Psychodynamic therapy... effective?

[Iconoclast08]

Psychology geeks on board-- do 'ya buy it? Are these sorts of meta-analyses trustworthy? Why/why not?

http://www.sciencedaily.com/releases/2010/01/100125094501.htm

[Dancing David]

Um, especially as it is a meta analysis. What were the measures used, what was the time frame of treatment? Looks bogus, I will have to find the paper.

[Iconoclast08]

Yeah, I need to look up the JAMA article myself (I'm surprised it made it into such a good journal).

Other key questions:
--How was "psychodynamic" therapy operationalized?
--Were the comparisons legitimate "CBT" or behavioral therapies, or were they just off-the-cuff "talk" therapy masquerading as CBT?
--Were the studies sampled RCTs? If so, how many?
--Were signed (+/-) effect sizes used, or did they take absolute values?

[Jeff Corey]

Yeah, I need to look up the JAMA article myself (I'm surprised it made it into such a good journal)...

Jonathan Shedler. The Efficacy of Psychodynamic Psychotherapy. American Psychologist, 2010; 65 (2)
Interesting that they didn't use APA style for the reference.

[Iconoclast08]

Jonathan Shedler. The Efficacy of Psychodynamic Psychotherapy. American Psychologist, 2010; 65 (2)
Interesting that they didn't use APA style for the reference.

Ah, screw APA style :)

http://www.psychologicalscience.org/observer/getArticle.cfm?id=1549

[Ivor the Engineer]

I wonder how talking about yourself for a year effects narcissism?

[Maia]

Hey, y'all, I found a link to the actual pdf of the study! (http://www.apa.org/pubs/journals/releases/amp-65-2-shedler.pdf) (How cool am I???) More updates as events warrant. :)

ETA: I didn't have a lot of time to read it, unfortunately, so somebody else probably should if they're interested in finding out more about what it said. Overall, it seems to be decent. The author is very clear that psychodynamic does not mean "psychoanalysis" and certainly does not mean anything "Freudian," and he defines exactly what he is talking about-- it's structured and really not what you might expect, so I think that the news stories may give a misleading viewpoint in some ways. The biggest criticisms I would have is that it doesn't include the amount of detailed information on improvement rates for CBT-based interventions that it could, and that the info provided on the not-very-impressive success rates for antidepressants, while not exactly inaccurate, is based on all types of depression rather than just major depressive disorder, which gives a skewed impression. But I do have to say that I've seen other studies on true psychodynamic psychotherapy-- some really good ones came from Finland and Scandinavian countries-- and I think it holds up well over time. It does not do so well as a shorter term treatment, which is a practical problem considering that most people can't afford anything long term (well, not here, anyway.) And some people just need the foundation of psych meds, or they're not going to be able to get anywhere with any type of talk therapy.

[Dancing David]

Well psychodynamic has a broader implication in the social work field as opposed to psychology. As opposed to skills training, network and family therapy strategies, so in social work settings psychodynamic includes CBT.

[Dancing David]

That is one heck of an article, it will take a while to digest that preprint, but it states clearly that there are huge problems with drawing any conclusions from the data that they used.

[Jeff Corey]

That is one heck of an article, it will take a while to digest that preprint, but it states clearly that there are huge problems with drawing any conclusions from the data that they used.

Data? This ain't data. It is subjective rating by people who have an agenda.
Look see:
Table 2: Defining Mental Health: Items from the Shedler-Westen Assessment
Procedure (SWAP-200)
Is able to use his/her talents, abilities, and energy effectively and productively.
Enjoys challenges; takes pleasure in accomplishing things.
Is capable of sustaining a meaningful love relationship characterized by genuine intimacy and caring.
Finds meaning in belonging and contributing to a larger community (e.g., organization, church,
neighborhood, etc.).
Is able to find meaning and fulfillment in guiding, mentoring, or nurturing others.
Is empathic; is sensitive and responsive to other peoples’ needs and feelings.
Is able to assert him/herself effectively and appropriately when necessary.
Appreciates and responds to humor.
Is capable of hearing information that is emotionally threatening (i.e., that challenges cherished beliefs,
perceptions, and self-perceptions) and can use and benefit from it.
Appears to have come to terms with painful experiences from the past; has found meaning in, and grown
from such experiences.
Is articulate; can express self well in words.
Has an active and satisfying sex life.
Appears comfortable and at ease in social situations.
Generally finds contentment and happiness in life’s activities.
Tends to express affect appropriate in quality and intensity to the situation at hand.
Has the capacity to recognize alternative viewpoints, even in matters that stir up strong feelings.
Has moral and ethical standards and strives to live up to them.
Is creative; is able to see things or approach problems in novel ways.
Tends to be conscientious and responsible.
Tends to be energetic and outgoing.
Is psychologically insightful; is able to understand self and others in subtle and sophisticated ways.
Is able to find meaning and satisfaction in the pursuit of long-term goals and ambitions.
Is able to form close and lasting friendships characterized by mutual support and sharing of experiences.

