Psychodynamic psychotherapy: A systematic review of techniques, indications and empirical evidence (original) (raw)
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The Empirical Status of Psychodynamic Psychotherapy - An Update: Bambi's Alive and Kicking
Psychotherapy and psychosomatics, 2015
The Task Force on Promotion and Dissemination of Psychological Procedures proposed rigorous criteria to define empirically supported psychotherapies. According to these criteria, 2 randomized controlled trials (RCTs) showing efficacy are required for a treatment to be designated as 'efficacious' and 1 RCT for a designation as 'possibly efficacious'. Applying these criteria modified by Chambless and Hollon, this article presents an update on the evidence for psychodynamic therapy (PDT) in specific mental disorders. A systematic search was performed using the criteria by Chambless and Hollon for study selection, as follows: (1) RCT of PDT in adults, (2) use of reliable and valid measures for diagnosis and outcome, (3) use of treatment manuals or manual-like guidelines, (4) adult population treated for specific problems and (5) PDT superior to no treatment, placebo or alternative treatment or equivalent to an established treatment. A total of 39 RCTs were included. Foll...
What Makes Psychodynamic Psychotherapy Work? A Review of Five Perspectives
Psychoanalytic Inquiry, 2017
We review and comment on five articles included in this special issue of Psychoanalytic Inquiry. Each article addresses potential moderators and mechanisms of change within psychodynamic psychotherapy. We briefly present the questions we find most relevant in assessing the research on the mechanisms of change discussed in each of these articles. We discuss conceptual and methodological advances and strengths of these articles. Last, we propose directions for future research in this rich field to, first, best serve our patients and, second, for dynamic therapy to stay a vital treatment option in the current climate of evidence-based treatments.
The Efficacy of Psychodynamic Psychotherapy
Empirical evidence supports the efficacy of psychodynamic therapy. Effect sizes for psychodynamic therapy are as large as those reported for other therapies that have been actively promoted as " empirically supported " and " evidence based. " In addition, patients who receive psychody-namic therapy maintain therapeutic gains and appear to continue to improve after treatment ends. Finally, nonpsy-chodynamic therapies may be effective in part because the more skilled practitioners utilize techniques that have long been central to psychodynamic theory and practice. The perception that psychodynamic approaches lack empirical support does not accord with available scientific evidence and may reflect selective dissemination of research findings .
Comparative Effects of Short-Term Psychodynamic Psychotherapy
1991
In a review of 19 clinically relevant comparative outcome studies published 1978-1988, short-term psychodynamic psychotherapy (STPP) was evaluated as to overall effects, differential effects, and moderating effects visa -vis no-treatment controls (NT) and alternative psychotherapies (AP), respectively Overall, STPP was superior to NT at posttreatment, inferior to AP at posttreatment, and even more so at 1-year follow-up. STPP was inferior to AP in treating depression and, in particular, to cognitive-behavioral therapy for major depression. STPP was equally successful with mixed neurotics. As research quality increased, STPP grew less superior to NT. Furthermore, STPP decreased its overall superiority over NT and increased its overall inferiority to AT on a series of clinically relevant variables. Improvement in research quality from 1978 to 1988 was noted. Evidence, although limited, supported the view that STPP approaches do seem to differ along a few major dimensions.
Psychodynamic Psychotherapy Vindicated
Over the years, research in psychotherapy has focused on simple treatments that are easily replicable, intentionally taking the person of the therapist out of the equation. This practice has led to a de facto divide between psychotherapy researchers and clinicians, as many clinical researchers began to view any therapies not empirically validated through randomized controlled trials (RCTs) as invalid. Since these researchers published in journals almost exclusively read by other researchers, practicing clinicians, on their part, tended to view research as esoteric and irrelevant to their work. At the same time, many researchers became contemptuous of the more complex and long-term therapies which were more dependent on clinical skill and thus more difficult to research. It is not surprising that this schism has hampered efforts to translate research into practice and vice versa. Patients and psychotherapists are all concerned about making sure that treatment is as brief as possible ...
