Designs for Studying the Effectiveness of Long-Term Psychoanalytic Treatments: Balancing level of Evidence and Acceptability to Patients

University of Amsterdam, the Netherlands.
Journal of the American Psychoanalytic Association (Impact Factor: 0.79). 04/2012; 60(2):361-87. DOI: 10.1177/0003065112441971
Source: PubMed


Long-Term Psychoanalytic Treatments (LTPT) include both long-term psychoanalytic psychotherapy (LTPP) and psychoanalysis (PsAn). Current opinion seems to be that there is some evidence for the effectiveness of LTPP, but none for that of PsAn. This may be due in part to researchers not balancing the level of evidence of randomized controlled studies (RCTs), cohort studies, and pre-post studies with patients' acceptance of these various research designs used in studying the effectiveness of LTPT. After a review of the merits of eight possible control conditions for LTPT in RCTs and cohort studies, and a consideration of the limitations and merits of pre-post studies, it was found that RCTs pair high levels of evidence with limited degrees of patient acceptance, especially where PsAn is concerned. Cohort studies appear to provide at most a moderate level of evidence. Their acceptability is hardly better than that of RCTs, as it depends on the acceptability of control conditions similar to those of RCTs. The acceptability of pre-post studies is much better, but they can provide, at most, a moderate level of evidence. Apart from randomization, they can meet all methodological criteria for high-quality research (often they do not, but there are ways to correct this). In summary, in the long-term treatment of complex mental disorders with LTPT, RCTs often pair a high level of evidence with limited patient acceptance of the method. Compared to RCTs, cohort studies show a lower level of evidence without much gain in acceptability. Pre-post studies pair the highest level of acceptability with the lowest level of evidence of the three designs. Limited acceptability is not to be confused with no acceptability, nor moderate level of evidence with none.

Download full-text


Available from: Jan Swinkels,
  • Source
    • "Interestingly, when done well, pre-post studies were found to have nearly the same level of evidential value as cohort studies and to be most acceptable of these three designs to patients. Although there is a loss of evidential value due to the absence of a control group in such a design, the likelihood of a patient being willing to be measured over time during a treatment greatly increases (deJonghe et al., 2012). Case studies, although considered to have lower evidential value, may be the most feasible design for use in the study of psychoanalytic treatment and may also be the most acceptable to patients. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Research in psychoanalysis is in many ways dependent on some level of engagement with patients in ongoing treatments. The use of patients as study participants may complicate the process of research as well as affect treatment outcomes, and, thus, requires that researchers and clinicians give careful thought to the ways in which they involve patients in research. This article discusses the impact that empirical study may have on the treatment, both positive and negative, while also keeping in mind the ethical issues raised by engaging active patients in research. The importance of balancing research design with patient experience is carefully considered, and suggestions are offered for designing studies that may minimize the potential for negative impact while maintaining the treatment enhancing aspects of research.
    Psychoanalytic Inquiry 01/2015; 35(sup1):135-149. DOI:10.1080/07351690.2015.987599 · 0.47 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: After participating in this educational activity, the reader should be better able to evaluate the empirical evidence for pre/post changes in psychoanalysis patients with complex mental disorders, and assess the limitations of the meta-analysis. The effectiveness of psychoanalysis is still a controversial issue, despite increasing research efforts. To investigate the empirical evidence for psychoanalysis by means of a systematic review of the literature and a meta-analysis of the research data. A systematic literature search was undertaken to find studies regarding the effectiveness of psychoanalysis, published between 1970 and 2011. A meta-analysis was performed. Fourteen studies (total n = 603) were included in the meta-analysis. All but one were pre/post cohort studies. At treatment termination, the mean pre/post effect size across all outcome measures was 1.27 (95% confidence interval [CI], 1.03-1.50; p < .01). The mean pre/post effect size for symptom improvement was 1.52 (95% CI, 1.20-1.84; p < .01), and for improvement in personality characteristics 1.08 (95% CI, 0.89-1.26; p < .01). At follow-up the mean pre/follow-up effect size was 1.46 across all outcome measures (95% CI, 1.08-1.83; p < .01), 1.65 for symptom change (95% CI, 1.24-2.06; p < .01), and 1.31 for personality change (95% CI, 1.00-1.62; p < .01). A limited number of mainly pre/post studies, presenting mostly completers analyses, provide empirical evidence for pre/post changes in psychoanalysis patients with complex mental disorders, but the lack of comparisons with control treatments is a serious limitation in interpreting the results. Further controlled studies are urgently needed.
    Harvard Review of Psychiatry 05/2013; 21(3):107-37. DOI:10.1097/HRP.0b013e318294f5fd · 1.73 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Sigal Zilcha-Mano & Jacques P. Barber Is Psychodynamic Therapy (PTPT) an evidence-based practice? What makes PT work? In the present article we shall discuss empirical evidence for these as well as other vital questions. First, we shall examine the existing findings concerning two of the most widespread myths about PT: (1) PT is not an evidence-based therapy; (2) PT is not directed at and, therefore, not effective at alleviating symptoms. Second, we shall examine some of the existing findings regarding what it is that actually enables change in PT. The aim of the paper is to provide some access to the knowledge accumulated from numerous studies on PT treatments, conducted by dozens of therapists, with the hope that it will benefit clinicians.
    Contemporary psychoanalysis 03/2014; DOI:10.1080/00107530.2014.880309 · 0.33 Impact Factor