Others’ Work

(This section is organized alphabetically by first author.)

Under Revision

Ablon, J., & Jones, E. E. (1998). How expert clinicians’ prototypes of an ideal treatment correlate with outcome in psychodynamic and cognitive-behavioral therapy. Psychotherapy Research,Psychother Res 8, 71–83.

Demonstrating how what a treatment is called by therapists, and how it benefits patients, may be two quite different matters. New methodology for assessing the processes of therapy combine with outcome assessment.

 

Ablon, J. S., Levy, R.A., & Katzenstein, T. (2006). Beyond Brand Names of Psychotherapy: Identifying Empirically Supported Change Processes. Psychotherapy: Theory, Research, Practice, Training 43, 216-231.

Bettelheim, B. 1982. Freud and Man’s Soul. Random House, New York.

The author, a psychoanalyst and native German speaker, traces out ways Freud’s ideas and down-to-earth style became distorted in translation into English, in the direction of attempting to be more ’scientific’. For example, the German term Freud used for the unconscious mind should be translated as “the It”. More evocative and less scientific sounding than the Id.]

One famous and painful example of excessive zeal in following narrow specifications for how to work therapeutically was described by John Bowlby, the British psychoanalyst whose work inspired the development of the field of attachment research. When he was in training, he was presenting a case to the famous  psychoanalyst Melanie Klein. He came to supervision and described an upsetting session with a young boy whose mother burst into the consulting room in an agitated state. Klein reprimanded him for addressing the child’s upset about his mother, saying he should just stick to the internal life of the child. After the supervision he found out that the mother had made a suicide attempt. He never returned to Klein as supervisor. Two excellent studies (among others) reported better outcomes when therapists are more flexible (citations pending).

The field of psychotherapy remains with largely inadequate empirical foundation to answer the classical question, paraphrased here: what treatment, for which patient, at what point in their unfolding relationship with the therapist, will prove to be most helpful? The latest extensive systematic effort to summarize what we do know is found in the two-volume 2019 edition of  Psychotherapy Relationships that Work (Norcross & Lambert, 2019; Norcross & Wampold, 2019). But even this admirable study does not sufficiently address the issue of efficacy of long-term psychotherapy relationships, nor can it compensate for the dearth of careful long term follow-ups to determine what psychotherapies with what patients conducted with what relational conditions, using what techniques actually lead to long-term benefit. And the even more difficult issue remains insufficiently studied:  how much variation in outcome is the result of the variation in therapist gifts to conduct therapy?

 

Blatt, S.J. & Shahar, G. (2004). Psychoanalysis – with whom, for what, and how? Comparisons with psychotherapy. Journal of the American Psychoanalytic Association, 52, 393-447.

Blatt and his colleagues’ work has shown a wide variety of important clinical features affecting the outcome of treatment.

 

Connolly, M.B. & Strupp, H.H. (1996). Cluster Analysis of Patient Reported Psychotherapy Outcomes. Psychotherapy Research, 6: 30-42.

This study explores the varieties of perceived benefits including changes in self-concept. A careful effort to determine what categories of changes patients actually appreciate after the treatment.

 

Frank, Jerome (1973). Persuasion and Healing. Baltimore: Johns Hopkins University Press.

 

Grande, T., Keller, W and Rudolf, G. (2012). What happens after treatment: Can structural change be a predictor of long-term outcome? Chapter in Levy, R., Ablon, J.S. & Kächele, H. [Eds] Psychodynamic psychotherapy research: Evidence-based practice and practice-based evidence. (pp. 169-183).Totowa, NJ, US: Humana Press – Springer.

This report comes from the Hamburg based Operationalized Psychodynamic Diagnosis group, whose very thorough and well thought out measures of psychological functioning developed over more than 30 years deserve careful study, as their methods are complex, but very sound.]

This website is designed to inform the participant as best we can of what evidence exists about aspects of psychodynamic psychotherapy which actually work,  with appropriate references to what we consider the most helpful, and scientifically sound studies available (e.g. Norcross et al. 2011; Shedler 2010; Leichsenring and Rabung 2008; Leichsenring and Leibing 2003; Wampold 2001). Of course, we can not in this setting do justice to the broad reach of studies in the world of CBT (cognitive behavioral therapy) and the countless other variants of psychotherapy invented in these past decades, but we hope that by addressing fundamental principles, the reader will end up better equipped to judge for him- or herself.

