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Cited by 190Psychotherapy Techniques and ApplicationsPersonality Disorders and PsychopathologyPsychological Testing and Assessment

The Effectiveness of Long-Term Psychoanalytic Therapy: A Systematic Review of Empirical Studies

Open access
de Maat, Saskia, de Jonghe, Frans, Schoevers, Robert, Dekker, Jack·2009·Harvard Review of Psychiatry
DOI 10.1080/10673220902742476
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Abstract

BACKGROUND: There is a gap in the research literature on the effectiveness of long-term psychoanalytic therapies (LPT). AIM: To present a systematic review of studies dealing with LPT effectiveness and published from 1970 onward. METHODS: A systematic literature search for studies dealing with the effectiveness of individual LPT in ambulatory, adult patients. Data about the overall effectiveness of LPT, its impact on symptom reduction, and its effect on personality changes were pooled both at treatment termination and at follow-up, using effect sizes (ESs) and success rates. RESULTS: We found 27 studies (n = 5063). Psychotherapy yielded large mean ESs (0.78 at termination; 0.94 at follow-up) and high mean overall success rates (64% at termination; 55% at follow-up) in moderate/mixed pathology. The mean ES was larger for symptom reduction (1.03) than for personality change (0.54). In severe pathology, the results were similar. Psychoanalysis achieved large mean ESs (0.87 at termination; 1.18 at follow-up) and high mean overall success rates (71% at termination; 54% at follow-up) in moderate pathology. The mean ES for symptom reduction was larger (1.38) than for personality change (0.76). CONCLUSION: Our data suggest that LPT is effective treatment for a large range of pathologies, with moderate to large effects.

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Registry

Crossref · 10.1080/10673220902742476

Cites

79 of 79 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

1 of 54 cited sources checked · 0 supported · 0 flagged · accuracy not yet measured

  • Findingown data

    In psychotherapy for moderate/mixed pathology, the mean effect size for symptom reduction was 1.03.

    “The mean ES was larger for symptom reduction (1.03) than for personality change (0.54).”
    • Also stated in: § LPT Effect Sizes · plain
      “The weighted mean ESs were 1.03 (n = 572; SD = 0.59) for symptom reduction”
    Quote in the paperSubstantial claim
  • Findingown data

    In psychotherapy for moderate/mixed pathology, the mean overall success rate was 64% at treatment termination.

    “high mean overall success rates (64% at termination; 55% at follow-up) in moderate/mixed pathology”
    Quote in the paperSubstantial claim
  • Findingown data

    The 27 studies covered 5,063 patients.

    “We found 27 studies (n = 5063).”
    • Also stated in: § Included Studies · plain
      “In all, the studies covered 5,063 patients (3,632 in psychotherapy, and 1,431 in psychoanalysis).”
    Quote in the paperNot a substantial claim
  • Findingown data

    In psychotherapy for moderate/mixed pathology, the weighted mean effect size was 0.94 at follow-up.

    “Psychotherapy yielded large mean ESs (0.78 at termination; 0.94 at follow-up)”
    • Also stated in: § LPT Effect Sizes · plain
      “The weighted mean ESs were large at both termination (0.78) and follow-up (0.94).”
    Quote in the paperSubstantial claim
  • Findingown data

    In psychotherapy for severe pathology, the weighted mean effect size was 0.94 at treatment termination.

    “The weighted mean ESs were large at both termination (0.94) and follow-up (1.02).”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 44
  • The quote only partly states this claim. 6
  • May combine two claims. 35

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Shadish and colleagues did not find a significant correlation between the degree of clinical representativeness and the size of effects reported in studies of psychotherapy.

