Purpose: Within the context of the empirically based practice movement, both the National Institute of Mental Health (NIMH) and the American Psychological Association (APA) have called upon psychodynamic practitioners to start demonstrating their psychotherapy outcomes. Gabbard, Gunderson, and Fogarty (2002) have pointed to the danger of dynamic therapists not doing so, and have called for research “in the field”, particularly on the nature of symptom change and in identifying those client variables which might begin to predict a favorable versus a poor response to this form of treatment. This effectiveness study attempts to begin to answer these calls.

Method: This study was a secondary data analysis of existing data from a psychodynamic mental health clinic in St. Paul, Minnesota. It used a single group, within subjects longitudinal design. The psychometrically validated “Outcome Questionnaire” (OQ 45.2) was used as a measure of change. A linear mixed and random effects model was used to analyze the data. The aims of this study were: (1) to look at whether subjects improve and, (2) if so, at what the process of change looks like in this therapy, asking in essence, “who gets better, and when?” That is, does symptom improvement vary by diagnosis, the presence of comorbidity, or other client factors? For whom is this treatment best suited? And finally, (3) do longer term therapies produce greater symptom change than shorter therapies, as dynamic theorists often assert?

Results: Findings suggest that psychodynamic treatment is effective over time, producing moderate effect sizes, and point to the particular importance of the first three months in bringing about symptom change. Findings suggest a common “course of recovery”, with some between-group variability (i.e. the notion that people recover “differently”) based on several important variables. In keeping with existing literature, demographic variables such as race, gender, age, and educational level were not found to moderate outcome. Comorbidity, initial symptom severity, diagnosis, and length of treatment (“number of sessions”) were all found to significantly moderate treatment outcome. Psychodynamic treatment was found to both impact and to be impacted by subjects' initial interpersonal functioning, as measured by the OQ.

Discussion: Implications for both practice and theory are discussed. This study, along with others (i.e. Lambert, 2003) points to the importance of producing early symptom improvement. It also challenges the idea that (1) longer term treatment is necessarily preferable to brief treatment, and (2) that clients must somehow get “worse before they can get better”.

Gabbard, Gunderson, & Fogarty. (2002). The place of psychoanalytic treatments within psychiatry. Archives of Gen. Psychiatry, 59, June, 505 - 510.

Lambert, M., et al. (2003). Is it time for clinicians to routinely track patient outcome? A meta analysis. Clinical Psychology: Science and Practice, 10(3), 288-315.