Hilsenroth, Mark J; Blagys, Matthew D; Ackerman, Steven J; Bonge, Dennis R; Blais, Mark A. (2005). Measuring Psychodynamic-Interpersonal and Cognitive-Behavioral Techniques: Development of the Comparative Psychotherapy Process Scale. Psychotherapy: Theory, Research, Practice, Training 42, 340-356. 

A 20 item scale very well developed and described, touching on typical features of psychodynamic and cognitive behavioral therapy.

 

Høglend, P. Hersoug, A.G., Bøgwald, K.P., Amlo, S., Marble, A., Sørbye, Ø., Røssberg, J.I.,, Ulberg, R., Gabbard, G. & Crits-Christoph, P. (2011). Effects of Transference Work in the Context of Therapeutic Alliance and Quality of Object Relations. Journal of Consulting and Clinical Psychology  79, 697–706.

 

Howard, K.I., Lueger, R.J., Maling, M.S. & Martinovich, Z. (1993).  A Phase Model of Psychotherapy Outcome: Causal Mediation of Change. J. Consult. & Clin. Psychol. 61, 678-685.

 

Howard, K.I., Moras, K, Brill, P.L., Martinovich, Z. & Lutz, W. (1996). Evaluation of Psychotherapy: Efficacy, Effectiveness, and Patient Progress. American Psychologist, 51, 1059-1064.

 

Jones, E.E. & Pulos, S.M. (1993). Comparing the Process in Psychodynamic and Cognitive Behavioral Therapies. Journal of Consulting and Clinical Psychology 61, 306-316.

Reports the development of the Psychotherapy Process Q-Set, a 100 item instrument which has been used widely since to evaluate differences among various therapies.

 

Leichsenring, F., & Leibing, E. (2003). The Effectiveness of Psychodynamic Therapy and Cognitive Behavior Therapy in the Treatment of Personality Disorders: a Meta-analysis. American Journal of Psychiatry, 160, 1223.

(From the Abstract) The authors conducted a meta-analysis to address the effectiveness of psychodynamic therapy and cognitive behavior therapy in the treatment of personality disorders. METHOD: Studies of psychodynamic therapy and cognitive behavior therapy that were published between 1974 and 2001 were collected. Only studies that 1) used standardized methods to diagnose personality disorders, 2) applied reliable and valid instruments for the assessment of outcome, and 3) reported data that allowed calculation of within-group effect sizes or assessment of personality disorder recovery rates were included. Fourteen studies of psychodynamic therapy and 11 studies of cognitive behavior therapy were included. RESULTS: Psychodynamic therapy yielded a large overall effect size (1.46), with effect sizes of 1.08 found for self-report measures and 1.79 for observer-rated measures. For cognitive behavior therapy, the corresponding values were 1.00, 1.20, and 0.87. For more specific measures of personality disorder pathology, a large overall effect size (1.56) was seen for psychodynamic therapy. Two cognitive behavior therapy studies reported significant effects for more specific measures of personality disorder pathology. For psychodynamic therapy, the effect sizes indicate long-term rather than short-term change in personality disorders. CONCLUSIONS: There is evidence that both psychodynamic therapy and cognitive behavior therapy are effective treatments of personality disorders. Since the number of studies that could be included in this meta-analysis was limited, the conclusions that can be drawn are only preliminary. Further studies are necessary that examine specific forms of psychotherapy for specific types of personality disorders and that use measures of core psychopathology. Both longer treatments and follow-up studies should be included.

 

Leichsenring, F. & Rabung, S. (2008). Effectiveness of Long-term Psychodynamic Psychotherapy: a Meta-analysis. Journal of the American Medical Association300, 1551-1565.

(Modified from the Abstract) Twenty-three studies involving a total of 1053 patients were included (11 RCTs and 12 observational studies). According to comparative analyses of controlled trials, long term psychoanalytic psychotherapy (LTPP) showed significantly higher outcomes in overall effectiveness, target problems, and personality functioning than shorter forms of psychotherapy. With regard to overall effectiveness, a between-group effect size of 1.8 (95% confidence interval [CI], 0.7-3.4) indicated that after treatment with LTPP patients with complex mental disorders on average were better off than 96% of the patients in the comparison groups (P=.002). According to subgroup analyses, LTPP yielded significant, large, and stable within-group effect sizes across various and particularly complex mental disorders (range, 0.78-1.98).

