Is Psychodynamic Psychotherapy Evidence-Based?
The public—and many clinicians—often assume that it is not. In fact, many university courses teach that only cognitive-behavioral approaches have current empirical support. This assumption is false and does a disservice to the field and to the public alike. A growing number of studies demonstrate that psychodynamic psychotherapy is evidence-based, and support the value of psychoanalytic and psychodynamic approaches, especially for complex cases and long-term change.
Some Psychological Approaches Are Easier to Research Than Others
Clinical psychology is a multifaceted discipline, with a history that spans over 100 years. Since its origins, approaches and perspectives have come and gone in popularity. Classical psychoanalysis, object relations theory, and ego psychology; humanistic client-centered, gestalt, and existential therapies; behavior therapies; cognitive, cognitive-behavioral, and mindfulness-based cognitive therapies; interpersonal therapy; eye movement desensitization therapy; dialectical behavior therapy; integrative or holistic therapy—and the list continues to grow. Some approaches have been studied more than others. Many show promising results in some studies, only to be found to be limited in others. Some win favor because they are simple to research, and so garner publicity and research grants. Others draw attention because they are easy to teach and to master, or are short in duration and so inexpensive. Psychoanalytic and psychodynamic approaches are complex; they are not easily taught and they pose challenges to research. But, despite this, they continue to have many followers and are gaining impressive scientific support.
A Growing Body of Research Supports the Value of Psychodynamic Psychotherapy, Despite Its Complexity
Is psychodynamic psychotherapy evidence-based? Absolutely! Numerous current scientific studies support the value of psychodynamic and psychoanalytic approaches. In fact, meta-analyses—studies that gather evidence across multiple studies—demonstrate the effectiveness of psychodynamic and psychoanalytic work and indicate that, in some cases, psychodynamic approaches may be more effective in the long-run than other therapeutic models (e.g., Abbass et al., 2014; Baardseth et al., 2013; Bastos, Guimaraes, & Trentini, 2015; Buchheim et al., 2012; Busch, 2015; Grande et al., 2009; Johansson et al., 2010; Kallestad, Valen, McCullough, Svartberg, Høglend, & Stiles, 2010; Klug, Zimmermann, & Huber, 2016; Leichsenring, & Rabung, 2011; Midgley & Kennedy, 2011; Parker & Turner, 2014; Rizeanu, 2016; Shedler, 2010; Shepherd & Beail, 2017; Soares et al., 2018; Waldron, Gazzillo, Genova, & Lingiardi, 2013; Waldron, Gazzillo, & Stukenberg, 2015).
Psychodynamic Psychotherapy Is Often Misperceived
As noted by Shedler (2010) in an article published by the American Psychologist—a well-regarded publication of the American Psychological Association, “the perception that psychodynamic approaches lack empirical support does not accord with available scientific evidence and may reflect selective dissemination of research findings” (p. 98). This faulty perception has led some educational programs to downplay its significance or even dismiss it as an “outdated” approach. It is in the public interest that the field conduct scientific inquiry into the potential benefits and mechanisms of all therapies that clinicians have found to be valuable. Researchers cannot adequately investigate theories that they do not fully understand—research draws from a theoretical base (Britzman, 2012), which must be clearly understood before meaningful studies can be conducted regarding its mechanisms (e.g., Gazzillo et al., 2017; Laska, Gurman, & Wampold, 2014; Waldron et al., 2015). It is, therefore, crucial for science as well that the field continue to be educated about the premises of these valuable therapeutic approaches. Unlike some behavioral theories, many of the constructs of psychodynamic and psychoanalytic theory can only be assessed indirectly. Fortunately, many researchers are accepting the creative challenge.
It Is Important to Continue Researching All Psychotherapy Approaches
It is important for psychologists, psychoanalysts, and counselors to stay current, with scientifically grounded evidence, regarding issues relevant to enhancing their service to the public and the profession. Research, and informed discussion and practice, strengthen the profession. Is psychodynamic psychotherapy evidence-based? Yes, psychodynamic and psychoanalytic therapies are indeed empirically validated as valuable approaches for a wide range of disorders and clients. And, to quote Eric Kandel, neuroscientist and Nobel Laureate, “Psychoanalysis still represents the most coherent and intellectually satisfying view of the mind” (1999, p. 505).
