Freud & Early Psychoanalysts

Freud & Early Psychoanalysts

• Early psychoanalysts, including Freud, dismissed the experimental method, leading to a lack of scientific studies verifying the effectiveness of their therapy.
• Hans Eysenck (1952) critiqued early studies, concluding that psychodynamic therapy was ineffective, claiming patients improved similarly without treatment.
• Eysenck's research was flawed due to poor study quality and biased measures of improvement.
• Bergin & Garfield corrected Eysenck's analysis, estimating spontaneous remission at 30-43%, while psychodynamic therapy showed improvement in up to 83% of patients.

Meta-Analysis: The Game Changer

• Smith & Glass (1977) introduced meta-analysis, a statistical method combining data from numerous studies to balance biases and identify overall trends.
• Meta-analysis demonstrated that all major therapies were effective and superior to no treatment.
• This finding resulted in the "equivalence paradox" or "dodo bird effect," suggesting all therapies are equally effective.

Sloane et al. (1975) Study

• A study compared behavioral therapy, psychoanalytic therapy, and a waiting list control group.
• Both therapies were more effective than no treatment.
• There was no significant difference between behavioral and psychoanalytic therapies overall.
• Behavioral therapy was more effective for actions/behaviors, while psychoanalytic therapy was better for feelings/emotions.

The Shift to Evidence-Based Practice (1990s onwards)

• The growth of Evidence-Based Medicine (EBM) led the British NHS to review existing research, fund new studies, and ensure the effectiveness of treatments used in public health.
• CBT/behavioral therapists were more receptive due to their research-friendly approach.
• Psychodynamic therapists faced challenges due to limited research and resistance to applying scientific methods.

The Parry Report (1996)

• The NHS commissioned Dr. Parry to investigate the evidence behind common therapies.
• Strong support was found for CBT and behavioral therapies.
• Limited but growing support was found for psychodynamic therapy.
• The report recommended psychodynamic therapy for conditions like depression and anorexia.
• The report safeguarded psychodynamic therapy temporarily but motivated the field to conduct more research.

Outcome Measures

• All therapies share the common goal of improving mental health and functioning, but use different methods.
• Behavioral therapy targets actions, CBT targets thoughts, and psychodynamic therapy targets deep emotional insight and unconscious processes.
• Measuring therapy effectiveness can be biased depending on what is being measured (behavior, thoughts, emotional change).
• CBT and behavioral therapies may appear more effective in studies focusing on symptom reduction.
• Psychodynamic therapy may show stronger results when using broader tools that measure overall life functioning, emotional well-being, or personality stability.
• Different measurement tools can yield different results regarding therapy effectiveness.
• Long-term psychoanalytic therapy can lead to deeper, long-lasting changes, not just symptom relief.
• It can take about 2 years on average for real personality change.

Efficacy vs Effectiveness Studies

• Efficacy studies are controlled experiments where patients are randomly assigned to groups, researchers control variables, and patients often have one specific problem.
• Efficacy studies are clean, scientific, and controlled, but not realistic, may miss the big picture, and don't show how therapy works in the real world.
• Effectiveness studies are conducted in real-world settings with diverse patients, and focus on before-and-after comparisons
• Effectiveness studies show how therapy works in real-life settings
• Ethical issues and the focus on deep, slow changes make "lab-style" studies challenging for psychodynamic therapy.
• Focusing on effectiveness studies, using tools that measure global improvement, and involving practitioners in defining good evidence are potential solutions.

Contemporary Outcome Studies

• There has been increasing pressure on psychodynamic therapies to demonstrate their effectiveness through research.
• Psychoanalysis involves more frequent sessions (4–5 times a week) compared to psychoanalytic psychotherapy (once or twice a week).
• Vaughan et al. (2000) found that patients were willing to participate in research, therapists were sometimes resistant, and outcome measures showed change over time.
• Wallerstein (1986) found similar levels of improvement in psychoanalysis and psychoanalytic psychotherapy for patients with serious, long-term issues.
• Sandell et al. (1999, 2000) found that psychoanalysis may have stronger long-term effects, and strict therapists in psychotherapy had worse outcomes.
• Freedman et al. (1999) found that longer and more intense therapy led to better patient-rated effectiveness.