    “Shadish and colleagues 89 did not find a significant correlation between the degree of clinical representativeness (i.e., RCTs vs. naturalistic studies) and the size of effects reported in studies of psychotherapy.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [89] 89. Kunz R, Oxman AD. The unpredictability paradox: review of empirical comparisons of randomised and non-randomised clin- ical trials. BMJ 1998;317:1185-90. source

      The Results and Tables 2 and 4 compare randomized with non-randomized trials and report some correlations between study quality and treatment effects, but not the claimed finding about psychotherapy. Searches for Shadish, clinical representativeness, psychotherapy, and naturalistic studies found no passage addressing that finding. (LLM, conf=0.76)

      Experimental — accuracy not yet measured

  • The quote only partly states this claim.

    Findingown data

    In psychoanalysis for moderate/mixed pathology, the mean effect size for symptom reduction was larger than that for personality change.

    “The mean ES for symptom reduction was larger (1.38) than for personality change (0.76).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing), S4 (based). The quote only partly states this claim.

    Findingreasoning

    Five of the eight low-quality studies were surveys.

    “Six of these studies were retrospective studies, and five of them were surveys”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    In psychoanalysis for moderate/mixed pathology, the mean overall success rate was 54% at follow-up.

    “high mean overall success rates (71% at termination; 54% at follow-up) in moderate pathology”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    In severe pathology, the results were similar to those in moderate/mixed pathology.

    “In severe pathology, the results were similar.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    In psychoanalysis for moderate/mixed pathology, the mean overall success rate was 71% at treatment termination.

    “high mean overall success rates (71% at termination; 54% at follow-up) in moderate pathology”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Of the cohort studies, 16 were prospective and 5 retrospective.

    “Of the cohort studies, 16 were prospective, and 5 retrospective.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    The survey by Stehle was based on inquiries among therapists.

    “The survey by Stehle 67 was based on inquiries among therapists.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Stehle 67

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Four surveys were replications of the study by Seligman.

    “Four surveys 45,51,52,54 were replications of the study by Seligman.76”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Seligman.76

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Hartman and Zepf found a mean Effectiveness Score of 237 in psychotherapy.

    “Hartman and Zepf 51 found a mean score of 237 in psychotherapy and 244 in psychoanalysis.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [51] 51. Rudolf G, Dilg R, Grande T, et al. Effektivit ät und Effizienz psychoanalytischer Langzeittherapie: die Praxisstudie Ana- lytische Langzeitpsychotherapie [Effectiveness and efficiency of long-term psychoanalytic psychotherapy: the practice study of long-term psychoanalytic psychotherapy]. In: Gerlach A, Springer A, Schlösser A, eds. Psychoanalyse des Glaubens [Psy- choanalysis of religious belief]. Giessen: Psychosozial Verlag, 2004.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Findingown data

    Only two studies of psychoanalysis reported personality-related outcomes, both based on patient opinions and both in moderate/mixed pathology.

    “There were only two studies of psychoanalysis (Table 4.3), each representing patient opinions, and resulting in a weighted mean of 61%.The studies dealt with moderate/mixed pathology.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In lower-quality psychoanalysis studies, pre/post success rates ranged from 41% to 75%, with a mean of 67%.

    “In psychoanalysis, the range was 41% to 75%, with a mean of 67%.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In psychoanalysis for moderate/mixed pathology, the weighted mean effect sizes were 0.87 at treatment termination and 1.18 at follow-up.

    “the weighted mean ESs (0.87 at termination; 1.18 at follow-up)”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Hartman and Zepf found a mean Effectiveness Score of 244 in psychoanalysis.

    “Hartman and Zepf 51 found a mean score of 237 in psychotherapy and 244 in psychoanalysis.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [51] 51. Rudolf G, Dilg R, Grande T, et al. Effektivit ät und Effizienz psychoanalytischer Langzeittherapie: die Praxisstudie Ana- lytische Langzeitpsychotherapie [Effectiveness and efficiency of long-term psychoanalytic psychotherapy: the practice study of long-term psychoanalytic psychotherapy]. In: Gerlach A, Springer A, Schlösser A, eds. Psychoanalyse des Glaubens [Psy- choanalysis of religious belief]. Giessen: Psychosozial Verlag, 2004.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Findingown data

    The mean psychotherapy success rate was 69% in lower-quality studies and 67% in higher-quality studies.

