The usefulness of research for psychodynamic psychotherapists – and vice versa Rolf Sandell Linköping University

1. PDT is no worse than CBT

Psychodynamic therapies vs. others

Psychodynamic brief psychotherapy (Anderson & Lambert, 1995)

Brief PDT ”outperformed alternative treatments at follow- up assessment when measures of personality were used or when assessment took place 6 or more months posttreatment” (Anderson & Lambert, 1995).

Comparative effects sizes of treatments for depression (Robinson, Berman & Neimeyer, 1990)

Are ”other therapies” really bona fide therapies?

Psychotherapy with personality disorder

Psychotherapy with schizofrenia ”This study used meta-analytic methods to determine the effectiveness of individual psychotherapy for schizophrenic patients. …included 37 studies from various countries. … the investigation yielded seven mean effect sizes from seven different treatment comparisons. Six out of seven effect sizes were positive… Without medication, the improvement rates … ranged from –6% to 47%; when used with medication the range was from 19% to 62%. There was no difference among treatments from different theoretical orientations, indicating that psychoanalytic psychotherapy, cognitive-behavioral therapy, and non-psychodynamic supportive therapy are equally effective. …. Individual psychotherapy is a highly effective treatment for schizophrenia …” [Gottdiener, W H (2001) The benefits of individual psychotherapy for schizophrenic patients: A meta-analytic review of the psychotherapy outcome literature. Diss Abstr, 2001–95002–225; Gottdiener, W H & Haslam N (2002). The benefits of individual psychotherapy for people diagnosed with schizophrenia: A meta-analytic review. Ethical Human Sciences and Services, 4, ]

Differences between techniques/schools account for less than 1% of the outcome variance (d = 0 – 0.2)!

Implications for psychodynamic self-esteem—and for competitive strategies on the psychotherapy market?

2. Long-term is not necessarily better than short-term …

… and more frequent is not necessarily better than less frequent

Duration and frequency interact

3. Money does not buy good outcome—directly

Implications for ”dosing” and ”subsidization”?

4. The therapy does not end when the therapist and the patient stop seeing each other

Outcome is a process

Extensive relapse (78-88%) mos. after termination in the NIMH-TDCRP (16 sessions).

At termination…

… and three years post-treatment

Implications for follow-up interviewing/boosting?

5. Psychodynamic psychotherapy is not a special case of psychoanalysis (or vice versa)

Therapeutic Attitudes Scales (TASC-2)

What doesn’t matter in psychoanalysis does so in psychotherapy.

Training therapy

Negative transfer from psychoanalysis to psychotherapy – ”as-if psychoanalysis.”

Implications for clinical practice of ”as-if psychoanalysis”?

6. Symptoms respond more easily to psychoanalysis than do social relations

7. Effects on well-being do not necessarily generalize to health care utilization

Well-being

”Sickness” absenteeism

Implications for aspirations and goal setting—and for cost-effectiveness analyses?

8. The main source of variation is not different psychotherapies but different psychotherapists

Outcome variation between therapists in the same form of therapy is 6-10 times larger than the variation between different forms of therapy (Wampold, 2001)

Implications for training, evidence-basing, and quality assurance?

”The dark continent” in psychotherapy (research)

”Vice versa”: The usefulness of psychodynamic psychotherapists for research

Participation in research