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Psychodynamic Psychotherapy Research pp 9–25Cite as

The Efficacy of Psychodynamic Psychotherapy

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Abstract

Empirical evidence supports the efficacy of psychodynamic psychotherapy. Effect sizes for psychodynamic psychotherapy are as large as those reported for other therapies that have been actively promoted as “empirically supported” and “evidence based.” Additionally, patients who receive psychodynamic therapy maintain therapeutic gains and appear to continue to improve after treatment ends. Finally, nonpsychodynamic 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.

*  Copyright © 2010 by the American Psychological Association. Reproduced with permission. The official citation that should be used in referencing this material is Shedler J. The efficacy of psychodynamic psychotherapy. Am Psychol. 2010;65(2):98–109. No further reproduction or distribution is permitted without written permission from the American Psychological Association.

The author thanks Mark Hilsenroth for his extensive contributions to this chapter; Marc Diener for providing some of the information reported here; and Robert Feinstein, Glen Gabbard, Michael Karson, Kenneth Levy, Nancy McWilliams, Robert Michels, George Stricker, and Robert Wallerstein, for their comments on earlier drafts. Visit “Jonathan Shedler, Ph.D.” on Facebook or send email correspondence to jonathan@shedler.com.

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Notes

  1. 1.

    I use the terms psychodynamic and psychoanalytic interchangeably.

  2. 2.

    This score, known as the standardized mean difference, is used to summarize the findings of randomized control trials. More broadly, the concept effect size may refer to any measure that expresses the magnitude of a research finding [16].

  3. 3.

    The measure of effect size in this study was Hedges’ g [23] rather than Cohen’s d [17] which is more commonly reported. The two measures are based on slightly different computational formulas, but in this case, the choice of formula would have made no difference: “Because of the large sample size (over 12,000), there is no change in going from g to d; both values are.31 to two decimal places” (Rosenthal R, Personal communication to Marc Diener).

  4. 4.

    Although antidepressant trials are intended to be double-blind, the blind is easily penetrated because the adverse effects of antidepressant medications are physically discernable and widely known. Study participants and their doctors can therefore figure out whether they are receiving medication or placebo, and effects attributed to medication may be inflated by expectancy and demand effects. Use of “active” placebos better protects the blind, and the resulting effect sizes are approximately half as large as those otherwise reported.

  5. 5.

    More widely known in medicine than in psychology, the Cochrane Library was created to promote evidence-based practice and is considered a leader in methodological rigor for meta-analysis.

  6. 6.

    These included nonpsychotic symptom and behavior disorders commonly seen in primary care and psychiatric services, e.g., non bipolar depressive disorders, anxiety disorders, and somatoform disorders, often mixed with interpersonal or personality disorders [26].

  7. 7.

    The meta-analysis computed effect sizes in a variety of ways. The findings reported here are based on the single method that seemed most conceptually and statistically meaningful (in this case, a random effects model, with a single outlier excluded). See the original source for more fine-grained analyses [26].

  8. 8.

    The authors had initially reported a higher effect size [31]; the value of.65 reported here is the more conservative value reported in a subsequent publication [32].

  9. 9.

    The exceptions to this pattern are specific anxiety conditions such as panic disorder and simple phobia, for which short-term, manualized treatments do appear to have lasting benefits [38].

  10. 10.

    The cognitive therapy study was an RCT for depression; the psychodynamic psychotherapy studies were panel studies for mixed disorders and for PTSD, respectively. See the original source for more detailed descriptions [55].

  11. 11.

    See the original source for more complete descriptions of the two therapy prototypes [56].

  12. 12.

    The study is one of the archival studies analyzed by Jones and his associates [56, 57].

  13. 13.

    Although the term “experiencing” derives from the humanistic therapy tradition, the phenomenon assessed by the scale – a trajectory of deepening self-exploration, leading to increased awareness of implicit or unconscious mental life – is the core defining feature of psychoanalysis and psychoanalytic psychotherapy.

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  1. Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA

    Jonathan Shedler PhD

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  1. Massachusetts General Hospital, Harvard Medical School, Department of Psychiatry, Parkman St., Boston, 02114, Massachusetts, USA

    Raymond A. Levy

  2. Massachusetts General Hospital, Harvard Medical School, Department of Psychiatry, Morrimac Street 101, Boston, 02114, Massachusetts, USA

    J. Stuart Ablon

  3. and Psychoanalysis, International Psychoanalytic University, Department of Clinical Psychology, Stromstr. 3, Berlin, 10555, Germany

    Horst Kächele

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Shedler, J. (2012). The Efficacy of Psychodynamic Psychotherapy. In: Levy, R., Ablon, J., Kächele, H. (eds) Psychodynamic Psychotherapy Research. Current Clinical Psychiatry. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60761-792-1_2

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