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The Efficacy of Psychodynamic Psychotherapy
Jonathan Shedler University of Colorado Denver School of Medicine
Empirical evidence supports the efficacy of psychodynamic
therapy. Effect sizes for psychodynamic therapy are as
large as those reported for other therapies that have been
actively promoted as “empirically supported” and “evi-
dence based.” In addition, patients who receive psychody-
namic therapy maintain therapeutic gains and appear to
continue to improve after treatment ends. Finally, nonpsy-
chodynamic therapies may be effective in part because the
more skilled practitioners utilize techniques that have long
been central to psychodynamic theory and practice. The
perception that psychodynamic approaches lack empirical
support does not accord with available scientific evidence
and may reflect selective dissemination of research find-
ings.
Keywords: psychotherapy outcome, psychotherapy
process, psychoanalysis, psychodynamic therapy, meta-
analysis
There is a belief in some quarters that psychodynamic
concepts and treatments lack empirical support or
that scientific evidence shows that other forms of
treatment are more effective. The belief appears to have
taken on a life of its own. Academicians repeat it to one
another, as do health care administrators, as do health care
policymakers. With each repetition, its apparent credibility
grows. At some point, there seems little need to question or
revisit it because “everyone” knows it to be so.
The scientific evidence tells a different story: Consid-
erable research supports the efficacy and effectiveness of
psychodynamic therapy. The discrepancy between percep-
tions and evidence may be due, in part, to biases in the
dissemination of research findings. One potential source of
bias is a lingering distaste in the mental health professions
for past psychoanalytic arrogance and authority. In decades
past, American psychoanalysis was dominated by a hierar-
chical medical establishment that denied training to non-
MDs and adopted a dismissive stance toward research. This
stance did not win friends in academic circles. When em-
pirical findings emerged that supported nonpsychodynamic
treatments, many academicians greeted them enthusiasti-
cally and were eager to discuss and disseminate them.
When empirical evidence supported psychodynamic con-
cepts and treatments, it was often overlooked.
This article brings together findings from several em-
pirical literatures that bear on the efficacy of psychody-
namic treatment. I first outline the distinctive features of
psychodynamic therapy. I next review empirical evidence
for the efficacy of psychodynamic treatment, including
evidence that patients who receive psychodynamic therapy
not only maintain therapeutic gains but continue to improve
over time. Finally, I consider evidence that nonpsychody-
namic therapies may be effective in part because the more
skilled practitioners utilize interventions that have long
been central to psychodynamic theory and practice.
Distinctive Features of
Psychodynamic Technique
Psychodynamic or psychoanalytic psychotherapy
1
re-
fers to a range of treatments based on psychoanalytic
concepts and methods that involve less frequent meetings
and may be considerably briefer than psychoanalysis
proper. Session frequency is typically once or twice per
week, and the treatment may be either time limited or open
ended. The essence of psychodynamic therapy is exploring
those aspects of self that are not fully known, especially as
they are manifested and potentially influenced in the ther-
apy relationship.
Undergraduate textbooks too often equate psychoan-
alytic or psychodynamic therapies with some of the more
outlandish and inaccessible speculations made by Sigmund
Freud roughly a century ago, rarely presenting mainstream
psychodynamic concepts as understood and practiced to-
day. Such presentations, along with caricatured depictions
in the popular media, have contributed to widespread mis-
understanding of psychodynamic treatment (for discussion
of how clinical psychoanalysis is represented and misrep-
resented in undergraduate curricula, see Bornstein, 1988,
1995; Hansell, 2005; Redmond & Shulman, 2008). To help
dispel possible myths and facilitate greater understanding
of psychodynamic practice, in this section I review core
features of contemporary psychodynamic technique.
Blagys and Hilsenroth (2000) conducted a search of
the PsycLit database to identify empirical studies that com-
pared the process and technique of manualized psychody-
namic therapy with that of manualized cognitive behavioral
therapy (CBT). Seven features reliably distinguished psy-
chodynamic therapy from other therapies, as determined by
empirical examination of actual session recordings and
I thank Mark Hilsenroth for his extensive contributions to this article;
Marc Diener for providing some of the information reported here; Robert
Feinstein, Glen Gabbard, Michael Karson, Kenneth Levy, Nancy McWil-
liams, Robert Michels, George Stricker, and Robert Wallerstein for their
comments on drafts of the article; and the 500-plus members of the
Psychodynamic Research Listserv for their collective wisdom and sup-
port.Correspondence concerning this article should be addressed
to Jonathan Shedler, Department of Psychiatry, University of Colo-
rado Denver School of Medicine, Mail Stop A011-04, 13001 East 17th
Place, Aurora, CO 80045. E-mail: jonathan@shedler.com
1
I use the terms psychoanalytic and psychodynamic interchangeably.
98 February–March 2010 ●American Psychologist
© 2010 American Psychological Association 0003-066X/10/$12.00
Vol. 65, No. 2, 98–109 DOI: 10.1037/a0018378
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