or networking events that I have heard a colleague psychoanalyst say in a half-whisper: “The patient can get better, sure, but they cannot “heal”.

On the other side of the ring, we have the so-called “alternative” therapies: hypnosis, eye-movement therapy, brief-therapy, body-centred therapy, etc. Here, “healing” becomes implicit, preferably in the lapse of time between one to five sessions. Yet, despite these miraculous promises, good-old talk therapy still persists… Why?
First, it is necessary to make the distinction between classical psychoanalysis and “psychoanalytically inspired” or “psychodynamic” psychotherapy. In classical analysis, the patient is on the couch, facing away from the analyst whom he cannot see. The analyst makes very few comments and mostly listens; any emotion on his part is not seen in a very positive light, indeed the best intervention is silence, because in this way the patient can “learn how to handle frustration” and “face reality”.

Psychoanalytically-inspired, or psychodynamic therapy, is very different, despite the confusion of the label. (Actually, psychodynamic therapy did originally evolve from psychoanalysis, but has come very far since its nineteenth-century relative).

Here, the therapist and the patient sit in armchairs facing each other, at a not-too-far-apart distance. Intimacy and non-verbal communication, thus eye-contact, are of the utmost importance. The therapist is much more engaged than he would be in a classical analytical cure. He listens, but he also supports, asks questions, structures each session, explains, and most of all informs or teaches the patient using all his experience and know-how so that the patient feels as equipped as possible to deal with issues in the outside world.

This “humanistic” therapy is not only very effective as far as patient testimonials go, but we might actually have scientific proof that amongst all the different psychotherapies under the sun, it is precisely this one that yields the best results. Best of all, benefits of this therapy continue to grow even after the end of treatment.
Jonathan Shedler, PhD, of the University of Colorado Denver School of Medicine, compared eight meta-analyses of 160 studies on psychodynamic therapy, with eight meta-analyses of other therapeutic techniques as well as antidepressant medication. According to Dr. Shedler , other therapies showed patient improvement but the improvement was limited in time, whereas psychodynamic therapy was the only one that initiated changes and an evolution in the psyche of the patient that grew even long after treatment was terminated.

Classical psychoanalysis has always looked down upon statistical findings, and this has been to its own detriment. The inevitable result of this was that other forms of treatment, for example the cognitive behavioural therapies or CBTs have been able to gain limelight by the pretext that they were “scientifically approved” and supported by “empirical evidence”. However, new research such as that of Dr Shedler, confirms that which numerous therapists and patients knew by experience: classical “talk therapy” not only works very well, but in terms of efficiency, it’s the best there is.