 

Leuzinger-Bohleber, M., Stuhr, U., Ruger, B., & Beutel, M. (2003) How to study the quality of psychoanalytic treatments and their long-term effects on patients’ well-being: a representative, multi-perspective follow-up study. International Journal of Psychoanalysis 84, 263-290.

This study of hundreds of patients about seven years after their analyses and psychotherapies is sensitive, in depth, yet methodologically sophisticated. One of the very best.

 

Levy, K.N., Meehan, K.B., Kelly, K.M., Reynoso, J.S., Weber, M., Clarkin, J.F., & Kernberg, O.F. (2006) Change in attachment patterns and reflective function in a randomized controlled trial of Transference Focused Psychotherapy for borderline personality disorder. Journal of Consulting and Clinical Psychology. 74, 1027-1040.

A superbly organized and executed study showing how the psychodynamic elements make a difference to outcome. Patients with severe and long-standing personality difficulties in psychoanalytic treatment improve significantly in their functioning and emotional health, and they do so by cultivating a greater ability to meaningfully reflect on themselves and others close to them.

 

Lingiardi, V., Muzi, L., Tanzilli, A., & Carone, N. (2017). Do therapist’s subjective variables impact on psychodynamic psychotherapy outcomes? Clinical Psychology & Psychotherapy, 25: 85-101.

A systematic review of studies examining the complex interactions between therapist attachment styles, interpersonal history, and other factors affecting therapists’ subjective self-concept on the one hand, with similar patient personality factors on the other. By attending to one’s own ‘subjective variables’ as a therapist, one can construct interventions better suited to the patient’s needs in treatment.

 

McCarthy, K. & Barber, J. (2009). The Multitheoretical List of Therapeutic Interventions (MULTI): Initial report. Psychotherapy Research 19: 96-113.

A 60 item scale derived from study of eight variants of psychotherapy:  (behavioral, cognitive, dialectical-behavioral, interpersonal, person centered, psychodynamic, process- experiential, and common factors). Developed so that assessments could be made from multiple perspectives (patient, therapist, observer). We have re-classified the items in accordance with our view that many items belong under psychodynamic because this is the original form of therapy, as discussed in “Why do we focus on psychoanalysis in the “home” tab. We found that there were 9 items we kept under “common elements”, then 33 under psychodynamic (although some of those had been discouraged by various psychoanalytic theoreticians through the years), then another 18 classified as “CBT” broadly conceived. Click here for the original and our reclassified list of the 60 items of the MULTI.]

 

Milrod, B., Leon, A.C., Busch, F., Rudden, M., Schwalberg, M., Clarkin, J., Aronson, A., Singer, M., Turchin, W., Klass, E.T., Graf, E., Teres, J.J. & Shear, M.K. (2007) A randomized controlled clinical trial of psychoanalytic psychotherapy for panic disorder. American Journal of Psychiatry 164: 265-272.

This randomized study of the results of twice-weekly panic focused therapy compared to a version of cognitive therapy often used to treat panic attacks, each lasting for 24 sessions, is noteworthy for the sophistication of its design.

Norcross, J. And Lambert, M. eds. (2019).Psychotherapy Relationships that Work Vol. 1 Evidence-Based Therapist Contributions. Oxford Universities Press, New York.

Norcross, J. And Wampold, B. eds. (2019). Psychotherapy Relationships that Work Vol. 2 Evidence-Based Therapist Contributions. Oxford Universities Press, New York.]

Follow-up studies have shown strong clinical evidence of changes after long term therapy and psychoanalysis (see Wallerstein, 1986; Sandell et al. 2000; Leuzinger-Bohleber et al. 2003; Grande et al. 2012) but leaving two main issues requiring further study: how much might these patients have benefited from shorter or different treatments, or found their own way to a healthier life if treatment were not available?  The results support the value of long term therapy, but not with the thoroughness that our field would benefit from, nor the careful exploration of treatment failures among the group of former patients over time.

Norcross, John C.  Ed. (2011) Psychotherapy Relationships That Work: Evidence – Based Responsiveness. New York, Oxford University Press.

This volume is a brilliantly written report stemming from a task force of the American Psychological Association Committee on Psychotherapy. Summarizing the entire field, there are also detailed meta analyses across the spectrum of psychotherapy. The first and last chapters do an admirable job summarizing the findings.

 

Sandell, R., Blomberg, J., Lazar, A., Carlsson, J., Broberg, J. & Schubert, J. (2000). Varieties of long-term outcome among patients in psychoanalysis and long-term psychotherapy: a review of findings in the Stockholm outcome of psychoanalysis and psychotherapy project (STOPPP). International Journal of Psychoanalysis: 81: 921-942.

