Re the meta-analysis "Effectiveness of Long-term Psychodynamic Pyschotherapy: http://jama.ama-assn.org/cgi/content/short/300/13/1551
My two attempts to purchase the article at the Jama website failed, but Mike Palij has kindly emailed the article to me (unsolicited). It needs someone with far more expertise than I have to examine the meta-analysis, but for what they're worth, here are some comments. 1. The 12 "observational studies" had no control groups. 2. For the 11 Long-term Psychodynamic Psychotherapy (LTPP) studies which included randomized control groups: The treatment of the control groups was a mish-mash of different psychotherapeutic procedures. These ranged from (a) TAU (treatment as usual), which seems to be ill-defined, and includes, e.g., continuing G.P. care. (b) Different kinds of cognitive behavioral therapies, such as "dialectical behavioural therapy" and "cognitive analytic therapy". (c) In one instance the treatment of a sub-group of the control group was described as "Control/nutritional counselling". (d) In three of the studies the control group treatments were split into "1st LTPP condition" and "2nd LTPP condition", which seems to mean Long Term Psychodynamic Psychotherapy applied to specific conditions. That the control for LTPP should be LTPP applied to specific conditions seems a bit odd to me. (Maybe it means something else, but LTPP is evidently involved for the control groups.) I see no evidence here that these studies show that the psychodynamic part of Long Term Psychodynamic Psychotherapy for the reported psychiatric/psychological problems is crucial for the improvements in the respective conditions. For that there would need to be studies with control groups treated over equal lengths of time with psychotherapy/counselling by therapists who had not been trained to use psychodynamic methods, and did not make probing for unconscious motivations a significant part of the treatment. Again, there is no attempt to differentiate between the psychodynamic psychotherapies, as if they are all much of a muchness, and I would like to know whether these adhered to more-or-less the same principles, or covered a variety of principles, in the sense that the therapists were informed by different psychodynamic notions, and sought to uncover very different kinds of unconscious motivations. (It might well turn out that the psychodynamic psychotherapists were generally eclectic in their approach, but that is something I would certainly be interested to know.) Allen Esterson Former lecturer, Science Department Southwark College, London http://www.esterson.org --- To make changes to your subscription contact: Bill Southerly ([EMAIL PROTECTED])
