This article by Oliver Burkeman takes a thorough look at the evidence base for psychoanalytic-based therapies compared to cognitive behavioural therapy. Given the increasing media chatter about an impending robotics revolution, some of his coverage evokes the (worrying) thought of the potential role for robots in some kind of future mental health provision. Burkeman cites a patient’s comments on the alienation and isolation she was left with when a computer programme all too unconvincingly announced its sympathy: ‘… “I don’t think anything has ever made me feel as lonely and isolated as having a computer program ask me how I felt on a scale of one to five, and – after I’d clicked the sad emoticon on the screen – telling me it was ‘sorry to hear that’ in a prerecorded voice,” Rachel recalled.’
‘Rachel’ goes on to suggest that completing CBT worksheets under a human therapist’s guidance wasn’t much better: ‘… “With postnatal depression,” she said, “you’ve gone from a situation in which you’ve been working, earning your own money, doing interesting things – and suddenly you’re at home on your own, mostly covered in sick, with no adult to talk to.” What she needed, she sees now, was real connection: that fundamental if hard-to-express sense of being held in the mind of another person, even if only for a short period each week.’
Burkeman uses data to argue that psychoanalytic therapies, long derided by their critics as too time and money intensive, are longer lasting in their effects: ‘Ask how people are doing as soon as their treatment ends, and CBT looks convincing. Return months or years later, though, and the benefits have often faded, while the effects of psychoanalytic therapies remain, or have even increased…’
Online comments to the article object that Burkeman’s analysis is too harsh and generalising, and insist that CBT, delivered by adequately trained therapists, can be effective – and it’s an argument worth thinking about. But central to Burkeman’s argument is the very question: what is the point of therapy? CBT and psychoanalytic approaches have different ends in mind to an important extent. These different ends shape the structures of the therapy and alter the subjective experience.
Burkeman puts it: ‘CBT’s implied promise is that there’s a relatively simple, step-by-step way to gain mastery over suffering. But perhaps there’s more to be gained from acknowledging how little control – over our lives, our emotions, and other people’s actions – we really have?’. He ponders: ‘what should count as a successful outcome anyway?’ Psychoanalysis argues that ‘there’s more to a meaningful life than being symptom-free. In principle, you might even end a course of psychoanalysis sadder – though wiser, more conscious of your previously unconscious responses, and living in a more engaged way – and still deem the experience a success.’