Peter Fonagy, head of the department of Clinical, Educational and Health Psychology at University College London and co-originator of Mentalization-based Therapy for Borderline Personality Disorder (BPD), recently published a report on the most current evidence for Psychodynamic Therapy in World Psychiatry. The 14-page article cites more than 200 recent studies and reviews the most current evidence for Psychodynamic Therapy for treating depression, anxiety, eating disorders, somatic (body) issues, drug dependence, psychosis, and personality disorders. Fonagy focused his review on individual studies (with a preference for randomized controlled trials when possible) over meta-analyses (although some meta-analyses were considered). While the review looked at all recent studies that claimed to use psychodynamic treatments, a broad definition of what Fonagy considers to be key aspects of psychodynamic theory and treatment was included:
“This review uses a broad definition of psychodynamic treatment as a stance taken to human subjectivity that is inclusive and aimed at comprehensive understanding of the interplay between aspects of the individual’s relationship with his/her environment, whether external or internal. It refers to the extraordinary potential for dynamic self-alteration and self-correction…(incorporating) a developmental perspective,…limitations on conscious influence, ubiquity of conflict, internal representation of relationships, mental defences, and that complex meanings can be attached to experience (pg 138).”
Here is a summary of his findings:There are several key disorders for which Fonagy was simply not able to find good research on Psychodynamic Therapy. It is important to note that absence of evidence does not constitute evidence of absence. In other words, the lack of strong research studies assessing the effectiveness of Psychodynamic Therapy for some conditions does not indicate that Psychodynamic Therapy is ineffective for those issues. It merely shows that more research needs to be done.Overall:
Psychodynamic Therapies appear to benefit individuals with depression, some forms of anxiety, eating disorders, somatic problems, and personality disorder.
Long-term Psychodynamic Therapies appear to benefit individuals with complex disorders. A strength of long-term Psychodynamic Therapies includes prolonged contact between patient and therapist.
As has long been the case, there is little evidence to suggest that Psychodynamic Therapies are superior to other approaches in general. Note: This does not mean that they are inferior. Assessing superiority of one treatment over another is a very complicated endeavor. CBT and Psychodynamic approaches continue to show comparable effectiveness across multiple domains. It is more a matter of individual fit.
Overall, Fonagy found support for the use of Psychodynamic Therapy for the treatment of depression. Effect sizes over placebo and other inactive controls were moderate rather than large. Evidence shows that benefits are maintained long-term.
There is no reliable evidence that CBT is superior to Psychodynamic treatment approaches. However, there are too few studies to establish equivalence. Evidence suggests that long-term Psychodynamic Therapy is effective for complex and chronic cases of depression.
Evidence supports effectiveness of Psychodynamic Therapy for Social Anxiety.
While CBT showed larger remission rates for phobia at termination, the differences between the two treatment approaches disappeared between 6-month and 2-year follow ups.
A lack of studies made it impossible to assess Psychodynamic Therapy for Generalized Anxiety Disorder.
Limited studies show support for Psychodynamic Therapy over applied relaxation for Panic Disorder. This is an area that needs further research.
There is some evidence for effectiveness in treating Post-traumatic Stress Disorder (PTSD).
No evidence was found to support effectiveness of Psychodynamic Therapy for Obsessive Compulsive Disorder (OCD).
Fonagy found strong evidence for effectiveness of Psychodynamic Therapy in the treatment of anorexia nervosa.
Evidence for the treatment of bulimia nervosa was inconclusive and warrants further study.
Somatic Disorders (e.g. chronic pain symptoms):
Fonagy found robust support for the effectiveness of Psychodynamic Therapy in the treatment of somatoform disorders compared to controls.
In particular, Interpersonal Therapy approaches (a type of Psychodynamic Therapy) showed substantial and long-term effects.
Fonagy did not find strong support for Psychodynamic Therapy or CBT over individual drug counseling.
In this area of treatment, it appears that group and individual treatment approaches that are specific to substance abuse issues may be superior.
Psychosis:Since psychotic disorders are often chronic and complex, treatment has increasingly focused on medication management.
Current evidence suggests that Psychodynamic Therapies provide short-term benefits, but that these benefits are not generally sustained long-term.
It should be noted that there is also limited evidence for the use of CBT to treat psychosis. This is another area where more research needs to be done.
Personality Disorders:This is an area where Psychodynamic Therapies continue to shine.
Evidence shows superiority over controls across suicidality, global and interpersonal functioning, and comorbid issues.
Fonagy notes that several Psychodynamic Therapies are officially endorsed by the American Psychological Association (Division 12) as empirically-supported for the treatment of personality disorders.
It is clear from Fonagy’s report that much research remains to be done assessing which treatment approaches yield benefits for specific issues and concerns. Overall, the evidence appears to support the continued use of Psychodynamic Therapies for chronic and complex issues. Here is a link to Fonagy’s report. I invite you to check it out for yourself.
*For more on the evidence supporting psychodynamic therapy, Dr. Ian Pritchard, a clinical psychologist in Reno, NV, has assembled a list of evidence-based psychodynamic psychotherapy research articles on his website.
Works Cited:Fonagy, P. (2015), The effectiveness of psychodynamic psychotherapies: An update. World Psychiatry, 14: 137–150.
