Psychodynamics - an archaic way of thinking?

[buttercup8d]

I realize this may start some controversy but I had this thought while interviewing with a few psychodynamic-oriented clinical PhD programs last year and wanted to get others' thoughts. To be fair, I am slightly biased because I'm a research-focused applicant (I was previously interested in psychodynamic theories before I became involved in more science-based and neuro-research while working after college).

From my experience, it seems like psychodynamically trained professors have a narrow view of what "real" psychotherapy is (i.e. psychodynamic only) and believe that clinical training needs to be gained during graduate school. In contrast, the research-focused professors seem to think that critical thinking skills are rooted in good researchers, which translates to good clinicians. It also seems like psychodynamically trained clinicians are very focused on pathologizing their clients and even validating the pathology in their research topics (which doesn't necessarily make the pathology untrue but seems like an illogical approach to me and limits the discussion of evidence-based research). I have found research-focused faculty to be more open-minded and stimulating when it comes to discussions.

With neuroscience becoming the forefront and computerized skills (Matlab, python, etc.) becoming more valued in the workforce, is the psychodynamic tradition dying? Do you think it is an archaic way of approaching the study of the human mind?

If we think of how we moved from the history of psychiatrists who used to lock up sane patients in mental hospitals and use (what is now considered) insane techniques to relieve mental ailments, can I ask what the difference between that is and the validation and pathologizing of techniques used by psychodynamically-trained clinicians today?

Edited October 28, 2016 by buttercup8d
typo

[eternallyephemeral]

I don't really know what to say other than that I completely agree with you.

 

As far as your own career/school decisions, I think you've made that clear. As far as what this means for the field, I think its a bit more muddy. We don't need neuroscience to know psychodynamics isn't a falsifiable theory. We won't need "computerized skills" (we've had good statistics for a lot longer) to know what is meaningful is not always what is statistically significant, among other things. And yet through all this, some people still believe in pseudoscientific theories. I don't think any "new approaches" will change what people believe in, because we don't believe in things because they're logically sound or empirically supported. It's just a belief.

 

[spunky]

 

Your post kind of reminds me of a famous quote of physicist Max Planck related to the progress of scientific knowledge:

“A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die, and a new generation grows up that is familiar with it.”  

For the case of psychology I find this to be particularly tricky because, like Thomas Leahy pointed out in his classic book A History of Psychology, psychology (like most social sciences) advances horizontally as opposed to vertically. His argument kind of goes like this: in physics, math, chemistry, etc. you start with a theory, say the motion of objects as described by Aristotle. At some point what Aristotle had to offer was no longer enough (and many things were wrong) so whatever was useful of his theories remained and along came Newton with classic mechanics. Then Newton’s laws were not enough, physics kept what it needed from it and then Einstein and relativity comes along… and the processes continues on and on. Think about what happened in psychology. Leaving aside Wundt and the psychophysics people, say we start with the dominant theory of psychoanalysis. Then at some point there comes a certain Skinner and Watson and whatnot, tears it all down and starts with his own separate theory, behaviourism. Then came Rogers and the humanist bunch… and the cognitive-behavioural people… etc. etc. Not all the theories are completely mutually-exclusive but they are sufficiently different from one another that any one person can, at one point or another, identify with a particular school and keep on building it further. So whereas you can’t really apply to a Physics Dept and say you exclusively ascribe to the Aristotelian laws of physics because there really is just one big tower of physics, you can definitely apply to any of the many condos of psychology and keep on developing their theories and methods further.

On 10/27/2016 at 5:11 PM, buttercup8d said:

With neuroscience becoming the forefront and computerized skills (Matlab, python, etc.) becoming more valued in the workforce, is the psychodynamic tradition dying? Do you think it is an archaic way of approaching the study of the human mind?

 

Will the psychodynamic approach eventually die out? I guess so. But it will probably happen at such a slow rate that we will not see it within our lifetimes. I do hope that the biological model of behaviour and brain function eventually triumphs over all others, but my own experience helping out with research in these area has let me down a little bit. There is just SO much that needs to be discovered and cleaned up before we can even have a solid account of the neuroscience of behaviour that, again, I’m not sure if we’ll ever see direct applications of this in our lifetimes in the form of a well thought-out body of knowledge capable of overarching and encompassing predictions.

I do think it is a somewhat archaic way of thinking but I also don’t think the way psychodynamic theories are taught and applied today have a lot  of the original ways in which Freud thought about behaviour. I mean, they do have changed in the light of evidence and I’d like to believe that most clinicians, regardless of their theoretical bent, keep up with their research and re willing to change their practice depending on the evidence they see published.

