Psychotherapy | Judith Staley

Does Psychotherapy Work?

Questions and Answers

Q. Does psychodynamic psychotherapy work?

A. The short answer is ‘Yes, psychodynamic psychotherapy has been shown to be effective. In fact many studies have shown that it works better than other psychological therapies, and better than medication.’
But read on.

Below is a quote from Scientific American Mind (www.ScientificAmerican.com/Mind). The author is Jonathan Shedler, an Assistant Professor of Psychiatry at the University of Colorado School of Medicine, and Director of Psychology at the University of Colorado Hospital Outpatient Psychiatry Service. (http://psychsystems.net/shedler.html).

‘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...’

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Q. How do you know psychodynamic psychotherapy works?

A. For many years researchers have been studying the effectiveness of various forms of psychological therapy. Some have studied patients' symptoms before and after treatment. Some have compared how a group of people fared before and after treatment in contrast to a comparable group of people who did not receive treatment. (The group who did not receive treatment is called a control group.) Some have compared the effectiveness of  psychodynamic psychotherapy in contrast to other psychological therapies like Cognitive Behaviour Therapy (CBT). More recently, researchers have also been following up on people who have received various forms of psychological therapy to see how they are doing months or years after therapy ended.

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Q. What are the results of these studies?

A. Some researchers have analysed the results of many studies taken together. This is called meta-analysis. One meta-analysis by researchers led by Abbass showed that the treatment benefit (the amount the patient improved)  for psychodynamic psychotherapy could be expressed in statistical terms as .97. Another meta-analyis by researchers led by Haby showed that the treatment benefit for Cognitive Behaviour Therapy (CBT) was less:  .68.  A higher number means greater gains for the patient. The Abbass meta-analysis also looked at how the patients were doing 9 months or more after psychodynamic psychotherapy ended. The therapeutic benefits were even greater: 1.5. This means that the patients continued to get better after psychodynamic psychotherapy ended.

Here is another quote from Shedler, this time from a professional journal called American Psychologist.

‘In contrast, the benefits of other (nonpsychodynamic)...  therapies tend to decay over time for the most common disorders.’

In other words, patients seen for psychodynamic psychotherapy continue to get better after treatment, but those seen for other types of psychological therapy generally deteriorate over time.

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Q. What do these numbers mean to someone like me?

A. There are several ways to answer this question.

First, let’s consider the numbers themselves. In scientific studies like the ones I have described, and scientific studies of the effectiveness of medication, for instance, the treatment benefits are usually categorised as small, moderate or large. A treatment benefit of. 2 would be a small benefit; .5 would be a moderate benefit; .8 would be large. Using this scale, the benefits of psychodynamic psychotherapy are large (.97) at the end of treatment, and even larger months later (1.5). By the way, the treatment benefits for antidepressants are typically .31.

Next, it is worth saying that the numbers are important, because they are an easily-understood way of communicating differences between the effectiveness of various forms of treatment.

Further, let’s consider what the benefits of psychological therapy might be. Someone considering psychological therapy might ask questions like these:

Of course, there are as many questions as there are people in the world, because each person has her or his own history and set of circumstances.

The questions listed above represent symptoms  that have underlying causes. (The person  who feels angry a lot might have been beaten or neglected as a child, for instance. The person who feels anxious a lot might have experienced a lot of criticism.)

All psychological  therapies  are designed to relieve symptoms, like reducing levels of depression and anxiety. But psychodynamic psychotherapy sets out to do more. Shedler again, from Scientific American Mind:

‘But psychodynamic treatment aims for more: it focuses on building core psychological strengths - such as the capacity have more fulfilling relationships, to make more effective use of one’s abilities, and to face life’s challenges with greater freedom and flexibility.’

This emphasis on ‘core psychological strengths’ might be the reason why patients continue to get better after psychodynamic psychotherapy ends.

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Q. How do I choose a psychological therapist?

A. If you are considering psychological therapy, it would be a good idea to interview therapists who work differently. This will give you the opportunity to judge whether you think you could work well with the therapist as a person, and with the model of therapy that the therapist uses.

You may find this book helpful:

Symington, N., Symington, J., Symington, A., & Symington D . (2003). How to Choose a Psychotherapist. London: Karnac.

If you have any questions about what you have read here, feel free to contact me.

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Q & A References:

Abbass, A. A., Hancock, J. T., Henderson, J., & Kisely, S. (2006). Short-term psychodynamic psychotherapies for common mental disorders. Cochrane Database of Systematic Reviews, Issue 4, Article No. CD004687. doi: 10.1002/14651858.CD004687. pub3   PDF Download

Haby, M. M., Donnelly, M., Corry, J., & Vos, T. (2006). Cognitive behavioural therapy for depression, panic disorder and generalized anxiety disorder: A meta-regression of factors that may predict outcome. Australian and New Zealand Journal of Psychiatry, 40, 9-19 PDF Download

Shedler, J. (2010). The Efficacy of Psychodynamic Psychotherapy.   American Psychologist, Feb - Mar, 98 - 109   PDF Download

Shedler, J. (2010). Getting to Know Me. Scientific American Mind, Nov- Dec, 52-57   PDF Download