It's about time psychotherapists started to ask the right questions | Letters

"Creativity and imagination, as found in active scientific fields, would suggest designing trials of psychodynamic psychotherapy versus talking to an untrained person; or therapy versus a weekly gym membership; or long versus short therapy; or therapy versus an evening education class; or therapy versus waiting list (a classic test of interventions); or therapy versus cash transfer in this age of universal basic income and financial strain."

"Prof Tallis's book review raises important questions about whether modern neuroscience has vindicated Sigmund Freud. But the debate itself reveals something troubling: we're still asking the wrong questions about mental health treatment. As someone who has spent more than 50 years applying Adlerian psychology in therapeutic settings, I find the entire discussion oddly beside the point. Whether brain imaging confirms Freudian hypotheses or psychoanalysis meets clinical trial criteria doesn't address the fundamental question: does this approach help people live more fulfilling, socially connected lives?"

Psychodynamic psychotherapy faces criticism for an apparent reluctance to pursue rigorous, comparative research despite its focus on people. Practical trial designs are readily conceivable, such as comparisons with untrained listeners, gym memberships, short versus long therapy, evening classes, waiting lists, or cash transfers. Generating trial ideas is straightforward; implementing them requires discipline, curiosity, creativity, and a solid knowledge base. The apparent disinterest in empirical exploration may result from selection effects or training practices. The core priority for any therapeutic approach should be whether it helps people live more fulfilling, socially connected lives.

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