    “The mean psychotherapy success rate was 69% in the lower-quality studies and 67% in the higher-quality studies.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In psychoanalysis for moderate/mixed pathology, patients and therapists concurred in their opinions about success rates, and assessment of changes in personality (61% and 51%, respectively) seemed lower than assessment of symptom reduction (73% and 70%, respectively).

    “Patients and therapists concurred in their opinions about success rates, and the assessment of changes in personality (61% and 51%, respectively) seemed to be lower than the assessment of symptom reduction (73% and 70%, respectively) (though note here, too, that the effects on personality change are based on only three studies).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In psychotherapy for moderate/mixed pathology, the percentage of large effect sizes was 65% at treatment termination and 69% at follow-up.

    “the percentage of large ESs (65% at termination; 69% at follow-up)”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In psychotherapy for severe pathology, there was a large weighted effect size for personality change (1.11) and no effect-size information about symptom reduction.

    “We found a large weighted ES for personality change (1.11) and no ES information about symptom reduction.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In psychoanalysis for moderate/mixed pathology, the percentage of large effect sizes was 50% at treatment termination and 80% at follow-up.

    “the percentage of large ESs (50% at termination; 80% at follow-up)”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    For psychoanalysis, success rates were 67% in lower-quality studies and 67% in higher-quality studies.

    “For psychoanalysis, the success rates were 67% and 67%, respectively.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Findingown data

    The review compiled the results of the 19 higher-quality studies by pooling their data.

    “We compiled the results of the 19”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    The review did not find effect sizes for psychoanalysis in severe pathology, and only one study provided information about the success of psychoanalysis for severe pathology: 59%.

    “We did not find ESs for psychoanalysis in severe pathology, and only one study provided information about the success of psychoanalysis for severe pathology: 59%.69”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [69] 69. Stevenson J, Meares R. An outcome study of psychotherapy for patients with borderline personality disorder. Am J Psychiatry 1992;149:358-62.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    The literature is not in agreement on whether patients and therapists might overestimate therapy success.

    “The literature is not in agreement, however, on the question whether patients and therapists might overestimate therapy success.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Findingnone given

    Patients and therapists do not seem to differ in their opinions about therapy success.

    “Patients and therapists do not seem to differ in their opinions about therapy success.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    LPT is an effective treatment modality, with moderate to large effects on both symptom reduction and personality changes.

    “Our review of the available empirical evidence suggests that LPT is an effective treatment modality, with moderate to large effects on both symptom reduction and personality changes.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The included studies had flaws including lack of pretreatment data, overgeneral patient descriptions, no mention of diagnoses, and no detailed information about therapies.

    “Flaws included: the lack of pretreatment data (retrospective design); an overgeneral description of the patient population (e.g., stating only that the sample included patients treated in a given period); no mention of diagnoses; no detailed information about the therapies”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingnone given

    LPT effectiveness has been extensively investigated, mainly by cohort studies of varying quality.

    “LPT effectiveness has been extensively investigated, mainly by cohort studies of varying quality.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisenone given

    There is a gap in the research literature on the effectiveness of long-term psychoanalytic therapies (LPT).

    “Background: There is a gap in the research literature on the effectiveness of long-term psychoanalytic therapies (LPT).”
    • Also stated in: § Abstract · plain
      “Reviews including psychoanalysis are scarce.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The Research Quality Score has not been validated beyond the consensus between the two raters who evaluated study quality.

    “The list has not yet been validated beyond the consensus between the two raters (SdM and FdJ) who evaluated the quality of the studies.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    LPT is effective treatment for a large range of pathologies, with moderate to large effects.

    “Our data suggest that LPT is effective treatment for a large range of pathologies, with moderate to large effects.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisenone given

    Although some reviews explicitly address study quality, they do not use systematic quality scores.

