“One of his delusions was that all the doctors treating him were fake doctors. After about two years of therapy, this delusion went away. He later considered that ‘you cannot be a doctor without listening to your patient. If you don’t listen to your patient and try to understand him, you’re a fake doctor.” There was an emotional sense behind the delusions and I think this is what we try to do in psychotherapy.”
Ilan Amir MD
Tel Aviv
Episode Description:
Harvey Schwartz welcomes Dr. Ilan Amir, who is a psychiatrist and a training and supervising psychoanalyst at the Israeli Psychoanalytic Society and is a lecturer at the Tel Aviv University Psychotherapy Program. Dr. Amir is a founding member and current chair of Lechol Nefesh — which means “for every soul”. This is a program dedicated to the use of psychoanalytic therapies for chronically mentally ill patients in public health settings. This program is equally devoted to the empirical study of the clinical outcome of these therapies.
As you will hear in today’s interview, Dr. Amir reveals himself to be an analyst quite capable both of deep immersion in the personal intimacy of long-term clinical treatment of patients, as well as someone who values the careful study of the utility of those treatments.
Key Takeaways:
[3:05] The concept of psycho-dialysis explained by Dr. Ilan Amir through a clinical example.
[14:33] Lechol Nefesh and Dr. Ilan Amir’s work.
[18:27] Patients needed to commit to come to sessions three times a week for three years.
[18:45] Outcome research.
[22:29] All patients stopped their hospitalization.
[23:31] Realizing the need for intensive and long-term psychotherapy.
[24:12] Psychoanalysts’ ability to listen.
[25:20] Having faith in therapy.
[26:33] The importance of the connection with patients and the understanding of the
complexities of each case.
[27:18] Why psycho-dialysis?
Recommended Readings
Balint, M. (1979). The Basic Fault. 1-196. London/New York: Tavistock Publications
Phases of patient-therapist interaction in the therapy of chronic Schizophrenia. In Searles, H. Collected Papers on Schizophrenia and Related Subjects. New York: International Universities Press 1965
Treatment of Psychotic States. In Stolorow RD, Brandchaft B, Atwood AE. Psychoanalytic Treatment: An Intersubjective Approach. The Analytic Press Hillsdale NJ 1987
Winnicott, D.W. Fear of Breakdown. Int. R. Psycho-Anal. (1974). 1:103-107.
Very impressive, makes a lot of sense relating treatment to dialysis. Glad to see how research showing cost effectiveness helped it increase public services.
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Thank you for your comment. The “Lechol Nefesh” (“For Every Soul”) is a Non Profit Organization established in Israel in 2010 by a group of members of the Israeli Psychoanalytic Society with the objective of setting up unique therapeutic units for the provision of long-term, intensive psychoanalytic psychotherapy in the framework of the public mental health clinics. An outcome study carried out over a period of more than 3 years for 18 patients suffering from severe, chronic and debilitating Mental Disorders treated in one of our units, presents a clear and statistically significant finding that long-term, intensive psychoanalytic psychotherapy is a valid and effective treatment option for this group of patients. Moreover, there is a clear and direct correlation between the provision of psychotherapy and a dramatic reduction in the number of psychiatric hospitalization days. During the 5 year period prior to starting psychotherapy, the 18 patients had accumulated 1600 days of hospitalization. In contrast, for the 5-year period after starting therapy (and, we can add, also for the three years of follow-up after the research ended), we measured only 50 days of hospitalization. These figures do not include the substantial saving in hospitalization days for one of the patients in the unit, who was released from a chronic 20-year-long hospitalization two years after beginning psychotherapy. He was not included in the study group because at the time his mental and emotional condition prevented him from completing the questionnaires and participating in the research.
These findings, and particularly the significant savings resulting from the reduced number of hospitalizations, have enabled to expand both the number of units and the number of patients in treatment
What I found helpful. How to stop the revolving door. The model used and celebrated here in this system is the “revolving door”. Supposedly cheaper. Cant be a Dr without listening to the patient.