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Validation of Psychodynamic Psychotherapy

A meta-analysis of 17 randomized, controlled studies of short-term psychodynamic psychotherapy has promising results, although some questions remain unanswered.

Although psychodynamic psychotherapy has less empirical support than interpersonal and cognitive-behavioral therapies, it remains a popular treatment for many psychiatric disorders. To investigate whether clinicians' faith in this treatment is justified, a German research group conducted a meta-analysis of 17 randomized, controlled trials of short-term psychodynamic psychotherapy (STPP). Thirteen of the studies had not been included in previous meta-analyses.

Selected studies used manual-based or well-described STPP (range, 7-40 sessions), did not include interpersonal therapy (because of its unclear relation to STPP), used experienced therapists, involved a single disorder, and employed well-defined outcome variables. Treated conditions were substance-use disorders, depression, eating disorders, personality disorders, social phobia, post-traumatic stress disorder, somatoform pain disorder, and "chronic functional dyspepsia." Comparison conditions were waiting list, treatment as usual, or other psychotherapies.

Effect sizes for improvement with STPP were robust. Effect sizes for the symptoms of the disorder being treated were 1.39 at the end of therapy and 1.57 at follow-up (average, 1 year). Effect sizes for symptoms of comorbid conditions and social functioning were 0.90 and 0.95, respectively, at the conclusion of therapy and 0.80 and 1.19 at follow-up. STPP was significantly more effective than a combination of no treatment and treatment as usual. STPP and other psychotherapies had equal efficacy.

Comment: STPP has greater effect sizes for treating various diagnoses than antidepressants have for treating major depression. However, this meta-analysis has covered too few studies to individually compare no treatment and treatment as usual with STPP, and it has not found STPP to be superior to other psychotherapies. Although these results are promising, the efficacy of long-term psychodynamic psychotherapy requires further study, as does the differential usefulness of this treatment in specific disorders.

— Steven Dubovsky, MD

Published in Journal Watch Psychiatry February 9, 2005

Citation(s):

Leichsenring F et al. The efficacy of short-term psychodynamic psychotherapy in specific psychiatric disorders: A meta-analysis. Arch Gen Psychiatry 2004 Dec; 61:1208-16.

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