    “Although some reviews explicitly address study quality, they do not use systematic quality scores.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    Two reviewers independently checked search results and evaluated study quality.

    “Two reviewers checked the search results (SdM and FdJ) and requested all potentially suitable studies.They conducted independent checks of all identified studies.”
    • Also stated in: § Identification of Relevant Publications and Quality Assessment · plain
      “The reviewers evaluated the quality of the studies independently using a self-developed Research Quality Score (RQS; see appendix).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In Doidge et al.'s survey of 510 analysts, 71% of patients had a DSM-III-R personality disorder, 68% a major depressive disorder, and 57% an anxiety disorder.

    “The results showed that 71% of the patients had a DSM-III-R personality disorder, 68% a major depressive disorder, and 57% an anxiety disorder.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Doidge and colleagues, 38,39

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    Reviews including psychoanalysis are scarce.

    “Reviews including psychoanalysis are scarce.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    There was no systematic effort to find additional unpublished data.

    “There was no systematic effort to find additional unpublished data.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Disagreements about whether a study should be included were resolved by discussion with a third member of staff.

    “Any disagreements about whether a study should be included were resolved by discussion with a third member of staff (JD).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisenone given

    More recent reviews are of good quality, but many do not pool the data from individual studies.

    “In short, the more recent reviews are of good quality, but many of them do not pool the data (e.g., calculate mean ESs or mean success rates) from individual studies.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In Doidge et al.'s survey, comorbidity was high, with the modus of patients presenting three disorders.

    “In addition, comorbidity was high, with the modus of patients presenting three disorders.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Doidge and colleagues, 38,39

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim.

    Premisereasoning

    The standardization of effect sizes allows the amount of change in different studies-on different scales in different populations-to be compared.

    “Consequently, since any particular ES expresses a particular degree of relative change, the amount of change in different studies-on different scales in different populationscan be compared.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisereasoning

    Fonagy did not pool the data or aim to reach general conclusions.

    “Probably because of the broad range of these studies, Fonagy did not pool the data or aim to reach general conclusions.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [18] 18. Fonagy P. An open door review of outcome studies in psycho- analysis. 1999. http://www.ipa.org.uk/R-outcome.htm

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The cut-off score for acceptable research quality was ultimately arbitrary.

    “Since this cut-off score was ultimately arbitrary, we also evaluated the studies falling below the cutoff score”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The Leichsenring and Rabung meta-analysis concentrated on psychotherapy and did not address psychoanalysis.

    “The metaanalysis concentrated on psychotherapy and did not address psychoanalysis.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Leichsenring and Rabung 22

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Fonagy's Open Door Review described the study designs and outcomes of scores of LPT studies.

    “Fonagy's Open Door Review 18 described the study designs and outcomes of scores of LPT studies.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [18] 18. Fonagy P. An open door review of outcome studies in psycho- analysis. 1999. http://www.ipa.org.uk/R-outcome.htm

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The Research Quality Score criteria were based on those postulated by the Cochrane Collaboration and by Leichsenring.

    “Its criteria, which are based on those postulated by the Cochrane Collaboration 29 and by Leichsenring, 21 deal with study design, patients included, interventions, outcome data, statistics, dropout, and follow-up.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Cochrane Collaboration 29

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Leichsenring, 21

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationown data

    In psychotherapy for moderate/mixed pathology, the overall success rates, percentage of large effect sizes, and weighted mean effect sizes indicate substantial effectiveness that was maintained for years after treatment termination.

    “In moderate/mixed pathology, the overall success rates (64% at termination; 55% at follow-up), the percentage of large ESs (65% at termination; 69% at follow-up), and the weighted mean ESs (0.78 at termination; 0.94 at follow-up) indicate substantial effectiveness, which was maintained for years after treatment termination.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The studies included in the review are sufficiently comparable in patient populations, settings, and therapies for their results to be pooled into overall success rates and effect sizes.

  • May combine two claims.

