But my belief has changed about what counts as a "gold standard." And it was a study by Consumer Reports (1995, November) that singlehandedly shook my belief. I came to see that deciding whether one treatment, under highly controlled conditions, works better than another treatment or a control group is a different question from deciding what works in the field (Muñoz, Hollon, McGrath, Rehm, & VandenBos, 1994). I no longer believe that efficacy studies are the only, or even the best, way of finding out what treatments actually work in the field. I have come to believe that the "effectiveness" study of how patients fare under the actual conditions of treatment in the field, can yield useful and credible "empirical validation" of psychotherapy and medication. This is the method that Consumer Reports pioneered.
The efficacy study is the wrong method for empirically validating psychotherapy as it is actually done, because it omits too many crucial elements of what is done in the field. (italics author's)
(Regarding the Consumer Reports survey) Long-term therapy produced more improvement than short-term therapy. This result was very robust, and held up over all statistical models. ... No specific modality of psychotherapy did any better than any other for any problem. These results confirm the "dodo bird" hypothesis, that all forms of psychotherapies do about equally well (Luborsky, Singer, & Luborsky, 1975). They come as a rude shock to efficacy researchers, since the main theme of efficacy studies has been the demonstration of the usefulness of specific techniques for specific disorders. ....
Respondents whose choice of therapist or duration of care was limited by their insurance coverage did worse ...
This is what psychoanalysts make conscious -- the patterns that disable and limit people -- ones that give ulcers either to individuals themselves, or to recipients in their orbit.
(Psychodynamic psychotherapy) helps people grow, change, integrate, modulate, decrease self-absorption, regard themselves accurately, take themselves seriously but not too seriously, free up emotional energy in service of mastery and generativity -- in short, become their best selves.
The reverberations go well beyond the individual, fostering richer and fuller family life, as well as functional and productive organizations, all with enormous ripple effect. This can help break the kinds of destructive cycles which, if left untreated, keep echoing through the generations.
Cognitive behavioral therapy (CBT) has emerged, both in the research literature and in the media, as a "first among equals" in psychotherapy — most often studied and most frequently cited in news reports. ..... But considerable research also supports the efficacy of other types of psychotherapy, in particular psychodynamic therapy. In fact, a review in American Psychologist cited evidence that psychodynamic therapy is just as effective as CBT, and that the benefits may increase over time
...randomized controlled studies support the use of psychodynamic therapy for anxiety,
borderline personality disorder, depression, eating disorders, post-traumatic stress disorder, panic disorder, somatoform disorders, and substance-use disorders.
Nevertheless, there is now enough research available to support the claim that psychodynamic therapy is an evidence-based treatment with effect sizes similar to or superior to those reported for other psychotherapies. In the current reimbursement environment, however, a significant practical challenge is whether psychodynamic therapy will also prove to be cost-effective — especially in the "real world," where practitioners vary in terms of skills and experience, and patients vary in commitment to continuing therapy.
For years psychoanalysts did little to disseminate ideas outside their own circles, and this self-imposed exile from academic research left a void, into which was born an alternative: cognitive-behavior therapy (CBT). In this newer approach, therapists focused on specific problems and readily observable thoughts and behaviors, rather than embracing the messy, emotional complexity of people’s mental lives.
The reality is that psychodynamic therapy has proved its effectiveness in rigorous controlled studies. Not only that, but research shows that people who receive psychodynamic therapy actually continue to improve after therapy ends—presumably because the understanding they gain is global, not targeted to encapsulated, one-time problems. Thanks to misinformation and entrenched interests, however, much of this research has been ignored.
I delved into the research supporting psychodynamic therapy because I kept encountering patients who had been shunted from one “quick "x” treatment to another, with little or no lasting benefit. In my experience, the brief therapies promoted as “empirically supported” were often failing, despite claims that their benefits are scientifically proven.
when CBT was successful, it was largely because therapists departed from their official playbook and did the kinds of things psychodynamic therapists do.
Psychodynamic therapy is based on these truths and has demonstrated its benefits scientifically. It’s time for academic researchers to examine their resistance to the truth.
In moderate/mixed pathology, the overall success rates (64% at termination; 55% at follow-up), the percentage of large ESs (65% at termination; 69% at follow-up), and the weighted mean ESs (0.78 at termination; 0.94 at follow-up) indicate substantial effectiveness, whichwas maintained for years after treatment termination.
When differentiating between symptom reduction and personality changes, it appears that the effects for moderate/mixed pathology were more pronounced for the former (ES=1.03) than for the latter (ES=0.54).
(Note "ES" = Effect Size - ed)
These findings are consistent with the assumption that (Long-term Psychodynamic Therapy is characterized by a slower rate of change compared with brief treatment (probably because it focuses less on symptomatic improvement), but is associated with more lasting, and perhaps broader, changes.
Several studies investigating the process of change in psychodynamic therapy have also found a significant relationship between the use of theoretically consistent techniques (such as interventions aimed at fostering emotional experience, addressing defenses, exploring the past, or drawing connections between different relationships in client’s life, including with his or her therapist) and therapeutic change.
Patients with Cluster A/B and C (Personality Disorder) were responsive to (Short-Term Pscyhodynamic Psychotherapy), with the majority of all patients studied showing clinically significant change on self-report measures.
STPP warrants consideration as a first line treatment for combined personality disorder and depression.
"It was a very long-term and comprehensive study done by the Menninger Clinic of 22 psychoanalytic patients and 20 in psychotherapy, starting in the early 1950’s. Wallerstein was the Menninger Foundation’s Director of Research at the time of publication; to the best of my knowledge it is still in press with a much lower cover price than the original $45."