Yesterday, we reported on a new meta-analysis of psychodynamic psychotherapy that demonstrates the effectiveness of this type of therapy. Traditionally, psychodynamic therapy is thought to be “less scientific” than newer, modern psychotherapy treatments, like cognitive-behavioral therapy (CBT). …
Before posting, please read our blog moderation guidelines. The comments below begin with the oldest comments first. Click on the last comments page to jump to the most recent comments.
Before posting, please read our blog moderation guidelines.
Post a Comment:
Copyright © 1995-2013 Psych Central. All rights reserved.
Site last updated: 19 Jun 2013
|
Read this for a critique of this article.
http://www.psychotherapybrownbag.com/psychotherapy_brown_bag_a/2010/01/what-do-we-know-about-psychodynamic-therapy-a-closer-look-at-shedlers-in-press-review.html
I actually am a firm believer in certain aspects of psychotherapy integration and see greatly value in some of the contributions and insights made by psychoanalytic therapists. And indeed, some of its derivatives have show significant potential in good research. However, readers should know that this meta-analytic study did suffer from some of its conclusions relying on many studies that failed to adequately define some of the disorders being treated and some contained no control groups. They often did not control for placebo effects, or for different lengths of treatment. Many of the studies ignored an important variable known as therapist allegiance effects, and did not adequately consider treatment dropouts. These confounds do not completely invalidate the auuthors’ conclusions, but place limitations on them (as is true of most psychological research).
At the same time, I expect psychoanalytic therapy to make furthe gains in research and look forward to seeing it happen. We plan to blog in the future about some modest psychotherapy integration ideas based on one view of schemas (that are inherent in both CBT and psychoanalytic approaches). This is why we also borrow some psychoanalytic perspectives in most of the books we write too.
Another evidence for the Dodo bird verdict… And still there are too many CBT specialists who claim they are giving the only evidence based therapies. That’s a real distortion in their cognition. One with dangerous consequences for clients who will be better with non-CBT but who are forced to get CBT (like in GB). The real question is: what works best for this person, instead of ‘CBT for all’.
My answer to the critiques: remember the study, last year of the real effectiveness of CBT by Lynch: http://www.ncbi.nlm.nih.gov/pubmed/19476688
Miek -
I left a similar reply to your comment on PBB, but wanted to voice my concerns with your assertions here as well:
- The dodo bird hypothesis is that all treatments work equally well for all conditions. Putting aside the fact that the studies used to justify that claim (e.g., Wampold’s work) are highly flawed, the bottom line is that the data from Shedler’s piece does nothing to support (or contrast) that claim. All it claims to demonstrate is the relative impact of psychodynamic therapy versus cognitive behavioral therapy.
- Proponents of empirically supported treatments do *not* saying that CBT is the best for all conditions or that everyone responds well to CBT for the conditions for which it is the treatment with the most empirical support. They are saying that certain treatments, on average, produce better results for particular diagnoses than others do and, as such, those treatments should be used first (if multiple treatments have equivalent evidence supporting their effectiveness, the client should be given complete control over that decision). Assessment should occur frequently throughout treatment and, if the client is not improving, either a new treatment approach should be attempted or the therapist and client should work together to determine if other factors are interfering with therapy.
- I won’t detail all the replies I gave to you over at PBB about the Lynch piece, but keep in mind: evidence that CBT is not an effective treatment for schizophrenia or bipolar disorder is not a sign that the dodo bird hypothesis is supported or that psychodynamic therapy is effective. It is simply evidence that CBT is not effective for those disorders (although here again, arguments can be made that the goals of CBT as an adjunct to medication are met quite well and that CBT is not offered as a “cure” for those conditions). The depression finding also offers no evidence of the relative efficacy of other treatment approaches (and runs counter to mountains of evidence from other studies).