    Interpretationown data

    In psychotherapy for severe pathology, the percentage of large effect sizes and weighted mean effect sizes were not inferior to those in moderate/mixed pathology.

    “In severe pathology, taking into consideration that the results mainly related to personality pathology, the percentage of large ESs (46% at termination; 56% at follow-up) and the weighted mean ESs (0.94 at termination; 1.02 at follow-up) were certainly not inferior to those in moderate/mixed pathology.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    In psychoanalysis for moderate/mixed pathology, the overall success rates, percentage of large effect sizes, and weighted mean effect sizes indicated substantial effectiveness that was maintained for years after treatment termination.

    “In moderate/mixed pathology, the overall success rates (71% at termination; 54% at follow-up), the percentage of large ESs (50% at termination; 80% at follow-up), and the weighted mean ESs (0.87 at termination; 1.18 at follow-up) indicated substantial effectiveness, which was maintained for years after treatment termination.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The studies included in the review are sufficiently comparable in patient populations, settings, and therapies for their results to be pooled into overall success rates and effect sizes.

  • The quote only partly states this claim.

    Interpretationown data

    In psychotherapy for severe pathology, success rates for personality change seemed lower than for symptom reduction.

    “As with the results for moderate/mixed pathology, success rates for personality change seemed lower than for symptom reduction.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The finding that symptom-reduction effect sizes are higher than personality-change effect sizes accords with the literature and clinicians' findings that personality change is harder to achieve than symptom reduction.

    “This result accords with the findings in the literature and the findings of clinicians that personality change is harder to achieve than symptom reduction.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Lipsey and Wilson concluded on the basis of 27 meta-analyses that the effect sizes of studies of varying methodological quality did not differ significantly.

    “Our findings concur with those of Lipsey and Wilson, 77 who concluded on the basis of 27 meta-analyses that the ESs of studies of varying methodological quality did not differ significantly.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [77] 77. Wilczek A, Berber, JP Gustavson JP, Asberg M, Weinryb RM. Change after long-term psychoanalytic psychotherapy. J Am Psychoanal Assoc 2004;52:1163-84.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationown data

    In psychotherapy for severe pathology, the review's findings were mainly suggestive because only a few studies presented data.

    “As only a few studies presented data on severe pathology, our findings were mainly suggestive.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    The comparability of psychotherapy and psychoanalysis remains unresolved, and the review's findings do not allow valid comparisons of their relative effectiveness.

    “The comparability of psychotherapy and psychoanalysis remains unresolved; in our opinion, our findings do not allow for valid comparisons of the relative effectiveness of psychotherapy and psychoanalysis.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Perry and colleagues estimated that 50% of patients would recover after 1.3 years (92 sessions), and 75% by 2.2 years (216 sessions).

    “They found that 50% of the patients would recover after 1.3 years (or 92 sessions), and 75% by 2.2 years (or 216 sessions).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [79] 79. Lipsey MW, Wilson DB. The efficacy of psychological, edu- cational, and behavioral treatment: confirmation from meta- analyses. Am Psychol 1993;48:1181-209.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Leichsenring and Rabung found lower effect sizes for personality functioning (0.78) than for symptoms (target problems, 1.54; psychiatric symptoms, 0.91).

    “In addition, they also seem to have found lower ESs for personality functioning (0.78) than for symptoms (target problems, 1.54; psychiatric symptoms, 0.91).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [22] 22. Leichsenring, F, Rabung, S. Effectiveness of long-term psychodynamic psychotherapy: a meta-analysis. JAMA 2008;300:1551-65. source

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Patients and therapists have much more exposure than independent observers to the relevant field of observation.

    “patients and therapists have much more exposure than independent observers to the relevant field of observation.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing).

    Premisecitation

    The personality characteristics of patients who opt for long-term psychoanalytic therapy differ from those of patients preferring other therapies.

