Reaction Formation in New York City

Beyond Boundaries column, The Psychologist, December 2011

Jonathan Shedler is recounting an anecdote. “So when the patient says ‘I’m frustrated’ you say ‘tell me more about that,’ and then you shut up!’ We’ve just bustled in from a crisp Manhattan evening and the story gets an appreciative laugh. City University of New York is home to one of the most psychodynamically-oriented clinical psychology courses in the US and Shedler is here to fire up the audience. He’s presenting his research on the effectiveness of psychodynamic therapy but the underlying message heralds a fight back. His data is mixed with anecdotes of supervising naïve cognitive therapy trainees and disdain for ‘manualised CBT’ (there is, it seems, no other sort) and the audience are firmly behind him.

New York City was famous for its Freudian émigrés and became a leading centre for psychoanalysis during the 20th century but the rising influence of drug treatment began to erode both the popularity of the couch and the therapeutic eminence of the Big Apple as a result. Moreover, the development of shorter therapies validated using the techniques of academic research has pressured both psychodynamic therapy, the younger relation of psychoanalysis, and its community of practice who traditionally eschewed the systematic collection of data for the introspective gaze.

Psychoanalysis never gripped the UK’s psychology and psychiatry departments as it did in the United States and so the division between clinicians and researchers has traditionally been much less acute. Meanwhile, in the New York lecture hall, this divide is reflected in the post-presentation discussion, driven by the split rhetoric of ‘practitioners’ and ‘researchers’ and how the latter don’t understand the former, despite the fact that we’re here to discuss research evidence. But most striking is the sense of revolt against the perceived oppression towards the psychodynamic approach, which, in the USA, is additionally fuelled by the financial motivations of insurance companies who want the most evidence-based bang for their buck.

The audience speak out. Person after person stands up, vociferously thanking the speaker, decrying the lack of respect afforded to psychodynamic treatment and promising to spread the word about this new evidence to colleagues, managers and patients. But beyond the fight back, there is a distinct culture change in the air. In an area famously divided by internecine feuding and bitter theoretical differences there is unity. And perhaps more significantly, the tools of clinical trials, systematic data collection and evidence based practice are now being taken up as essential allies. New York City may yet be home to psychodynamic revolutionaries once more.