This visual, lead by John Thor Cornelius, M.D., highlights the effectiveness of Psychoanalysis while exploring the scientific evidence

Marianne Leuzinger-Bohleber, Johannes Kaufhold, Lisa Kallenbach, Alexa Negele, Mareike Ernst, Wolfram Keller, Georg Fiedler, Martin Hautzinger, Ulrich Bahrke & Manfred Beutel (2019) How to measure sustained psychic transformations in long-term treatments of chronically depressed patients: Symptomatic and structural changes in the LAC Depression Study of the outcome of cognitive-behavioural and psychoanalytic long-term treatments, The International Journal of Psychoanalysis, 100:1, 99- 127, DOI: 10.1080/00207578.2018.1533377 In a large multi-centre study, the results of psychoanalytical and cognitive-behavioral longterm therapies in chronically depressed patients were compared, Both psychotherapies led to statistically highly significant changes in depressive symptoms three years after the start of the treatments However, the focus of psychoanalytic treatments is not exclusively on reducing psychopathological symptoms, but on changes in the inner world of the patients. This article reports results on such changes achieved with the help of a sophisticated measuring instrument, the Operationalized Psychodynamic Diagnostics (OPD). These changes are compared with symptomatic changes. Three years after the start of the treatments, significantly more patients in psychoanalytical treatments show such inner changes than patients in cognitive-behavioral treatments.

(DeMaat, et al, 2007, Berghout, Zevalkink, & Haakaart-van Roijen, 2010a and b). Both long-term psychoanalytic psychotherapy and traditional psychoanalysis yield significantly reduced work absenteeism and lowered hospitalization at seven-year follow-up. (Beutel, Rasting, Stuhr, et al, 2004.) Both long-term psychoanalytic psychotherapy and traditional psychoanalysis lead to reduced health care use and sick leave.

Levy, K.N., Meehan, K.B., Kelly, K.M., Reynoso, J.S., Weber, M., Clarkin, J.F., & Kernberg, O.F. (2006) Change in attachment patterns and reflective function in a randomized controlled trial of Transference Focused Psychotherapy for borderline personality disorder. Journal of Consulting and Clinical Psychology. 74, 1027-1040. A superbly organized and executed study showing how the psychodynamic elements make a difference to outcome. Patients with severe and long-standing personality difficulties in psychoanalytic treatment improve significantly in their functioning and emotional health, and they do so by cultivating a greater ability to meaningfully reflect on themselves and others close to them.

Roy, C.A., Perry, J.C., Luborsky, L. and Banon, E. (2009). Changes in Defensive Functioning in Completed Psychoanalyses: the Penn Psychoanalytic Treatment Collection. Journal of the American Psychoanalytic Association, 57: 399-415. Connolly, M.B. & Strupp, H.H. (1996). Cluster Analysis of Patient Reported Psychotherapy Outcomes. Psychotherapy Research, 6: 30-42. This study explores the varieties of perceived benefits including changes in self-concept. A careful effort to determine what categories of changes patients actually appreciate after the treatment. Leads to a much broader notion of the benefits of psychotherapy than simply symptom removal. Roy, C.A., Perry, J.C., Luborsky, L. and Banon, E. (2009). Changes in Defensive Functioning in Completed Psychoanalyses: the Penn Psychoanalytic Treatment Collection. Journal of the American Psychoanalytic Association, 57: 399-415. Using 17 recorded psychoanalyses, now included in the PRC collection, the authors show that when outcome is measured by well-established methods there is a substantial overlap of changes in defenses and the direction of greater health. The article is also useful for its description of other studies of changes in defenses and other aspects of adaptation with psychotherapy.

Effectiveness of Long-term Psychodynamic Psychotherapy: a Meta-analysis. Leichsenring, F. & Rabung, S. (2008). Journal of the American Medical Association, 300, 1551-1565. (Modified from the Abstract) Twenty-three studies involving a total of 1053 patients were included (11 RCTs and 12 observational studies). According to comparative analyses of controlled trials, long term psychoanalytic psychotherapy (LTPP) showed significantly higher outcomes in overall effectiveness, target problems, and personality functioning than shorter forms of psychotherapy. With regard to overall effectiveness, a between-group effect size of 1.8 (95% confidence interval [CI], 0.7-3.4) indicated that after treatment with LTPP patients with complex mental disorders on average were better off than 96% of the patients in the comparison groups (P=.002). According to subgroup analyses, LTPP yielded significant, large, and stable within-group effect sizes across various and particularly complex mental disorders (range, 0.78-1.98). Levy, K.N., Meehan, K.B., Kelly, K.M., Reynoso, J.S., Weber, M., Clarkin, J.F., & Kernberg, O.F. (2006) Change in attachment patterns and reflective function in a randomized controlled trial of Transference Focused Psychotherapy for borderline personality disorder. Journal of Consulting and Clinical Psychology. 74, 1027-1040. A superbly organized and executed study showing how the psychodynamic elements make a difference to outcome. Patients with severe and long-standing personality difficulties in psychoanalytic treatment improve significantly in their functioning and emotional health, and they do so by cultivating a greater ability to meaningfully reflect on themselves and others close to them. Leichsenring, F., & Leibing, E. (2003). The Effectiveness of Psychodynamic Therapy and Cognitive Behavior Therapy in the Treatment of Personality Disorders: a Meta-analysis. American Journal of Psychiatry, 160, 1223. (From the Abstract) The authors conducted a meta-analysis to address the effectiveness of psychodynamic therapy and cognitive behavior therapy in the treatment of personality disorders. METHOD: Studies of psychodynamic therapy and cognitive behavior therapy that were published between 1974 and 2001 were collected. Only studies that 1) used standardized methods to diagnose personality disorders, 2) applied reliable and valid instruments for the assessment of outcome, and 3) reported data that allowed calculation of within-group effect sizes or assessment of personality disorder recovery rates were included. Fourteen studies of psychodynamic therapy and 11 studies of cognitive behavior therapy were included. RESULTS: Psychodynamic therapy yielded a large overall effect size (1.46), with effect sizes of 1.08 found for self-report measures and 1.79 for observer-rated measures. For cognitive behavior therapy, the corresponding values were 1.00, 1.20, and 0.87. For more specific measures of personality disorder pathology, a large overall effect size (1.56) was seen for psychodynamic therapy. Two cognitive behavior therapy studies reported significant effects for more specific measures of personality disorder pathology. For psychodynamic therapy, the effect sizes indicate long-term rather than short-term change in personality disorders.

