Article archive / August 1, 2011
Originally published: . Volume 2, No. 12. Source pages: 1, 6, 7, 8, 9.
In a mental health industry driven by lower costs and increasing reliance on pharmacology, psychoanalytically trained psychologists remain steadfast in offering their clients an intimate, personal approach for lasting change, and a process that acknowledges the unique inner journey of the individual.
The Times spoke with psychoanalytically trained psychologists in our community, several on the faculty of the New Orleans–Birmingham Psychoanalytic Center, who have remained committed to the values inherent in the psychodynamic process. In recent years careful outcome research has shown that psychodynamic approaches are on par with other evidenced-based techniques. Advances in cognitive psychology, neuroscience, and even evolutionary psychology, support the main tenets of Freud and other depth psychologies: The unconscious really exists and is important; inner conflicts cause human suffering; and the defenses restrict well-being and creativity.
Empirical support
“There is plenty of empirical support for psychoanalytic technique and psychoanalytic concepts in the scientific literature…” said Dr. Denise Newman, New Orleans psychologist and former Tulane professor, who specializes in developmental psychopathology, the way normal development can cause mental health problems. She looks at the role of personality processes and identity formation in mental health, especially for cultural and racial minority youth.
“As a scientist,” said Newman, “I have no problem with psychoanalytic theories guiding my clinical treatment of patients. But I came to that conclusion after a very lengthy course of study and comparative analysis of different models of the mind and explanations of psychopathology.”
“Most of the current trends, economic pressures, and politics of clinical training and treatment were not supportive of my conclusions,” she explained. “Nonetheless, to my way of thinking, psychoanalytic theory, with all of its various revisions over the last 120 years, most closely respects the intricate contours of the human mind. It most closely observes the multiplicity of subjective experience and the over-determined nature of complex human behavior.”
Dr. Eric Cerwonka, a clinical psychologist practicing in Lafayette, agrees. He pointed to the work of Dr. Jonathan Shedler whose “The Efficacy of Psychodynamic Psychotherapy,” (American Psychologist, Feb-Mar 2010) made a splash in the media, including a review in Psychology Today and an APA press release in January this year.
Cerwonka practices psychodynamic psychotherapy because “I like to see people get better, especially patients that have not benefitted from other types of psychotherapy,” he told the Times. He remarked on Shedler’s finding that psychodynamic approaches are equal to cognitive behavioral therapies, and that the benefits last well after therapy has been completed.
These conclusions emerged from Shedler’s review of eight meta-analyses focusing on effect size as a measure of change. In one meta-analysis of 1,431 patients in psychodynamic therapy the effect size was .97 (.80 being large) for symptom improvement. This placed the psychodynamic approach on par with cognitive behavioral therapy. But perhaps even more important was that effect size increased by 50 percent on follow-up, nine months later.
Shedler noted to APA, “Pharmaceutical companies and health insurance companies have a financial incentive to promote the view that mental suffering can be reduced to lists of symptoms, and that treatment means managing those symptoms and little else. For some specific psychiatric conditions, this makes sense,” he said. “But more often, emotional suffering is woven into the fabric of the person’s life and rooted in relationship patterns, inner contradictions and emotional blind spots. This is what psychodynamic therapy is designed to address.”
Self-Awareness, Creativity & Culture
For many who provide psychoanalysis the outcomes of reduced anxiety or depression are a result of deeper changes, such as greater emotional congruence or creativity.
Dr. Randolph Harper, psychologist, psychoanalyst, past president of the New Orleans–Birmingham Psychoanalytic Center (NOBPC) and faculty instructor said to the Times, "What is most gratifying to me is to be able to do personal growth, to meet the patient where they are, in a personal, intimate way. And when they are blocked, to help them open up and be more creative."
Dr. Harper is also an instructor in psychoanalysis, teaching formally and informally since the 70s. “That sort of teaching is very exciting and very stimulating,” he said about his work at the Center. “You meet really good people who want to learn and grow.” Dr. Alvin Burstein, professor and past Chair of Psychology at Southeastern Louisiana University, clinical psychologist, and psychoanalyst, spoke with the Times about the trend away from personal introspection.
