Psychoanalytical therapy, also named psychodynamic therapy, comes from the psychoanalysis method developed by Sigmund Freud at the end of the 19th century. This particular treatment has always triggered strong reactions, heavy criticism and denigration.
In his article, Getting to know me, (2010) Jonathan SHEDLER, associate professor of psychiatry at the University of Colorado School of Medicine and director of psychology at the University of Colorado Hospital Outpatient Psychiatry Service, defends psychodynamic therapy by reporting results of recent studies which show the efficiency and benefits of this specific approach.
First of all, J. Shedler points out that psychodynamic therapy as it is practiced today has evolved, has been modernized and so does not exactly look like the original method. Freud’s legacy, as Shelder reminds us, is not a specific theory but rather a sensibility, «an appreciation of the depth and complexity of mental life, and a recognition that we do not fully know ourselves».
But, says J. Shedler, the modernization of psychoanalytic therapy has gone largely unnoticed. According to him, Psychoanalysts did not put a great deal of effort to disseminate ideas outside their own circles. This self-imposed exile from academic circle has encouraged the emergence of an alternative: cognitive-behavior therapy (CBT).
CBT was portrayed as the gold standard, and psychodynamic therapy was qualified as ancient and unscientific. However, a lot of actual and rigorous controlled studies reported by Shedler, like the meta-analysis of Allan Abbass from Dalhousie University published in 2006 in the prestigious Cochrane Library, shows us that psychodynamic therapy has largely proved its effectiveness.
Abbass examined the effectiveness of psychodynamic treatments that lasted for fewer than 40 sessions. His team compiled the results of 23 randomized controlled trials that involved 1,431 patients who suffered from depression, anxiety, stress-related physical ailments and other psychological problems. Abbass’s meta-analysis found an effect size of 0.97 for overall psychiatric improvement. Effect size measures the amount of treatment benefit. In this type of study, an effect size of 0.2 is considered small, 0.5 moderate and 0.8 large, so the benefit Abbass found is huge. In contrast, another meta-analysis of 33 rigorously conducted studies of cognitive-behavior therapy for depression and anxiety showed an effect size of 0.68.
More amazingly, Abbass’s meta-analysis shows that people who receive psychodynamic therapy actually continue to improve after the therapy ends, the effect size growing from 0.97 to 1.51. Researchers highlight seven distinctive features explaining the power of psychodynamic therapy : exploring emotions, examining avoidances, identifying recurring patterns, discussing past experiences, focusing on relationships, examining the patient and therapist’s relationship, and valuing fantasy life. Even if Cognitive-behavior therapists may also incorporate some of the seven features described above, it seems they do not push it to same extent as psychodynamic therapists do. Shedler reports in his encounters with patients who try « empirical supported » brief therapy as CBT, that they feel better temporarily, then continue replaying patterns that cause suffering.
Psychodynamic therapy has demonstrated its benefits scientifically and as J. Shedler says, « It’s time for academic researchers to examine their resistance to the truth. »
But beyond the affinity for an approach or another, what could be the secret ingredient for a successful psychotherapy? What really works?
Working-alliance.
Indeed, many studies have proven the powerful effect of the patient/therapist relationship, and every therapist, psychoanalyst or not, is free to explore the question of how he meets his patient and to build his own way to be a good psychologist.