A complicated study to understand fully, but of the highest quality, showing that the benefits of more intensive work (in comparison with infrequent sessions) begin to show only as the years go on. There are other findings in regard to therapists who attempt to conduct therapy too much like classical analysis, to the detriment of their patients.

 

Seligman, M. (1995). The effectiveness of psychotherapy: the Consumer Reports study. American Psychologist, 50: 965-974.

This is a classical study, compiling carefully what our patient “consumers” really got out of their treatments. Clear and sensible.

 

Shea, M. Tracie; Elkin, Irene; Imber, Stanley D; Sotsky, Stuart M; Watkins, John T; Collins, Joseph F; Pilkonis, Paul A; Beckham, Edward; Glass, David R; Dolan, Regina T. 1992. Course of depressive symptoms over follow-up: Findings from the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Archives of General Psychiatry. 49: 782-787.

Shea is the lead author in reporting the results of an approximately two-year follow-up of the NIMH 20 million dollar study in the 1980s comparing four different short term treatments of depression, with random assignment to each (the study is more completely described in Wampold, 2000 pp.106-109) The study itself was of only 16 session treatments, and my follow-up less than 25% of the patients overall had maintained their gains.

 

Shedler, J. (2010). The Efficacy of Psychodynamic Psychotherapy. American Psychologist, 65, 98-109.

(Abstract) Empirical evidence supports the efficacy of psychodynamic therapy. Effect sizes for psychodynamic therapy are as large as those reported for other therapies that have been actively promoted as “empirically supported” and “evidence based.” In addition, patients who receive psychodynamic therapy maintain therapeutic gains and appear to continue to improve after treatment ends. Finally, nonpsychodynamic therapies may be effective in part because the more skilled practitioners utilize techniques that have long been central to psychodynamic theory and practice. The perception that psychodynamic approaches lack empirical support does not accord with available scientific evidence and may reflect selective dissemination of research findings.

 

Stern, D.N. (1998). The process of therapeutic change involving implicit knowledge: Some implications of developmental observations for adult psychotherapy. Infant Mental Health Journal, 19, 300-308.

Seminal work leading to increasing awareness of the importance of implicit processes in psychotherapy. Despite past bias privileging explicit insights gained by the patient, many important and helpful things occur more implicitly in treatment, in the background of the conversation and often without either therapist or patient realizing.

 

Wallerstein, R. (1986) Forty-Two Lives in Treatment: A Study of Psychoanalysis and Psychotherapy. New York: Guilford Press.(746 pages) and Wallerstein, R.S. (1989) The Psychotherapy Research Project of the Menninger Foundation: an overview. Journal of Consulting and Clinical Psychology, 57 (2), 195-205.

This monumental, sophisticated and thorough clinical study is fascinating reading. The short version is in the second reference. Patients benefited substantially (see WALDRON, S. Book Review: (1989) Psychoanalytic Quarterly 58: pp. 643-647 for an interesting way of assessing the degree of benefit). Two limitations: there was no comparison group, and there was no recording of the treatments to make possible detailed process assessments. Nevertheless, the study demonstrated strikingly that long term change took place as much with supportive elements as insight.

Wampold, B. E. (2001). The Great Psychotherapy Debate: Models, Methods, and Findings.  Mahwah, NJ: Lawrence Erlbaum.

Bruce Wampold is an incisive and creative thinker who is also brilliant in detecting the flaws and weak points of arguments put forward on one side or another of the psychotherapy wars, Very informative.

 

Werbart, A., Hagertz, M., & Olander, N.B. (2018). Matching patient and therapist anaclitic-introjective personality configurations matters for psychotherapy outcomes. Journal of Contemporary Psychotherapy, 48: 241-251.

This study examined patients and their therapists, according to Blatt’s theory of personality development, and differential personality patterns emphasizing either relatedness or self-definition. The authors found that convergent patterns in patient and therapist were associated with more robust treatment outcomes, and they suggest additional attention and intervention in patients known to differ from therapists in these respects, in order to collaborate effectively in psychotherapy.

 

Westen, D., Novotny, C.M., & Thompson-Brenner, H. (2004). The empirical status of empirically supported psychotherapies: Assumptions, findings, and reporting in controlled clinical trials. Psychological Bulletin. 130: 631-663.

These writers demonstrate the inadequacy of the empirically supported approach to benefit, from a variety of convincing perspectives.