Leichsenring Falk, Leibing Eric
Clinic of Psychosomatics and Psychotherapy, University of Goettingen, Goettingen, Germany.
Psychol Psychother. 2007 Jun;80(Pt 2):217-28. doi: 10.1348/147608306X117394.
Psychodynamic psychotherapy is one of the most frequently applied methods of psychotherapy in clinical practice. However, it is the subject of controversial discussion, especially with regard to empirical evidence. In this article we aim to give an up-to-date description of the treatment and to review the available empirical evidence. Evidence is reviewed for both efficacy and mechanisms of change of short- and moderate-term psychodynamic psychotherapy. Furthermore, results of effectiveness studies of long-term psychoanalytic therapy are reviewed.
With regard to efficacy, a protocol for a Cochrane review for (short-term) psychodynamic psychotherapy is available specifying inclusion criteria for efficacy studies.
Twenty-three randomized controlled trials of manual-guided psychodynamic psychotherapy applied in specific psychiatric disorders provided evidence that psychodynamic psychotherapy is superior to control conditions (treatment-as-usual or wait list) and, on the whole, as effective as already established treatments (e.g. cognitive-behavioural therapy) in specific psychiatric disorders. With regard to process research, central assumptions of psychodynamic psychotherapy were confirmed by empirical studies.
Further research should include both efficacy studies (on specific forms of psychodynamic psychotherapy in specific mental disorders) and effectiveness studies complementing the results from experimental research settings. Future process research should address the complex interactions among interventions, patient's level of functioning, helping alliance and outcome.
心理动力心理治疗是临床实践中最常用的心理治疗方法之一。然而，它是一个存在争议的讨论主题，尤其是在实证证据方面。在本文中，我们旨在对该治疗方法进行最新描述，并回顾现有的实证证据。对短期和中期心理动力心理治疗的疗效及改变机制的证据进行了回顾。此外，还回顾了长期精神分析治疗的有效性研究结果。
关于疗效，有一项Cochrane综述（针对短期心理动力心理治疗）的方案，其中规定了疗效研究的纳入标准。
23项针对特定精神疾病应用手册指导的心理动力心理治疗的随机对照试验提供了证据，表明心理动力心理治疗优于对照条件（常规治疗或等待名单），总体上在特定精神疾病中与已确立的治疗方法（如认知行为疗法）效果相当。关于过程研究，心理动力心理治疗的核心假设得到了实证研究的证实。
进一步的研究应包括疗效研究（针对特定精神疾病中特定形式的心理动力心理治疗）和有效性研究，以补充实验研究环境中的结果。未来的过程研究应关注干预措施、患者功能水平、治疗联盟和结果之间的复杂相互作用。
