The Institute of Psychotherapy and Disability promotes access to psychotherapy for learning disabled children and adults. The IPD promotes good practice – including basic awareness that learning disabled people can make good use of psychotherapy, particularly if practitioners are trained to listen and communicate appropriately and well. In thinking about how important this work is, the current social context is important. The public sector cuts that have been ongoing now for several years have had a specific impact on disabled people and on attitudes to disabled people. A United Nations inquiry concluded that austerity measures represented violations of the human rights of disabled people. The same report noted that a climate where disabled people were represented as lazy and a burden was accompanied by rising hostility and aggression directed at individuals. The consequences for emotional and psychological health are clear. The IPD’s work is as relevant now as ever.
If you are interested in research evidence, this meta-analysis (from the Journal of the American Medical Association) supported the effectiveness of psychodynamic psychotherapy. Published in 2008, the researchers analysed the outcomes of 23 studies and concluded that ‘long term psychodynamic psychotherapy’ showed significantly higher outcomes in ‘overall effectiveness’ than shorter forms of psychotherapy.
The study also supported the effectiveness of long-term psychodynamic therapy over shorter therapy, for some specific diagnosed conditions. As APEL point out in their comment on the research, some of these conditions, (or, we might say, the terms – such as ‘personality disorder’ – used to describe experience), might be thought of differently by a psychodynamic or psychoanalytic psychotherapist in any case. The study remains very interesting, and APEL comment that their own experience is in line with its findings. Overall the researchers concluded that there is ‘evidence that LTPP is an effective treatment for complex mental disorders.’
The research was based on a total of 1053 patients spread across 23 studies (11 randomised control trials and 12 observational studies) that used individual psychodynamic psychotherapy lasting for at least a year, or 50 sessions. Some of the studies may have lasted much longer than a year, but this minimum threshold is interesting in itself. While a year of once a week psychotherapy is longer than the brief counselling or cognitive behavioural therapy mostly currently on offer through the NHS, it is still a relatively brief time frame.
I missed this article from the Guardian when it was first published in 2015, but it is well worth a read. It sets out how Freud’s radical views about the unconscious are being increasingly reaffirmed by new research in neuroscience.
This interesting article reports on a new study analysing the results of brain imagining studies and their usefulness, or otherwise, in determining psychological or emotional states. The study concluded that such use of brain imaging studies was more flawed than had been argued. It found that research bias and holding back of negative data influenced results, and overall that brain imaging was not able to determine and discriminate specific diagnoses.
The study highlights the difficulty in assuming an easy read through between physiological characteristics and emotional states – and the writer of the article concludes that ‘brain scan research is of limited use in explaining the complex psychological states of human beings’.
What is also interesting is that even in the report of the study the writer talks about people who have ‘mental health conditions’ and those who don’t. In fact, what also complicates such physiologically based studies is surely that for all of us, our emotional states may vary radically from moment to moment, day to day. Extremes of experience and entrenched states can be empathised with by those of us who don’t have such enduring extremes because most of us have a hint of them from time to time. We all have ‘mental health conditions’, in this sense. While it is crucial to recognise particular experiences for what they are – and crucial that we don’t minimise the pain involved – it is also important to avoid a ‘them’ and ‘us’ framework. This is a difficult balance when, for example, trying to make the case for better provision of psychological services. But, it is an important one.
Nevertheless, a helpful report about an interesting study.
The case for psychoanalysis
This excellent programme, Freud for our Times, broadcast on BBC Radio 4, in December 2016 and January 2017, looks at what psychoanalysis has to offer and what it is about it that is distinctive from other options such as CBT or medication.
View the programme here