As such, experimental psychology (of which clinical psychology is a part) has focused fairly much on cognitive behavior therapy. Because:

- It is teachable. You can teach training therapists particular techniques (such as those mentioned above).
- It is suitable for control trials. It can be operationalized into the above techniques so that different therapists are delivering the relevantly same thing.
- It is newer than Freud (hence we have made scientific progress)
- It (is seen to) tie into the experimental psychology literature rather well (even though behaviorism heyday was in the 60′s and the `cognitive’ in `CBT’ really has nothing to do with the experimental cognitive psychology movement.

It is important to note that the absence of evidence (e.g., the relative lack of evidence for the efficacy of psychodynamic therapy) really isn’t evidence for inefficacy. There are a number of problems with experimentally investigating the efficacy of psychodynamic therapy (some of them noted above). Some of those come down to political considerations and arbitrary field divisions rather than anything inherently unscientific…

If I were my dx then I’d give a shit about the most effective treatment for my dx. Fortunately… I am not my dx so I really don’t give a shit about efficacy studies. I think… That I can tell whether something is helpful for me or not. And I can assure you that I’d well and truly done my time with CBT. I can teach myself how to cognitively restructure or activity schedule from a book. I can’t teach myself how to deal with interpersonal relationships and the physical presence of a therapist from a book, however. Or not in a way that translates into my way of interacting with the world, at any rate.

All psychotherapies suffer from this generalized effect — paying someone to sit and listen to your problems is likely therapeutic in and of itself (assuming the professional does indeed listen and is generally nonjudgmental).

I am loathe to call human companionship for the mentally ill a ‘placebo effect.’ It is a release valve. It is therapy, although it is not particularly psychodynamic.

@Jaya – Thanks for your insightful comments. I think this study is an important milestone for psychodynamic psychotherapy, and puts a stake in the ground for future research to aspire to. Long term therapies such as psychodynamic therapy definitely have their place in this world, and this study shows that such treatments can likely be effective for people who stick with them, especially for difficult mental health problems.

Your critique brought to mind a comment made by one of my grad research professors — “if you torture the numbers long enough, they’ll tell you whatever you want them to say.” I’m not sure how valid this is but, my guess is it could be applied to many things.

My experience has been, if you look hard enough, you can find a flaw with pretty much any study — some more glaring than others. In addition, many studies that support a null hypothesis don’t get published even though this might add to our pool of knowledge. Even the “best practice” literature is currently being questioned and critiqued. Ultimately, without critique there can be no progress in knowing what works — mistakes bring about the possibility of doing things in a new way.

I have been discouraged by what I call the “therapy wars” — therapists arguing about which modality is better than another. I appreciate you stating clearly the finding that one therapy has not been shown to be better than others. The common factors research has been fascinating in this sense.

I was also impressed with your statement regarding cultural differences. The literature has had a long history of not speaking to this reality (for a number of valid reasons) — one which can no longer be ignored in the face of globalization.

Your brief article covered a number of pertinent points. I thank you for being thorough with the issues.

Thanks!