“It seems to me,” he said, “that as a society, we increasingly value external stimulation as opposed to reflection and introspection. There is a related expectation that ‘rewards’ a la Skinner should be external rather than internal. The measure of personal worth is one’s salary, and the dollar obviates the need to cultivate personal values.”
Psychoanalysts often consider art, literature, and personal or cultural symbolism to be important to self- awareness. For Dr. Newman, whose clinical emphasis is with adolescents, adults, and families, these are also significant. Her research while at Tulane explored these issues, such as, “Ego Development and Ethnic Identity Formation in Rural American Indian Adolescents,’ published in Child Development. “I have a special interest,” she said, “in how life transitions stress human adaptive capacities, call us to question who we are, and then how people transform themselves out of that distressed state into a more differentiated self.”
She was recently interviewed for Yahoo Associated Content, “Tips on Overcoming Racial Identity Issues.” She explained some of the psychological connections for overcoming racial identity issues and encouraged the exploration of “one's cultural roots and heritage and to express one's sense of identity,” through music, dance, poetry, and other artistic expressions.
Dr. Carolyn Weyand, clinical psychologist and psychoanalyst from New Orleans, and instructor at NOBPS, is also faculty member for the China American Psychoanalytic Alliance. She explained there are “four psychologies” in the Freudian tradition: Freud’s Drive Theory, Ego Psychology of Anna Freud, Self Psychology of Hans Kohut, and the school of Object Relations.
“All overlap,” Weyand noted, “in that they all assert the presence of a dynamic unconscious, and that we have powerfully formative experiences with the significant people in our lives.” While the four schools disagree on which motivations drive fantasy and behavior, she explained that “They all agree on the function of defense mechanisms; on the observations that children are psychologically different from adults in their mental functioning, changing over time.”
They also all agree “on the importance of fantasy in psychological process–that internal reality trumps external reality every time,” she said.
New Orleans–Birmingham Psychoanalytic Center
Drs. Weyand, Newman, Burstein and Harper are members of the New Orleans-Birmingham Psychoanalytic Center, a regional organization for training, education, and community outreach.
The NOBPC is the oldest psychoanalytic training center in the southeastern United States, originating as a study group in 1947. Acknowledged by the American Psychoanalytic Association in 1949, it became a fully accredited institute in 1961.
Dr. Harper, past president and faculty instructor, explained that the Center’s purpose is education but also to apply its principles to the human condition. From the bylaws, he noted one of their goals, “…to develop a community of analysts, analytically informed clinicians, scholars, artists and lay people who share an interest in psychoanalysis and the application of a psychoanalytic point of view to the human condition.”
Harper explained, “…We created only one class of membership, not different classes of membership if one is an analyst or a clinician, scholar or lay person who is not an analyst.” Center members strive for an organization that promotes participation, mutual respect, and creative involvement for its diverse membership, a group that includes psychologists, physicians, social workers, professors, and others, he noted.
This is working well, he said. Following a site visit by the American Psychoanalytic Association, the committee members said they were “very impressed” with the quality of membership and the Center’s collegiality. “They said they thought that this model represented what would be considered ‘best practices’ as a model of organization and governance,” Harper noted.
Dr. Harper himself has an unusual honor. He was the first non-physician applicant accepted to the New Orleans Institute following the 1980s lawsuits that opened training to psychologists.
Outreach and education is inherent in many of the Center’s programs. Their popular “Film and Discussion Series” is enjoyed by mental health professionals and local film buffs. The series has included reviews of films Grey Gardens (1976), Harold and Maude (1971), and Pan’s Labyrinth (2006). The psychological and cultural significant of characters and story lines are explored using psychoanalytic themes.
