Click Here to Read: Physician Heal Thyself Part I by Frederick Crews in the New Review of Books September 29. , 2011.
Click Here to Read: Physician Heal Thyself Part II by Frederick Crews in the New Review of Books October 13, 2011.
Crews’ vs. Freud’s need for Certainty
By William J. Massicotte and Harold J. Bursztajn
On Crews’ Physician, Heal Thyself: the scientific studies showing clinical effectiveness for the psychodynamic psychotherapies have detached the issue from Freud the person.[1]. Within Crew’s piece Freud’s discovery of countertransference attitudes are implicitly mentioned when discussing Freud’s own occasional unhelpful attitudes towards patients. One condition required for effectiveness is the management of countertransference, including both consciously rationalized and unconsciously motivated desires for diagnostic and therapeutic certainty, which shadow much of clinical and medical practice.[2] In psychoanalytically informed therapy, when countertransference is not recognized and managed this becomes one predictor of therapeutic failure.[3]
Freud himself quite often changed his mind both about theory, the causes if his patients’ suffering, and how best to be of help. We continue to learn with our patients’ help. Crews’rehash of his own clever, nowcocaine focused, ad hominemcertainties as to Freud’s cocaine use being responsible for the limitations in Freud’s theories, arefantasies reminiscent of Newton’s religious and alchemistic views being held responsible for the limitations of Newtonian mechanics on the quantum level. By way of full disclosure neither of the authors below is a cocaine or opiate user.
William J. Massicotte Ph.D., FIPA
Co-Chair, Public Information Committee, International Psychoanalytical
Association
Montreal West, CANADA
Harold J. Bursztajn, M.D.
Associate Clinical Professor of Psychiatry
Harvard Medical School
Cambridge, Ma USA
[1]E.g., Jonathan Shedler’sThe Efficacy of Psychodynamic Psychotherapy (American Psychologist, vol 65, p 98). The letter signed by 54 credible scientific researchers (The New Scientist, 27 October 2010) all of whom have produced evidence. The JAMA piece by Leichsenring and Rabung, Effectiveness of Long-term Psychodynamic Psychotherapy: A Meta-analysis, JAMA. 2008;300(13):1551-1565.
[2]Bursztajn HJ, Feinbloom RI, Hamm RM, Brodsky A. Medical Choices, Medical Chances: How Patients, Families, and Physicians Can Cope With Uncertainty. New York: Delacorte, 1981; New York: Routledge, Chapman & Hall, 1999.
[3]Therapeutic outcome success is commonly defined as an effect size on a scale out of 2. For psychodynamic therapies, the effect size is between .69 and 1.46 depending on the initial condition; compared to the common antidepressants, between .17 and .31. (Shedler).