Not so sure what programming ability and computer skills have to do with actual clinical practice in this setting though. I mean, I guess it’s cool if therapists also know how to program but as far as whether this type of training is relevant to their therapeutic experience… well…

Edited October 29, 2016 by spunky

[St0chastic]

That's an interesting way of putting it spunky! Horizontal vs. vertical advancement. 

I'm biased towards the modern biopsychosocial model and don't have much regard for psychodynamics. That said, I think it's important not to view a biological/neuroscientific approach as superseding behavioral or social approaches. There's always a danger in science of framing phenomena reductively. Taken to an extreme, this leads to views like this:

Nobel laureate P.W. Anderson wrote an essay about the dangers of reductionism: https://www.sccs.swarthmore.edu/users/08/bblonder/phys120/docs/anderson.pdf

In his words, " At each stage, entirely new laws, concepts and generalizations are necessary, requiring inspiration and creativity to just as great a degree as in the previous one. Psychology is not applied biology nor is biology applied chemistry. "

I think you could perhaps extend this to say that social psychology or clinical psychology are not just applied cognitive neuroscience. So while advances in neuroscience are yielding important insights about the operation of the human brain and mind, behavioral and intentional level approaches are not necessarily supplanted by lower-level explanations.

I don't think you can explain high-level cognition purely in terms of neural firing patterns. At some point you need to invoke emergent properties (emotions, thoughts, memories, language, etc.) that are the product of complex interactions or arrangements of lower-level phenomena. In fact, the brain itself is structured hierarchically, with feedback and feedforward pathways that give rise to higher level percepts from more basic sensory patterns (e.g., the work of Hubel and Wiesel on visual processing, the dorsal and ventral streams). Each level of abstraction has its own set of constituent units and rules governing how they are processed. Language is similarly hierarchically organized (phones --> phonemes --> morphemes --> words --> semantics --> syntax --> pragmatics --> etc). 

Edited October 29, 2016 by St0chastic

[eternallyephemeral]

6 hours ago, St0chastic said:

I don't think you can explain high-level cognition purely in terms of neural firing patterns. At some point you need to invoke emergent properties (emotions, thoughts, memories, language, etc.) that are the product of complex interactions or arrangements of lower-level phenomena. In fact, the brain itself is structured hierarchically, with feedback and feedforward pathways that give rise to higher level percepts from more basic sensory patterns (e.g., the work of Hubel and Wiesel on visual processing, the dorsal and ventral streams). Each level of abstraction has its own set of constituent units and rules governing how they are processed. Language is similarly hierarchically organized (phones --> phonemes --> morphemes --> words --> semantics --> syntax --> pragmatics --> etc). 

I completely agree. Emergence is a fascinating, extremely complex phenomenon. As well, it can be damaging to hold a purely biological view of psychology in some cases, for example with the disease model of mental illness. So reductionism is not the answer to this issue, as both psychoanalysis and neuroscience may (and do!) have statistical issues and methodological issues. Psychoanalysis can be wrong without the biological model needing to be right (or completely all-encompassing).

[buttercup8d]

SO interesting! Never thought of the topic that way. I'll definitely check out the paper. Thanks for all of your responses! It's a good reminder to keep perspective on the value and contribution of each field 

[dancedementia]

I'm going to offer a different perspective here. I work in a private practice office with a group of psychodynamically-trained psychologists, and damn - they are good at what they do.

It also seems like psychodynamically trained clinicians are very focused on pathologizing their clients and even validating the pathology in their research topics.

I can't speak to how the research sphere is in psychoanalytic/psychodynamic circles, but in practice that couldn't be further from the truth. In fact, a lot of psychodynamically-trained clinicians dislike CBT/behavioral-trained clinicians because they are always "searching for a solution". Simply put, they state that theories like CBT focus on altering cognitions/behaviors, on fixing symptoms, and on changing things... whereas psychodynamics focuses more on understanding the underlying person. Yes, along the way psychodynamics can offer solutions, but the reason for utilizing a psychoanalytic approach usually stems from a more "philosophical" desire. Instead of, "How can I reduce my anxiety symptoms?", the psychodynamic approach addresses, "I'm feeling anxious. Why?"