Høglend, P. Hersoug, A.G., Bøgwald, K.P., Amlo, S., Marble, A., Sørbye, Ø., Røssberg, J.I.,, Ulberg, R., Gabbard, G. & Crits-Christoph, P. (2011). Effects of Transference Work in the Context of Therapeutic Alliance and Quality of Object Relations. Journal of Consulting and Clinical Psychology 79, 697–706. A randomized controlled study of the effect of transference work (addressing the patient’s reaction to the analyst or analytic situation) on the course of treatment in the first 100 sessions. The authors demonstrated that, for those patients who had more difficulty in their relationships, the transference work enhanced the results of psychotherapy. A unique study. The definition of “transference work” is also succinct and explains why such work may be viewed as central: “[F]ocusing on the themes and conflicts that arise in the therapeutic relationship will have immediate affective resonance and illuminate the true nature of problems in the patient’s relationships outside of therapy" (Kernberg, Diamond, Yeomans, Clarkin and Levy, 2008: Strachey, 1934). .Analysis of transference may increase insight regarding intrapsychic conflicts and problematic relations, which may in turn lead to better adaptive and interpersonal functioning (Gabbard and Westen, 2003; McGlashan and Miller, 1982; Messer and McWilliams, 2007; Strachey, 1934).” (p.698).

Both longer duration and higher frequency of psychotherapy have independent positive effects for the more severely and chronically ill, and together they contribute to the most positive treatment outcomes. However 96% of today's analysts regularly conduct therapy 1-2 times per week with patients. 100% agree they are still able to provide the same level of expertise, enabling the achievement of deeper awareness. (Rudolf, Manz, and Ori, 1994; Sandell, Blombert, Lazar, et al, 2000; Grande, Dilg, Jakobsen et al, 2006, Leichsenring and Rabung, 2008, 2011, Huber, Zimmermann, et al, 2012, Mullin, Hilsenroth, Gold, et al, 2016. Psychoanalysis Now National Survey 2019)

Results supporting the efficacy of psychodynamic and psychoanalytic treatment are extensive (De Maat et al., 2013, 2006; Huber 2017; Knekt et al., 2013; Kivlighan, Wampold, 2015; Klug et al., 2016; Leichsenring, 2005; Leichensring & Leibing, 2007; Leuzinger-Bohleber, & Target, 2002; Sandell et al., 2000; Shedler, 2010; Waldron et al. 2017; Werbart, Forsström, Jeanneau, 2012; Wilczek et al., 2004). Results about the degree to which a favorable outcome by the end of treatment contributes to the subsequent course of life include: Falkenström et al., 2007; Huber 2017; Kantrowitz et al., 1987a, 1990a, b, c; Sandell et al., 2002. Brief listing of individual papers: Sandell, R., Blomberg, J., Lazar, A., Carlsson, J., Broberg, J. & Schubert, J. (2000). Varieties of long-term outcome among patients in psychoanalysis and long-term psychotherapy: a review of findings in the Stockholm outcome of psychoanalysis and psychotherapy project (STOPPP). International Journal of Psychoanalysis: 81: 921-942. A complicated study to understand fully, but of the highest quality, showing that the benefits of more intensive work (in comparison with infrequent sessions) begin to show as the years go on. "Empirical evidence supports the efficacy of psychodynamic therapy. Effect sizes for psychodynamic therapy are as large as those reported for other therapies that have been actively promoted as "empirically supported" and "evidence based." In addition, patients who receive psychodynamic therapy maintain therapeutic gains and appear to continue to improve after treatment ends. Finally, nonpsychodynamic therapies may be effective in part because the more skilled practitioners utilize techniques that have long been central to psychodynamic theory and practice. The perception that psychodynamic approaches lack empirical support does not accord with available scientific evidence and may reflect selective dissemination of research findings." Shedler, J. American Psychologist, Vol. 65, No. 2, 98 –109 (2010) Recent studies have found that psychodynamic theory can provide more long-term benefits than CBT. In 2015, University College London psychoanalyst and clinical psychologist Peter Fonagy, PhD, led a study through the National Health Service in England comparing 18 months of once-a-week psychoanalytic therapy with "treatment as usual," which included CBT, among adults with chronic depression. The researchers found that 18 months of psychoanalysis provided similar benefits in terms of observer-based and self-reported depression scores compared with the control treatment. But the team also found that patients who received psychoanalytic therapy experienced much longer effects: Two years after treatment ended, 44 percent of patients who received psychoanalysis no longer met the criteria for major depression, compared with 10 percent of the CBT group (World Psychiatry, Vol. 14, No. 3, 2015).