Share this article on:

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:

CME Harvard Review of Psychiatry offers CME for readers who complete questions about featured articles. Questions can be accessed from the Harvard Review of Psychiatry website ( by clicking the CME tab. Please read the featured article and then log into the website for this educational offering. If you are already online, click here to go directly to the CME page for further information.

© 2013 President and Fellows of Harvard College