Psychodynamic Therapy and Psychotic Disorders

• Traditionally, psychodynamic therapy was not thought to help with psychosis.
• Chadwick et al. (2000) found that CBT can help patients with schizophrenia manage delusions.
• Hauff et al. (2002) found that high-functioning patients with schizophrenia benefited from psychodynamic therapy, while low-functioning patients may have worsened.

Efficacy Studies of Long-Term Psychodynamic Therapies

• Bateman and Fonagy (1999) found that patients with borderline personality disorder improved more with psychoanalytic therapy than standard hospital care in a randomized study.
• Strupp (2001) stated that there’s no strong evidence that long-term psychodynamic therapy is better than brief therapy.
• Fonagy (2001) disagreed, saying there’s plenty of evidence that long-term therapy is more effective.

Child Psychotherapy

• Research on psychodynamic therapy for children is limited, and earlier studies were often flawed.
• Better studies show more positive results, such as Moran et al. (1991) finding that psychotherapy helped diabetic children manage their condition.
• Fonagy & Target’s archival studies showed mixed results, with younger children doing better overall.
• Lush, Boston, & Grainger (1991) found that kids in foster care, adoption, or group homes who had psychotherapy showed improvements in anxiety and relationships.

Group Psychoanalytic Psychotherapy

• Research supports group analytic psychotherapy as an effective treatment.
• Lorentzen (2000) found that patients in weekly group therapy showed significant improvement.
• Lundqvist & Oejehagen (2001) found that women in group therapy after childhood sexual abuse showed clear reductions in symptoms and improvements in functioning.
• Heinzel et al. (2000) found no difference between group vs. individual therapy in reducing symptoms, sick days, and doctor visits, but the study had flaws.
• Levkovitz et al. (2000) found that group psychotherapy + meds improved significantly more than meds only for patients with major depression.

Brief Dynamic Therapy (BDT) & Psychodynamic Counselling

• BDT is a short-term form of psychodynamic therapy that focuses on helping people gain insight into their emotions and relationship patterns.
• BDT is popular due to its short-term nature, cost-effectiveness, and compatibility with efficacy studies.
• Guthrie et al. (2001) found that BDT reduced suicidal thinking and new suicide attempts in patients after a suicide attempt.
• De Jongh et al. (2001) found that antidepressants + BDT resulted in lower dropout, more symptom relief, and patient preference compared to antidepressants alone for patients with depression.
• Burnand et al. (2002) found that clomipramine + BDT resulted in better outcomes, global functioning, and reduced hospital costs compared to clomipramine alone for patients with depression.
• A large study in London by Archer et al. on psychodynamic counseling had a large, real-world sample but no control group and a wide range of client issues.

Meta-Analyses on Psychodynamic Therapy

• Meta-analyses combine data from multiple studies to get a clearer, more reliable result, but results on psychodynamic therapies have been inconsistent.
• Most focus on brief psychodynamic therapy because there are fewer studies on long-term therapies.
• Crits-Christoph (1992) and Anderson & Lambert (1995) found brief psychodynamic therapy to be highly effective, showing results comparable to other established therapies.
• Svartberg & Stiles (1991) showed that CBT often outperforms psychodynamic therapy, especially in terms of long-term outcomes.
• Matt & Navarro (1997) found that CBT and behavioral therapy tended to have better outcomes than psychodynamic therapy when differences in efficacy did show up.
• Some meta-analyses support the "dodo-bird phenomenon," finding that different types of therapy have similar outcomes overall, with no one therapy consistently better than another.
• There’s growing support for psychodynamic therapies, especially brief psychodynamic therapy, as effective.
• Long-term psychoanalytic psychotherapy may be superior to BDT in some cases, though this is still debated.
• Tension exists between research-based practice and practice-led research.
• Meta-analysis is still under discussion because it may not always capture the complexity or nuances of psychodynamic therapies.
• There are still unresolved questions with finding evidence that psychodynamic therapies are more or less effective than other therapies.