Skip to main content

Psychodynamic psychotherapy: developing the evidence base

  • Jessica Yakeley

Psychodynamic psychotherapy has been criticised as being based on outdated principles of psychoanalysis and lacking an adequate evidence base to convincingly demonstrate its efficacy. This article summarises the recent evidence from high-quality outcome studies to show that psychodynamic psychotherapy is as effective in the treatment of a range of mental disorders as other psychological treatment modalities such as cognitive-behavioural therapy, as well as reviewing process-outcome research aiming to elucidate mechanisms of therapeutic change. A paradigm for psychodynamic psychotherapy research based on attachment theory is introduced, which may inform the development of psychodynamic therapeutic modalities tailored for specific conditions.


  1. Understand the basic principles and techniques of psychodynamic psychotherapy.
  2. Be able to summarise the recent evidence base for the efficacy of psychodynamic psychotherapy.
  3. Appreciate process-outcome research that elucidates therapeutic mechanisms underpinning psychodynamic psychotherapy.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Psychodynamic psychotherapy: developing the evidence base
      Available formats
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Psychodynamic psychotherapy: developing the evidence base
      Available formats
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Psychodynamic psychotherapy: developing the evidence base
      Available formats
Corresponding author
Dr Jessica Yakeley, Portman Clinic, 8 Fitzjohns Avenue, London NW3 5NA, UK. Email:
Hide All

