Psychodynamic Treatment for Panic Disorder

The Bornstein, 2005 discussed the phenomenon of psychoanalytic concepts being taken from the original discipline and transformed into non-psychoanalytic concepts. Throughout, the author makes the argument that those within the psychoanalytic tradition need to not only emphasize these instances of concepts being co-opted, but also to teach psychoanalysis in a way that does not bias students and the public against it. Although this is a good way of framing the issue, I wonder how feasible it is to continue doing this into the next 40-60 years. With new waves of therapy and mechanistic technology emerging, I wonder how motivated clinicians and researchers will be to continue fighting for psychoanalytic therapy. Throughout this article, I kept wondering at what point the argument chalks up to sunken cost fallacy. In general, it is hard to let go of a theory that a researcher has thought about a lot and has worked on for years. This is not to say that psychoanalytic concepts are not useful or important. As the author points out, many of the concepts in cognitive psychology would not exist if not for the work of Freud and Wundt. However, I think that unless psychoanalytic researchers commit to the empirical research that Bornstein (2005) discussed, they will inevitably fade out of consciousness. I also wonder, in general, in this world of academic and economic incentive to always be pushing to be new and interesting, is truth enough? For example, if psychoanalytic concepts are truly what lies beneath everything in psychology, does this necessarily matter in this day and age? As the video last week mentioned, a good theory is one that is interesting and generates new ideas and is talked about. It almost seems that is psychoanalytic researchers would have started to apply their concepts to other fields (cognition, neuroimaging) sooner, they would have continued to be in the media in a refined sort of way. I also thought that this analysis overall was a very psychoanalytic take on the situation. For example, the author said that people often unconsciously co-opt ideas. I thought this was sort of ironic. Lastly, I have the opinion that the point of a theory is to take old concepts, refine them, and apply them in new and practical ways. This feels like what many disciplines have done that psychoanalysis itself has failed to do. 

The Busch et al. (2009) article seems to do exactly what Bornstein (2005) requests and does it at a high level. Throughout the article, I found myself thinking of critiques that were then later addressed. The study examines a manualized psychoanalytic theory for panic disorder against a control, and finds improvement for the clients on a variety of measures. A few weeks ago, we read a piece critiquing RCTs in their focus on manualized steps which is inherently opposed to a client-centered therapeutic process.  However, this piece seems to serve as a counterexample, for therapists were able to explore individual's dynamics, but did so in a systematic way. Overall, I think this step of operationalizing their variables and explicating what specific dynamics psychoanalysis predicts in a certain disorder is crucial. I could also see this being an avenue for psychoanalysis to be integrated with a lot of other therapies. For example, if there is an element that psychoanalysis emphasizes that is not the same as other therapies, examinations of these active ingredients could be done to determine which theory is more advantageous to use for a certain disorder. This outlining of dynamics present in a disorder could also be a useful way to teach people about psychoanalytic concepts in a practical way. Often, psychoanalysis is posed as something that used to be helpful and previously helped our development as a field, but is impractical to use now. However, manualized treatments could serve as an opposing viewpoint to that. In general, I am not opposed to psychoanalytic ideas, and appreciate the rigorous testing that studies like these do for the concepts that psychoanalytic theory provides. 

The Milrod (1995) case analysis was interesting to read, for although I have learned some about psychological principles through a psychodynamic lens, I do not think I have ever seen an actual case conceptualized through ideas such as the ego, attachments, and repression. This case analysis is supposed to explicate how psychoanalysis is very helpful for patients. However, I feel like I do not quite understand the author's argument as to why psychoanalysis was effective for this patient. It seemed like insight was a large part of the therapy sessions and allowed Mr. L to see aspects of his like or certain behaviors he did more clearly. Additionally, it seems that Dr. Milrod does not seem to conceptualize Mr. L's behaviors as broadly as other theories do such as "avoidance" or "sexual trauma". Instead, it seems to be focused on moment to moment issues that arise in session. In this way, I wonder how much psychoanalysis can predict. For example, if Mr. L's case vignette was given to a psychoanalytic therapist without actually doing the therapy, I wonder if they could predict behaviors. In general, the applicability of a theory is important to me as it relates to generalizable cases. Therefore, it seems that this article was a way to illustrate an example of psychoanalysis for panic disorder, but did not seem to pull out specific aspects of the theory that would be helpful for other patients. In this way, I can see psychoanalysis being very hard to teach as it relies on much clinical judgement and expertise. 

The McKay et al. (2007) article seems to ask if we care about mechanisms and understanding why something works. This debate makes me think of EMDR, and the concept of knowing something works vs. needing the science behind it. I think the difference here is being able to convince new psychotherapists or existing clinicians to use something just because it works. Personally, if I can be given a reason why something works, I feel like I could better explain this to my client if they had questions about it. Therefore, even if the two theories worked in a similar manner, I fear I would pick the one that makes sense to me and has a clearer explanation. This may be a bias on my part, for a theory does not necessarily have to be clear to work. However, explaining theory to clients may be an area where this debate is particularly relevant. However, I understand Dr. Milrod's replies that just because one therapy works does not require us to stop researching all others. The issue here seems to be understanding which therapies work best for certain clients and circumstances instead of necessarily disregarding either. However, empirical research with comparison on specific variables must be done.  

Grade: 24/25