Psychoanalytic Psychotherapy: What is the Evidence? 

Psychoanalytic psychotherapy has a robust and expanding evidence base, with numerous outcome studies demonstrating its efficacy for various conditions. Long-term follow-up consistently shows increased effect sizes, indicating that patients continue to improve after treatment ends. Furthermore, research suggests that non-psychoanalytic therapies may benefit from incorporating psychoanalytic techniques.

​Defining Elements of Psychoanalytic Psychotherapy
Psychoanalytic psychotherapy draws on psychoanalytic principles, particularly the influence of childhood experiences on adult personality. Sessions typically occur once or twice weekly over months or years, with techniques including:
Free Association: Patients speak freely, while therapists identify unconscious themes and resistances.
Interpretations: Insights into repetitive conflicts help patients understand unconscious patterns (Gabbard, 2004).
Countertransference: Therapists' responses offer insight into patients’ relational patterns. Blagys and Hilsenroth (2000) identified seven core processes distinguishing psychoanalytic psychotherapy:
1. Exploring emotions to foster deep emotional insight.
2. Investigating avoidance of distressing thoughts and feelings.
3. Identifying recurring patterns in relationships and experiences.
4. Examining past experiences to understand present functioning.
​5. Focusing on relationships as central to psychological difficulties.
6. Analyzing the therapeutic relationship (transference) as it reflects broader relational patterns.
7. Exploring fantasies, dreams, and desires as rich sources of self-understanding.

Psychoanalytic psychotherapy aims not only to alleviate symptoms but also to build psychological resilience, enabling patients to face challenges more effectively.
​
General Efficacy
A growing body of high-quality randomized controlled trials (RCTs) supports the efficacy of psychoanalytic psychotherapy. Shedler (2010) cites meta-analyses demonstrating significant effect sizes. For example:
A Cochrane Library meta-analysis (Abbass et al., 2006) of 23 RCTs (1,431 patients) found an effect size of 0.97 for general symptom improvement, increasing to 1.51 at nine-month follow-up. In comparison, the most commonly used antidepressants exhibit a more modest effect size of 0.31 (Wampold, 2001). Another meta-analysis (Leichsenring et al., 2004) reported an effect size of 1.17, increasing to 1.57 during long-term follow-up. Long-term psychoanalytic therapy (Leichsenring & Rabung, 2008) demonstrated a superior effect (1.8) compared to shorter therapies for complex disorders. See further for the evidence for the effectiveness of psychoanalytic Psychotherapy for specific disorders is outlined.
 
Effectiveness for Specific Disorders
While diagnostic categories have limitations (Blatt & Zuroff, 2005; Westen et al., 2006), psychoanalytic psychotherapy has been effective for specific conditions:
Personality Disorders: A meta-analysis (Leichsenring & Leibing, 2003) found pre- to post-treatment effect sizes of 1.46for psychoanalytic therapy versus 1.0 for CBT.

Borderline Personality Disorder: Clarkin et al. (2007) found that transference-focused psychotherapy led to broader improvements than dialectical behavior therapy.

Major Depressive Disorder: Emerging evidence supports efficacy (Driessen et al., 2013).

Somatic Disorders: Psychoanalytic therapy has shown positive outcomes for medically unexplained symptoms (Abbass et al., 2008, 2009).

General Mental Disorders: A meta-analysis of 47 RCTs (Leichsenring & Klein, 2014) confirmed their efficacy in treating depression, anxiety, personality disorders, PTSD, eating disorders, and substance-related disorders.

​Psychoanalytic Techniques in Other Therapies
Research suggests that psychoanalytic techniques contribute to the success of other therapies (Elkin et al., 1989; Goldfried & Wolfe, 1996; Kazdin, 2007, 2008). Studies using the Psychotherapy Process Q-Sort (Ablon & Jones, 1998) found that therapist adherence to psychoanalytic techniques predicted better outcomes in both psychoanalytic and cognitive therapy, whereas adherence to CBT techniques was less predictive.