Psychodynamic therapy is an approach that involves facilitation a deeper understanding of one’s emotions and other mental processes. It works to help people gain greater insight into how they feel and think.
By improving this understanding, people can then make better choices about their lives. They can also work on improving their relationships with other people and work toward achieving the goals that will bring them greater happiness and satisfaction.
Psychodynamic therapy is rooted in psychoanalytic theory but is often a less intensive and lengthy process than traditional psychoanalysis. While psychoanalysis tends to focus a great deal on the patient and therapist relationship, psychodynamic therapy also places a great deal of emphasis on a patient’s relationships with other people in the outside world.
What Is Psychodynamic Therapy?
Psychodynamic therapy is a form of talk therapy. It is based on the idea that talking to a professional about problems people are facing can help them find relief and reach solutions.
Through working with a psychodynamic therapist, people are able to better understand the thoughts, feelings, and conflicts that contribute to their behaviors. This approach to therapy also works to help people better understand some of the unconscious motivations that sometimes influence how people think, feel, and act.
This approach to psychotherapy can be helpful for dealing with mental or emotional distress. It can help promote self-reflection, insight, and emotional growth.
By better understanding your emotional patterns and their roots, you are better equipped to manage your problems and develop coping techniques that will help you both now and in the future.
While it is similar to psychoanalysis in many respects, it is often less frequent and shorter in duration. Like other forms of therapy, it can be used to treat a variety of mental health problems.
- Eating disorders
- Interpersonal problems
- Personality disorders
- Psychological distress
- Post-traumatic stress disorder
- Social anxiety disorder
- Substance use disorders
Factors that may impact what type of treatment is used include cost-effectiveness, availability, patient preferences, and the severity of the symptoms the person is experiencing. While cognitive-behavioral therapy (CBT) is a popular and effective approach, evidence suggests that psychodynamic therapy can be just as effective for many conditions.
Online therapy is another option that you might consider. Some research also suggests that online psychodynamic therapy may be as effective as online CBT.
How It Works
Psychodynamic therapy helps people recognize repressed emotions and unconscious influences that may be affecting their current behavior. Sometimes people act in certain ways or respond to others for reasons that they don’t really understand.
Psychodynamic therapy helps people learn to acknowledge, bear, and put into perspective their emotional lives. It also helps people learn how to express their emotions in more adaptive and healthier ways.
Some important aspects of psychodynamic therapy include:
- Identifying patterns: Psychodynamic therapy helps people learn to recognize patterns in behavior and relationships. People often develop characteristic ways of responding to problems without really being aware of these tendencies. Learning to spot them, however, can help people find new approaches to coping with problems.
- Understanding emotions: Research has found that psychodynamic therapy is useful for exploring and understanding emotions. Through gaining insight into emotional experiences, people are better able to recognize patterns that have contributed to dysfunction and then make changes more readily.
- Improving relationships: Relationships with others are a key focus of psychodynamic therapy. In working with a therapist, people are able to understand how they often respond to others.
The therapeutic relationship itself can serve as a way to look into the relationships a person has with other people through a process known as transference. This gives people an immediate “in vivo” way to explore and then change their pattern of responses in order to improve their relationships.
How Effective Is It?
How effective is psychodynamic therapy and how does it compare to other forms of treatment?
Assessing the efficacy of psychodynamic therapy presents some challenges, but research does suggest that it can be useful in the treatment of a variety of psychological problems.
One reason that it may be difficult to assess the full efficacy of psychodynamic therapy is that many of the changes it produces can be tough to measure.
While it is relatively easy to measure changes in specific acute symptoms, it is much more difficult to measure underlying personality changes, noted researcher Jonathan Shedler in a press release by the American Psychological Association (APA).
Despite this difficulty, research supports the efficacy and use of psychodynamic therapy to treat a variety of conditions.
- One notable review published in the journal American Psychologist concluded that the evidence supports the efficacy of psychodynamic therapy.
- Another study found that psychodynamic therapy could be at least as effective as cognitive-behavioral therapy (CBT).
- A 2017 review published in the American Journal of Psychiatry concluded that psychodynamic therapy was as effective as other established treatments. However, the authors of the study suggested that further research was needed to determine who benefited the most from this type of treatment.
What You Can Expect
If you decide to try psychodynamic therapy, you may meet with your therapist weekly to a few time each week. Each session typically lasts for around 45 minutes and you will continue to see your therapist for several months. In some cases, you may keep having sessions for a year or longer.
During psychodynamic therapy, people are often encouraged to talk about anything that might be on their minds. This might include things they are currently experiencing or memories of things that have happened in the past.
One form of psychodynamic therapy known as brief psychodynamic therapy is designed to produce results more rapidly, often in 25 to 30 sessions. In this shorter-term form of treatment, people may initially determine a particularly emotional area where they want to focus on.
Long-term psychodynamic therapy may take a year or longer and involve 50 or more therapy sessions.
A Word From Verywell
If you are experiencing symptoms of a mental health condition, talk to your doctor or mental health professional. They can make a diagnosis and recommend treatment options that may be best for your individual needs. Psychodynamic psychotherapy may be a good fit for you.