That is not reliably measurable behavior. Because it is only rated by the therapist.

[Maia]

Data? This ain't data. It is subjective rating by people who have an agenda.
Look see:
Table 2: Defining Mental Health: Items from the Shedler-Westen Assessment
Procedure (SWAP-200)
Is able to use his/her talents, abilities, and energy effectively and productively.
Enjoys challenges; takes pleasure in accomplishing things.
Is capable of sustaining a meaningful love relationship characterized by genuine intimacy and caring.
Finds meaning in belonging and contributing to a larger community (e.g., organization, church,
neighborhood, etc.).
Is able to find meaning and fulfillment in guiding, mentoring, or nurturing others.
Is empathic; is sensitive and responsive to other peoples’ needs and feelings.
Is able to assert him/herself effectively and appropriately when necessary.
Appreciates and responds to humor.
Is capable of hearing information that is emotionally threatening (i.e., that challenges cherished beliefs,
perceptions, and self-perceptions) and can use and benefit from it.
Appears to have come to terms with painful experiences from the past; has found meaning in, and grown
from such experiences.
Is articulate; can express self well in words.
Has an active and satisfying sex life.
Appears comfortable and at ease in social situations.
Generally finds contentment and happiness in life’s activities.
Tends to express affect appropriate in quality and intensity to the situation at hand.
Has the capacity to recognize alternative viewpoints, even in matters that stir up strong feelings.
Has moral and ethical standards and strives to live up to them.
Is creative; is able to see things or approach problems in novel ways.
Tends to be conscientious and responsible.
Tends to be energetic and outgoing.
Is psychologically insightful; is able to understand self and others in subtle and sophisticated ways.
Is able to find meaning and satisfaction in the pursuit of long-term goals and ambitions.
Is able to form close and lasting friendships characterized by mutual support and sharing of experiences.

That is not reliably measurable behavior. Because it is only rated by the therapist.

Look, nobody is trying to say that this study is the be-all and end-all, but I don't think it helps to support criticism by attacking a part of it which actually is well supported. To say that "that is not reliably measurable behavior" is simply not an accurate statement. The Shedler-Westen Assessment Procedure has been assessed for validity in the same way as other standardized scaling instruments, and it does appear to have good validity-- this concentrated on convergent validity (http://www.ncbi.nlm.nih.gov/pubmed/19684499?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed _ResultsPanel.Pubmed_RVDocSum&ordinalpos=4), also see here, (http://www.ncbi.nlm.nih.gov/pubmed/19790028?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed _ResultsPanel.Pubmed_RVDocSum&ordinalpos=2) here, (http://www.ncbi.nlm.nih.gov/pubmed/18020727?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_SingleItemSupl.Pubmed_Discovery_RA&linkpos=3&log$=relatedarticles&logdbfrom=pubmed) here-- this was more about discriminant validity (http://www.ncbi.nlm.nih.gov/pubmed/17563203?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed _ResultsPanel.Pubmed_RVDocSum&ordinalpos=12), inter-rater validity, (http://www.ncbi.nlm.nih.gov/pubmed/19742291?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed _ResultsPanel.Pubmed_RVDocSum&ordinalpos=13) and so forth.

Now, I don't care much about the Shedler-Westen Assessment Procedure either way, but I don't like to see such inaccurate statements, whether they're made about a standardized scaling instrument, an aspect of biological psychiatry, a medication, or anything else. And this is minor, but it does irritate me: is it really necessary to use terms like "ain't" and "look see" when we know perfectly well that Jeff Corey is more than capable of using proper grammar?

[blutoski]

I wonder how talking about yourself for a year effects narcissism?

Well, you don't have to spend a lot of time. ISTDP (Intenstive Short-Term Dynamic Psychotherapy) can be pretty brief.

Dr. Tarzwell is a psychiatrist here in Vancouver who uses ISTDP for appropriate indications. He believes it has good evidence-based support. Dr. Tarzwell is a pretty active anti-quackery skeptic, not prone to woo.

See:

[Short-term psychodynamic psychotherapy for somatic disorders. Systematic review and meta-analysis of clinical trials. (http://www.ncbi.nlm.nih.gov/pubmed/19602915?ordinalpos=5&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum)]
[Direct diagnosis and management of emotional factors in chronic headache patients. (http://www.ncbi.nlm.nih.gov/pubmed/18771494?ordinalpos=14&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum)]
[Chest pain–consider panic disorder. (http://www.ncbi.nlm.nih.gov/pubmed/17872738?ordinalpos=20&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum)]


Dalhousie (Halifax, NS) has a team that use ISTDP and conduct research: [istdp.ca (http://www.istdp.ca/)]