Does psychoanalysis have a valuable place in modern mental health services? No

Psychoanalysis is of historical value only and, at best, has no place in modern mental health services. Not only is there no evidence base for the treatment, but there is no empirical grounding for the key constructs underpinning it. In addition, we suggest that the theory and practice of psychoanalysis are inimical to modern mental health services and so are, at worst, counterproductive and perverse in that context.

We do not doubt the historical significance of psychoanalysis, psychoanalytic theory, and its founding father, Sigmund Freud. The theoretical concept of the unconscious provided the foundations of current cognitive sciences. Modern evidence based and empirically grounded psychological therapies,1 including cognitive behaviour therapy, were initially developed by clinicians who were trained in psychoanalytic approaches but found the approach wanting.2 Even the small number of evidence based psychodynamic therapies are very far removed from the basic dogmas of psychoanalysis and show little or no evidence of their provenance; neither the analyst’s couch nor free association is in evidence. As regards evidence, they are often ineffective, …