Clinical Social Work Journal

, Volume 39, Issue 4, pp 347–354 | Cite as

Mixing Apples and Oranges and Other Methodological Problems with a Meta-Analysis of Long Term Psychodynamic Psychotherapy

  • Monica PignottiEmail author
  • David Albright
Original Paper


Current trends in mental health practice indicate that mental health practitioners, including clinical social workers, are tending to move away from psychodynamic approaches and are favoring short-term empirically supported approaches such as cognitive-behavioral therapy (CBT). Recently, the presumption that long-term psychodynamic psychotherapy (LTPP) approaches lack empirical support has been challenged, however, with the publication in major peer reviewed journals of meta-analyses that are claimed to demonstrate its equality to or superiority over empirically supported short-term therapies for some conditions. The present article examines the methodology employed in one particular meta-analysis which compared LTPP to short term therapies and the studies upon which the analysis was based. We found that major methodological and statistical flaws with the meta-analysis and with the individual studies preclude drawing any conclusions regarding the efficacy of LTPP.


Meta-analysis Long-term psychodynamic psychotherapy Campbell collaboration Treatment fidelity Clinical social work 


  1. Bachar, E., Latzer, Y., Kreitler, S., & Berry, E. M. (1999). Empirical comparison of two psychological therapies: Self psychology and cognitive orientation in the treatment of anorexia and bulimia. Journal of Psychotherapy Practice & Research, 8, 115–128.Google Scholar
  2. Bateman, A., & Fonagy, P. (1999). Effectiveness of partial hospitalization in the treatment of borderline personality disorder: A randomized controlled trial. American Journal of Psychiatry, 156, 1563–1569.PubMedGoogle Scholar
  3. Beck, A. T., & Bhar, S. S. (2009a). Letter to the Editor. Journal of the American Medical Association, 301, 931.PubMedCrossRefGoogle Scholar
  4. Beck, A. T., & Bhar, S. S. (2009b). Treatment integrity of studies that compare short-term psychodynamic psychotherapy with cognitive-behavior therapy. Clinical Psychology: Science and Practice, 16, 370–378.CrossRefGoogle Scholar
  5. Bhar, S. S., Thombs, B. D., Pignotti, M., Bassel, M., Jewett, L., Coyne, J. C., et al. (2010). Is longer term psychodynamic psychotherapy more effective than shorter term therapies: Review and critique of the evidence. Psychotherapy and Psychosomatics, 79, 208–216.PubMedCrossRefGoogle Scholar
  6. Boutron, I., Moher, D., Altman, D. G., Schulz, K. F., & Ravaud, P. (2008). Extending the CONSORT Statement to randomized trials of nonpharmacologic treatment: Explanation and elaboration. Annals of Internal Medicine, 148, 295–309.PubMedGoogle Scholar
  7. Chambless, D. L., & Hollon, S. D. (1998). Defining empirically supported therapies. Journal of Consulting and Clinical Psychology, 66, 7–18.PubMedCrossRefGoogle Scholar
  8. Clarkin, J. F., Levy, K. N., Lenzenweger, M. F., & Kernberg, O. F. (2007). Evaluating three treatments for borderline personality disorder: A multiwave study. American Journal of Psychiatry, 164, 922–928.PubMedCrossRefGoogle Scholar
  9. Dare, C., Eisler, I., Russell, G., Treasure, J., & Dodge, L. (2001). Psychological therapies for adults with anorexia nervosa: Randomised controlled trial of out-patient treatments. British Journal of Psychiatry, 178, 216–221.PubMedCrossRefGoogle Scholar
  10. Gambrill, E. (1999). Evidence-based practice: An alternative to authority-based practice. Families in Society, 80, 341–350.Google Scholar
  11. Gambrill, E. (2006). Evidence-based practice and policy: Choices ahead. Research on Social Work Practice, 16, 338–357.CrossRefGoogle Scholar
  12. Glass, R. M. (2008). Psychodynamic psychotherapy and research evidence: Bambi survives Godzilla? Journal of the American Medical Association, 300, 1587–1589.PubMedCrossRefGoogle Scholar
  13. Gregory, R. J., Chlebowski, S., Kang, D., Remen, A. L., Soderberg, M. G., Stepkovitch, J., et al. (2008). A controlled trial of psychodynamic psychotherapy for co-occurring borderline personality disorder and alcohol use disorder. Psychotherapy: Theory, Research, Practice, Training, 45, 28–41.CrossRefGoogle Scholar
  14. Higgins, J. P. & Altman, D. (2008). Chapter 8: Assessing risk of bias in included studies. In J. Higgins & S. Green (Eds.), Cochrane collaboration for systematic reviews of interventions (Version 5.0.1 (updated September 2008) ed.). The Cochrane Collaboration: Available from
  15. Jadad, A. R., Moore, R. A., Carrol, D., Jenkinson, C., Reynolds, D. J. M., Gavaghan, D. J., et al. (1996). Assessing the quality of reports of randomized clinical trials: Is blinding necessary? Control Clinical Trials, 17, 1–12.CrossRefGoogle Scholar
  16. Korner, A., Gerull, F., Meares, R., & Stevenson, J. (2006). Borderline personality disorder treated with the conversational model: A replication study. Comprehensive Psychiatry, 47, 406–411.PubMedCrossRefGoogle Scholar
