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The aim of Therapy's Delusions is to show that psychodynamic psychotherapy is unscientific, wasteful, ineffective and dangerous. The term "psychodynamic psychotherapy" is defined as "any talk therapy that claims to have the power to cure mental illness or derives its status from that claim or from its relation to the theory of the mind promoted by Freud" (p.13). In the introduction, the authors clearly describe how they intend to present their case, and promise that they will show that there is no scientifically credible evidence for repression of memories, and that there is no evidence that psychotherapists have any means of breaking through the repression barrier. They aim to show that both patient and therapist are profoundly influenced by cultural factors, and by each other's beliefs, and also that talk therapy in general can make little claim to cure mental illness.
The book is written in a clear and readable style without jargon or unnecessarily technical language. However, its overall structure and plan of campaign are unclear, and the arguments are presented as conclusions, with little evidence to back them up. The bias of the authors against psychodynamic psychotherapy is so obvious that it detracts from the credence of their statements. For example, a published case study of a successful outcome in psychoanalysis is discussed as though it were a myth, saying that the patient was "supposedly able to walk, unaided" (p. 74). On the other hand, a case study of an unsuccessful outcome in psychoanalysis is discussed sympathetically without doubting any of its claims (pp. 94-99). There does not appear to be any scientific reason for the difference in treatment of the case studies.
To show that there is no evidence for the validity and efficacy of psychodynamic theories is not enough. Discrediting a theory requires either the production of evidence that contradicts the theory, or the demonstration that an alternative theory is "better" in some way. There are numerous case studies that appear to support psychodynamic psychotherapy; if these are to be shown to be invalid, then they must be examined carefully and objectively, and other explanations for the apparent success of the therapy must be proposed and backed up with other evidence. To reject psychodynamic explanations on the grounds that they are "bizarre" and "not compelling", as in the case of the interpretations of the analyst Harold Boris (pp. 168-170), is no more scientific than it would be to support them on the grounds that the patient apparently believes in them.
The principal alternative explanation for reported successes in psychoanalysis is that patients believe their therapy is successful because they are influenced by their therapists and the culture supporting therapy, and that therapists in turn build up their beliefs because of the patients' confidence in their interpretations. When this loop of positive feedback has completed many iterations, the therapist's professional reputation is assured. Although the power of the therapist to influence the patient is generally well known, the effect of the patient's beliefs feeding back to the therapist is less appreciated, and the chapters on "Why patients believe" and "Why therapists believe" are perhaps the most important parts of the book. Once again, however, it would have been helpful if the authors had drawn more evidence from the vast supply of social psychology experiments that show how easily people can be influenced without even being aware of it.
A book which aims to discredit a form of therapy many people hope will solve their troubles would be incomplete, even irresponsible, not to suggest an alternative. The authors' favoured alternative is a biomedical approach to reduce or remove the most crippling symptoms, together with cognitive behavioural therapy to help the patient cope with the day-to-day aspects of living. These treatments do indeed have much more empirical support than does psychodynamic therapy. However, such treatments usually offer management of symptoms, not a cure. Psychodynamic therapy offers, in contrast, the promise of gaining insight and understanding of the origin of symptoms and a permanent release from them with no further effort for maintenance. It is not hard to see why, despite the plethora of books and papers debunking Freud's theories, patients are still attracted to psychoanalysis. The authors recognise this, and offer the hope that when symptoms become more controllable, patients will have less need to develop dramatic narratives to provide an emotional cause for their illness. Perhaps they are right. Until then, however, no attempt to discredit psychodynamic therapy, including this book, will have the power to stem the demand for it from patients.
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