Psychodynamic Psychotherapy: A Systematic Review of Techniques, Indications and Empirical Evidence Falk Leichsenring & Eric Leibing University of Goettingen, Germany Leyla Feize University of Utah Leyla Feize University of Utah

Background Psychodynamic psychotherapy is the most common therapy method, but the efficacy and effectiveness of this model is controversial. The purpose of this review is to find out if short and long term psychodynamic psychotherapy are effective in comparison with control groups and other therapeutic models. Psychodynamic psychotherapy is the most common therapy method, but the efficacy and effectiveness of this model is controversial. The purpose of this review is to find out if short and long term psychodynamic psychotherapy are effective in comparison with control groups and other therapeutic models.

Objective To review efficacy and mechanisms of short-term and long-term Psychodynamic psychotherapy with regard to empirical evidence.

Plain Language Summary Psychodynamic Psychotherapy is an umbrella concept for treatments that operate on a continuum of supportive interpretive psychotherapeutic interventions Patient’s insight about repetitive conflicts sustaining his/her problems. Strengthen abilities: acute stress, not developed abilities Transference: repetition of past experiences in present interpersonal relations Short-term Psychodynamic psychotherapy: 7-24 sessions Long-term Psychodynamic psychotherapy: Several months or several years, in this review maximum 18 months. RCT’s have indicated that psychodynamic is effective Psychodynamic Psychotherapy is as effective as cognitive- behavioral therapy Psychodynamic Psychotherapy is an umbrella concept for treatments that operate on a continuum of supportive interpretive psychotherapeutic interventions Patient’s insight about repetitive conflicts sustaining his/her problems. Strengthen abilities: acute stress, not developed abilities Transference: repetition of past experiences in present interpersonal relations Short-term Psychodynamic psychotherapy: 7-24 sessions Long-term Psychodynamic psychotherapy: Several months or several years, in this review maximum 18 months. RCT’s have indicated that psychodynamic is effective Psychodynamic Psychotherapy is as effective as cognitive- behavioral therapy

Inclusion Criteria 1- Randomized Controlled Trials (RCTs) of psychodynamic psychotherapy in adult patients 2- Psychodynamic psychotherapy clinical practice studies in adult patients 1- Randomized Controlled Trials (RCTs) of psychodynamic psychotherapy in adult patients 2- Psychodynamic psychotherapy clinical practice studies in adult patients

PRISMA Search Flow Diagram Identification: They selected 24 studies. One of them was a Cochrane review. Screening: No record of duplicated studies. No record of exclusion Eligibility: 24 articles, one record of full text article exclusion Included: 23 articles which two of them were meta-analysis. Identification: They selected 24 studies. One of them was a Cochrane review. Screening: No record of duplicated studies. No record of exclusion Eligibility: 24 articles, one record of full text article exclusion Included: 23 articles which two of them were meta-analysis.

Exclusion Criteria Long term (more than 18 months) psychoanalytic therapy was excluded

Data Synthesis 1- Outcome of psychodynamic psychotherapy Psychotherapeutic techniques Therapist skillfulness ‘Purity’ of technique Accuracy of interpretation 1- Outcome of psychodynamic psychotherapy Psychotherapeutic techniques Therapist skillfulness ‘Purity’ of technique Accuracy of interpretation

Data Synthesis Competent delivery of interpretive techniques Patient variables: The patient’s psychological health- sickness Interactions of technique outcome and patient variables: Transference interpretation in severely disturbed clients in short- term psychodynamic psychotherapy results in less effective outcome and also less therapeutic alliance. Competent delivery of interpretive techniques Patient variables: The patient’s psychological health- sickness Interactions of technique outcome and patient variables: Transference interpretation in severely disturbed clients in short- term psychodynamic psychotherapy results in less effective outcome and also less therapeutic alliance.

Data Synthesis 2- Specific changes in transference patterns 3- Helping alliance: Patient’s group Treatment models Time of assessment 2- Specific changes in transference patterns 3- Helping alliance: Patient’s group Treatment models Time of assessment

Data Synthesis Efficacy of short-term psychodynamic psychotherapy in the treatment of nine mental disorders: Minor Depressive Disorders Borderline Personality Disorder Post Traumatic Stress Disorder (PTSD) Efficacy of long-term psychodynamic psychotherapy in the treatment of seven mental disorder: Borderline Personality Disorder Cluster C Personality Disorders Social Phobia Efficacy of short-term psychodynamic psychotherapy in the treatment of nine mental disorders: Minor Depressive Disorders Borderline Personality Disorder Post Traumatic Stress Disorder (PTSD) Efficacy of long-term psychodynamic psychotherapy in the treatment of seven mental disorder: Borderline Personality Disorder Cluster C Personality Disorders Social Phobia

