The new emphasis on evidence in assessing psychotherapy has led to a deep rift among therapists, partly because some types of therapies have benefited from this trend more than others.
Cognitive-behavioral therapy (CBT), for instance, is the king of the evidence-based therapies. A brief, focused treatment geared toward relieving a patient’s immediate symptoms, CBT has been studied more than 300 times; its success in these trials largely accounts for its skyrocketing popularity.
Several studies have suggested that CBT is at least as effective as antidepressants for patients with major depression, and researchers have reported promising results for anxiety disorders as well. CBT also appears to be especially effective in the long term: A 1998 review of several CBT studies found that patients who are successfully treated with cognitive therapy are about half as likely as patients taking antidepressants to relapse after the end of treatment.
Now CBT is looking to expand its reach. Nearly 150 clinical trials are currently under way to determine CBT’s effectiveness for conditions ranging from gambling addiction to chronic pain.
Psychodynamic psychotherapy, a more traditional school of therapy derived from psychoanalysis, has not fared as well under the new evidence-based paradigm. Though it is among the most common types of therapy, there is less evidence for its efficacy than there is for CBT. Studies showing that psychodynamic therapy is effective at relieving symptoms of mood disorders in both the short and long term do exist, but there are far fewer of them and they tend to be on the small side. In one study comparing a group of patients who underwent long-term psychodynamic therapy with a group that received no therapy at all, three-quarters of the therapy patients showed a significant improvement in their symptoms, while there was no significant improvement in the control group. But the study included just 55 patients.
Psychodynamic treatments are at something of an unfair disadvantage in this respect, according to Prudence Gourguechon, MD, president of the American Psychoanalytic Association. "Something that is ‘evidence-based’ is much more amenable to large-scale data collection, large-scale payment programs—anything that is large," says Dr. Gourguechon. "And psychoanalysis is a very individualistic thing. It is the smallest enterprise: one analyst and one patient trying to understand what has caused the patient’s suffering and how it can get better."
