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

BMJ 2012; 344 doi: (Published 20 February 2012) Cite this as: BMJ 2012;344:e1188
  1. Paul Salkovskis, professor of clinical psychology and applied science1,
  2. Lewis Wolpert, emeritus professor of biology as applied to medicine2
  1. 1Department of Psychology, University of Bath, Bath BA2 7AY, UK
  2. 2Department of Cell and Developmental Biology, University College London, London, UK
  1. P.M.Salkovskis{at}

Peter Fonagy and Alessandra Lemma say that the psychoanalytical approach can provide a useful and unique contribution to modern healthcare (doi:10.1136/bmj.e1211), but Paul Salkovskis and Lewis Wolpert argue that it may have no place there at all

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, …

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