Is Psychoanalysis Effective?
Is Psychoanalysis Effective?
Although not generally known and surprising to some, the effectiveness of psychoanalysis has been researched repeatedly in recent decades. Several surveys of the research have shown large Effect Sizes* (ESs) with 60% and 90% of the patients deriving meaningful and lasting improvement in symptoms. Since psychoanalysis is a long-term, intensive, and expensive treatment, some degree of certainty about its effectiveness is helpful for those who are considering pursuing psychoanalytic treatment.
What Kind of Psychoanalytic Studies Were Included in the Review?
Recently, a thorough and detailed meta-analysis of 14 good-quality studies of psychoanalysis by S. deMaat and colleagues has been conducted with the basic results reported here. The psychoanalytic treatment lasted from 2.5 to 6.5 years with a range of 234 to 971 sessions across the 14 studies. Only a few studies presented information about the long-term benefit of psychoanalysis with follow-up periods ranging from 1 to 3.5 yrs. On average, 77% of the patients in this review suffered from a depressive disorder, 50% from an anxiety disorder and 47% from a personality disorder. Other diagnoses included eating disorders, sexual and relational disorders, work problems, obsessive-compulsive disorders, psychosomatic complaints, and substance abuse. While four of the studies defined psychoanalysis as meeting 2-3 times per week on the couch, the majority defined psychoanalysis as 3-5 sessions or more per week on the couch.
How Large Were the Clinical Benefits of Psychoanalysis?
At the end of treatment psychoanalysis was found to have an effect size of 1.27 meaning that the impact of psychoanalysis can be described as very large. The effect size was even higher for 5 studies that followed-up patients for at least a year after the end of treatment (1.46) indicating that the benefits of psychoanalysis remain stable and extended beyond the treatment period itself.
The effect sizes increases to 1.52 when measures of depression or anxiety are used to evaluate the impact of psychoanalysis. At the follow-up, the effect size is even larger (1.65) showing that the effect of psychoanalysis on symptoms is stable or even enlarged at follow-up. The effect size is somewhat smaller when measures of personality or psychosocial functioning are used (1.08) although this is still considered to be a very robust outcome. At the follow-up, the effect size rises to 1.31, indicating that the effect of psychoanalysis personality or psychosocial functioning at follow-up remains stable. This is not surprising since it is easier to show improvements on specific symptoms (such as depression, anxiety, anger) than personality dysfunction.
Does the Number of Sessions per Week Affect Outcomes?
It is important to stress that there were no differences between patients who attended psychoanalysis 2-3 times per week (an average of 266 treatment sessions) and those who attended 3-5 sessions per week (an average of 793 treatment sessions) regardless of whether improvement was measured by a change in symptom severity, personality pathology or overall psychosocial functioning.
How Much Did Patients Improve From Psychoanalysis?
Another way to evaluate the benefit of psychoanalysis is to assess what percent of the patients who complete treatment score at the same level as people who do not have an emotional problem. For example, if someone is depressed, enters psychoanalysis and then, following treatment scores at the same level as people who are not depressed, this would be a good indication of a very positive impact of treatment. This review showed that at the end of psychoanalysis an average of 77% of the patients achieved scores similar to people who did not have depression and anxiety symptoms. At follow-up an average of 75% achieved that status. For personality and psychosocial functioning instruments, the results indicate that an average of 62% of the patients achieved scores similar to people who did not have a personality problem or psychosocial difficulty. At follow-up, an average of 65% achieved such a status.
Summary of the Benefits of Psychoanalysis
The review by deMaat and colleagues studied 14 good-quality studies of psychoanalysis and found converging evidence that psychoanalysis yields substantial benefit both at the end of, and within a few years following, psychoanalysis. These benefits were found primarily on depression, anxiety, personality disorders and general psychosocial functioning. Although the quality of the studies is not without weakness the available evidence strongly supports the empirical effectiveness of psychoanalysis. Since these studies do not directly compare psychoanalysis with other treatments means we cannot conclude at the present time that the benefits described are specifically attributable to psychoanalysis.
A very accessible, clear and brief description of the benefits of psychoanalysis and psychoanalytic psychotherapy compared to psychiatric medications and cognitive-behavioral therapy can be found on Youtube: https://www.youtube.com/watch?v=IQBx5TONHac
Written by: Tony Toneatto, Ph.D. FIPA; Clinical Psychologist/Psychoanalyst
Director, Buddhism, Psychology and Mental Health Minor Program New College, University of Toronto