Efficacy

It is often said that there are no studies on the effectiveness of psychoanalysis and long-term psychodynamic psychotherapy. In fact, this is not true. In a recent review undertaken by the International Psychoanalytic Association of outcome studies in psychoanalysis and long-term psychodynamic psychotherapy, (92) four case record studies, 13 naturalistic pre-post or quasi-experimental studies, nine follow-up studies, and nine experimental studies were identified. In addition, six process-outcome studies were reviewed.

Quite comprehensive reviews of such studies have been carried out,(9,94) and they tend to come to quite different conclusions. It is of course easy to be critical of psychoanalytic studies. There are no definitive studies which show psychoanalysis to be unequivocally effective to an active placebo or even an alternative method of treatment. In fact, there are no methods available that would unequivocally indicate the existence of a psychoanalytic process. Most studies have significant limitations which would lead critics of the discipline to discount their results. Amongst the most common problems are lack of standardized diagnoses, inadequate specification of the treatment procedures, lack of control on selection biases in sampling, the use of inexperienced therapists, unstandardized methods of assessment, lack of statistical power, failures of randomization, and the reliance on retrospectively collected data. Notwithstanding these severe limitations, many of the studies are impressive for the following reasons: they report results which other psychotherapies have not been able to achieve; some studies show very-long-term benefits from psychoanalytic treatment; the results tend to be highly consistent across studies; some of the populations studied have been larger than most better-controlled treatment trials. So, whereas it is true to say that little that is definite can be stated about the outcome of psychoanalysis, a number of suggestive conclusions may be drawn and these are listed below.

Across a number of studies and measures psychoanalysis has been shown to benefit the majority of those who are offered this treatment (92,> and can bring the functioning of a clinical group to the level of the normal population. (95,> Completed treatments tend to be associated with greater benefits. (96> On the whole, longer treatments have better outcomes(97) and intensive psychoanalytic treatment is generally more effective than psychoanalytic psychotherapy, (98) but its superiority sometimes only becomes apparent on long-term follow-up/,99' Psychoanalysis can lead to a reduction in health-care-related use and expenditure, (100) and this is maintained for a number of years after therapy ends.(!01) Psychoanalytic treatment can lead to a reduction in the use of psychotropic medication amongst inpatients/!.02) Long-term psychoanalytic therapy can reduce symptomatology in severe personality disorder such as borderline personality disorder (103) and these improvements are maintained.*1,,04) Psychoanalysis may be an effective treatment for severe psychosomatic disorders.(5 ,102,,105)

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