(This section is organized alphabetically by first author.)
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.
A particularly clear discussion of how knowing the name of a therapy does not begin to do an adequate job of assessing its nature and impact on the patient.
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.
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,with two principal dimensions of personality, which he calls anaclitic and introjective. Variations along these dimensions determine to a substantial degree whether a more or less supportive approach by the therapist leads to better results.
A lively and original discussion of cases and the meaning of the work undertaken.
Together with his 1982 book, Brenner makes a wonderfully clear exposition of the complexity of dealing with defenses in actual patients.
A succinct description of how the mind works, elegantly presented.
Connolly Gibbons, M. B, Crits-Christoph, P, Barber, J.P., Wiltsey Stirman, S, Gallop, R, Goldstein, L.A., Temes, C.M. & Ring-Kurtz, S. (2009). Unique and Common Mechanisms of Change Across Cognitive and Dynamic Psychotherapies. Journal of Consulting and Clinical Psychology, 77, 801–813.
The therapies in this study are mostly quite short-term, but the discussions are nevertheless interesting, and relevant to longer term therapies as well.
Connolly, M. B., Crits-Christoph, P., Shelton, R. C., Hollon, S., Kurtz, J., & Barber, J. P. (1999). The reliability and validity of a measure of self-understanding of interpersonal patterns. Journal of Counseling Psychology, 4, 472–482.
This paper further elaborates one aspect of what patients develop as a result of successful psychotherapy. Note the overlap between self-understanding of interpersonal problems and the role of mentalization (self-reflection)
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. Leads to a much broader notion of the benefits of psychotherapy than simply symptom removal.
This ground-breaking book, outlining the eight ages of man, had widespread impact on our views about development.
A well written account of changes occurring in the course of extended treatments.
A wide-ranging discussion of the relationships of mind and body, individual and culture, with findings centering on the role of the healer in a wide variety of cultures, and the universal feature of demoralization and ways of restoring hope.
Provides a systematic description of defenses that was seminal in influencing technique, and still has relevance today.
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.
A systematic discussion of approaching the patient’s reactions to the therapist or therapeutic situation as a means of bringing the patient’s core difficulties more into focus in the treatment.
Provides a current overview of the role of emotions in cure, in a well-established and articulated version of therapy focusing particularly on emotions.
Thoroughly explores the way humans are inclined to view their decisions and views as coming from the conscious part of their minds, whereas the evidence is overwhelming that the unconscious part rules mostly.
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.
A randomized controlled study of the effect of transference work (addressing the patient’s reaction to the analyst or analytic situation) on the course of treatment in the first 100 sessions. The authors demonstrated that, for those patients who had more difficulty in their relationships, the transference work enhanced the results of psychotherapy. A unique study.
The definition of “transference work” is also succinct and explains why such work may be viewed as central: “[F]ocusing on the themes and conflicts that arise in the therapeutic relationship will have immediate affective resonance and illuminate the true nature of problems in the patient’s relationships outside of therapy (Kernberg, Diamond, Yeomans, Clarkin and Levy, 2008: Strachey, 1934). . . Analysis of transference may increase insight regarding intrapsychic conflicts and problematic relations, which may in turn lead to better adaptive and interpersonal functioning (Gabbard and Westen, 2003; McGlashan and Miller, 1982; Messer and McWilliams, 2007; Strachey, 1934).” (p.698).
Remoralization, then symptom reduction, and finally character change.
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.
(Abstract) A case study is provided of a schizoid patient in her mid-sixties who in a lengthy analysis had made significant clinical improvement. The treating analyst’s impression of clinical improvement was independently verified through systematic analysis of transcripts of audiotapes of thirty-six sessions over a four-year period of treatment. The patient showed significant improvement on measures of character pathology, object relations, mentalization, and superego anxiety. The results suggest that some patients with entrenched character pathology who seem to be in analysis interminable may still make clinically significant improvement. It is suggested that the scientific status of psychoanalysis would be greatly enhanced if the anecdotal evidence generated in private practice were supported by independent verification. The current study illustrates one methodology, “case study plus,” for providing independent verification while retaining the richness of the traditional case study.
This presentation integrates perspectives on how increasing awareness of feelings functions within the brain to provide provide the opportunity to alter preconceptions with ensuing therapeutic benefit.
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.
(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.
This comprehensive approach to diagnosis and assessment of the individual far surpasses the fragmented approach of the DSM, with a rich discussion of all major aspects of diagnosis from childhood to later life, and an extensive consideration of methods of evaluation, with case illustrations.
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.
A brilliant delineation of the tripod of therapeutic activity, linking the feelings and reactions to the therapist, to contemporary extratherapeutic issues, and to the developmental past.
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.
A remarkably clear book representing the best of the humanistic tradition in working with patients.
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.
Extensive updating of the 2011 volume.
Extensive updating of the 2011 volume.
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.
A rather brilliant exposition of how one can attentively arrive at a deeper understanding of the patient based upon scrutiny of what can be seen and heard.
Perry, J. Christopher; Høglend, Per. (1998). Convergent and discriminant validity of overall defensive functioning. Journal of Nervous and Mental Disease..186, 529-535.
Description of the Defense Mechanisms Rating Scale (DMRS), which in turn leads to a useful measure of psychological health called Overall Defensive Functioning.
Roy, C.A., Perry, J.C., Luborsky, L. and Banon, E. (2009). Changes in Defensive Functioning in Completed Psychoanalyses: the Penn Psychoanalytic Treatment Collection. Journal of the American Psychoanalytic Association, 57: 399-415.
Using 17 recorded psychoanalyses, now included in the PRC collection, the authors show that when outcome is measured by well-established methods there is a substantial overlap of changes in defenses and the direction of greater health. The article is also useful for its description of other studies of changes in defenses and other aspects of adaptation with psychotherapy.
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.
This is a classical study, compiling carefully what our patient “consumers” really got out of their treatments. Clear and sensible.
Reviews the concepts relevant to assessing processes and outcomes of seven patients, with some long-term follow up.
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.
(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.
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.
A thoughtful exploration of the impact upon the patient of having an attentive and devoted listener.
An early exploration of what may lead to changes in the patient in the course of therapy. Emphasizes the mutative impact of what is now called transference work (see Høglend et al. 2011 for an elegant demonstration of the utility of this approach).
A vivid application of neuroscience findings to appreciation of the role of experience, including experience within the therapy hour, as they contribute to transforming habitual patterns in the patient.
Vaillant,George E. (2012). Triumphs of experience: The men of the Harvard Grant Study. Cambridge, MA, US: Harvard University Press.
Two hundred sixty-eight men from the classes of 1939 to 1942 were followed as long as they lived or into their nineties with a variety of measures of physical and mental health, in a unique study
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.
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.