    “He pointed out that the personality characteristics of patients who opt for long-term psychoanalytic therapy differ from those of patients preferring other therapies.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] 20. Leichsenring F. Are psychodynamic and psychoanalytic ther- apies effective? A review of empirical data. Int J Psychoanal 2005;86:841-68.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Concato and colleagues compared randomized controlled trials with cohort studies for five somatic disorders and found that the results of observational studies were remarkably close to those of randomized controlled trials.

    “Concato and colleagues 88 compared the results of RCTs to those of cohort studies dealing with the same interventions for five different somatic disorders.Analyses of 72 metaanalyses of RCTs, 24 meta-analyses of cohort or case-control studies, and 6 meta-analyses involving both designs showed that the results of the observational studies were remarkably close to those of RCTs.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [88] 88. Sacks H, Chalmers TC, Smith H Jr. Randomized versus histor- ical controls for clinical trials. Am J Med 1982;72:33-40. source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Some pooled results are based on only a few studies, and in some cases the results of only one study are mentioned.

    “some of the pooled results are based on only a few studies, and in some cases the results of only one study are mentioned.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    For lack of original data, the authors could not calculate mean effect sizes based on the original means and standard deviations.

    “For lack of the original data, we could not calculate mean ESs based on the original means and standard deviations.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Leichsenring argued that when studying long-term treatments, it is not possible to maintain a waiting list of untreated patients, to apply manualized treatments, or to create equal treatment conditions.

    “Leichsenring 20 has cogently argued that when studying long-term treatments, it is not possible to maintain a waiting list of untreated patients, to apply manualized treatments, or to create equal treatment conditions.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [20] 20. Leichsenring F. Are psychodynamic and psychoanalytic ther- apies effective? A review of empirical data. Int J Psychoanal 2005;86:841-68.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Many patients have tried briefer therapies, apparently to no avail.

    “Many have also tried briefer therapies, apparently to no avail.38,39”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [38] 38. Doidge N, Simon B, Brauer L, et al. Psychoanalytic patients in the US, Canada, and Australia: I. DSM-III-R disorders, indica- tions, previous treatment, medications and length of treatment. J Am Psychoanal Assoc 2002;50:575-614. source
    • cites [39] 39. Doidge N, Simon B, Lancee WJ, et al. Psychoanalytic patients in the US, Canada, and Australia: II. A DSM-III-R validation study. J Am Psychoanal Assoc 2002;50:615-27.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationreasoning

    Global assessment scales do not provide the same information as detailed questionnaires; they are simple instruments that often demand considerable clinical competence to generate reliable information.

    “but such scales do not provide the same information as detailed questionnaires; they are simple instruments that often demand considerable clinical competence to generate reliable information.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationreasoning

    According to psychoanalytic diagnostic criteria, the patient group shows more actual homogeneity.

    “However, according to psychoanalytic diagnostic criteria, the patient group shows more actual homogeneity.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: All patients in the included studies were appropriately indicated for psychoanalytic therapy.

  • Classified as probably not a substantial claim.

    Premisecitation

    It has been extensively argued that it is difficult to conduct randomized controlled trials of long-term therapies, whether psychological or somatic.

    “It has been extensively argued 21,76,[83][84][85] that it is difficult to conduct RCTs of long-term therapies (be they psychological or somatic).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites 21,76,[83][84][85]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    The authors devised a 24-item Research Quality Score inspired by Leichsenring and the Cochrane Collaboration to safeguard quality.

    “In an effort to safeguard quality, we devised a 24-item Research Quality Score inspired by the criteria put forward by Leichsenring 21 and by the Cochrane Collaboration.29”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Leichsenring 21

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Cochrane Collaboration.29

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationreasoning

    Independent observers are less invested in the treatment and might therefore be less biased in their judgment of results.

    “independent observers are less invested in the treatment and might therefore be less biased in their judgment of results.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    The review tried to enhance comparability by restricting the search to individual therapy in adult, ambulant patients, by distinguishing between moderate/mixed and severe pathology, and by applying a quality criterion.

