The Efficacy of Psychodynamic Psychotherapy (original) (raw)
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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.
A Quality-Based Review of Randomized Controlled Trials of Psychodynamic Psychotherapy
American Journal of Psychiatry, 2011
describe a "hierarchy of evidence" ranging from case studies and uncontrolled trials to randomized controlled trials that support the utility, if not the effi cacy, of various forms of psychodynamic psychotherapy for treatment of patients with a wide range of DSM-IV axis I and II psychiatric disorders. Although each of these meta-analyses attempts, in its own way, to make use only of studies that are considered of high enough quality to warrant inclusion in a meta-analysis, there is sharp disagreement in the fi eld about whether the quality and number of studies included is suffi cient to warrant the conclusions drawn. Ambiguity about the state of psychodynamic empirical research presents a signifi cant problem for training and practice in the mental health fi elds. The objective evaluation of the quality of randomized controlled trials of psychodynamic psychotherapy is a cogent place to begin the process of correcting this problem. Such trials are widely accepted in medicine as the gold standard for assessing treatment effi cacy, and there is good conceptual The depth and quality of the evidence base for psychodynamic psychotherapy has long been a subject of controversy among psychodynamic and nonpsychodynamic clinicians and researchers. Some have argued that the relative absence of randomized controlled trials has doomed psychodynamic treatments to obsolescence (1). This argument is sometimes used to support the further marginalization or even elimination of training in psychodynamic techniques in psychiatry, psychology, and social work training programs, to be replaced by "evidencebased treatments" (2). Others have argued that a body of empirical evidence for psychodynamic treatments exists and is underappreciated in the context of contemporary emphasis on shortterm, manualized, and symptom-focused treatments and targeted medications (3-5). Over the past several years, meta-analyses have appeared in mainstream research outlets that argue for the effi cacy of psychodynamic treatments for specifi c disorders (6-11). Gabbard et al. (12)
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 ...
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...
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.
The Empirical Status of Psychodynamic Therapies
Annual Review of Clinical Psychology, 2008
The goal of the current review is to examine the evidence for the efficacy of dynamic psychotherapy, primarily focusing on studies that meet the rigorous criteria proposed by . We examine whether any progress has been made over the past decade in evaluating the efficacy of dynamic psychotherapy using well-controlled randomized designs. Over the past decade, multiple studies have been published supporting the efficacy of dynamic psychotherapy for the treatment of specific mental disorders. Dynamic psychotherapy should now be included as a possibly efficacious treatment for panic disorder and borderline personality disorder, as well as the original designation of possibly efficacious in the treatment of opiate dependence. In the context of medication usage, dynamic psychotherapy should be considered efficacious in the treatment of major depressive disorder (MDD). Studies suggest that dynamic psychotherapy has great promise as a monotherapy for MDD and alcohol dependence and thus should be evaluated further.
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: A systematic review of techniques, indications and empirical evidence
Psychology and Psychotherapy: Theory, Research and Practice, 2007
Purpose. Psychodynamic psychotherapy is one of the most frequently applied methods of psychotherapy in clinical practice. However, it is the subject of controversial discussion, especially with regard to empirical evidence. In this article we aim to give an up-to-date description of the treatment and to review the available empirical evidence. Evidence is reviewed for both efficacy and mechanisms of change of short-and moderate-term psychodynamic psychotherapy. Furthermore, results of effectiveness studies of long-term psychoanalytic therapy are reviewed.
Once psychoanalysis or psychodynamic therapy ruled the earth. Unlike the dinosaurs, it did not disappear but rather sprouted many variations and new offspring. Today those offspring have forgotten everything about their origins.
On the future of psychodynamic therapy research
Psychotherapy research : journal of the Society for Psychotherapy Research, 2015
Objective and Method: Two psychodynamic therapists and researchers from different generations reflected upon the past and present state of psychodynamic therapy research as well as possibilities for the future. Results and Conclusions: Several issues (e.g., decreased research funding, increased medicalization of mental health problems, and declining psychodynamic representation among research faculty) were identified as potential impediments for future high-quality research. In addition to encouraging the field to face these challenges directly, a number of specific recommendations were provided. These included not only suggestions for traditional process and outcome research, but also recommendations to modify our current assessment practices, improve our field's cohesiveness, increase our public visibility, and improve relationships with our non-psychodynamic colleagues. In is argued that, if the field confronts these many challenges in a creative and flexible manner, psychody...