I don't think either approach is better than the other, but as someone who does highly respect the historical underpinnings of psychology, I think the psychodynamic/psychoanalytic approach is useful for certian clients. In my practice's case, most of our clients are middle/upper class, white adults who are wrestling with "higher order" problems - things like anxiety, adjustment disorders, personality disorders, etc. For people who are coming in saying, "I feel uncomfortable with my life, but I can't really pin down why," the psychodynamic approach is perfect for them. It allows them to explore, to address past memories and emotions, to view how that has shaped their lives. It allows them to - in the previous example - figure out the underlying cause of their anxiety, to sit with that discomfort to gain further insight, instead of focusing primarily on techniques to reduce it.

For people who are coming in with debilitating depression, alcohol abuse, and uncontrollable fits of anger.... yeah, CBT would probably be better. These are people who do need to work on their cognitions and behaviors. These are not the people who need to delve into the philosophical, unconscious points of their lives. They need fixes.

So really, different theories for different patients.

Now research, I have no idea, lol......

Edited December 27, 2016 by dancedementia

[Jay's Brain]

Just to lend an observation and to continue where @dancedementia left off, I think psychodynamic theories relate to research in how we discuss the difference between medical vs. psychotherapeutic diagnoses of human behaviour/disorders. Regardless of your penchant for a particular model or "wave" of theories of human cognition and behaviour, the scientifically rigourous ways of these pursuits can be understood by the common factors that bind all forms of psychology together. In the case of psychotherapy, what is it about a contextual viewpoint that may or may not trump a medical model? You can speak of the way psychodynamic theorists explores the person, the relationship between the client/patient and the clinician, and the factors that separate the two. So when you get to talking about abstract theories, it becomes much more nuanced and murkier about what is right and wrong. Are we looking for a way to diagnose and categorize individuals? If so, perhaps a biological/neuroscience basis is necessary. If not, there are other ways, and psychodynamic theories, the modern view (and not Freudian), can be just as useful. When we moved from theories to application, sometimes the old and new ways of thinking balance each other out. 

Note: personal views of a neuroscience student studying clinical psychology  

 

[buttercup8d]

16 hours ago, dancedementia said:

I don't think either approach is better than the other, but as someone who does highly respect the historical underpinnings of psychology, I think the psychodynamic/psychoanalytic approach is useful for certian clients. In my practice's case, most of our clients are middle/upper class, white adults who are wrestling with "higher order" problems - things like anxiety, adjustment disorders, personality disorders, etc. For people who are coming in saying, "I feel uncomfortable with my life, but I can't really pin down why," the psychodynamic approach is perfect for them. It allows them to explore, to address past memories and emotions, to view how that has shaped their lives. It allows them to - in the previous example - figure out the underlying cause of their anxiety, to sit with that discomfort to gain further insight, instead of focusing primarily on techniques to reduce it.

For people who are coming in with debilitating depression, alcohol abuse, and uncontrollable fits of anger.... yeah, CBT would probably be better. These are people who do need to work on their cognitions and behaviors. These are not the people who need to delve into the philosophical, unconscious points of their lives. They need fixes.

Thanks, I'm curious. Can you clarify what you mean by "higher order" problems? Is there an underlying assumption in the tradition that individuals (i.e. low SES, disenfranchised minorities) who struggle with basic needs/immediate problems in their lives are not capable of philosophical thinking?

[dancedementia]

23 hours ago, buttercup8d said:

Thanks, I'm curious. Can you clarify what you mean by "higher order" problems? Is there an underlying assumption in the tradition that individuals (i.e. low SES, disenfranchised minorities) who struggle with basic needs/immediate problems in their lives are not capable of philosophical thinking?

No, not at all. Think of it as a Maslow's hierarchy problem - if I'm an alcohol addicted, lower SES, unemployed single mother, my first line of needs would probably be to get my symptoms under control so that I can hold down a job, can put food on the table, and can be a nurturing mother. Of course everyone - regardless of SES or background - deserves and has capability to deeply explore ideas of self-actualization, legacy, etc. But for those individuals you mentioned, that is not their immediate need (and most likely not the reason they are seeking and/or referred to therapy). They would be much better served by approaches such as CBT/DBT or systems-based theory rather than the typical psychoanalytic approach.

Another tidbit that might help you understand is that a lot of psychodynamic-trained therapists hate diagnosing patients. My clinicians in particular dislike assigning ICD codes from the DSM because they don't like labelling individuals with a "disorder" that needs to be "fixed". In that way, psychoanalytics is really quite the opposite of the medical model; I would also argue that it harmonizes quite well with the newer, popular "holistic" models that focus on 1) treating the whole person and not just the disorder, 2) a wellness model of mental health.

Edited December 28, 2016 by dancedementia