Psychodynamic therapy – the evidence
The Maya Centre provides one year of weekly psychodynamic counselling for low-income
women. This leaflet summarises the evidence for the effectiveness and cost-effectiveness of
this approach.
Psychodynamic counselling
Psychodynamic counselling (or psychotherapy) looks not only at problems in the present but,
crucially, at the roots of these problems in the past. Careful understanding of the relationship
between the client and the counsellor helps to identify how emotional patterns from early in a
person’s life may repeat themselves in later life in a damaging way. Coming to understand
this enables change to take place. Psychoanalysis and psychoanalytic psychotherapy (from
which psychodynamic counselling is derived) are based on more than one hundred years of
intensive clinical practice and research, in which developments in understanding how to work
most effectively have traditionally been based on the close scrutiny of individual cases. More
recently, however, quantitative empirical methods have also been used to provide evidence of
the effectiveness of this kind of treatment.
Empirical research
Many empirical studies of different forms of psychotherapy in the past have found ‘valid’
therapies (those based on a clear model and using trained practitioners) to be superior to no
treatment but to produce similar results to each other.1 This ‘equivalence’ position (the idea
that all therapies produce equivalent outcomes), combined with the proliferation of empirical
studies of other forms of therapy such as cognitive behavioural therapy (CBT), have
sometimes given the misleading impression that CBT is the only ‘evidence-based’ form of
therapy. In fact, psychodynamic psychotherapy has been shown to be effective in treating
people with serious psychiatric disorders, personality disorders and depression, while there is
evidence that longer-term therapies - such as psychodynamic counselling or therapy lasting at
least one year – are more effective than shorter-term ones (including CBT).
For instance, a recent randomised controlled trial (RCT) compared long-term psychotherapy
(18 months on average) to both short-term psychotherapy and solution-focused therapy for
patients with depression and anxiety. Although the short-term psychotherapy patients
improved faster than the long-term ones, at three-year follow-up, it was the long-term
psychotherapy patients who had benefited most. This was not due to relapse by the short-term
patients but due to the greater ‘effect sizes’ produced by the longer-term treatment.2
This was confirmed by a recent meta-analysis of studies of psychodynamic psychotherapy
lasting for at least a year, which combined 23 studies involving 1053 patients. This metaanalysis found psychodynamic psychotherapy of at least a year to be more effective than
shorter-term psychotherapy, in terms of overall effectiveness, target problems and personality
functioning, thus proving it to be an effective treatment for complex mental disorders. 3 This is
consistent with an earlier meta-analysis of six studies of short-term psychodynamic
psychotherapy (13 to 20 sessions) compared to cognitive therapy for depression. This found
the two treatments to be equally effective, but also found some evidence that such short-term
treatment was insufficient to achieve lasting remission.4
Psychodynamic psychotherapy lasting up to 40 sessions has also been found to be effective
for patients with psychiatric disorders (including major depression, maternal depression,
PTSD, eating disorders, drug dependence, borderline personality disorder) in a meta-analysis
of 17 studies. Overall improvements in target problems, general psychiatric symptoms and
social functioning after treatment were large and these improvements were stable and tended
to increase at follow-up.5 Psychodynamic psychotherapy lasting from eight sessions to two
years has also been found to be effective for personality disorders in a meta-analysis of 14
studies. Large improvements were found both overall and in personality disorder pathology,
which indicated long-term rather than short-term change.6
Cost-effectiveness
Layard and colleagues have demonstrated that the cost of providing psychological therapies
would be fully covered by the consequent savings made in incapacity benefit and extra taxes
that would result from more people being able to work.7 Specific evidence for the costeffectiveness of psychodynamic psychotherapy is sparse, due the paucity of studies
conducted, but long-term psychotherapy for borderline personality disorder has been found to
improve health-related quality of life and decrease societal costs8 while psychotherapy has
been found to be cost-effective for treating depression in some patient groups.9 Long-term
psychotherapy has also been found to reduce health care use and sick leave substantially,
producing benefits which endure long after treatment and counterbalance treatment costs
within three years.10
Societal costs
Considering broader societal costs is complex but important when considering the treatment
of socially disadvantaged groups. Maternal depression is known to be one predictor of child
antisocial behaviour.11 Children displaying antisocial behaviour are known to place
substantial economic costs on multiple agencies and families12, while such antisocial
behaviour is a known predictor of these individuals’ costs to society in adulthood.13 Treating
the depression of disadvantaged women is highly likely to benefit their children, leading to
reduced societal costs in the future.
References
1. Wampold BE, Minami T, Baskin TW, Tierney SC (2002) A meta-(re)analysis of the effects of
cognitive therapy versus ‘other therapies’ for depression. Journal of Affective Disorders 68, 159-65.
2. Knekt P et al (2008) Randomized trial on the effectiveness of long- and short-term psychodynamic
psychotherapy and solution-focused therapy on psychiatric symptoms during a 3-year follow-up.
Psychological Medicine 38 (5), 689-703.
3. Leichsenring F, Rabung S (2008) Effectiveness of long-term psychodynamic psychotherapy. JAMA
300 (13), 1551-1565.
4. Leichsenring F (2001) Comparative effects of short-term psychodynamic psychotherapy and
cognitive-behavioural therapy in depression: a meta-analytic approach. Clinical Psychology Review
21 (3), 401-419.
5. Leichsenring F, Rabung S, Leibing E (2004) The efficacy of short-term psychodynamic
psychotherapy in specific psychiatric disorders. Archives of General Psychiatry 61, 1208-1216.
6. Leichsenring F & Leibing E (2003) The effectiveness of psychodynamic therapy and cognitive
behaviour therapy in the treatment of personality disorders: a meta-analysis. American Journal of
Psychiatry 160 (7), 1223-1232.
7. Layard R, Clark D, Knapp K, Mayraz G. (2007) Cost-benefit analysis of psychological therapy.
National Institute Economic Review 202, 90-98.
8. van Asselt MDI, Dirksen CD, Arntz A, Glesen-Bloo JH, van Dyck R, Spinhoven P, van Tilberg W,
Kremers IP, Nadort M, Severens JL (2008) Out-patient psychotherapy for borderline personality
disorder: cost-effectiveness of schema-focused therapy v. transference-focused psychotherapy.
British Journal of Psychiatry 192, 450-457.
9. Barrett B, Byford S, Knapp M (2005) Evidence of cost-effective treatments for depression: a
systematic review. Journal of Affective Disorders, 4, 1-13.
10. de Maat S, Philipszoon F, Schoevers R, Dekker J, de Jonghe F (2007) Costs and benefits of longterm psychoanalytic therapy: changes in health care use and work impairment. Harvard Review of
Psychiatry 15 (6), 289-300.
11. Rutter M, Giller H, Hegell A (1997) Antisocial behaviour by young people. New York: Cambridge
University Press.
12. Romeo R, Knapp M, Scott S (2006) Economic cost of severe antisocial behaviour in children – and
who pays for it. British Journal of Psychiatry 188, 547-553.
13. Scott S, Knapp M, Henderson J, Maughan B (2001) Financial cost of social exclusion: follow up
study of antisocial children into adulthood. BMJ 323 (28 July), 1-5.