Psychodynamic therapy: as efficacious as other empirically supported treatments? A meta-analysis testing equivalence of outcomes
Abstract
OBJECTIVE: Pharmacotherapy, cognitive-behavioral therapy (CBT), and psychodynamic therapy are most frequently applied to treat mental disorders. However, whether psychodynamic therapy is as efficacious as other empirically supported treatments is not yet clear. Thus, for the first time the equivalence of psychodynamic therapy to treatments established in efficacy was formally tested. The authors controlled for researcher allegiance effects by including representatives of psychodynamic therapy and CBT, the main rival psychotherapeutic treatments (adversarial collaboration). METHOD: The authors applied the formal criteria for testing equivalence, implying a particularly strict test: a priori defining a margin compatible with equivalence (g=0.25), using the two one-sided test procedure, and ensuring the efficacy of the comparator. Independent raters assessed effect sizes, study quality, and allegiance. A systematic literature search used the following criteria: randomized controlled trial of manual-guided psychodynamic therapy in adults, testing psychodynamic therapy against a treatment with efficacy established for the disorder under study, and applying reliable and valid outcome measures. The primary outcome was "target symptoms" (e.g., depressive symptoms in depressive disorders). RESULTS: Twenty-three randomized controlled trials with 2,751 patients were included. The mean study quality was good as demonstrated by reliable rating methods. Statistical analyses showed equivalence of psychodynamic therapy to comparison conditions for target symptoms at posttreatment (g=-0.153, 90% equivalence CI=-0.227 to -0.079) and at follow-up (g=-0.049, 90% equivalence CI=-0.137 to -0.038) because both CIs were included in the equivalence interval (-0.25 to 0.25). CONCLUSIONS: Results suggest equivalence of psychodynamic therapy to treatments established in efficacy. Further research should examine who benefits most from which treatment.
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Psychoanalytic therapy has efficacy comparable to other evidence-based treatments like CBT.
“Psychoanalytic therapy has demonstrated efficacy comparable to other evidence-based treatments, such as cognitive-behavioral therapy (CBT), while remaining distinct in its emphasis on early development and unconscious processes (119).”
From Psychoanalytically informed MDMA-assisted therapy for pathological narcissism: a novel theoretical approach (2025) · cites this paper as [119]
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- Authors
- Steinert, C., Munder, T., Rabung, S., Hoyer, J., & Leichsenring, F.
- Affiliations
- Justus-Liebig-Universität Gießen (DE)
- From the Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany; Psychologische Hochschule Berlin, Berlin; the Department of Psychology, Alps-Adriatic University of Klagenfurt, Klagenfurt, Austria; and the Institute of Clinical Psychology and Psychotherapy, Technical University Dresden, Dresden, Germany.
- Venue
- American Journal of Psychiatry
- Published
- 2017-10-01
- Volume
- 174
- Issue
- 10
- Pages
- 943-953
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- OpenAlex
- W2618809932
- Cited by
- 244
- References
- 68
- Citations by year
- 2026: 15 · 2025: 22 · 2024: 22 · 2023: 34 · 2022: 24 · 2021: 28 · 2020: 34 · 2019: 25 · 2018: 30 · 2017: 10
- FWCI
- 4.15
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Keywords
- psychodynamic psychotherapy, cognitive behavioral therapy, treatment equivalence, empirically supported treatments, two one-sided tests, adversarial collaboration, depressive symptoms, mental illness, treatment efficacy comparison
- MeSH terms
- Anxiety Disorders, Feeding and Eating Disorders, Mental Disorders, Depressive Disorder, Humans, Personality Disorders, Stress Disorders, Post-Traumatic, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Treatment Outcome, Substance-Related Disorders, Psychotherapy, Psychodynamic
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