Hi All: Thanks much for the kind words and for posting this letter to the
list, Stephen. As for the claim regarding short-term psychodynamic
treatments, several recent meta-analyses have shown promising research
support for several disorders, including depression. I don't find the
evidence as convincing or as extensive as that for several other treatments,
particularly behavioral and cognitive-behavioral (which is why I wrote
"perhaps"), but I do think that we consider it carefully. My own hypothesis
is that these treatments do often work largely because they adventitiously
incorporate behavioral techniques, but that possibility requires testing
using dismantling techniques.
One recent meta-analysis on this front is by Leichsenring et al. (2004,
Archives of General Psychiatry: The efficacy of short-term psychodynamic
therapy in specific psychiatric disorder: A meta-analysis). The Abstract is
reproduced below (and now it's my turn to apologize for the strange
formatting!). Thanks again, Stephen...Scott
Background: The efficacy of psychodynamic therapy is controversial. Previous
meta-analyses have reported discrepant results. Objective: To test the
efficacy of short-term psychodynamic psychotherapy (STPP) in specific
psychiatric disorders by performing a meta-analysis of more recent studies.
We assessed outcomes in target problems, general psychiatric symptoms, and
social functioning. Design: We identified studies of STPP published between
January 1, 1970, and September 30, 2004 by means of a computerized search
using MEDLINE, PsycINFO, and Current Contents. Rigorous inclusion criteria,
included randomized controlled trials, use of treatment manuals and
ensurance of treatment integrity, therapists experienced or specifically
trained in STPP, treatment of patients with specific psychiatric disorders,
reliable and valid diagnostic measures, and data necessary to calculate
effect sizes. Studies of interpersonal therapy were excluded. Seventeen
studies fulfilled the inclusion criteria. The information was extracted by 3
raters. Effect sizes were calculated for target problems, general
psychiatric symptoms, and social functioning using the data published in the
original studies. To examine the stability of outcome, we assessed effect
sizes separately for end of therapy and follow-up assessment. The effect
sizes of STPP were compared with those of waiting-list control patients,
treatments as usual, and other forms of psychotherapy. Results: Short-term
psychodynamic psychotherapy yielded significant and large
pretreatment-posttreatment effect sizes for target problems (1.39), general
psychiatric symptoms (0.90), and social functioning (0.80). These effect
sizes were stable and tended to increase at follow-up (1.57, 0.95, and 1.19,
respectively). The effect sizes of STPP significantly exceeded those of
waiting-list controls and treatments as usual. No differences were found
between STPP and other forms of psychotherapy. Conclusions: Short-term
psychodynamic psychotherapy proved to be an effective treatment in
psychiatric disorders. However, further research of STPP in specific
psychiatric disorders is needed, including a study of the active ingredients
of STPP. Effectiveness studies should be included. (PsycINFO Database Record
(c) 2005 APA, all rights reserved) (journal abstract)
----- Original Message -----
From: <[EMAIL PROTECTED]>
To: "Teaching in the Psychological Sciences" <[email protected]>
Sent: Thursday, March 02, 2006 10:43 AM
Subject: Psychotherapy claims
An op-ed piece was published recently in the New York Times, in which
a psychoanalyst declared that his profession was beyond mere grubby
evaluation of effectiveness. The colleague who drew this to my
attention also sent me a collection of responses to it, among them a
great one from our very own Scott Lilienfeld. I'm sure he won't mind
if I reproduce it here (please excuse me if the formatting gets
messed up in the re-posting; it looks ok at the moment).
New York Times, March 2 2006 Beyond Data: Does Therapy Work?
To the Editor: Re "A Mind Is a Terrible Thing to Measure" (Op-Ed,
Feb. 26): Adam Phillips revives the old and worn argument that the >
effects of psychotherapy are so ineffable that they cannot,
or perhaps should not, be quantified. In fact, hundreds of
carefully controlled studies now demonstrate that several
psychotherapeutic modalities, especially behavioral, cognitive-
behavioral, interpersonal and perhaps short-term psychodynamic
treatments, exert positive and measurable effects on the symptoms > of
depression, anxiety, bulimia, insomnia, sexual dysfunction and > other
conditions. Mr. Phillips's claim to the contrary, the
primary impetus underlying the increasing pressure to assess
psychotherapy outcomes is not the desire to appear scientific.
It is the laudable desire to hold psychotherapists accountable for >
their claims to alleviate mental suffering. Mr. Phillips cannot >
have things both ways. If he charges his clients for his therapy
hours, which I assume that as a psychoanalyst he does, he must
presumably be offering a legitimate service with measurable
effects. If he is not offering such a service, then it is not
clear what benefit he is offering beyond that of an empathic
or perceptive friend who is surely less expensive.
Scott O. Lilienfeld, Ph.D. Atlanta, Feb. 26, 2006
The writer is an associate professor of psychology at Emory
> University and editor of the Scientific Review of Mental Health >
Practice.
My only quibble is with Scott's claim that "perhaps short-term
psychodynamic treatment" may be effective, which may be just Scott
being nice (not a problem I have). While psychodynamic treatment may
be better than no treatment, I'm not aware that it offers anything
"beyond that of an empathic or perceptive friend".
And from a satisfied customer of psychoanalysis, this:
To the Editor:
I have been to a psychiatrist a couple of times in my life <snip> And
when all else fails, my therapist has these
wonderful little hard candies I am quite fond of.
Bruce Neuman
East Hampton, N.Y., Feb. 26, 2006
Ah, the therapeutic power of wonderful little hard candies. Expensive
way to get them, though.
Stephen
-----------------------------------------------------------------
Stephen L. Black, Ph.D.
Department of Psychology
Bishop's University e-mail: [EMAIL PROTECTED]
Lennoxville, QC J1M 1Z7
Canada
Dept web page at http://www.ubishops.ca/ccc/div/soc/psy
TIPS discussion list for psychology teachers at
http://faculty.frostburg.edu/psyc/southerly/tips/index.htm
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