Risk of Bias Adequate sequence generation: 23 RCT’s studies Allocation Concealment: 23 RCT’s studies Blinding: Assessing the interventions by blinded evaluators Discrimination psychodynamic from other therapy models Incomplete outcome data : No record Free of selective reporting: Reporting of one article which did not support effectiveness of the psychodynamic psychotherapy. Adequate sequence generation: 23 RCT’s studies Allocation Concealment: 23 RCT’s studies Blinding: Assessing the interventions by blinded evaluators Discrimination psychodynamic from other therapy models Incomplete outcome data : No record Free of selective reporting: Reporting of one article which did not support effectiveness of the psychodynamic psychotherapy.

Limitations 1-No RCTs of psychodynamic psychotherapy Panic Disorder Obsessive-Compulsive Disorder Narcissistic Personality Disorder 2- The methodology of RCT’s is not appropriate for long-term psychoanalytic therapy 3- Using different models of psychodynamic psychotherapy in the RCTs. 1-No RCTs of psychodynamic psychotherapy Panic Disorder Obsessive-Compulsive Disorder Narcissistic Personality Disorder 2- The methodology of RCT’s is not appropriate for long-term psychoanalytic therapy 3- Using different models of psychodynamic psychotherapy in the RCTs.

Results Psychodynamic psychotherapy is superior to control conditions Psychodynamic psychotherapy is as effective as cognitive-behavioral therapy in specific psychiatric disorders. Psychodynamic psychotherapy is superior to control conditions Psychodynamic psychotherapy is as effective as cognitive-behavioral therapy in specific psychiatric disorders.

Results Long-term psychoanalytic psychotherapy is effective in treatment of multi-morbid mental disorder, large effect size was recorded. Long-term psychoanalytic psychotherapy is more effective than short-term psychoanalytic psychotherapy. Long-term psychoanalytic psychotherapy is effective in treatment of multi-morbid mental disorder, large effect size was recorded. Long-term psychoanalytic psychotherapy is more effective than short-term psychoanalytic psychotherapy.

Conclusions 1- Further research should include both efficacy and effectiveness of experimental studies. Cost-effective treatment Generalizing the result of one model to other models of treatment 2- Further research should address the complex interactions among interventions, patients’ level of functioning, helping alliance and outcome. 1- Further research should include both efficacy and effectiveness of experimental studies. Cost-effective treatment Generalizing the result of one model to other models of treatment 2- Further research should address the complex interactions among interventions, patients’ level of functioning, helping alliance and outcome.

Questions and Concerns 1- No record of searching strategies such as database, and keywords. They only mentioned a Cochrane review for short-term psychodynamic psychotherapy. 2- No clear inclusion or exclusion criteria, no tables. 3- No record of any effect size: “ Long-term psychoanalytic psychotherapy is effective in treatment of multi-morbid mental disorder, large effect size was recorded.” 1- No record of searching strategies such as database, and keywords. They only mentioned a Cochrane review for short-term psychodynamic psychotherapy. 2- No clear inclusion or exclusion criteria, no tables. 3- No record of any effect size: “ Long-term psychoanalytic psychotherapy is effective in treatment of multi-morbid mental disorder, large effect size was recorded.”

Questions and Concerns 5- Using broad and subjective terms: “outcome of the psychodynamic psychotherapy is related to skillfulness of the therapists, purity of technique, and accuracy of interpretation.” 6- No clear explanation of comparing different models of therapy “Psychodynamic psychotherapy is as effective as cognitive-behavioral therapy in specific psychiatric disorders.” 5- Using broad and subjective terms: “outcome of the psychodynamic psychotherapy is related to skillfulness of the therapists, purity of technique, and accuracy of interpretation.” 6- No clear explanation of comparing different models of therapy “Psychodynamic psychotherapy is as effective as cognitive-behavioral therapy in specific psychiatric disorders.”

Reference Leichsenring, F., & Leibing, E.(2007).Psychodynamic psychotherapy: A systematic review of techniques, indications and empirical evidence, Psychology and Psychotherapy: Theory, Research and Practice, 80, 217–228.doi: / X Leichsenring, F., & Leibing, E.(2007).Psychodynamic psychotherapy: A systematic review of techniques, indications and empirical evidence, Psychology and Psychotherapy: Theory, Research and Practice, 80, 217–228.doi: / X117394