Evidence-Based Psychodynamic Therapy

Review of research

There is extensive scientific evidence, collected over several decades, that psychodynamic and psychoanalytic treatment is an effective and clinically useful approach for treating many complex psychiatric problems such as severe character disorders, traumas, borderline personality disorder, anxiety, and depression (1). On this basis, experts agree that psychodynamic and psychoanalytic treatment is empirically based and a standard part of contemporary psychiatric practice (2). In fact, standard practice guidelines issued by major organizations such as the American Psychiatric Association include psychodynamic psychotherapy among other evidence-based treatment options (3).

Since the late 1960s, over 300 randomized control trials have been published which show conclusively that psychodynamic treatment is superior to inactive comparison groups and is not inferior to other active evidence-based treatments (4–11). These findings support the notion that psychodynamic treatment is as effective as other forms of active treatment. They also demonstrate the efficacy of psychodynamic and psychoanalytic treatments in reducing symptom severity and improving quality of life across a broad and diverse range of patient populations and treatment settings.

The work conducted by these research groups has helped address basic questions about whether psychoanalytic treatment “works” when compared to other treatment approaches for certain disorders. Improvements in these trials have been defined in various ways, from general symptom domains (e.g., depression, anxiety), to interpersonal functioning (e.g., severity of interpersonal problems, relationships quality), perceived quality of life, and specific clinically relevant behaviors (e.g., self-harm, substance use). A more limited number of studies have targeted outcomes that are more central to psychoanalytic models of the mind, most notably reflective functioning and mentalization capacities (12), level of personality organization (13, 14), and maturity of defense mechanisms.

References

1. Leichsenring, Falk, Frank Leweke, Susanne Klein, and Christiane Steinert. “The empirical status of psychodynamic psychotherapy-an update: Bambi’s alive and kicking.” Psychotherapy and Psychosomatics 84, no. 3 (2015): 129–148. DOI: https://doi.org/10.1159/000376584.

2. Oldham, John M. “Guideline watch: Practice guideline for the treatment of patients with borderline personality disorder.” Focus 3, no. 3 (2005): 396–400. DOI: https://doi.org/10.1176/foc.3.3.396.

3. APA Practice Guidelines. http://www.psychiatryonline.com/pracGuide/pracGuideTopic_7.aspx.

4. Barber, Jacques P., Marna S. Barrett, Robert Gallop, Moira A. Rynn, and Karl Rickels. “Short-term dynamic psychotherapy versus pharmacotherapy for major depressive disorder: A randomized, placebo-controlled trial.” The Journal of Clinical Psychiatry 73, no. 1 (2012): 66–73. DOI: https://doi.org/10.4088/jcp.11m06831.

5. Barkham, Michael, David A. Shapiro, Gillian E. Hardy, and Anne Rees. “Psychotherapy in two-plus-one sessions: Outcomes of a randomized controlled trial of cognitive-behavioral and psychodynamic-interpersonal therapy for subsyndromal depression.” Journal of Consulting and Clinical Psychology 67, no. 2 (1999): 201–11. DOI: https://doi.org/10.1037//0022-006x.67.2.201.

6. Cooper, Peter J., Lynne Murray, Anji Wilson, and Helena Romaniuk. “Controlled trial of the short-and long-term effect of psychological treatment of post-partum depression.” The British Journal of Psychiatry 182, no. 5 (2003): 412–419. DOI: https://doi.org/10.1192/bjp.182.5.420.

7. de Jonghe, Frans, Mariëlle Hendricksen, Gerda van Aalst, Simone Kool, Vjaap Peen, Rien Van, Ellen van den Eijnden, and Jack Dekker. “Psychotherapy alone and combined with pharmacotherapy in the treatment of depression.” The British Journal of Psychiatry 185, no. 1 (2004): 37–45. DOI: https://doi.org/10.1192/bjp.185.1.37.

8. Driessen, Ellen, Lisa M. Hegelmaier, Allan A. Abbass, Jacques P. Barber, Jack J. M. Dekker, Henricus L. Van, Elise P. Jansma, and Pim Cuijpers. “The efficacy of short-term psychodynamic psychotherapy for depression: A meta-analysis update.” Clinical Psychology Review 42 (2015): 1–15. DOI: https://doi.org/10.1016/j.cpr.2015.07.004.

9. Leichsenring, Falk, Simone Salzer, Manfred E. Beutel, Stephan Herpertz, Wolfgang Hiller, Juergen Hoyer, Johannes Huesing, et al. “Long-term outcome of psychodynamic therapy and cognitive-behavioral therapy in social anxiety disorder.” American Journal of Psychiatry 171, no. 10 (2014): 1074–1082. DOI: https://doi.org/10.1176/appi.ajp.2014.13111514.

10. Levy, Kenneth N., Kevin B. Meehan, Kristen M. Kelly, Joseph S. Reynoso, Michal Weber, John F. Clarkin, and Otto F. Kernberg. “Change in attachment patterns and reflective function in a randomized control trial of transference-focused psychotherapy for borderline personality disorder.” Journal of Consulting and Clinical Psychology 74, no. 6 (2006): 1027. DOI: https://doi.org/10.1037/0022-006x.74.6.1027.

11. Svartberg, Martin, Tore C. Stiles, and Michael H. Seltzer. “Randomized, controlled trial of the effectiveness of short-term dynamic psychotherapy and cognitive therapy for cluster C personality disorders.” American Journal of Psychiatry 161, no. 5 (2004): 810–817. DOI: https://doi.org/10.1176/appi.ajp.161.5.810.

12. Suchman N. E., Cindy L. DeCoste, Thomas J. McMahon, Rachel Dalton, Linda C. Mayes, and Jessica Borelli. “Mothering from the Inside Out: Results of a second randomized clinical trial testing a mentalization-based intervention for mothers in addiction treatment.” Development and Psychopathology 29, no. 2 (May 2017): 617–636. DOI: 10.1017/S0954579417000220.

13. Leichsenring F. “Development and first results of the Borderline Personality Inventory: A self-report instrument for assessing borderline personality organization.” Journal of Personality Assessment 73, no. 1 (Aug 1999): 45–63. DOI: 10.1207/S15327752JPA730104.

14. Ulberg, Randi, Benjamin Hummelen, Anne Grete Hersoug, Nick Midgley, Per Andreas Høglend, and Hanne-Sofie Johnsen Dahl. “The first experimental study of transference work–in teenagers (FEST–IT): A multicentre, observer- and patient-blind, randomised controlled component study.” BMC Psychiatry 21 (2021). DOI: 10.1186/s12888-021-03055-y.