Conclusion
The evidence base for psychoanalytic psychotherapy is substantial, methodologically rigorous, and growing. The assertion that psychoanalytic work lacks scientific credibility (e.g., Barlow & Durand, 2005) is no longer tenable. The significant and enduring effect sizes at long-term follow-up highlight its value beyond symptom relief, fostering lasting psychological growth. Patients deserve access to the most effective treatments, making it essential to set aside theoretical biases in favour of evidence-based care.

Reference List:
Abbass, AA., Hancock, JT., Henderson, J., et al. (2006). Short-term psychodynamic psychotherapies for common mental disorders. Cochrane Database of Systematic Reviews, 4: CD004687. 
Barlow, D., Durand, VM (2005). Abnormal psychology: An integrative approach (4th edition), Pacific Grove, CA: Brooks/Cole.
Blagys, M., Hilsenroth, M (2000). Distinctive features of short-term psychodynamic-interpersonal psychotherapy: a comparative psychotherapy process literature review. Clinical Psychology: Science and Practice, 7: 167–188 Clarkin, JF., Levy, KN., 
Lensenweger, MF., et al. (2007). Evaluating three treatments for borderline personality disorder: A multi-wave study. American Journal of Psychiatry, 164: 922-928.
Cuijpers, P., Van Straten, A., Andersson, G., et al. (2008). Psychotherapy for depression in adults: A meta-analysis of comparative outcome studies. Journal of Consulting and Clinical Psychology, 76: 909-922.
De Matt, D., De Jonghe, F., Schoevers, R., et al. (2009). The effectiveness of long-term psychoanalytic psychotherapy: a systemic review of empirical studies. Harvard Review of Psychiatry, 17: 1-23.
De Matt, D., Dekker, J., De Jonghe, F., et al. (2006). Relative efficacy of psychotherapy and pharmacotherapy in the treatment of depression: A meta-analysis. Psychotherapy Research, 16: 562-572.
Diener, MJ., Hilsenroth, MJ., Weinberger J (2007). Therapist affect focus and patient outcomes in psychoanalytic psychotherapy: A meta-analysis. American Journal of Psychiatry, 164: 936-941.
Elkin, I., Shea., T., Watkins, JT., et al. (1989) National Institutes of Mental Health Treatment of Depression Collaborative Research Program. Archives of General Psychiatry, 46: 971–982.
Goldfried, MR., Wolfe, BE (1996) Psychotherapy practice and research: Repairing a strained alliance. American Psychologist, 51: 1007–1016.
Kazdin, AE (2007). Mediator and mechanisms of change in psychotherapy research. Annual Review of Clinical Psychology, 61: 1–27.
Kazdin, AE (2008). Evidence-based treatment and practice: New opportunities to bridge clinical research and practise, enhance the knowledge base, and improve patient care. American Psychologist, 63: 146–159.
Leichsenring, F., Klein, S (2014). Evidence for psychodynamic psychotherapy in specific mental disorders: a systematic review. Psychoanalytic Psychotherapy, 28: 4-32.
Leichsenring, F., Rabung, S (2008) Effectiveness of long-term psychodynamic psychotherapy. Journal of the American Medical Association, 300: 1151-65.
Leichsenring, F., Rabung, S (2011) Long-term psychodynamic psychotherapy in complex mental disorders: Update of meta-analysis. British Journal of Psychiatry, 199: 15-22.
Leichsenring, F (2001). Comparative effects of short-term psychodynamic psychotherapy and cognitive-behavioural therapy in depression: A meta-analytic approach. Clinical Psychology Review, 21: 401-419.
Leichsenring, F (2005) Are psychodynamic and psychoanalytic therapies effective? International Journal of Psychoanalysis, 86: 841-868.
Leichsenring, F., Leibing, E (2003). The effectiveness of psychodynamic therapy and cognitive behaviour therapy in the treatment of personality disorders: A meta-analysis. American Journal of Psychiatry, 160: 1223-1232.
Leichsenring, F., Rabung, S., Leibing, E (2004). The efficacy of short-term psychodynamic psychotherapy in specific psychiatric disorders. A meta-analysis. Journal of the American Medical Association, 300: 1551–1565.     
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