Declaration of Interest


Hide All
Abbass, AA, Hancock, JT, Henderson, J et al (2006) Short-term psychodynamic psychotherapies for common mental disorders. Cochrane Database of Systematic Reviews, 4: CD004687.
Abbass, A, Kisely, S, Kroenke, K (2009) Short-term psychodynamic psychotherapy for somatic disorders: systematic review and meta-analysis of clinical trials. Psychotherapy and Somatics, 78: 265–74.
Ainsworth, MS, Blehar, MC, Waters, E et al (1978) Patterns of Attachment A Psychological Study of the Strange Situation. Lawrence Erlbaum Associates.
Barlow, DH, Allen, LB, Choate, ML (2004) Toward a unified treatment for emotional disorders. Behavior Therapy, 35: 205–30.
Bateman, A, Fonagy, P (2004) Psychotherapy for Borderline Personality Disorder: Mentalization-Based Treatment. Oxford University Press.
Bateman, A, Fonagy, P (2006) Mentalization-Based Treatment for Borderline Personality Disorder: A Practical Guide. Oxford University Press.
Berlin, LJ, Cassidy, J, Appleyard, K (2008) The influence of early attachments on other relationships. In Handbook of Attachment: Theory, Research and Clinical Applications (eds Cassidy, J, Shaver, PR) 333–47. Guilford Press.
Blagys, M, Hilsenroth, M (2000) Distinctive features of short-term psychodynamic-interpersonal psychotherapy: a review of the comparative psychotherapy process literature. Clinical Psychology: Science and Practice, 7: 167–88.
Bowlby, J (1969) Attachment and Loss: Vol 1, Attachment. Basic Books.
Bowlby, J (1973) Attachment and Loss: Vol 2, Separation, Anxiety and Anger. Basic Books.
Bowlby, J (1977) The making and breaking of affectional bonds. I. Aetiology and psychopathology in the light of attachment theory. British Journal of Psychiatry, 130: 201–10.
British Psychoanalytic Council, UK Council for Psychotherapy (2013) Quality Psychotherapy Services in the NHS: Summary Findings from the UK Council for Psychotherapy and British Psychoanalytic Council Members' Survey. BPC/UKCP.
Clarkin, JF, Yeomans, FE, Kernberg, OF (2006) Psychotherapy for Borderline Personality: Focusing on Object Relations. American Psychiatric Association.
Connolly, MB, Crits-Christophe, P, Shappel, S et al (1999) Relations of transference interpretations to outcome in the early sessions of brief supportive-expressive psychotherapy. Psychotherapy Research, 9: 485–95.
de Maat, S, de Jonghe, F, Schoevers, R et al (2009) The effectiveness of long term psychoanalytic psychotherapy: a systemic review of empirical studies. Harvard Review of Psychiatry 17: 123.
Department of Health (2007) Commissioning a Brighter Future: Improving Access to Psychological Therapies. Department of Health.
Dozier, M, Cue, KL, Barnett, KL (1994) Clinicians as caregivers: role of attachment organization in treatment. Journal of Consulting and Clinical Psychology 62: 793800.
Evans, C, Mellor-Clark, J, Margison, F et al (2000) CORE: Clinical Outcomes in Routine Evaluation. Journal of Mental Health, 9: 247–55.
Fonagy, P, Leigh, T, Steele, M et al (1996) The relation of attachment status, psychiatric classification and response to psychotherapy. Journal of Consulting and Clinical Psychology, 624: 2231.
Fonagy, P, Target, M, Steele, H et al (1998) Reflective Functioning Manual Version 5.0 for Application of Adult Attachment Interviews. University College London.
Fonagy, P, Adshead, G (2012) How mentalisation changes the mind. Advances in Psychiatric Treatment, 18: 353–62.
Gabbard, GO (2004) Long-Term Psychodynamic Psychotherapy: A Basic Text. American Psychiatric Publishing Inc.
George, C, Kaplan, N, Main, M (1996) The Adult Attachment Interview (3rd edn). Department of Psychology, University of California, Berkeley.
Gerber, AJ, Kocsis, JH, Milord, BL et al (2010) A quality-based review of randomized controlled trials of psychodynamic psychotherapy. American Journal of Psychiatry, 168: 1928.
Guthrie, E, Creed, F, Dawson, D et al (1991) A controlled trial of psychological treatment for the irritable bowel syndrome. Gastroenterology, 100: 450–7.
Guthrie, E (1999) Psychodynamic interpersonal therapy. Advances in Psychiatric Treatment, 5: 135–45.
Hilsenroth, MJ, Cromer, TD, Ackerman, SJ (2012) How to make practical use of therapeutic alliance in your clinical work. In Psychodynamic Psychotherapy Research: Evidence-Based Practice and Practice-Based Evidence (eds Levy, RA, Ablon, JS, Kachele, H) 361–80. Humana Press.
Hobson, RF (1985) Forms of Feeling: The Heart of Psychotherapy. Basic Books.
H⊘glend, P (1993) Transference interpretations and long-term change after dynamic therapy of brief to moderate length. American Journal of Psychotherapy, 47: 494507.
H⊘glend R B⊘gwald, KP, Amlo, S et al (2008) Transference interpretations in dynamic psychotherapy: do they really yield sustained effects? American Journal of Psychiatry, 165: 763–71.
H⊘glend R Gabbard, GO (2012) When is transference work useful in psychodynamic psychotherapy? A review of empirical research. In Psychodynamic Psychotherapy Research: Evidence-Based Practice and Practice-Based Evidence (eds Levy, RA, Ablon, JS, Kachele, H) 449–67. Humana Press.
Kachele, H, Schacter, J, Thoma, H (2009) From Psychoanalytic Narrative to Empirical Single Case Research: Implications for Psychoanalytic Practice. Routledge.
Kernberg, OF, Yeomans, FE, Clarkin, JF et al (2008) Transference focused psychotherapy: overview and update. International Journal of Psychoanalysis, 89: 601–20.
Klerman, GL, Weissma, MW, Rounsaville, BJ et al (1996) Interpersonal Psychotherapy of Depression. Jason Aronson.
Leichsenring, F, Leibing, E (2003) The effectiveness of psychodynamic therapy and cognitive therapy in the treatment of personality disorders: a meta-analysis. American Journal of Psychiatry, 160: 1223–32.