Another community outreach project is the FAR Fund Project, headed up by psychologist, psychoanalyst, and Board Member at Large, Dr. Kathryn Nathan. The project offers education, support and help to local mental health professional following the challenges of Katrina and other disasters. Nathan and New York colleague, Dr. Ghislaine Boulanger, recently presented at APA Division 39 (Psychoanalysis) regarding the psychodynamic perspective for those in natural disasters.
The team has helped produce a mini-documentary for wider distribution and education, that dramatically and beautifully describes the journey of New Orleans therapists during the city’s crisis. The 18-minute documentary, “Shared Trauma- Psychotherapy in New Orleans After Hurricane Katrina,” directed by Neil Alford and produced in conjunction with FAR Fund Project of New York, can be viewed at http://www.neilalford.com/portfolio/
Perspectives
Dr. Alvin Burstein, clinical psychologist, psychoanalyst, professor, author and poet, serves as Board Member at Large, on Outreach and Continuing Education Committee, Clinical Assistance Committee, and Ethics Committee at NOBPC.
He has been responsible for university training programs for clinical psychologists at University of the Michigan at Ann Arbor, the University of Illinois Neuropsychiatric Institute in Chicago, the University of Texas Health Science Center at San Antonio and the University of Tennessee, Knoxville. He has served as Chair of Psychology at Southeastern Louisiana University in Hammond.
“I got my doctoral training in the years before full time fee for service careers for clinical psychologists were common,” he told the Times. “Indeed, my psychoanalytic practice has always been combined with an academic career”. Burstein served on the APA Committee on Accreditation for many years, and also as member and chair of the APA Board of Education and Training. “So,” he explained, “I am very sensitized to the connections between the university and the professions, as well as to interrelations among the professions.”
“Under financial pressures at the state and national levels,” he said, “universities are becoming much more pressed to justify their activities on the basis of subsequent employment and there has been a simultaneous skepticism about the importance of a general education, one not focused on a particular career path.”
In the 60s and 70s, clinical and counseling psychology flourished, he explained, because the National Institute of Mental Health and the Veteran’s Administration began to provide support. “Those same years were the salad days for psychoanalysis,” he said, “when department of Psychiatry chairs were likely to be psychoanalysts and psychiatric careers focused on psychotherapy.”
“Much has changed since that time,” he said. “External support for clinical and counseling psychology has dried up. Psychiatric practice, and research, has become much more biochemically oriented. Psychoanalysis, or more generally, depth psychology, is not, as it was in the post-WW II years, an engrossing topic in the eyes of the intelligentsia.”
“From my perspective,” he said, “this last poses the most significant challenge. Psychoanalysis as a general theory of the mind and a way of understanding human nature and as professional practice depends upon it being seen as relevant by the intelligentsia, the educated classes.”
“… we need analysts and analysands,” he explained. “Analysts will only emerge from the educated classes, and analysands will only emerge in a society in which depth psychology is seen as valuable.”
“The humanities– literature, history, art, etc.– are important and are so named because their study generates an understanding of human nature. The reason that Introductory Psychology attracts great quantities of students is not because of a general aspiration to become practitioners, but because of a hopefully unquenchable interest in human nature.”
“That includes the question, Dr. Burstein said, of ‘Who and what am I?’ There is no more important question beyond that of brute survival.”
The New Orleans–Birmingham Psychoanalytic Center. Panel of New Orleans clinicians at the FAR Fund Project community presentation, September 2010, “Stetched Thin.” (L to R) Ghislaine Boulanger, PhD, Debby Poitevent, LCSW, Elsa Pool, PhD (at that time President of the NOBPC), and Kathryn Nathan, PhD, grant coordinator of the project. A community outreach effort of the NOBPC, the group discussed the personal and professional impact of shared trauma of Katrina and then the BP oil spill for therapists and their clients. (Photo courtesy of the NOBPC) Neil Alford directing the 18-minute documentary, “Shared Trauma- Psychotherapy in New Orleans After Hurricane Katrina,” at the Center, produced in conjunction with FAR Fund Project and the NOBPC. It can be viewed at http://www.neilalford.com/portfolio/ (Photo courtesy of NOBPC.)
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