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OF mental health care and mentally ill

Evaluation of psychoanalysis

Psychoanalysis is best suited to the treatment of neuroses. Freud himself regarded it as unsuitable for psychotic patients and as requiring a reasonable level of education, an assessment confirmed by Luborsky and Spence (1978). Later writers such as Boker (1992) have argued that these criteria are not essential. Psychoanalysis is often described as most suitable for patients who display the YAVIS syndrome, that is to say they are young, attractive, verbal, intelligent and successful. On the negative side, psychoanalysis is a lengthy process, involving five one-hour sessions per week for a minimum of two years.

At times during this process the patient will be extremely vulnerable psychologically. It can also be a costly process, partly because it is so lengthy and partly because it is not generally available on the National Health Service. Another problem is that both psychoanalysis and the Freudian theory derived from it are widely regarded as lacking in scientific support (e.g. Grunbaum 1984). Many of the ideas cannot be subjected to rigorous testing as it is not possible to derive explicit predictions about behaviour from them. After the event, on the other hand, it is possible to explain virtually any outcome in psychodynamic terms.

The credibility of Freud’s case studies has also been questioned (Masson 1988) because in many cases the facts appear to have been distorted. Anna O., for example, one of Freud’s best known cases, was in fact far from cured by her analysis and suffered many relapses. In other cases, Freud would appear to have shown considerable bias in his dealings with patients. For example, his claims that patients’ reports of sexual abuse by relatives were purely fantasies have been questioned. Both therapy and reporting can therefore be regarded as potentially manipulative.

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