By Harlene Goldschmidt, Ph.D. and Debi Roelke, Ph.D.

This is the first of a series of three articles focusing on scientific studies and brain research that support psychodynamic treatment.  This first article serves as a general overview of research relating to psychodynamic psychotherapy. The hope is that as psychodynamic therapists, we will expand our “comfort zone” in talking about science and the brain as it relates to psychodynamic treatment. This will give us more ways to demonstrate the unique benefits of psychodynamic therapy to other health professionals, patients, prospective candidates, policy makers, and the community we wish to serve.

The second article will look at relational trauma, how brain functioning is affected and the ways in which psychodynamic therapy provides reparative experiences (Spring edition). The third and final article will look at unconscious processes like dreams, and how we can better understand the inner workings of the brain in terms of memory, desire, and regulating emotions (Summer edition).

Recent Review of Research Showing Efficacy of Psychodynamic Therapy
Psychodynamic therapists have received some welcome support from the scientific community documenting the benefits of psychodynamic treatment.  A recent paper in the American Psychologist by Jonathan Shedler (Feb. 2010) looks at dozens of studies all showing that psychodynamic therapy has the same or greater effectiveness when compared to other evidence based treatments, i.e., cognitive behavioral (CBT)  and dialectical  behavioral therapy (DBT).  In addition, results from a large group of well crafted studies involving over 2,000 patients showed that improvements from psychotherapy increased significantly after termination. Follow-up intervals were anywhere from one to five years.  This increase was not shown for CBT treatment, where in fact some of the treatment improvements “decayed”  (Shedler, 2010).

Shedler describes research showing that the “active ingredients”  of all therapy approaches seem to be psychodynamic factors, namely, the therapeutic alliance and “experiencing” (becoming aware of and articulating emotions in the session). He argues that these “active ingredients” explain therapeutic change in treatment  modalities other than psychodynamic approaches.  Rotely applied manualized treatments were shown to be the least effective of all.  In studies comparing psychodynamic treatment with DBT for patients with borderline personality disorder, the psychodynamic therapy not only produced symptom improvement but also showed changes in underlying psychological mechanisms – reflective functioning and attachment organization.  In other words, psychodynamic therapy helped patients to learn important psychological skills that support profound changes in how one relates to oneself, as well as others.

Shedler comments that he is “struck” by the fact that psychodynamic therapy is often depicted as lacking empirical evidence, and that “historically psychoanalysts have been dismissive of this line of research,” when in fact there is a sizable and growing body of “…high-quality empirical evidence supporting psychodynamic concepts and treatment.”  Shedler writes passionately, “ Such attitudes are changing, but they cannot change quickly enough “ (2010, p.107).