References for Evidence-Based Psychodynamic Psychotherapy
Abbass, A. A., Kisely, S. R., Town, J. M., Leichsenring, F., Driessen, E., De Maat, S., Gerber, A., Dekker, J., Rabung, S., Rusalovska, S., & Crowe, E. (2014). Short-term psychodynamic psychotherapies for common mental disorders (review). Cochrane Database of Systematic Reviews, 7, 1-108. doi: 10.1002/14651858.CD004687.pub4
Baardseth, T. P., Goldberg, S. B., Pace, B. T., Wislocki, A. P., Frost, N. D., Siddiqui, J. R., Lindemann, A. M., Kivlighan III, D. M., Laska, K. M., Del Re, A. C., Minami, T., & Wampold, B. E. (2013). Cognitive-behavioral therapy versus other therapies: Redux. Clinical Psychology Review, 33, 395-405. http://dx.doi.org/10.1016/j.cpr.2013.01.004
Bastos, A. G., Guimaraes, L. S. P., & Trentini, C. M. (2015). The efficacy of long-term psychodynamic psychotherapy, fluoxetine and their combination in the outpatient treatment of depression. Psychotherapy Research, 25(5), 612-624. https://doi.org/10.1080/10503307.2014.935519
Britzman, D. P. (2012). What is the use of theory? A psychoanalytic discussion. Changing English: Studies in Culture and Education, 19(1), 43-56. https://doi.org/10.1080/1358684X.2012.649143
Buchheim, A., Viviani, R., Kessler, H., Kächele, H., Cierpka, M., et al. (2012). Changes in prefrontal-limbic function in major depression after 15 months of long-term psychotherapy. PLoS ONE, 7(3). https://doi.org/10.1371/journal.pone.0033745
Busch, F. N. (2015). Discussion: Psychoanalytic research: Progress and questions. Psychoanalytic Inquiry, 35, 196-203. https://doi.org/10.1080/07351690.2015.987607
Gazzillo, F., Waldron S., Gorman, B. S., Stukenberg, K. W., Genova, F., Ristucci, C., Faccini, F., & Mazza, C. (2017). The components of psychoanalysis: Factor analyses of process measures of 27 fully recorded psychoanalyses. Psychoanalytic Psychology, advance online publication, 1-12. http://dx.doi.org/10.1037/pap0000155
Grande, T., Dilg, R., Jakobsen, T., Keller, W., Krawietz, B., Langer, M., Oberbracht, C., Stehle, S., Stennes, M., & Rudolf, G. (2009). Structural change as a predictor of long-term follow-up outcome. Psychotherapy Research, 19(3), 344-357. https://doi.org/10.1080/10503300902914147
Johansson, P., Høglend, P., Ulberg, R., Amlo, S., Marble, A., Bøgwald, K.-P., Sørbye, Ø., Sjaastad, M. C., & Heyerdahl, O. (2010). The mediating role of insight for long-term improvements in psychodynamic therapy. Journal of Consulting and Clinical Psychology, 78(3), 438-448. http://dx.doi.org/10.1037/a0019245
Kallestad, H., Valen, J., McCullough, L., Svartberg, M., Høglend, P., & Stiles, T. C. (2010). The relationship between insight gained during therapy and long-term outcome in short-term dynamic psychotherapy and cognitive therapy for cluster C personality disorders. Psychotherapy Research, 20(5), 526-534. https://doi.org/10.1080/10503307.2010.492807
Kandel, E. (1999). Biology and the future of psychoanalysis: New intellectural framework for psychiatry revisited. American Journal of Psychiatry, 156, 505-524. https://ajp.psychiatryonline.org/doi/pdf/10.1176/ajp.156.4.505
Klug, G., Zimmermann, J., & Huber, D. (2016). Outcome trajectories and mediation in psychotherapeutic treatments of major depression. Journal of the American Psychoanalytic Association, 64(2), 307-343. https://doi.org/10.1177/0003065116644742
Laska, K. M., Gurman, A. S., & Wampold, B. E. (2014). Expanding the lens of evidence-based practice in psychotherapy: A common factors perspective. Psychotherapy, 51(4), 467-481. http://dx.doi.org/10.1037/a0034332
Leichsenring, F., & Rabung, S. (2011). Long-term psychodynamic psychotherapy in complex mental disorders: Update of a meta-analysis. The British Journal of Psychiatry, 199, 15–22. https://doi.org/10.1192/bjp.bp.110.082776
Midgley, N., & Kennedy, E. (2011). Psychodynamic psychotherapy for children and adolescents: A critical review of the evidence base. Journal of Child Psychotherapy, 37(3), 232-260. http://dx.doi.org/10.1080/0075417X.2011.614738
Parker, B., & Turner, W. (2014). Psychoanalytic/psychodynamic psychotherapy for sexually abused children and adolescents: A systematic review. Research on Social Work Practice, 24(4), 389-399. https://doi.org/10.1177/1049731514525477
Rizeanu, S. (2016). Psychotherapy of borderline personality disorder. Romanian Journal of Experimental Applied Psychology, 7(3), 76-81. doi: 10.15303/rjeap.2016.v7i3.a7
Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 65(2), 98-109. doi: 10.1037/a0018378,
Shepherd, C., & Beail, N. (2017). A systematic review of the effectiveness of psychoanalysis, psychoanalytic and psychodynamic psychotherapy with adults with intellectual and developmental disabilities: Progress and challenges. Psychoanalytic Psychotherapy, 31(1), 94-117. https://doi.org/10.1080/02668734.2017.1286610
Soares, M. C., Mondin, T. C., Silva, G. D. G. D., Barbosa, L. P., Molina, M. L., Jansen, K., Souza, L. D. M., & Silva, R. A. D. (2018). Comparison of clinical significance of cognitive-behavioral therapy and psychodynamic therapy for major depressive disorder: A randomized clinical trial. Journal of Nervous and Mental Disease, 206(9), 686-693.
Waldron, S., Gazzillo, F., Genova, F., & Lingiardi, V. (2013). Relational and classical elements in psychoanalyses: An empirical study with case illustrations. Psychoanalytic Psychology, 30(4), 567-600. Waldron, S., Gazzillo, F., & Stukenberg, K. (2015). Do the processes of psychoanalytic work lead to benefit? Studies by the APS Research Group and the Psychoanalytic Research Consortium. Psychoanalytic Inquiry, 35, 169-184. https://doi.org/10.1080/07351690.2015.987602