    “We have tried to enhance the comparability of the studies included by restricting our search to individual therapy in adult, ambulant patients, by distinguishing between moderate/mixed and severe pathology, and by applying a quality criterion.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The Research Quality Score cutoff point was arbitrary and the list has not been validated.

    “We defined an admittedly arbitrary cutoff point, and the list has not been validated.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Study design and conductreasoning

    The decisions to categorize measures as involving symptom reduction versus personality changes may be debated.

    “our decisions to categorize measures as involving symptom reduction versus personality changes may be debated.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The authors were limited to a simple calculation of the average of the effect sizes reported in the individual studies.

    “we were limited to a simple calculation of the average of the ESs reported in the individual studies.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Benson and Hartz found little evidence that estimates of treatment effects in observational studies reported after 1984 are either consistently larger than or qualitatively different from those obtained in randomized controlled trials.

    “The authors concluded:”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [90] 90. Concato J, Shah N, Horwitz RI. Randomised controlled trials, observational studies and the hierarchy of research designs. N Engl J Med 2000;342:1887-92. source

  • Probably not a substantial claim: may not pass S2 (checkable).

    Premisenone given

    The quality of any review depends heavily on the quality of the studies included.

    “the quality of any reviewincluding this one-depends heavily on the quality of the studies included.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The statistical analyses performed in the review were rather simple.

    “the statistical analyses we performed were rather simple.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationreasoning

    The rigorousness of the quality check could be amenable to improvement.

    “The rigorousness of our quality check could therefore, in this respect, be amenable to improvement.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    The review pools data from studies conducted in different countries and settings, at different times, for different patients, and using nonmanualized therapies.

    “A second limitation is that our review pools data from studies that were conducted in different countries and settings, at different times, and for different patients, and that used nonmanualized therapies (i.e., ones that, despite being psychoanalytic, undoubtedly have different features).”
    Quote in the paperSubstantial claim
75 of 75

  • The authors state this as an assumption.

    All patients in the included studies were appropriately indicated for psychoanalytic therapy.

    “After all, all patients were indicated, presumably on solid grounds, for psychoanalytic therapy.”

  • The paper relies on this without support.

    The studies included in the review are sufficiently comparable in patient populations, settings, and therapies for their results to be pooled into overall success rates and effect sizes.

    “A second limitation is that our review pools data from studies that were conducted in different countries and settings, at different times, and for different patients, and that used nonmanualized therapies (i.e., ones that, despite being psychoanalytic, undoubtedly have different features).”

  • The paper relies on this without support.

    Moderate changes in personality are clinically significant in terms of quality of life and relapse prevention.

    “but moderate changes in personality may be more significant clinically in terms of quality of life and relapse prevention.”
3 of 3

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Discussion attributes a personality success rate to psychoanalysis therapists despite no such data

    Major

    The discussion reports a 51% therapist-rated personality success rate for psychoanalysis. Table 6 marks that result as unavailable; its 51% figure concerns independent-observer ratings for severe-pathology psychotherapy.

  • Grande psychoanalysis sample is both 31 and 32

    Minor

    Table 1 lists 31 psychoanalysis patients for Grande and colleagues, while the psychoanalysis effect-size table lists 32 for the same study.

  • Psychoanalysis therapist table understates its total sample

    Minor

    The seven study sample sizes in Table 3.3 sum to 654, not the reported total of 610.

    Reported 610 · recomputed 654

  • Dührssen psychoanalysis sample uses the psychotherapy count

    Minor

    Table 1 lists 30 psychoanalysis patients and 60 psychotherapy patients for Dührssen. The psychoanalysis outcomes table gives its sample as 60.

  • First screening round leaves 70 articles, not 73

    Minor

    Subtracting the 672 exclusions from the 742 initially found leaves 70 articles. The next stage says 73 remained.

    Reported 73 · recomputed 70

5 of 5

Cites

Flagged first, then by citations

11 of the 90 references couldn’t be matched to a known paper.

