ScienceDaily (Jan. 27, 2010) — Psychodynamic psychotherapy is
effective for a wide range of mental health symptoms, including
depression, anxiety, panic and stress-related physical ailments, and
the benefits of the therapy grow after treatment has ended, according
to new research published by the American Psychological Association.
Psychodynamic therapy focuses on the psychological roots of emotional
suffering. Its hallmarks are self-reflection and self-examination, and
the use of the relationship between therapist and patient as a window
into problematic relationship patterns in the patient's life. Its goal
is not only to alleviate the most obvious symptoms but to help people
lead healthier lives.
"The American public has been told that only newer, symptom-focused
treatments like cognitive behavior therapy or medication have
scientific support," said study author Jonathan Shedler, PhD, of the
University of Colorado Denver School of Medicine. "The actual
scientific evidence shows that psychodynamic therapy is highly
effective. The benefits are at least as large as those of other
psychotherapies, and they last."
To reach these conclusions, Shedler reviewed eight meta-analyses
comprising 160 studies of psychodynamic therapy, plus nine
meta-analyses of other psychological treatments and antidepressant
medications. Shedler focused on effect size, which measures the amount
of change produced by each treatment. An effect size of 0.80 is
considered a large effect in psychological and medical research. One
major meta-analysis of psychodynamic therapy included 1,431 patients
with a range of mental health problems and found an effect size of
0.97 for overall symptom improvement (the therapy was typically once
per week and lasted less than a year). The effect size increased by 50
percent, to 1.51, when patients were re-evaluated nine or more months
after therapy ended. The effect size for the most widely used
antidepressant medications is a more modest 0.31. The findings are
published in the February issue of American Psychologist, the flagship
journal of the American Psychological Association.
The eight meta-analyses, representing the best available scientific
evidence on psychodynamic therapy, all showed substantial treatment
benefits, according to Shedler. Effect sizes were impressive even for
personality disorders -- deeply ingrained maladaptive traits that are
notoriously difficult to treat, he said. "The consistent trend toward
larger effect sizes at follow-up suggests that psychodynamic
psychotherapy sets in motion psychological processes that lead to
ongoing change, even after therapy has ended," Shedler said. "In
contrast, the benefits of other 'empirically supported' therapies tend
to diminish over time for the most common conditions, like depression
and generalized anxiety."
"Pharmaceutical companies and health insurance companies have a
financial incentive to promote the view that mental suffering can be
reduced to lists of symptoms, and that treatment means managing those
symptoms and little else. For some specific psychiatric conditions,
this makes sense," he added. "But more often, emotional suffering is
woven into the fabric of the person's life and rooted in relationship
patterns, inner contradictions and emotional blind spots. This is what
psychodynamic therapy is designed to address."
Shedler acknowledged that there are many more studies of other
psychological treatments (other than psychodynamic), and that the
developers of other therapies took the lead in recognizing the
importance of rigorous scientific evaluation. "Accountability is
crucial," said Shedler. "But now that research is putting
psychodynamic therapy to the test, we are not seeing evidence that the
newer therapies are more effective."
Shedler also noted that existing research does not adequately capture
the benefits that psychodynamic therapy aims to achieve. "It is easy
to measure change in acute symptoms, harder to measure deeper
personality changes. But it can be done."
The research also suggests that when other psychotherapies are
effective, it may be because they include unacknowledged psychodynamic
elements. "When you look past therapy 'brand names' and look at what
the effective therapists are actually doing, it turns out they are
doing what psychodynamic therapists have always done -- facilitating
self-exploration, examining emotional blind spots, understanding
relationship patterns." Four studies of therapy for depression used
actual recordings of therapy sessions to study what therapists said
and did that was effective or ineffective. The more the therapists
acted like psychodynamic therapists, the better the outcome, Shedler
said. "This was true regardless of the kind of therapy the therapists
believed they were providing."
Adapted from materials provided by American Psychological
Association, via EurekAlert!, a service of AAAS.
1. Jonathan Shedler. The Efficacy of Psychodynamic Psychotherapy.
American Psychologist, 2010; 65 (2)