Le temps de la psychothérapie des psychotiques est-il révolu ?

Objectives

During the sixties, the important development of psychotherapies gave rise to great expectations for the treatment of psychoses. Are those days over or are there still publications that support the place and effectiveness of psychoanalytically-inspired psychotherapies?

Material and methods

Bibliographical research was carried out focusing on the 15-year period from 2005 to 2020 using Pubmed, Scopus, Psycart, and Cairninfo, and with the keywords: psychodynamics and psychosis or schizophrenia, psychoanalysis and schizophrenia or psychosis, Articles dealing only with theoretical issues related to psychoses or schizophrenia were excluded.

Results

By excluding meta-analyses, all of which have moreover shown at best a discrete effectiveness of cognitive-behavioral therapies, we retained 63 articles, 26 of which with the word psychoanalysis. This observation alone is indicative of the lack of publications addressing these themes with fewer than 5 publications per year at the international level! As far as effectiveness studies are concerned, the results are even rarer: We found 11 studies among the 63 selected articles. Only two of these studies used a control group and standardized scales. The need for standardization has resulted in the creation of a simplified form of psychotherapy, “Supportive Psychoanalytic Psychotherapy”.

Conclusion

The pressure to demonstrate efficiency rather than effectiveness has prevailed over psychoanalytic psychotherapies in the treatment of psychoses. However, that is probably not the only reason. The complexity of the theory of psychoses and the lack of synthesis works render its transmission difficult. If we do not want all the theoretical advances that have been made to be lost, we must ensure that the teaching of these theories be more specific and synthetic. Similarly, we need to launch longer-term studies so that a sufficient duration of treatment allows for a real evaluation of the efficiency of these therapies.