The Current State of the Empirical Evidence for Psychoanalysis: A Meta-analytic Approach

de Maat, Saskia PhD; de Jonghe, Frans PhD; de Kraker, Ruth MSc; Leichsenring, Falk PhD; Abbass, Allan MD; Luyten, Patrick PhD; Barber, Jacques P. PhD; Van, Rien MD, PhD; Dekker, Jack PhD

doi: 10.1097/HRP.0b013e318294f5fd

Learning Objectives: After participating in this educational activity, the reader should be better able to evaluate the empirical evidence for pre/post changes in psychoanalysis patients with complex mental disorders, and assess the limitations of the meta-analysis.

Background: The effectiveness of psychoanalysis is still a controversial issue, despite increasing research efforts.

Objective: To investigate the empirical evidence for psychoanalysis by means of a systematic review of the literature and a meta-analysis of the research data.

Method: A systematic literature search was undertaken to find studies regarding the effectiveness of psychoanalysis, published between 1970 and 2011. A meta-analysis was performed.

Results: Fourteen studies (total n = 603) were included in the meta-analysis. All but one were pre/post cohort studies. At treatment termination, the mean pre/post effect size across all outcome measures was 1.27 (95% confidence interval [CI], 1.03–1.50; p < .01). The mean pre/post effect size for symptom improvement was 1.52 (95% CI, 1.20–1.84; p < .01), and for improvement in personality characteristics 1.08 (95% CI, 0.89–1.26; p < .01). At follow-up the mean pre/follow-up effect size was 1.46 across all outcome measures (95% CI, 1.08–1.83; p < .01), 1.65 for symptom change (95% CI, 1.24–2.06; p < .01), and 1.31 for personality change (95% CI, 1.00–1.62; p < .01).

Conclusions: A limited number of mainly pre/post studies, presenting mostly completers analyses, provide empirical evidence for pre/post changes in psychoanalysis patients with complex mental disorders, but the lack of comparisons with control treatments is a serious limitation in interpreting the results. Further controlled studies are urgently needed.

From the Vrije Universiteit Amsterdam (Dr. de Maat); Nederlands Psychoanalytisch Instituut, Arkin, Amsterdam, the Netherlands (Drs. de Maat and de Jonghe); Arkin, Amsterdam, the Netherlands (Ms. Kraker; Drs. Van and Dekker); University of Giessen (Dr. Leichsenring); Dalhousie University (Dr. Abbass); University of Leuven and University College London (Dr. Luyten); Derner Institute of Advanced Psychological Studies, Adelphi University (Dr. Barber).

Original manuscript received 27 December 2011; revised manuscript received 16 July 2012, accepted for publication subject to revision 13 August 2012; revised manuscript received 28 August 2012.

Correspondence: Jack Dekker, PhD, Klaprozenweg 111, 1033 NN, Amsterdam, The Netherlands. Email:

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