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By Falk Leichsenring 4 and Susanne Klein
Clinic of Psychosomatics and Psychotherapy, Justus-Liebig-University Giessen, Giessen, Germany
This article reviews the empirical evidence for psychodynamic therapy for specific mental disorders in adults. According to the results presented here, there is evidence from randomized controlled trials (RCTs) that psychodynamic therapy is efficacious in common mental disorders, including depressive disorders, anxiety disorders, somatoform disorders, personality disorders, eating disorders, complicated grief, posttraumatic stress disorder (PTSD), and substance-related disorders. These results clearly contradict assertions repeatedly made by representatives of other psychotherapeutic approaches claiming that psychodynamic psychotherapy is not empirically supported. However, further research is required, both on outcome and processes of psychodynamic psychotherapy. There is a need, for example, for RCTs of psychodynamic psychotherapy of PTSD. Furthermore, research on long-term psychotherapy for specific mental disorders is required.
Keywords: psychodynamic psychotherapy; empirically supported treatments; psychotherapy outcome research; evidence-based medicine
In this article, the available evidence for psychodynamic psychotherapy (PDT) in adults is reviewed. The focus will be on randomized controlled trials (RCTs), which are regarded as the ‘gold standard’ for demonstrating treatment efficacy. Previous reviews have been undertaken, for example, by Fonagy, Roth, and Higgitt (2005), Leichsenring, Klein, and Salzer (in press), Shedler (2010), and Gerber et al. (2011). Shedler (2010) came to the conclusion that effect sizes of PDT are as large as those reported for other forms of psychotherapy that are regarded as ‘empirically supported.’ In addition, he found that effects of PDT were stable or tended to improve after the end of treatment. In a quality-based review of RCTs, Gerber et al. (2011) found PDT to be at least as efficacious as another active treatment in 34 of 39 studies (87%). In comparison with inactive conditions, PDT was superior in 18 of 24 adequate comparisons (75%). In another quality-based review of RCTs, Thoma et al. (2012) examined the methodological quality of RCTs of cognitive-behavioral therapy (CBT) in depression. Contrary to their expectation, the authors found no significant differences in methodological quality between RCTs of CBT in depression and RCTs of PDT. Taking the frequently put forward criticism of the methodological quality of studies of PDT into account (e.g., Bhar & Beck, 2009), the result reported by Thoma et al. (2012) is of some importance. In another context, we showed that often double standards were applied when studies of PDT were criticized by representatives of other approaches (Leichsenring & Rabung, 2011).
4 Corresponding author. Email: falk.leichsenring@psycho.med.uni-giessen.de
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