The Efficacy of Psychodynamic Psychotherapy

The Paper That Changed the Conversation

Shedler’s 2010 paper is the single most consequential document in the modern defense of psychodynamic psychotherapy’s empirical credentials. Published in the American Psychologist — the flagship journal of the American Psychological Association — it brought the full weight of meta-analytic evidence to bear on a claim that had calcified into institutional orthodoxy: that psychodynamic approaches lack empirical support, that cognitive-behavioral therapy is the only “evidence-based” treatment, and that insurers and training programs are therefore justified in marginalizing psychodynamic training. Shedler dismantled this claim systematically. His meta-analysis demonstrated that psychodynamic therapy produces effect sizes of 0.97 for overall symptom improvement — a number that equals or exceeds those reported in the CBT outcome literature. The evidence was not new; it had been accumulating for decades. What was new was the forcefulness, clarity, and venue of its presentation.

The Growing Edge: Why Depth Work Keeps Working

The paper’s most consequential finding is not that psychodynamic therapy works — this had been demonstrated in individual studies for years — but that it works in a distinctive way. Shedler shows that the therapeutic gains from psychodynamic treatment continue to increase after treatment ends. Patients who complete psychodynamic therapy show larger effect sizes at follow-up than they did at termination. By contrast, the gains from CBT and other manualized treatments tend to plateau at termination and sometimes diminish over time. This pattern has a name in the depth tradition: individuation. The analytic process, when it succeeds, does not simply relieve symptoms; it initiates a transformation in the patient’s relationship to their own unconscious that continues to unfold independently of the therapist’s presence. Jung described this as the activation of the transcendent function — the psyche’s capacity to generate its own integrative solutions once the ego has learned to attend to the unconscious. Shedler’s data give this claim an effect size.

The Methodological Trap

Shedler devotes significant attention to the structural biases in psychotherapy research that have systematically disadvantaged psychodynamic approaches. Randomized controlled trials — the gold standard of outcome research — are designed for manualized, time-limited interventions that can be standardized across therapists and replicated across sites. Psychodynamic therapy is none of these things by design. It is responsive rather than manualized, open-ended rather than time-limited, and dependent on the unique therapeutic relationship rather than a standardizable protocol. The RCT framework, Shedler argues, is not a neutral instrument but a methodological choice that privileges certain treatment modalities by the structure of the measurement itself. This is not a call to abandon empirical rigor but to recognize that rigor requires methods adequate to the phenomenon being studied.

What This Means for Depth Psychology

For clinicians trained in Jungian, Hillmanian, or psychodynamic traditions, Shedler’s paper is both vindication and instrument. It provides the empirical evidence needed to justify psychodynamic training, to secure insurance reimbursement, and to resist the institutional pressure to convert every therapeutic encounter into a manualized protocol. More fundamentally, it demonstrates that the features that make depth work distinctive — attention to the unconscious, the centrality of the therapeutic relationship, the commitment to personality transformation rather than symptom reduction — are precisely the features that produce its most durable clinical outcomes.