Research works printed but not linked: 13

  1. Coriat, 1917, Some statistical results of the psychoanalytic treatment of the psychoneuroses., Psychoanal Rev, 4, 209
  2. Doidge, 2001, Is psychoanalysis effective., Econ Neurosci, 3, 41
  3. Duhrssen, 1986, Dynamische Psychotherapie, Psychoanalyse und analytische Gruppenpsychotherapie im Vergleich., Z Psychosom Med, 32, 161
  4. Heinzel, 1998, Ambulante analytische Einzel- und Gruppenpsychotherapie in ein der bundesweiten katamnestischen Evaluationsstudie., Gruppenpsychotherapie und Gruppendynamik, 34, 135
  5. Holm-Hadulla, 1997, Zur Effektivitat tiefenpsychologisch fundierter Kurz- und Psychotherapien., Psychother Psychosom Med Psychol, 47, 271
  6. von Rad, 1998, Psychotherapie und Psychoanalyse in der Krankenversorgung: Ergebnisse des Heidelberger Katamnese-Projektes., Psychother Psychosom Med Psychol, 48, 88
  7. Heuft, 1996, Langzeitoutcome ambulanter psychoanalytischer Psychotherapien und Psychoanalysen. Ein textinhaltsanalytische Untersuchung von 53 Katamneseinterviews., Forum der Psychoanalyse, 12, 342
  8. Rudolf, 1994, Ergebnisse psychoanalytischer Therapien., Z Psychosom Med, 40, 25
  9. Kernberg, 1972, Psychotherapy and psychoanalysisthe final report of the Menninger Foundations Psychotherapy Research Project., Bull Menninger Clin, 36, 1
  10. Weber, 1985, Factors associated with outcome of psychoanalysis: a report of the Colombia Psychoanalytic Center Research Project (II)., Int Rev Psychoanal, 12, 127
  11. Bachrach, 1985, Factors associated with the outcome of psychoanalysis (clinical and methodological considerations): report of the Colombian Psychoanalytic Center Research Project (IV)., Int Rev Psychoanal, 12, 379
  12. Weber, 1985, Factors associated with outcome of psychoanalysis: a report of the Colombia Psychoanalytic Center Research Project (III)., Int Rev Psychoanal, 12, 251
  13. Wallerstein, 1999, Comment on Gunderson and Gabbert., J Am Psychoanal Assoc, 47, 728

Cited by

Sorted by citations

Related

Authors
de Maat, S., de Jonghe, F., Schoevers, R., & Dekker, J.
Affiliations
Mentrum (NL)
Corresponding author
Dekker, Jack
ORCID
Venue
Harvard Review of Psychiatry
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2009-01
Volume
17
Issue
1
Pages
1-23
ISSN
1067-3229 (ISSN-L)
DOI
10.1080/10673220902742476
OpenAlex
W2144415795
Cited by
190
References
90
Citations by year
2026: 4 · 2025: 6 · 2024: 7 · 2023: 7 · 2022: 1 · 2021: 10 · 2020: 7 · 2019: 13 · 2018: 13 · 2017: 10 · 2016: 2 · 2015: 16 · 2014: 16 · 2013: 22 · 2012: 13
FWCI
3.01
Type
journal article
Language
en
Open access
Locations
  • Harvard Review of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Pure Amsterdam UMC (publishedVersion)
  • Amsterdam UMC (VU Amsterdam) - Institutional Repository (acceptedVersion)
  • VU Research Portal (submittedVersion, other-oa)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
  • Social Sciences › Psychology › Applied Psychology › Psychological Testing and Assessment
Keywords
psychotherapy effectiveness, symptom relief, personality change, treatment outcomes, follow-up outcomes, adult patients, effect size, success rate
MeSH terms
Mental Disorders, Follow-Up Studies, Humans, Long-Term Care, Personality Assessment, Psychoanalytic Therapy

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-11.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-11.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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