Effectiveness

Meta-Analyses



 

Shedler, Jonathan. (2010) Efficacy of psychodynamic psychotherapy. American Psychologist 65 (2) 98-109

Excerpts:

There is a belief in some quarters that psychodynamic concepts and treatments lack empirical support or that scientific evidence shows that other forms of treatment are more effective. The belief appears to have taken on a life of its own. Academicians repeat it to one another, as do health care administrators, as do health care policymakers. With each repetition, its apparent credibility grows. At some point, there seems little need to question or revisit it because “everyone” knows it to be so. The scientific evidence tells a different story: Considerable research supports the efficacy and effectiveness of psychodynamic therapy.

The consistent trend toward larger effect sizes at follow-up suggests that psychodynamic therapy sets in motion psychological processes that lead to ongoing change, even after therapy has ended. ….. In contrast, the benefits of other (nonpsychodynamic) empirically supported therapies tend to decay over time for the most common disorders (e.g., depression, generalized anxiety.-----

Findings concerning personality disorders are particularly intriguing. A recent study of patients with borderline personality disorder (Clarkin, Levy, Lenzenweger, & Kernberg, 2007) not only demonstrated treatment benefits that equaled or exceeded those of another evidence-based treatment, dialectical behavior therapy (Linehan, 1993), but also showed changes in underlying psychological mechanisms (intrapsychic processes) believed to mediate symptom change in borderline patients (specifically, changes in reflective function and attachment organization; Levy et al., 2006). These intrapsychic changes occurred in patients who received psychodynamic therapy but not in patients who received dialectical behavior therapy.-----

The “active ingredients” of therapy are not necessarily those presumed by the theory or treatment model. …. studies indicate that the active ingredients of other therapies include unacknowledged psychodynamic elements….  psychodynamic interventions, not CBT interventions, predicted successful outcome in both cognitive and psychodynamic treatments …. the findings do indicate that the more effective therapists facilitated therapeutic processes that have long been core, centrally defining features of psychoanalytic theory and practice..-----

….The goals of psychodynamic therapy include, but extend beyond, alleviation of acute symptoms. Psychological health is not merely the absence of symptoms; it is the positive presence of inner capacities and resources that allow people to live life with a greater sense of freedom and possibility. Symptom-oriented outcome measures commonly used in outcome studies ….. do not attempt to assess such inner capacities.

In light of the accumulation of empirical findings, blanket assertions that psychodynamic approaches lack scientific support ….. are no longer defensible.

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Leichsenringen, Falk and Rabung, Sven (2008) Effectiveness of long-term psychodynamic psychotherapy: A meta-analysis JAMA 300(13): 1551-1565
 

Excerpts:
 

Evidence suggests that short-term psychotherapy is sufficiently effective for most individuals experiencing acute distress.9 Evidence, however, also indicates that short-term treatments are insufficient for a considerable proportion of patients with complex mental disorders, ie, patients with multiple or chronic mental disorders or personality disorders.

In this meta-analysis, LTPP was significantly superior to shorter-term methods of psychotherapy with regard to overall outcome, target problems, and personality functioning. Long-term psychodynamic psychotherapy yielded large and stable effect sizes in the treatment of patients with personality disorders, multiple mental disorders, and chronic mental disorders. The effect sizes for overall outcome increased significantly between end of therapy and follow up.

In this meta-analysis, the number of LTPP sessions was significantly correlated with improvements in both target problems and general psychiatric symptoms. These results are consistent with previous findings. However, no such correlations were found for the duration of LTPP. The number of sessions and duration of LTPP appear to be different parameters that function differently with regard to the psychotherapeutic process and outcome.

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Lipsey, Mark W. and Wilson, David B.(1993: The efficacy of psychological, educational and behavioral treatment: Confirmation from meta-analysis. American Psychologist, 1181-1209


Excerpts:

What we conclude from this broad review of meta-analytic evidence is that well-devloped psychological, educational and behavioral treatments have meaningful effects on the intented outcome variables.  The number and scope of effective treatments covered by this conclusion are impressive, and the magnitude of the effects for a substantial portion of those treatments is in the range of practical significance by almost any reasonable criterion.

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Burlingame, Gary M., Fuhriman, A., & Mosier (2003). The differential effectiveness of group psychotherapy: A meta-analytic perspective. Group Dynamics: Theory, Research, and Practice, 7, 3-12.
 

Excerpts:

The fact that the average active group treatment client was better off than the untreated controls (average ES _ 0.58) provides quantitative support for group treatment as an independently efficacious treatment. The pre- to posttreatment change comparisons begin by underscoring the overall effectiveness of group therapy. Improvement did, indeed, take place, thus confirming that group therapy works.

Patients suffering from depression and eating disorders indicated more improvement than did those with other disorders ….. the results indicate that clients in homogeneous groups outperformed those in  groups with mixed symptoms.

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Miller, Scott, Bruce Wampold and Katelyn Varhely (2008), Direct comparisons of treatment modalities for youth disorders: a meta-analysis, Psychotherapy Research, 18(1) 5-14.
 

Excerpts:

In a meta-analysis of treatments for depression in children, Weisz, McCarty, and Valeri (2006) found that, although various treatments were more effective than no treatment (but with smaller effects than the adult literature), no difference in outcome was found between cognitive and noncognitive approaches. Importantly, none of the approaches currently listed by the American Academy of Child and Adolescent Psychiatry (1997, 1998) Task Force on the Promotion and Dissemination of Psychological Procedures (1995) have been shown to be demonstrably superior to other treatments intended to be therapeutic for the disorder treated.

Analyses of the adult literature limited to direct comparisons of bona fide treatments have provided strong support for the equivalence of outcome, what has long been referred to as the ‘‘dodo bird verdict

Furthermore, controlling for allegiance of the researcher to the treatment approach under investigation removed all variability among the effects. In other words, allegiance explained all the observed systematic differences among treatments.

Interestingly, this result is consistent with the finding that evidence-based treatments for youth are superior to usual care only if the evidence-based treatment was developed by the researcher

Given the significant effect that researcher allegiance was shown to have on outcome in this and other studies, considerable care will need to be exercised to ensure evenly balanced allegiance between the treatments being compared.

In light of these and other findings cited, current attempts aimed at identifying and codifying a list of best practices for the treatment of children and adolescents can at best be viewed as premature and at worst misleading. At a minimum, much more research comparing two or more bona fide treatments needs to be done before professional organizations, payers, and regulators deem specific approaches as ‘‘best.’’

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Smith, Mary Lee and Glass, Gene V (1977).  Meta-analysis of psychotherapy outomce studies.  American Psychologist September, p752-776

This article is included here because this is the first meta-analysis of of psychotherapy outcome

Excerpts

Most academics have read little more than Eysenck's (1952,1965) tendentious diatribes ...

Thus, the average client receiveing therapy was better off than 75% of the untreated controls.

Depite volumes devoted to the theoretical differences among different schools of psychotherapy, the results of research demonstrate negligible differences in the effects produced by different therapy types.  Unconditional judgjments of superiority of one type or another of psychotherapy, and all that these claims imply about treatment and training policy, are unjustified.

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