THE ROUGH GUIDE TO PSYCHOLOGYworked through and resolved. Traditionally, this exercise was performed
with the analysand prostrate on a couch to aid the flow of ideas – hence
the mythical symbolism of the psychoanalyst and his or her couch.
Psychoanalysis has inspired countless other schools of psychodynamic
therapy, from Jungian variants (named after Freud’s student Carl Jung) to
the more contemporary interpersonal therapy. A technique pioneered by
Jung was word association. Similar to free association, this involves the
analyst saying a word to which the analysand must immediately offer the
first thoughts that come to mind. One of the first interpersonal thera-
pists was the US psychoanalyst Harry Stack Sullivan. His approach was
based on the idea that psychological problems often arise from a person
having dysfunctional interpersonal relations. The interpersonal thera-
pist typically uses their own interactions with the analysand to identify
the problematic ways in which the latter relates to others.
A theme common to all psychodynamic therapies is the idea of trans-
ference and counter-transference. Transference is when the dynamics
What works?
Psychotherapy can be highly effective. Over thirty years of research
has shown that about eighty percent of clients are in a better state
following therapy than if they hadn’t had any. For forty percent of
clients, therapeutic progress occurs in a sudden burst between one
particular session and another. Unfortunately, there is also evidence
that around five to ten percent of clients are worse off for having
therapy (see p.348). Partly because of the risk of harm, advocates
of the empirically-supported therapies movement believe there
is an onus on the different therapeutic schools to conduct research
to demonstrate their effectiveness, and that those lacking evidence
should be avoided.
Which forms of therapy work better and indeed which work at all is
a political hot potato in the world of psychology and psychotherapy.
To be told that a therapeutic approach that you have spent years
delivering is substandard or ineffective must be hard to swallow,
although continuing to practise a harmful therapy is, surely, insupport-
able. Perhaps because of this, the field of research into psychotherapy
effectiveness is plagued by what’s known as “allegiance effects” – the
tendency for psychologists of a particular therapeutic orientation to
find supporting evidence for their own particular brand of psycho-
therapy.
Another criticism is that there is a world of difference between
the “manualized” therapy used in research, which is conducted with
carefully selected clients, and the messiness of therapy in the real