Off the Couch

We write with regard to the March 7 article titled “Future of Psychoanalysis Put on the Couch,” the content and tone of which did much to confirm how psychoanalysis ended up in a reclining position.

Psychoanalysis is indeed a “marginalized” treatment, but not because of psychopharmacology, competing psychotherapies, or “managed care.” Psychoanalysis is simply not effective for addressing the treatment needs of patients with most psychiatric disorders. We don’t think the problem lies with “Americans. . .not [being] as verbal as they used to be” or with their “terr[or] of death.” We think that the problem is with the method, which has not stood up to research scrutiny or validation in everyday clinical practice. To blame the patient for the inadequacies of the method is, unfortunately, a time-honored approach within the analytic movement.

What are analysts doing these days? According to Dr. Erik Gann, quoted in the article, the future of psychoanalysis (after all) is “not going to be in treatment per se, but in the extension of psychoanalytic thinking into 21st-century culture.” Really? If so, what place, if any, should psychoanalysis have in psychiatry residency training? For that matter, why should APA remain interested in analysis, any more so than in musicology or particle physics or other areas of cultural inquiry relevant to the new millennium? And the spectacle of a physician offering advice to a corporation, which apparently leads to an employee’s losing his job, is disturbing.

We agree with Dr. Phyllis Cath, quoted in the article, that analytic concepts can be of use in certain settings. Finding a place for those concepts within the medical profession remains a challenge. This article, however, does little credit to that effort.