Psychoanalysis/Archives/2003-2005 - Training and Research - Evaluation of Effectiveness

Evaluation of Effectiveness

Several meta-analyses have shown psychoanalysis and psychodynamic therapy to be effective, with outcomes comparable or greater than other kinds of psychotherapy or antidepressant drugs. These arguments have also been subjected to various criticisms. A 2005 review of randomized controlled trials found that "psychoanalytic therapy is (1) more effective than no treatment or treatment as usual, and (2) more effective than shorter forms of psychodynamic therapy". Empirical research on the efficacy of psychoanalysis and psychoanalytic psychotherapy has also become prominent among psychoanalytic researchers. Recently, however, the methodologies of some meta-analytic studies have been criticised.

A 2001 systematic review of the medical literature by the Cochrane Collaboration concluded that no data exist demonstrating that psychodynamic psychotherapy is effective in treating schizophrenia, and cautioned that medication should always be used alongside any type of talk therapy in schizophrenia cases. Further data also suggest that psychoanalysis is not effective (and possibly even detrimental) in the treatment of sex offenders. Experiences of psychoanalysts and psychoanalytic psychotherapists and research into infant and child development have led to new insights. Theories have been further developed and the results of empirical research are now more integrated in the psychoanalytic theory. The Schizophrenia Patient Outcomes Research Team against the use of psychodynamic therapy in cases of schizophrenia, arguing that more trials are necessary to verify its effectiveness. (PORT) report argues in its Recommendation 22

According to a 2004 French review conducted by INSERM, psychoanalsysis was presumed or proven effective at treating panic disorder, post-traumatic stress and personality disorders. However it was said to have "little or no effect" on treating schizophrenia.

In 2011, the American Psychological Association made 103 comparisons between psychodynamic treatment and a non-dynamic competitor and found that 6 were superior, 5 were inferior, 28 had no difference and 63 were adequate. The study found that this could be used as a basis "to make psychodynamic psychotherapy an "empirically validated" treatment."

Meta-analyses of Short Term Psychodynamic Psychotherapy (STPP) have found effect sizes ranging from 34-71% compared to no treatment and was found to be slightly better than other therapies in follow up. Other reviews have found an effect size of 78-91% for somatic disorders compared to no treatment and 69% for treating depression. A 2012 meta-analysis by the Harvard Review of Psychiatry of Intensive Short-Term Dynamic Psychotherapy (I-STPP) found effect sizes ranging from 84% for interpersonal problems to 151% for depression. Overall I-STPP had an effect size of 118% compared to no treatment.

A system review of Long Term Psychodynamic Psychotherapy in 2009 found an overall effect size of 33%. Others have found effect sizes of 44-68%. Some have used these findings to suggest LTPP is not a worthwhile therapy, writing in Psychology Today, Jim Coyne said "The bottom line is that available evidence suggests that LTPP is not worthwhile, at least in terms of the conventional ways of evaluating therapies."

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