Psychodynamic therapy: a poorly defined concept with questionable evidence
Evidence-based mental health, 2016
Psychodynamic therapy (PDT) is widely practiced, but the empirical evidence for it is unclear. 1 As relatively few well-controlled studies exist, some authors resort to metaanalyses that include numerous poorly controlled and underpowered clinical trials in order to support their claim that PDT is efficacious. 2 METHODS OF THE STUDY After reviewing the distinction between superiority, non-inferiority and equivalency trials, Leichsenring and colleagues conducted a traditional literature search, which identified 64 randomised controlled trials (RCTs) examining the efficacy of PDT in common mental health disorders. The authors then proceeded to provide their own interpretation of the literature by concluding that PDT is as effective as cognitive-behavioural therapy (CBT). However, this conclusion is unjustified given the poor or unknown quality of the studies included in this review. Produced by BMJ Publishing Group Ltd under licence. Competing interests None declared.
This volume presents 12 highly instructive case studies grounded in the evidence-based psychodynamic therapy model developed by Richard F. Summers and Jacques P. Barber. Bringing clinical concepts vividly to life, each case describes the patient's history and presenting problems and takes the reader through psychodynamic formulation, treatment planning, and the entire course of therapy, including the challenges of termination. The cases address a variety of core psychodynamic problems, with outcomes ranging from very successful to equivocal. The emotional experience of the therapist is explored throughout. Commentary from Summers and Barber on every case highlights important points and key clinical dilemmas. See also the authored book Psychodynamic Therapy: A Guide to Evidence-Based Practice http://www.amazon.com/Practicing-Psychodynamic-Therapy-Richard-Summers/dp/1462517188/ref=sr\_1\_2?s=books&ie=UTF8&qid=1418591091&sr=1-2
Psychotherapy and Psychosomatics, 2010
Background: In 2008, Leichsenring and Rabung performed a meta-analysis of 8 studies of longer-term psychodynamic psychotherapy (LTPP). The work was published in the Journal of the American Medical Association (vol. 300, pp 1551-1565), and they concluded that LTPP was more effective than shorter-term therapies. Method: Given that such claims have the potential to influence treatment decisions and policies, we re-examined the meta-analysis and the 8 studies. Results: We found a miscalculation of the effect sizes used to make key comparisons. Claims for the effectiveness of LTPP depended on a set of small, underpowered studies that were highly heterogeneous in terms of patients treated, interventions, comparison-control groups, and outcomes. LTPP was compared to 12 types of comparison-controls, including control groups that did not involve any psychotherapy, short-term psychodynamic psychotherapy, and unvalidated treatments. Additionally, the studies failed to protect against threats to bias, and had poor internal validity. Conclusion: Overall, we found no evidence to support claims of superiority of LTPP over shorter-term methods of psychotherapy.
Psychodynamic therapy meets evidence-based medicine: a systematic review using updated criteria
The Lancet Psychiatry, 2015
Psychodynamic therapy (PDT) is an umbrella concept for treatments that operate on an interpretive-supportive continuum and is frequently used in clinical practice. The use of any form of psychotherapy should be supported by suffi cient evidence. Effi cacy research has been neglected in PDT for a long time. In this review, we describe methodological requirements for proofs of effi cacy and summarise the evidence for use of PDT to treat mental health disorders. After specifying the requirements for superiority, non-inferiority, and equivalence trials, we did a systematic search using the following criteria: randomised controlled trial of PDT; use of treatment manuals or manual-like guidelines; use of reliable and valid measures for diagnosis and outcome; adults treated for specifi c mental problems. We identifi ed 64 randomised controlled trials that provide evidence for the effi cacy of PDT in common mental health disorders. Studies suffi ciently powered to test for equivalence to established treatments did not fi nd substantial diff erences in effi cacy. These results were corroborated by several meta-analyses that suggest PDT is as effi cacious as treatments established in effi cacy. More randomised controlled trials are needed for some mental health disorders such as obsessive-compulsive disorder and post-traumatic stress disorder. Furthermore, more adequately powered equivalence trials are needed.