Handbook of Evidence-Based Psychodynamic Psychotherapy


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Vibrant body of research featured
in book

(December 2009 Issue)

“Handbook of Evidence-Based Psychodynamic Psychotherapy: Bridging the Gap Between Science and Practice”
Edited by Raymond A. Levy and
J. Stuart Ablon
Humana Press
New York, NY, 2009

By Paul Efthim, Ph.D.

Perhaps the most surprising thing about this book is that it exists at all. Even though I consider myself psychoanalytically oriented, I was not aware of the recent surge in research on psychodynamic therapy. Probably like most of my peers, I assumed that psychoanalytic clinicians' attitudes toward research were ambivalent at best or downright contemptuous at worst. How could the psychoanalytic enterprise be studied without intruding, without reducing its complexity, meaning and mystery? Indeed, the term "psychoanalytic research" seems freighted with paradox, much like "airline food" or "domestic cat."

If the goal of this volume's editors was to shatter these sorts of assumptions about research on psychodynamic psychotherapy, then they have succeeded admirably.

Edited by Boston psychologists Raymond Levy and Stuart Ablon, both at Massachusetts General Hospital, this book comprises a rich set of previously unpublished papers written by a Who's Who of clinician-researchers including Glen Gabbard, Drew Westen, Leigh McCullough, Jeremy Safran and many others. They present a vibrant body of research that demonstrates that psychodynamic therapy is an effective treatment for a range of common problems.

Beyond presenting ample empirical support for the efficacy of psychodynamic approaches, there are several themes that run through this volume. One is the myth of theoretical purity: most psychotherapy as practiced by experienced clinicians integrates a variety of approaches. Even highly seasoned practitioners who describe themselves as "psychoanalytic" or "psychodynamic" in orientation are found to integrate behavioral, cognitive and other principles into the process with their real-world patients.

Another major theme is the primacy of the relationship, above technique. As has been repeatedly demonstrated, specific techniques only explain five to 15 percent of the variance in therapeutic outcome.

Psychodynamic approaches are particularly well-suited to promote a strong working alliance. For example, concepts such as transference, interpretation and unconscious enactments can help guide the therapist to negotiate difficulties in the alliance. A chapter by Safran and colleagues presents relatively recent empirical research on how alliance ruptures can be repaired. They note that even seasoned practitioners experience difficulties in recognizing and resolving breakdowns in the working alliance.

Also central is the role of emotion. Several contributors emphasize the unique ways in which psychodynamic interventions can help patients acknowledge, bear and put into perspective their most painful affective states.

Although the going gets dense in a few chapters due to psychometric issues, other parts are quite compelling, such as the fascinating sections on psychodynamic treatment of panic disorder and McCullough's affect-focused model. Some of the most satisfying chapters consist of personal reflections by senior clinicians.

The editors group the nineteen chapters into five sections: research on specific disorders (including panic, eating disorders and borderline personality), process research, technique, neurobiology and a final section offering reflections on research. Most chapters incorporate clinical case illustrations and session excerpts to convey moment-to-moment process. The authors take care to describe the strengths and weaknesses of randomized control trial research and explain how recent developments in psychotherapy process and outcome studies involve the use of more naturalistic settings in order to study how treatment actually unfolds in the real world.

At its best, clinical research serves as a check on our biases and allegiances to particular theories while helping us learn which approaches are most helpful in our work with patients. This book makes a powerful plea to professional organizations to foster the development of research, a call that all psychodynamic institutes would do well to heed.

Paul Efthim, Ph.D. is a licensed psychologist in private practice in Brookline, Mass. and holds a faculty appointment at the Boston Institute for Psychotherapy.