"it's just not evidence based"

[eponymous85]

Calling all psychodynamic peeps...

I was recently in a conversation with a psychiatrist and the topic came around to psychodynamic psychotherapy. I was a little shocked (I don't know why really) when he came out with "I'm sorry, but it's just not evidence based". Now, I've been a skeptic in the past but have had some really wizard teaching over the past couple of years that has really changed my mind and made me see the value of the psychodynamic approach, at the very least as an option amongst a range of therapies. However, I'm aware that there is a large gap in my knowledge in terms of the evidence base for psychodynamic work. Basically, my response to his comment was my brain going <error 404: snappy comeback not found>.

Can any of you bods in the know point me towards some good reviews, meta-analyses, longitudinal studies etc? My tutors tend to use book chapters in their teaching, most of which are decades old. I know they're seminal texts but I just don't think they'd convince a positivist. I'm aware I may also be missing the point (i.e., there are certain types of therapy that are easier to measure, etc.) but I couldn't articulate my ideas about this at the time. Can any of you lovely people provide me with a dose of clarity?

[urmaserendipity85]

Hi Eponymous85,
I wrote an essay in my first year of training comparing CBT to psychodynamic psychotherapy for use with depression and considering the different mechanisms of change at work. There are a lot of studies that suggest the therapies are equally as effective as each other. I'd be happy to send you parts of my essay if this would be helpful? PM me you email address if you want

[miriam]

It would be nice if you were prepared to sharethem on the forum - could make the bones of a new wiki on evidence for therapies if other people were prepared to add to it...

[eponymous85]

Hi Eponymous85,
I wrote an essay in my first year of training comparing CBT to psychodynamic psychotherapy for use with depression and considering the different mechanisms of change at work. There are a lot of studies that suggest the therapies are equally as effective as each other. I'd be happy to send you parts of my essay if this would be helpful? PM me you email address if you want

yes please that would be great. Have pm'd my email address

[eponymous85]

actually yeah, what Miriam said ^

[alsmithee]

You can look up Jonathan Shedler's paper on the efficacy of psychodynamic therapy, which can be found here: http://nvpp.nl/JonathanShedlerStudy20100202.pdf

[eponymous85]

You can look up Jonathan Shedler's paper on the efficacy of psychodynamic therapy, which can be found here: http://nvpp.nl/JonathanShedlerStudy20100202.pdf

Wow what a fantastic article! That's just the sort of thing I was after, thank you. I strongly encourage others to read it; I really wish I'd read it before the conversation in the OP! Which obviously would then have gone like this :

ME: Actually, meta-analyses consistently show that psychodynamic-oriented psychotherapy has equivalent outcomes compared to other types of therapy and better outcomes compared to medication. It also consistently shows further improvement at longitudinal follow-up.

PSYCH: Well yes, but we all know that CBT's got a better evidence base, I mean that's why it's NICE recommended isn't it?

ME: True, there are a greater number of studies for CBT, but the outcomes are equivalent to psychodynamic therapy. The evidence base is now self-perpetuating in that CBT now attracts more funding and therefore further increases its kudos by running more studies. There's some really interesting studies that show many of the active ingredients in CBT are actually psychodynamic concepts.

PSYCH: <stunned silence> <long pause> well then, I must admit I was totally wrong. Please accept my most profuse and humble apologies.

[SCENE]

(hey, a girl can fantasise, can't she?)

So then, I guess the next question would be: why on earth isn't this stuff in NICE reviews of therapy?!

[ell]

So then, I guess the next question would be: why on earth isn't this stuff in NICE reviews of therapy?!

Cos it takes ages.

L

[eponymous85]

hmm I guess so, even brief approaches seem to be around 40 sessions. But then I'm not aware of a huge amount of evidence for briefer CBT, which was always originally supposed to be around 40 sessions (and what the original studies are based on). Didn't they just go "ooh, CBT looks good. Let's do it, but halve the number of sessions"?

[baa]

Brief Psychodynamic therapy is already in the NICE depression guidelines.

[alsmithee]

You can look up NICE guidelines for depression where they recommend Dynamic Interpersonal Therapy which is, very slowly, becoming part of IAPT. I have articles about the apporach (developed by Fonagy, Lemma and others), so if you want me to email them to you just PM me.

[eponymous85]

Brief Psychodynamic therapy is already in the NICE depression guidelines.

and yet their conclusiosn seem so much more modest compared to those of the article above with little explanation of why more studies/meta-analyses weren't included. I wonder why?

[schizometric]

I've also done a CPR on the above for depression. Efficacy studies are abundant, and what works for whom (Roth & Fonagy) presents a cogent argument for psychodynamic therapy for a variety of difficulties.

My personal issue is the way that evidence is often spun for Psychodynamic theory. I've had one particular experience where automaticity (as in, automatic attentional processes) were taken as evidence for something in the theory and presented like "this is how it is" (it wasn't, and I can't remember what, blocked it out thinking what a load of......**). I think that as a theoretical framework it is very helpful but that's if you can discount the lack of theoretical evidence and just focus on effectiveness :p

[russ]

You're wasting your time if you think you'll ever 'prove' things like an unconscious or transference

[schizometric]

Well exactly, but people trying to spin it such that you're taking one lot of evidence from a completely different area and applying it to something that can't be measured is ridic :p

I was actually surprised to learn that so far psychodynamic fits with me better than other theoretical frameworks