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Empirical Evidence: Psychodynamic & Psychoanalytic Psychotherapy

Clients have a right to know that the psychotherapy they are engaging in can really work. It can be confusing, however, to sort out the rhetoric, biases, and politics involved in descriptions of the effectiveness of psychotherapy.

Some sources of funding (certain government agencies, selected managed care companies) may make incomplete statements regarding the effectiveness of one treatment compared to another without disclosing how their vested interests in conserving resources may bias their conclusions.

Even worse, some groups of clinicians pit their favored form of therapy against another, each camp convinced they have the answers. This kind of infighting hurts the profession and does a disservice to the public.

Lately, psychodynamic and psychoanalytic psychotherapies have been favorite targets for derision, often lampooned in cartoons and movies (granted, there’s humor in it, but the stereotype isn’t the whole story). All the while documentation of these treatments’ effectiveness remains conveniently ignored.

Compiling the Evidence

Dynamic and analytic clinicians are hereby invited for commentary on and submissions of empirical evidence of dynamic/analytic practice. A wealth of such information exists, yet it’s consistently excluded from so-called ‘evidence based practices.’ So what counts as persuasive evidence: the politically expedient, or those treatments that truly work?

Selected Evidence for Psychoanalytic/Psychodynamic Practice

Let’s start here–a recent, a widely circulated, peer-reviewed article on the effectiveness of psychoanalytic therapy in the treatment of panic disorder:

Milrod, B. & Leon, A.C., et al., (2007). A randomized controlled clinical trial of psychoanalytic psychotherapy for panic disorder. American Journal of Psychiatry (164), 265-272.

Though work of this kind isn’t new: Here’s 90 years of psychoanalytic therapy research, briefly summarized (Wallerstein, 2002):
http://www.psychomedia.it/spr-it/artdoc/waller02.htm

A more recent article, comparing the effect sizes of psychodynamic, cognitive-behvavioral, and medication treatment across multiple meta-analyses:

Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 65(2),98-109.
http://www.apa.org/pubs/journals/releases/amp-65-2-98.pdf

Reading Lists

8,000+ articles on empirical evidence for dynamic and analytic therapy: Google Scholar List
A collection of articles on effectiveness of psychoanalysis (in German).

Attempting to sort through the major works is a work in progress, contributions welcome:

Westen (1999) discussed empirical evidence supporting the existence of unconscious phenomena, and by extension, validation of methods used in psychoanalytic psychotherapy to bring such phenomena into consciousness.

Westen & Bradley (2005) on the sometimes restrictive use of the concept of “evidence” in evidence-based practice, with suggestions for broadening the program of study.

A broader concept of evidence, the APA Presidential Task Force (2006) on Evidence Based Practice in Psychology, including discussions of research methods, culture, and clinical expertise.

Ritvo, R. (2006). Is there research to support psychodynamic psychotherapy? American Psychoanalytic Association.

The vast majority of successful psychotherapy outcomes take place within the private confines of thousands of individual practitioners’ careers. While such outcomes are usually not included in quantitative research programs, their qualitative evaluation within an individual practice constitute another form of evidence for psychotherapy effectiveness. Here’s an excellent, recent example of such evaluation within a single psychoanalytic practice:

Young, B. (2007). Long-term effects of psychotherapy: The internalized therapeutic relationship. Psychiatric Times, 24(4).

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