EVALUATION DES PSYCHOTHERAPIES

La psychothérapie, c'est bien joli, mais est-ce-que ça marche?

Vous trouverez ici une archive des articles publiés sur ce site sur la question de l'évaluation de l'efficacité - c'est à dire est-ce que ça marche - et l'efficience - c'et à dire est-ce que ça marche avec un minimum de moyens - des psychothérapies. 

 

 

NOUVELLE ETUDE RANDOMISEE ACT dans la prise en charge de la douleur idiopathique de l'adolescent

Une étude randomisée ACT vs pharmacothérapie et TCC classiquea été conduite par Rickard Wicksell en Suède et publiée dans la grande revue Pain (Vol.141, 3) où elle a les honneurs d'un éditorial annonçant que l'ACT constitue une véritable avancée dans la prise en charge de la douleur chronique.

L'évènement a reçu un retentissement jusque dans les pages du grand magazine américain Time. Cette étude, qui suggère une plus grande efficacité et éfficience de l'ACT, est d'autant plus intéressante que les 16 enfants dans la condition ACT ont reçu en moyenne 10 séances de thérapie d'une heure contre 23 pour les 16 dans la condition TCC et pharmacothérpaie (amitriptyline). Une indication de plus que l'ACT (et peut-être plus généralement les stratégies d'acceptation) peut se montrer une méthode efficace dans la prise en charge des cas les plus difficiles. B. Schoendorff
Pour commenter, rendez-vous sur mon blog (BS)

(posté le 5 mars 2009)

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Copie_de_Leichsenring._03._meta_anaperso.pdf

 

 

 

 

Perso__03._Svartberg_RCT_CBT_vs_AT

 

 

 

 

MA_Psychana_Leichsen.05_.pdf

 

 

 

 

Les psychanalystes évaluent la psychanalyse et les psychothérapies analytiques

Conclusions du rapport de l’Association psychanalytique internationale(Fonagy et coll, téléchargé en 2002)

« Il n’y a pas d’étude qui permette de conclure sans équivoque que la psychanalyse soit efficace par rapport à un placebo actif ou une autre forme de traitement. Il n’y a pas de méthodes disponibles qui pourraient d’une manière incontestable indiquer l’existence d’un processus psychanalytique »

 

“La plupart des études ont des limitations majeures qui pourraient conduire ceux qui critiquent la discipline à ne pas prendre en compte leurs résultats. D’autres études ont des limitations si graves que même un évaluateur qui a de la sympathie pour la psychanalyse pourrait être enclin à ne pas tenir compte de leurs résultats”

 

“En tant que psychanalystes nous savons tous que la psychanalyse marche. Notre propre expérience de l’analyse est probablement suffisante dans la plupart des cas à nous persuader de son efficacité”.

 

TEXTE ANGLAIS INTEGRAL DE LA CONCLUSION <?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />

 

An Open Door Review of Outcome Studies in Psychoanalysis

Report prepared by the Research Committee of the IPA at the request of the President

Editor and Chair: Peter Fonagy, PhD FBA

Contributors:

Horst Kächele (Europe)

Rainer Krause (Europe)

Enrico Jones (Process Studies)

Roger Perron (Epistemology)

Peter Fonagy (Epistemology, UK & US)

Document complet disponible : Cette adresse e-mail est protégée contre les robots spammeurs. Vous devez activer le JavaScript pour la visualiser. (taper research)

Part 5 Summary and Conclusions

Limitations of the evidence

It is easy to be critical of psychoanalytic studies. There are no definitive studies which show psychoanalysis to be unequivocally effective relative to an active placebo or an alternative method of treatment. There are no methods available that might definitively indicate the existence of a psychoanalytic process. Most studies have major limitations which might lead critics of the discipline to discount their results. Others have limitations that are so grave that even a sympathetic reviewer might be inclined to discount the findings. For example, is the analyst in a position to judge the outcome of a treatment? Not only is there the issue of a self-serving bias, but also is the context of free association not totally incompatible with the systematic gathering of data concerning adjustment and the like? Amongst the most common problems are: the lack of use of standardised diagnoses, inadequate specification of the treatment procedures, lack of control for selection biases in sampling, the absence of intent to treat controls and the failure to follow up drop outs, the use of inexperienced therapists, the lack of homogeneity of the patient groups considered, heterogeneous methods of intervention and related to this the lack of a generally accepted manualised method of intervention, the lack of statistical power, the lack of random assignments to treatment groups, lack of independent assessment of outcome, lack of standardisation of measures of outcome, questionable validity of some outcome measures, poorly matched comparison groups, absence of control for the law of initial and of regression to the mean, failure to take adequate baseline measures, and related to this reliance on retrospectively collected data, inadequate detail on statistical analysis and inappropriate statistics reported, inadequate control for intercurrent treatments, and so on.

Notwithstanding the many limitations, however, the sheer number of studies available is encouraging, particularly the range of ongoing studies. This was by no means an exhaustive review. Limitations of time principally prevented us from reviewing a large number of investigations, some very well known, many with findings consistent with those which were included. The review is labelled "open" to underscore our intention to include further studies as time permits and as these are brought to our attention. The emphasis has been on some less well publicised studies and studies with challenging findings, not necessarily on investigations with the best methodology. Many of the conclusions should therefore be heavily qualified in the light of the questionable internal validity of the observations reported. In summarising these results, however, we will adopt a cautiously optimistic attitude in relation to the evidence presented. It is not that in this way we are turning a blind eye to the weakness of the evidence, but rather we wish to highlight what could be shown by these studies and which way the evidence currently points. Many of the ongoing studies are methodologically "state of the art" and this is of course encouraging from the point of view of persuading sceptics in the field. The present review, however, is intended for "internal" consumption. As psychoanalysts we all know that psychoanalysis works. Our own analytic experience is probably sufficient in most instances to persuade us of its effectiveness. The purpose of the review was to assist in making accessible studies which have systematically explored the patient groups which benefit from treatments administered by members of our organisation. In general, the findings underscore the effectiveness of our work and should encourage us to undertake further, even more rigorous, explorations of treatment outcome.

 

Dodo_bird_verdict_-_Phoenix.pdf

 

 

 

 

treatment_choice.pdf

 

 

 

 

troubles_anxieux_03.Eval_Canada_96