How effective is long-term, intensive psychoanalytic therapy? New research, conducted with mentally ill patients in Israel, suggests that it may be highly effective.
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The finding comes in the wake of debate over which treatment — psychoanalysis, medication or cognitive therapy — can better help those suffering from serious mental illness.
Psychoanalytic theory, first proposed by Sigmund Freud in the early 20th century, holds that in addition to inborn (genetic) and biological traits, other traits, which are acquired over a lifetime, shape a person’s personality and affect their chances of suffering from psychological disorders and illnesses. The relationships between a person and his or her parents in infancy, traumatic experiences and suicidal feelings all have an impact.
Psychoanalytic psychotherapy is a derivative of the psychoanalytic theory and consists of mental health treatment through talking with a therapist. It is possible to conduct the treatments over a long period of time (a number of years), regularly and intensively ( a number of meetings a week). This increases the chances that the psychotherapist and the patient will succeed in identifying the unconscious events, feelings and conflicts that are often at the base of psychological distress; bring them into consciousness; and process and deal with them.
The past 50 years have seen the development of other therapeutic approaches, particularly medical-pharmacological treatment and psychological-cognitive treatment. With the advent of these approaches, a mistaken assumption has taken root, according to which psychoanalytic psychotherapy is not effective as a treatment for serious mental illness, such as schizophrenia, manic depression and severe depression, or for anxiety and other serious personality disorders; and its results have not been proved empirically. However, in these years there has been disappointment with the inability of medicinal treatment, or short-term, symptom-based psychological treatment, to bring about deep and lasting changes among those suffering from mental illness. That has brought psychoanalytic psychotherapy back to the therapeutic arena for these groups of patients — and, along with it, the renewed need to evaluate the results empirically.
As a result, Lechol Nefesh, a nonprofit organization for the advancement of psychoanalytic psychotherapy in public mental health services, has initiated a project in which two units were established for the treatment of those suffering from mental illness using continued long-term and intensive psychoanalytic psychotherapy by a professional staff in public mental health clinics. One unit is for adults in the outpatient clinics in the Abarbanel Mental Health Center (in Bat Yam). The other is a unit for children and adolescents in the community mental health clinic in Jaffa. The patients participated in two or three psychoanalytic psychotherapy sessions every week for at least three years.
The results of the research on the adults were presented by the authors in June at the 47th international annual meeting of the Society for Psychotherapy Research, which was held in Jerusalem. The study examined how the long-term and intensive psychoanalytic psychotherapy affected the psychological state and functioning of some 20 patients who are dealing with mental illnesses, and who were referred by their therapists from the outpatient clinics and hospital wards in Abarbanel.
The patients filled out questionnaires every six months in which they evaluated their mental state, and in which they were asked about their moods, level of fears and anxieties, the quality of their relationships and functioning.
After four years of research, we found that starting with the second year of treatment, the intensity of their symptoms, such as anxiety, fear, suspicion, outbursts of rage, depression, psychosis, obsessivity and suicidal tendencies, was dramatically reduced in a statistically significant way.
In addition, some of the patients returned to study and work and lead normal lives. During the first year of the treatment, their symptoms worsened, most likely because the patients were not accustomed to such intensive conversations, which for the first time raised their awareness of their difficult psychological state. Until then they had participated only in therapy sessions which were focused and limited in duration. Using the computerized records at Abarbanel, we compared the total number of days of psychiatric hospitalization over the four years they were treated in the unit, with the total number of hospitalization days in the previous five years and found a dramatic difference: 30 days, as opposed to 1,500 days.
The story of D., who was diagnosed with chronic and treatment-resistant schizophrenic paranoia, demonstrates the findings excellently. D., who is about 40, was hospitalized in psychiatric hospitals for some 20 years without the ability to function independently. After about a year of treatment in our unit, he was released from psychiatric hospitalization and today he is able to meet his own needs independently, including taking his medications and coming to sessions at the hospital twice a week.
The findings of the research show that for patients suffering from mental illness, who are not responding to the existing treatment in the public health clinics, and who are capable of coming regularly to treatment sessions, long-term and intensive psychoanalytic psychotherapy is an effective option. It succeeds in easing the psychological symptoms, suffering, despair and lack of functioning, and strengthens the patients’ psychological capabilities.
Today, as a result of the success of the pioneering research in this project, Lechol Nefesh is working in cooperation with the nonprofit organization Elah - The Center for Coping with Loss, and with psychoanalytical societies in Israel, to establish additional treatment units. These units will provide those dealing with mental illness, who are unable to pay for private treatments, a realistic possibility of breaking out of the circle of illness and rehabilitating themselves.
Dr. Ilan Amir is a psychiatrist and psychoanalyst, and the chairman of the board of the Lechol Nefesh nonprofit organization for the advancement of psychoanalytic psychotherapy in public mental health services.
Prof. Gaby Shefler is a clinical psychologist and psychoanalyst. He is the chief psychologist at Herzog Hospital and the head of the Freud Center for Psychoanalytical Research at Hebrew University in Jerusalem.