Is Less More or is More More?
Spending a lot of time, as I do, working within the APA with general psychiatrists, I am used to an anti-analytic/anti-psychodynamic bias from some quarters. Like recently at a meeting when a full professor of psychiatry said he didn’t understand the construct of personality, so he didn’t believe in personality disorders. Or the time a few years ago that an award winning schizophrenia researcher said in his award presentation that although there were good data that the quality of the mother-child relationship played a role in the etiology of schizophrenia, he had left it off the slide because it wasn’t politically correct. This “my mind is made up so don’t confuse me with facts” perspective often includes a resolute conviction that CBT [developed by Riggs graduate, Aaron Beck] is demonstrably superior to psychodynamic therapy.
So I was quite interested to notice a paper by Ellen Driessen and an editorial on it by Michael Thase in the September issue of the American Journal of Psychiatry. Driessen’s high quality head to head comparison of short term [16 session] CBT to psychodynamic therapy for Major Depressive Disorder [40% of 341 patients were severe cases] examined whether one treatment could be found to be inferior to the other. The results showed no difference in efficacy. No surprise to me, but I found myself wondering whether this paper and Michael Thase’s editorial would have any impact on the field’s reflexive bias against psychodynamic therapy. Time will tell, but in the meantime, psychodynamic clinicians should know about this study and other similar ones [see my paper “Concepts psychiatry needs from psychoanalysis”] and spread the word!
One more interesting finding from Driessen’s paper--Only 23% of patients responded to either therapy—apparently because the “dose,” at 16 sessions, was so low. Though the world of managed care invites us to believe that less is more, or at least enough, it turns out that more is more after all!