Leichsenring, F, Rabung, S, Leibing, E (2004) The efficacy of short-term psychodynamic psychotherapy in specific psychiatric disorders: a meta-analysis. Archives of General Psychiatry, 61: 1208–16.
Leichsenring, F, Rabung, S (2008) Effectiveness of long-term psychodynamic psychotherapy. JAMA, 300: 1151–65.
Leichsenring, F, Rabung, S (2009) Analyzing effectiveness of long-term psychodynamic psychotherapy reply JAMA, 301: 932–3.
Leichsenring, F, Klein, S (2014) Evidence for psychodynamic psychotherapy in specific mental disorders: a systematic review. Psychoanalytic Psychotherapy, 28: 432.
Lemma, A, Target, M, Fonagy, P (2010) The development of a brief psychodynamic protocol for depression: Dynamic Interpersonal Therapy (DIT). Psychoanalytic Psychotherapy, 24: 329–46.
Lemma, A, Target, M, Fonagy, P (2012) Brief Dynamic Interpersonal Therapy: A Clinician's Guide. Oxford University Press.
Levy, KN, Meehan, KB, Kelly, KM et al (2006) Change in attachment patterns and reflective function in a randomized control trial of transference-focused psychotherapy for borderline personality disorder. Journal of Consulting and Clinical Psychology, 74: 1027–40.
Levy, KN, Meehan, KB, Temes, CM et al (2012) Attachment theory and research: implications for psychodynamic psychotherapy. In Psychodynamic Psychotherapy Research: Evidence-Based Practice and Practice-Based Evidence (eds Levy, RA, Ablon, JS, Kachele, H) 401–16. Humana Press.
Luborsky, L, Singer, B, Luborsky, L (1975) Comparative studies of psychotherapies. Is it true that “everyone has won and all must have prizes”? Archives of General Psychiatry, 32: 9951008.
Luyten, P, Blatt, SJ, Mayes, LC (2012) Process and outcome in psychoanalytic psychotherapy research: the need for a (relatively) new paradigm. In Psychodynamic Psychotherapy Research: Evidence-Based Practice and Practice-Based Evidence (eds Levy, RA, Ablon, JS, Kachele, H) 345–59. Humana Press.
Lysaker, PH, Buck, KD, Fogley, RL et al (2013) The mutual development of intersubjectivity and metacognitive capacity in the psychotherapy for persons with schizophrenia. Journal of Contemporary Psychotherapy, 43: 6372.
Main, M, Kaplan, N, Cassidy, J (1985) Security in infancy, childhood and adulthood: a move to the level of representation. Monographs of the Society for Research in Child Development, 50: 66104.
Malan, DH (1976) Toward the Validation of Dynamic Psychotherapy. Plenum.
Marziali, EA (1984) Prediction of outcome of brief psychotherapy from therapist interpretive interventions. Archives of General Psychiatry, 41: 301–4.
McHugh, RK, Murray, HW, Barlow, DH (2009) Balancing fidelity and adaptation in the dissemination of empirically-supported treatments: the promise of transdiagnostic interventions. Behaviour Research and Therapy, 47: 946–53.
Norton, PJ, Phillip, LM (2008) Transdiagnostic approaches to the treatment of anxiety disorders: a quantitative review. Psychotherapy: Theory, Research, Practice, Training, 45: 214–26.
Ogrodniczuk, JS, Piper, WE, Joyce, AS et al (1999) Transference interpretations in short-term dynamic psychotherapy. Journal of Nervous and Mental Disease, 187: 572–9.
Perry, JC (1990) Defense Mechanism Rating Scales (DMRS) (5th edn). Cambridge MA, published by author.
Perry, JC, Petraglia, J, Olson, TR et al (2012) Accuracy of defense interpretation in three character types. In Psychodynamic Psychotherapy Research: Evidence-Based Practice and Practice-Based Evidence (eds Levy, RA, Ablon, JS, Kachele, H) 417–47. Humana Press.
Piper, WE, Delbane, EG, Bienvenu, J-R et al (1986) Relationships between the object focus of therapist interpretations and outcome of short-term individual psychotherapy. British Journal of Medical Psychology, 59: 111.
Piper, WE, Azim, HF, Joyce, AS et al (1991) Transference interpretations, therapeutic alliance and outcome in short-term individual therapy. Archives of General Psychiatry, 48: 946–53.
Rosenbaum, B, Harder, S, Knudsen, P et al (2012) Supportive psychodynamic psychotherapy versus treatment as usual for first episode psychosis: two-year outcome. Psychiatry: Interpersonal and Biological Processes, 75: 331–41.
Rosenbaum, B, Martindale, B, Summers, A (2013) Supportive psychodynamic psychotherapy for psychosis. Advances in Psychiatric Treatment, 19: 310–8.
Rosenzweig, S (1936) Some implicit common factors in diverse methods of psychotherapy. American Journal of Orthopsychiatry, 6: 412–5.
Rosser, R, Denford, J, Heslop, A et al (1983) Breathlessness and psychiatric morbidity in chronic bronchitis and emphysema: a study of psychotherapeutic management. Psychological Medicine, 13: 93110.
Ryle, A (1982) Psychotherapy: A Cognitive Integration of Therapy and Practice. Academic Press.
Ryle, A (1990) Cognitive Analytic Therapy: Active Participation in Change. John Wiley & Sons.
Shedler, J (2010) The efficacy of psychodynamic psychotherapy. American Psychologist, 65: 98109.
Westen, D, Shedler, J (1999) Revising and assessing Axis II. Part 1: Developing a clinically and empirically valid assessment method. American Journal of Psychiatry, 156: 258–72.
Yakeley, J, Adshead, G (2013) Locks, keys and security of mind: psychodynamic approaches to forensic psychiatry. Journal of the American Academy of Psychiatry and the Law, 41: 3845.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

BJPsych Advances
  • ISSN: 1355-5146
  • EISSN: 1472-1481
  • URL: /core/journals/bjpsych-advances
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Psychodynamic psychotherapy: developing the evidence base

  • Jessica Yakeley
Submit a response


No eLetters have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *