Shedler’s paper aggregates these studies and presents the encouraging results. He analyzed multiple studies conducted around the world by clustering them into single, larger studies (meta-analyses). And perhaps his most important finding, concluded from five different meta-analyses that he created, is that positive change and patient growth continue to develop beyond therapy termination, as measured in follow-up assessments conducted as long as three years post-treatment. This finding suggests that psychodynamic psychotherapy provides patients with the tools to continue to function better in the world, feel better about themselves, reduce psychiatric symptoms and face life’s challenges with greater flexibility and freedom well beyond the end of their sessions.
Shedler explains that the scope of psychodynamic psychotherapy includes the reduction of psychiatric symptoms but is more ambitious in that it hopes to foster the positive presence of psychological capacities and resources. Improving self-esteem, changing distorted views of self and others and helping patients to find greater satisfaction in relationships while mastering life’s many challenges are often goals of the therapy, mutually determined by patient and therapist.
The second section of the paper delivers the strongest message for both the general public and the larger world of psychiatric care. Shedler’s analyses demonstrate very strong effects for psychodynamic psychotherapy. As he says, “Randomized controlled trials support the efficacy of psychodynamic psychotherapy for depression, anxiety, panic disorder...eating disorders, substance disorders and personality disorders.” Shedler’s findings withstood unusually rigorous demands of journal reviewers, over a full year, who required three revisions and re-submissions before publication.
The third section of Shedler’s paper describes studies that suggest that many forms of therapy share common “active ingredients” that traditionally characterize psychodynamic psychotherapy. And that may partly explain the positive outcomes they achieve. There may even be active ingredients -- such as empathic listening, establishing a therapeutic alliance, setting treatment goals and the patient’s hopes and expectations -- that are common to all psychotherapy approaches. For example, perhaps the distinctions between an emphasis on cognition, as in cognitive-behavioral therapy, and an emphasis on emotions, as in psychodynamic psychotherapy, are not as critical as theory dictates.
Shedler’s findings are not without detractors, however, and he too describes the limitations of his work. He calls for more research on psychodynamic psychotherapy, explaining that, despite the strength of his current findings, there are not yet an adequate number of studies. And he points out that many of the studies he analyzed are treatments for a range of conditions rather than for specific psychiatric disorders. Other treatments, cognitive-behavioral therapy in particular, have conducted studies for specific disorders -- which allows for a sharper focus on whether the specifics of a treatment are effective for a given disorder. Work to correct that deficit is under way: since 2005, an increasing number of studies have looked at psychodynamic psychotherapy treatments for specific disorders.
Other criticisms have appeared, mostly from researchers in cognitive-behavioral approaches to treatment. The criticism tends to mirror Shedler’s statements of the limitations of his conclusions but takes them to an extreme. For example, some critics dismiss the value of the research entirely because the efficacy studies are for mixed disorders rather than for a specific disorder.
This paper is born into a psychological world that has seen rancorous disputes, often seeming to be guild-based rather than scientifically based. The adherents of cognitive-behavioral therapy understandably resented the arrogance of the psychodynamic practitioners who refused to submit their treatments to research initiatives. Now that psychodynamic psychotherapists have a sense of urgency to provide an evidence base, some cognitive-behavioral researchers can’t find room to consider them scientists. Some even want only their treatments to be considered evidence-based, despite the growing evidence base on psychodynamic psychotherapy, and ask that training programs in psychology teach only their treatment approaches while accusing other psychologists of not being interested in science.
We would counter that psychodynamic psychotherapy has evolved. There is a freshness to its modern forms, which include an emphasis on the healing power of the relationship in addition to Freud's emphasis on making the unconscious conscious. It's not an outdated relic or a spiritual exercise. As accumulating research confirms, it provides lasting benefits in people's lives and is worth the energy and expense. To those who dismiss it as outmoded we would say: You might want to try it again for the first time.
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Add CommentFinally, somebody did the work that was needed to show what we have already known. Bravo!
Reply | Report Abuse | Link to thisThis is a wonderfully interesting article, and Im glad that it gives the larger public an awareness of this whole body of research. From my vantage-point as a therapist, one of the things the authors make reference to thats most interesting is the notion of how common factors appear operative in various schools of psychotherapy. Id love to see Scientific American do a piece on this issue within the field. Meanwhile, thanks for publishing this!
Reply | Report Abuse | Link to thisThis is a wonderfully interesting article, and I’m glad that it gives the larger public an awareness of this whole body of research. From my vantage-point as a therapist, one of the things the authors make reference to that’s most interesting is the notion of how “common factors” appear operative in various schools of psychotherapy. I’d love to see Scientific American do a piece on this issue within the field. Meanwhile, thanks for publishing this!
Reply | Report Abuse | Link to thisWell, I wouldn't say it what WE have already known, if we place the WE in the larger context of everyone. There is a large contingent of the general populace who disagrees with the efficacy of talk therapy..."you're seeing a therapist? What are you, crazy??"...having empirical evidence behind it makes it a bit more "valid".
Reply | Report Abuse | Link to thisNow, when we consider a world where Kevin Trudeau can convince millions of people they can cure their own cancer with some herbs, empirical evidence isn't generally considered valuable, but it can help those who are on the fence in dealing with reality. :)
Besides, it's not good science to say something works without empirical evidence!
Spoonman - Exactly my thoughts. I'd say that this article affirms what psychotherapists already believed, anyway! Not that I have any real knowledge of the subject, but I've always been very skeptical of it: this article did not change that.
Reply | Report Abuse | Link to thisAs a Psychodynamic Psychotherapist I am excited about this paper. Not enough research about PP but this paper says it all!!
Reply | Report Abuse | Link to thisLyn Ezekiel
The idea that some critics (presumably CBT disciples) “dismiss the value of the research entirely because the efficacy studies are for mixed disorders rather than for a specific disorder” is ludicrous.
Reply | Report Abuse | Link to thisConsidering that DSM-IV has no established scientific validity or reliability calls into question the validity of all research based on DSM-IV criteria. Are they truly measuring what they are trying to measure? is my understanding of validity. Reliability pertains to the results being reliably reproducible. Validity itself is dependent on reliability.
It is not for want of trying. The APA has attempted to establish validity and reliability for the DSM-IV but has been unable to. Basically, people can get ten different diagnoses from ten different practioners. Moreover, once an accurate diagnosis (which is often characterized as an all important goal to proper treatment) there is no empirically demonstrated single treatment model showing consistent efficacy for these supposed categorical disorders.
As a mental health practioner DSM-IV diagnostic categories are useless in helping to understand the etiology of an individual's psychological problems or treatment. I have never encountered one patient whose symptoms were restricted to the categorized constellation of symptoms equating to a specific mental disorder (five symptoms, yes, four no) described in the DSM-IV and which have no correspondence to anything in nature. The universe just doesn't work this way.
In my experience, all mental disorders are mixed disorders. Indeed, more often, the medical model causes narrow symptom based thinking and treatment that excludes learning the underlying source of the problem. Like fevers, psychological maladies have many different sources but similar presentations. One can take ibuprofin to treat a fever. However, I would suggest that if the fever lingers, treating the underlying source would be better course of action.
Moreover, the common variable across psychotherapy models and the best predictor of outcome is the quality of the Therapeutic Alliance. Psychodynamic psychotherapy methods inherently, if unintentionally, place more emphasis on initiating and preserving the alliance (a genuine interest in the individual and understanding the idiosyncratic sources of their suffering as opposed to symptom focus, respect for complexity, empathy, emphasis on the therapeutic relationship and transference and attachment impediments that inhibit establishing and maintaining a productive working relationship, the unconscious wishes and fears revealed in fantasy and interpretation or, in other words, helping a patient create a narrative--creating language for experience--which allows, as humans think in language, the patient to think and feel about their experience—mindfulness--which allows for greater emotional regulation and control) all foster therapeutic alliance.
Neuroscience is, in fact, confirming many of the constructs of psychodynamic theory.