The Effectiveness of Psychoanalytic Therapy: Evidence From ResearchA three-part series by Nancie Senet, PhD
Part 1: The Dodo Bird Verdict
Lewis Carroll first introduced us to the judicial talents of the Dodo Bird in Alice in Wonderland. This wise bird devised a race to dry everyone off after they had gotten wet in the pool of tears that Alice had unwittingly created. The Dodo called it a Caucus-race. It was a helter-skelter affair, sort of like the present day political ‘Caucus races’. But I digress. Back to Alice. Of course, the runners wanted to know who was the winner when the race was finally called to a stop. The Dodo giving serious thought to the matter handed down his famous verdict. “EVERYBODY has won, and all must have prizes.”
In 1936 the beloved Dodo waddled onto the scene in psychology. At that time as is so now, there were a variety of psychotherapies in use. Saul Rosenzweig, a psychologist at Worcester State Hospital, noted that “proponents of psychoanalysis, treatment by persuasion, Christian Science and any number of other psychotherapeutic ideologies can point to notable successes.” He lamented that “the proud proponent, having achieved success in the cases he mentions, implies, even when he does not say it, that his ideology is thus proved true, all others false.” Invoking the Dodo bird’s verdict he argued that there were successes in each of the forms of psychotherapy and that the successes must be due to implicit common factors. He proposed that the effect of having a “good” therapist who uses a systematic ideology providing formal consistency would be effective no matter what the method.
Fast forward to 1975. There was now a multiplicity of psychotherapies. There was also a growing interest in proving that one or another particular form of treatment was the empirically validated one. A proliferation of controlled efficacy studies ensued, mostly within the behavioral framework. Lester Luborsky, a psychoanalyst and researcher, began looking at the accumulating data. He and his research colleagues had their eyes on Rosenzweig’s earlier opinion that all psychotherapies were effective. They asked the question “is it true that ‘everyone has won and all must have prizes”? They published a meta-analysis of the existing therapeutic efficacy studies. The studies available at that time only allowed for comparisons of “psychotherapy”, which lumped together all traditional forms including psychoanalytic, vs. behavior therapy, psychotherapy vs. client-centered therapy, psychotherapy vs. group psychotherapy, time-limited vs. time-unlimited, psychopharmacotherapy vs. psychotherapy, psychotherapy vs. “control” groups, and one other that concerned medical management and psychotherapy for psychosomatic disorders. So what was the outcome? Yes, the Dodo bird verdict prevailed again in all of the comparisons of single forms of psychotherapy with each other. Luborsky and colleagues noted that all of the studies were of short-term therapy and that there was a glaring lack of studies of long-term treatment. They also agreed with Rosenzweig’s assessment of possible implicit common factors underlying the results.
Moving forward nearly 20 more years to 1993, Luborsky and colleagues again published a meta-analysis of comparative studies of psychotherapy outcomes. This time the focus was on dynamic therapies vs. other therapies, a comparison that had been missing in their first analysis. But yet again, the Dodo bird’s verdict prevailed. “Our examination of the comparisons clearly shows that dynamic psychotherapy is in general no better or worse in its benefits than other therapies.” (p.504) They noted, however, that almost of all the studies still were short-term treatment. They thought that perhaps if long-term treatment such as psychoanalysis were to be included that in that case improvement might be greater.
Two years later Consumer Reports (1995) published results of a study they had conducted using a large-scale survey of their readers. It was a self-report of 2,900 respondents who had seen a mental health professional at some time during the preceding 3 years. They answered 26 questions pertaining to what kind of a professional they had seen, what the treatment modality had been, how long that had been in treatment, and what their experience had been. There were several significant results. The patients believed that they had benefitted from psychotherapy. They were just as satisfied whether they saw a social worker, a psychologist, or a psychiatrist, but less so if they saw a marriage counselor or worked long-term with a family doctor. Additionally, and a very important addition it was, the longer people stayed in treatment, the more they improved. People who stayed in treatment for more than 2 years reported the best outcomes.
Martin Seligman (1995), a psychologist who had served as a consultant to this Consumer Reports project discussed the findings in greater depth. He opined that psychotherapy comparison studies existed in two forms, the efficacy study and the effectiveness study, and that they should be differentiated. The efficacy study had been the popular research method. He described that form of research as one that “contrasts some kind of therapy to a comparison group under well-controlled conditions.” (p.965) The Consumer Reports survey, on the other hand, had pioneered the effectiveness study, which he believed had set the “gold standard” for empirical validation of psychotherapy because it produces a naturalistic measure of real life outcomes rather than a measure of outcomes in a contrived situation. He also reported a finding of the Consumer Reports project that had not been mentioned originally in the magazine’s results of its survey: No specific modality of psychotherapy did any better than any other one for any problem.
And the Dodo bird sat smugly, knowing that his verdict had been upheld. Its reign of nearly 60 years continued.
Look next time for Part II: Jonathan Shedler tackles the Dodo bird!
Consumer Reports. (1995, November). Mental health: Does therapy help? pp. 734-739.
Luborsky, L., Singer, B., & Luborsky, L. (1975). Comparative studies of psychotherapies. Archives of General Psychiatry, 32, 995-1008.
Luborsky, L., Diguer, L., Luborsky, E., Singer, B., Dickter, D., and Schmidt, K.1993). The efficacy of dynamic psychotherapies. In N. Miller, L. Luborsky, J. Barber, J. Docherty (Eds.), Psychodynamic Treatment Research (pp. 497-516). New York: Basic Books.
Rosenzweig, S. (1936). Some implicit common factors in diverse methods of psychotherapy. American Journal of Orthopsychiatry, 6, 412-415.
Seligman, M. (1995). The effectiveness of psychotherapy. American Psychologist, 50 (12), 965-974.