Something stunning has just occurred in the psychology literature. The premier journal in psychology, The American Psychologist, has just published (February, 2010) an article by University of Colorado researcher Jonathan Shedler, Ph.D. that challenges prevailing thinking about psychotherapy by using multiple sophisticated meta-analyses of psychodynamic therapy and other psychological and pharmacological treatments. Shedler focuses on effect sizes which were found to be far more robust in the psychodynamic treatments than expected by many. Here is a link to Shedler's article: http://www.apa.org/pubs/journals/releases/amp-65-2-shedler.pdf.

This is the disarming way Shedler begins his ground breaking paper:

There is a belief in some quarters that psychodynamic concepts and treatments lack empirical support or that scientific evidence shows that other forms of treatment are more effective. The belief appears to have taken on a life of its own. Academicians repeat it to one another, as do health care administrators, as do health care policy makers. With each repetition, its apparent credibility grows. At some point, there seems little need to question or revisit it because "everyone" knows it to be so. 

As President of the American Psychoanalytic Association, and someone who has been struggling for years to overcome this odd and blind and misguided certainty, I feel like having that paragraph emblazoned on a sweatshirt and just wearing it around.

Shedler then socks psychoanalysis head on, holding it accountable for its shaky empirical reputation, pointing to "a lingering distaste in the mental health professions for past psychoanalytic arrogance and authority". We in American psychoanalysis must plead guilty to Shedler's charges of a past history of an overly hierarchical structure dominated by M.D.'s, exclusion of non-M.D.'s from training, and an habitual disdain for empirical research.

The complex statistical and conceptual analysis that forms the core of Shedler's paper is difficult to summarize and is best read in its entirety. A few of the intriguing  points include:

• Use of the metric effect size to be able to compare disparate findings
• Psychodynamic therapy shows larger effect size at follow-up and the effects endure and increase with time
• Three quarters of of studies of short term psychodynamic therapy for patients with physical complaints reported reductions in health care utilization
• The "active ingredients" of other therapies may in fact be psychodynamic elements
• The goals of psychodynamic treatment includes but extends beyond symptom relief

Here is Shedler's elegantly concise description of the aim of psychodynamic psychotherapy, and in fact his definition of the very essence of psychological health:

Psychological health is not merely the absence of symptoms; it is the positive presence of inner capacities and resources that allow people to live life with a greater sense of freedom and possibility.

An invaluable section of Shedler's paper delineates 8 distinctive features of psychodynamic technique. Clean, clear and tremendously valuable. I'll revisit this in a subsequent blog. Another gem is his Table 2, "Definition of Mental Health" consisting of 23 items from the Shedler-Westen Assessment Procedure.

In January, 2005, the American Psychoanalytic Association awarded honorary membership to Jonathan Shedler. The certificate read in part, "In recognition that few in the psychoanalytic field have his talent for writing about research that assesses complex psychoanalytic constructs." I think we hit it spot on.

"Classics" are usually identified only in retrospect, as their importance emerges over time. This is one of the rare instances where one can read a paper and feel you were there at the beginning-brand new and exciting, it already has the hallmarks of a classic.

About the Author

Prudence Gourguechon, M.D.

Prudence Gourguechon, M.D., served as President of the American Psychoanalytic Association from 2008-2010. She has a clinical and consulting practice in Chicago.

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