  17. Kraemer, H. C., Gardner, C., Brooks, J. O., III & Yesavage, J. A. (1998). Advantages of excluding underpowered studies in meta-analysis: Inclusionist versus exclusionist viewpoints. Psychological Methods, 3, 23–31.CrossRefGoogle Scholar
  18. Kriston, L. (2009). Letter to the Editor. Journal of the American Medical Association, 301, 930–931.PubMedCrossRefGoogle Scholar
  19. Lau, J., Loannidis, J. P. A., Terrin, N., Schmid, C. H., & Olkin, I. (2006). The case of the misleading funnel plot. British Medical Journal, 333, 597–600.PubMedCrossRefGoogle Scholar
  20. Leichsenring, F., & Rabung, S. (2008). Effectiveness of long-term psychodynamic psychotherapy: A meta-analysis. Journal of the American Medical Association, 300, 1551–1565.PubMedCrossRefGoogle Scholar
  21. Leichsenring, F., Rabung, S., & Leibing, E. (2004). The efficacy of short-term psychodynamic psychotherapy in specific psychiatric disorders: A meta-analysis. Archives of General Psychiatry, 61, 1208–1216.PubMedCrossRefGoogle Scholar
  22. Lundahl, B., & Yaffe, J. (2007). Use of meta-analysis in social work and allied disciplines. Journal of Social Service Review, 33, 1–11.CrossRefGoogle Scholar
  23. National Association of Social Workers. (1996). Code of ethics. Revised and adopted by the Delegate Assembly of the National Association of Social Workers. Washington, DC: NASW Press.Google Scholar
  24. Nelson, T. D., & Steele, R. G. (2008). Influences on practitioner treatment selection: Best research evidence and other considerations. The Journal of Behavioral Health Services & Research, 35, 170–178.CrossRefGoogle Scholar
  25. Norcross, J. C., Karpiak, C. P., & Santoro, S. O. (2005). Clinical psychologists across the years: The division of clinical psychology from 1960 to 2003. Journal of Clinical Psychology, 61, 1467–1483.PubMedCrossRefGoogle Scholar
  26. Pedhazur, E. J., & Schmelkin, L. P. (1991). Measurement, design, and analysis: An integrated approach. New York, NY: Psychology Press.Google Scholar
  27. Perepletchikova, F. (2009). Treatment integrity and differential treatment effects. Clinical Psychology: Science and Practice, 16, 379–382.CrossRefGoogle Scholar
  28. Perepletchikova, F., Treat, T. A., & Kazdin, A. E. (2007). Treatment integrity in psychotherapy research: Analysis of the studies and examination of the associated factors. Journal of Consulting and Clinical Psychology, 75, 829–841.PubMedCrossRefGoogle Scholar
  29. Pignotti, M. (2009). The use of novel unsupported and empirically supported therapies by licensed clinical social workers. Dissertation Abstracts International. Google Scholar
  30. Pignotti, M., & Thyer, B. A. (2009). Use of novel unsupported and empirically supported therapies by licensed clinical social workers: An exploratory study. Social Work Research, 33, 5–17.Google Scholar
  31. Piper, W. E., Debbane, E. G., Bienvenu, J. P., & Garant, J. (1984). A comparative study of four forms of psychotherapy. Journal of Consulting and Clinical Psychology, 52, 268–279.PubMedCrossRefGoogle Scholar
  32. Roepke, S. (2009). Letter to the Editor. Journal of the American Medical Association, 301, 931–932.PubMedCrossRefGoogle Scholar
  33. Rosen, G. (1999). Treatment fidelity on research of Eye Movement Desensitization and Reprocessing (EMDR). Journal of Anxiety Disorders, 13, 173–184.PubMedCrossRefGoogle Scholar
  34. Rothstein, H. R. (2008). Publication bias as a threat to validity of meta-analytic results. Journal of Experimental Criminology, 2, 459–487.Google Scholar
  35. Rucker, G., Schwarzer, G., Carpenter, J. R., & Schumacher, M. (2008). Undue reliance on I 2 in assessing clinical heterogeneity may mislead. BMC Medical Research Methodology, 8, 79.PubMedCrossRefGoogle Scholar
  36. Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 65, 98–109.PubMedCrossRefGoogle Scholar
  37. Stewart, R. E., & Chambless, D. L. (2007). Does psychotherapy research determine treatment decisions in private practice? Journal of Clinical Psychology, 63, 267–281.PubMedCrossRefGoogle Scholar
  38. Strom, K. (1994). Social workers in private practice: An update. Clinical Social Work Journal, 22, 73–89.CrossRefGoogle Scholar
  39. Svartberg, M., Stiles, T. C., & Seltzer, M. H. (2004). Randomized, controlled trial of the effectiveness of short-term dynamic psychotherapy and cognitive therapy for cluster C personality disorders. American Journal of Psychiatry, 161, 810–817.PubMedCrossRefGoogle Scholar
  40. Thombs, B., Bassel, M., & Jewett, L. (2009). Letter to the Editor. Journal of the American Medical Association, 301, 930.PubMedCrossRefGoogle Scholar
  41. Thyer, B. A. (2004). What is evidence-based practice? Brief Treatment and Crisis Intervention, 4, 167–176.CrossRefGoogle Scholar
  42. Wampold, B. E., Mondin, G. W., Moody, M., Stich, F., Benson, K., & Ahan, H. (1997). A meta-analysis of outcome studies comparing bona fide psychotherapies: Empirically, “all must have prizes”. Psychological Bulletin, 122, 203–215.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Florida State UniversityTallahasseeUSA

Personalised recommendations