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Earlier this century, a common misconception about psychodynamic therapy treatment was that it lacked the empirical support that other well-known therapies and treatments—such as CBT, general psychotherapy, or the use of antidepressant medications—had established. But in Jonathan Shedler’s (currently the professor of clinical psychiatry at the University of California, and a renowned author, consultant, and clinician) now-acclaimed 2010 research study The Efficacy of Psychodynamic Therapy, the case is made that psychodynamic therapy is just as useful and effective as other more common forms of therapy.
Before diving into some of Shedler’s findings and reasonings, it’s useful to first establish an outline of what psychodynamic psychotherapy is and how it works.
What is Psychodynamic Psychotherapy?
Shedler describes psychodynamic psychotherapy (also called psychoanalytic psychotherapy) as being a form of therapy that “refers to a range of treatments based on psychoanalytic concepts and methods that involve less frequent meetings and may be considerably briefer than psychoanalysis proper.” Sessions are typically held with a patient once or twice per week, and treatment can be open ended or limited to within a certain timeframe. At the core of psychodynamic therapy is an exploration for the patient of “those aspects of self that are not fully known, especially as they are manifested and potentially influenced in the therapy relationship.” (Shedler, 98).
Professor Shedler outlines seven features that distinguish psychodynamic therapy from other common forms of therapy. These features are:
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Focus on affect and expression of emotions. An exploration and discussion of the patient’s full range of emotions is strongly encouraged. With help from the therapist, a patient is made to describe their feelings (contradictory feelings, troubling feelings, threatening feelings, or feelings the patient may not have previously recognized) in an in-depth manner.
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Exploration of attempts to avoid distressing thoughts and feelings. Therapists actively engage with a client’s thoughts and feelings that they have knowingly or unknowingly been avoiding/repressing. This avoidance can take a great many forms, such as skipping or arriving late to scheduled sessions, shifting topics, or focusing on less meaningful aspects of certain experiences.
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Identification of recurring themes and patterns. This step sees therapists working to “identify and explore recurring themes and patterns in patients’ thoughts, feeling, self-concept, relationships, and life experiences.” (Shedler, 99).
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Discussion of past experiences (developmental focus). Here, the therapist will identify any recurring themes or patterns in past experiences (especially those of attachment figures) and see how they affect the patient’s relationship to the present.
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Focus on interpersonal relations. Looking at a patient’s relationships and interpersonal experiences is crucial in psychodynamic therapy. According to Shedler, “Both adaptive and nonadaptive aspects of personality and self-concept are forged in the context of attachment relationships, and psychological difficulties often arise when problematic interpersonal patterns interfere with a person’s ability to meet emotional needs.”
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Focus on therapy relationship. Of course, the relationship between the patient and their therapist is also an important interpersonal bond that will be impacted and shaped strongly by past relationships. For instance, if the patient struggles with anger in some regard, they may be hostile toward the therapist during sessions. By focusing on this relationship, the patient can reach a greater flexibility and improved capacity to meet their own interpersonal needs.
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Exploration of a fantasy life. The final aspect of psychodynamic psychotherapy is the exploration of a fantasy life. In this regard, psychodynamic therapy differs from many other forms of therapy by letting the patient speak freely about whatever is on their mind. In doing so, a patient will freely consider and discuss a large range of their desires, daydreams, fears, fantasies, etc. This material is ideal for analyzing how the patient views themselves, others, and their wider overall collection of experiences, and ultimately can lead to the patient finding a greater meaning in their life.
The Empirical Support Behind Psychodynamic Psychotherapy
Aside from offering an expansive look into the singularities of psychodynamic psychotherapy, Shedler also aimed to cast aside the notion that this method of therapy was not as empirically supported as other methods were. And while his findings back up his assertion, Shedler also notes that there are several “important limitations” surrounding the empirical literature on psychodynamic therapy. For instance, “the number of randomized controlled trials for other forms of psychotherapy, notably CBT, is considerably larger than that for psychodynamic therapy, perhaps by an order of magnitude.” (Shedler, 106).
And yet despite these limitations, Shedler still proves that the empirical data behind psychodynamic therapy more than backs up the practice. He observed and analyzed several studies that were conducted over the years, among them meta-analyses from both the Journal of the American Medical Association and the Harvard Review of Psychiatry. These meta-analyses compared long-term psychodynamic therapy with shorter term therapies for the treatment of complex mental disorders and examined the effectiveness of long-term psychodynamic therapy for adult outpatients with a range of diagnoses, respectively. Both studies proved the long-term efficacy of psychodynamic psychotherapy, and throughout his article Shedler also referenced several other insightful studies and analyses.
Shedler’s findings support his final claim regarding psychodynamic therapy, that “the available evidence indicates that effect sizes for psychodynamic therapies are as large as those reported for other treatments that have been actively promoted as ‘empirically supported’ and ‘evidence based.’” (Shedler, 107). His evidence also “indicates that the benefits of psychodynamic treatment are lasting and not just transitory and appear to extend well beyond symptom remission.”
In closing, Shedler asserted that psychodynamic therapy can “foster inner resources and capacities that allow richer, freer, and more fulfilling lives” for patients of such therapy. And ever since his study first appeared in American Psychologist way back in 2010, the use of psychodynamic therapy has become far more accepted than it had previously been.
Source:
- Shedler, J. (2010). The Efficacy of Psychodynamic Psychotherapy. American Psychologist (February-March 2010), 98-109
Evan Manning for Asadis
