The effectiveness of psychodynamic psychotherapy

A team from the Justus-Liebig University Giessen in Germany has conducted a systematic search for evidence for the effectiveness of psychodynamic psychotherapy. They concluded that this form of therapy was effective for a range of common mental disorders including major depressive disorder, social anxiety disorder, some personality disorders, somatoform pain disorder and anorexia nervosa. They also found some evidence for effectiveness in treating dysthymia, complicated grief, panic disorder, generalized anxiety disorder and substance abuse/dependence.

One of the criticisms made of psychodynamic psychotherapy is that it lacks evidence of effectiveness, especially as demonstrated by randomised controlled trials (RCTs). While there is some debate as to whether or not RCTs are the only acceptable evidence for the effectiveness of psychological treatments, they do remain the ‘gold standard’ for evidence-based medicine. For example, in the UK they are used by the National Institute for Health and Care Excellence (NICE) in forming its treatment guidelines.1 To date many RCTs have considered the effectiveness of cognitive behavioural therapies and these make up the majority of NICE’s recommended treatments for mild to moderate psychological difficulties. However, while psychodynamic psychotherapy may have lacked RCTs in the past, an increasing number of RCTs are now being conducted that look at other therapies, including psychodynamic psychotherapy.

The team from the Justus-Liebig University looked for RCTs which showed that psychodynamic psychotherapy was effective. They used strict selection criteria in choosing which studies to include, for example, the studies needed to have reliable and valid measures for diagnosis and outcome, to use treatment manuals or manual-like guidelines, and to involve adults being treated for specific problems. RCTs were chosen in which psychodynamic psychotherapy was shown to be superior to no treatment, placebo or an alternative treatment, or to be equivalent to an established treatment. In all, 39 trials were found which showed psychodynamic psychotherapy to be effective.

In considering specific conditions, the team considered psychodynamic psychotherapy to be effective if at least two trials showed positive results. Where only one trial was positive with a particular condition, then the team described this treatment as possibly effective. As noted above, this review of evidence indicates that psychodynamic psychotherapy is effective or possibly effective for most of the common mental disorders.

With an increasing amount of evidence that psychodynamic psychotherapy is at least as effective as other approaches, it is to be hoped that this form of therapy will become more widely available. Where therapies are broadly equally effective, then it should be for individuals to choose with which approach they feel most comfortable. As noted in the NICE Surveillance Report on depression, ‘one GDG member highlighted that the existing guideline has endorsed access to CBT at the expense of access to other equally effective therapies and by depriving patients of choice has also led to continued increases in anti-depressant prescribing’.

See ‘International psychoanalysis

1 For example, the NICE Pathway for depression currently recommends CBT and/or medication for mild to moderate depression. However, this recommendation may change. A 2013 NICE Surveillance Report notes that more recent evidence shows that CBT is no more effective than other several treatment modalities, including psychodynamic psychotherapy.

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