Information about Psychoanalytic, Psychodynamic Therapy and Society
The status of psychodynamic psychotherapy as an empirically supported treatment for common mental disorders –an umbrella review based on updated criteria
Falk Leichsenring, Allan Abbass, Nikolas Heim, John R. Keefe, Steve Kisely, Patrick Luyten, Sven Rabung, Christiane Steinert.
To assess the current status of psychodynamic therapy (PDT) as an empirically supported treatment (EST), we carried out a pre-registered systematic umbrella review addressing the evidence for PDT in common mental disorders in adults, based on an updated model for ESTs. Following this model, we focused on meta-analyses of randomized controlled trials (RCTs) published in the past two years to assess efficacy. In addition, we reviewed the evidence on effectiveness, cost-effectiveness and mechanisms of change. Meta-analyses were evaluated by at least two raters using the proposed updated criteria, i.e. effect sizes, risk of bias, inconsistency, indirectness, imprecision, publication bias, treatment fidelity, and their quality as well as that of primary studies. To assess the quality of evidence we applied the GRADE system. A systematic search identified recent meta-analyses on the efficacy of PDT in depressive, anxiety, personality and somatic symptom disorders. High quality evidence in depressive and somatic symptom disorders and moderate quality evidence in anxiety and personality disorders showed that PDT is superior to (inactive and active) control conditions in reducing target symptoms with clinically meaningful effect sizes. Moderate quality evidence suggests that PDT is as efficacious as other active therapies in these disorders. The benefits of PDT outweigh its costs and harms. Furthermore, evidence was found for long-term effects, improving functioning, effectiveness, cost-effectiveness and mechanisms of change in the aforementioned disorders. Some limitations in specific research areas exist, such as risk of bias and imprecision, which are, however,comparable to those of other evidence-based psychotherapies. Thus, according to the updated EST model, PDT proved to be an empirically-supported treatment for common mental disorders. Of the three options for recommendation provided by the updated model (i.e., “very strong”, “strong” or “weak”), the new EST criteria suggest that a strong recommendation for treating the aforementioned mental disorders with PDT is the most appropriate option. In conclusion, PDT represents an evidence-based psychotherapy. This is clinically important since no single therapeutic approach fits all psychiatric patients, as shown by the limited success rates across all evidence-based treatments.
John Thor Cornelius, M.D. has posted an accessible presentation that scrutinizes the evidence base for antidepressant medication, cognitive-behavioral therapy, and psychoanalytic treatment.
By Jonathan Shedler, University of Colorado Denver School of Medicine
Empirical evidence supports the efficacy of psychodynamic
therapy. Effect sizes for psychodynamic therapy are as
large as those reported for other therapies that have been
actively promoted as “empirically supported” and “evidence
based.” In addition, 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.
Click for full article
Just when you thought psychoanalysis had breathed its last, research resurrects and even validates certain core Freudian beliefs. Forget penis envy. Think conflicting motives and what talking to a shrink four days a week can do for you.
…..What attracted Shteyngart to psychoanalysis is precisely what has for more than a century made it fodder for impassioned, and often ugly, debate.
It is time-intensive and prohibitively expensive. Its benefits are not easy to measure, particularly compared with those promised by more popular, contemporary methods of treatment like cognitive behavioral therapy (CBT). As a result, psychoanalysis has been dropped from the curriculum of many medical schools and is rarely covered by insurance plans. When it is taught and practiced, experts say, modern psychoanalysis, also called psychodynamic psychotherapy, often bears little resemblance to the treatment put forward by its founding father, Sigmund Freud.
But psychoanalysis is a profound exploration of human subjectivity—our inner world with all its memories and desires and impulses—and its relation to the external, objective world. And it is much more than a treatment. It’s also a set of theories about the nature of human experience, its depth and complexity. “Analysis is the most elaborate and nuanced view of the mind that we have,” Nobel-winning neuroscientist Eric Kandel recently told a meeting of the American Psychoana-lytic Association.