McGill University, Jewish General Hospital, Canada.
Am Psychol. 2011 Feb-Mar;66(2):148-9; discussion 152-4. doi: 10.1037/a0021248.
Comments on the original article, "The efficacy of psychodynamic psychotherapy," by J. Shedler (see record 2010-02208-012). Shedler declared unequivocally that "empirical evidence supports the efficacy of psychodynamic therapy" (p. 98). He did not mention any specific criticisms that have been made of evidence on psychodynamic psychotherapies or address possible distinctions between evidence for short-term versus long-term psychodynamic psychotherapies. Instead, he attributed dissenting views to biases in evidence dissemination and review, which he suggested are rooted in a "lingering distaste in the mental health professions professions for past psychoanalytic arrogance and authority" related to a "hierarchical medical establishment that denied training to non-MDs and adopted a dismissive stance toward research" (Shedler, 2010, p. 98). Shedler (2010) justified his blanket dismissal of criticisms of evidence supporting psychodynamic psychotherapy on the basis of several published meta-analyses. The validity of conclusions from metaanalyses depends on the quality of the evidence synthesized, the nature of the studies included, and the rigor of the statistical analyses employed. Many meta-analyses, however, are not performed rigorously, which can result in treatment efficacy estimates that obscure important intertrial differences and that are unlikely to be replicated in clinical practice.
对 J.谢德勒（参见记录 2010-02208-012）的原始文章“精神动力心理疗法的疗效”的评论。谢德勒明确宣称，“经验证据支持精神动力疗法的疗效”（第 98 页）。他没有提到任何针对精神动力学心理疗法证据的具体批评，也没有讨论短期和长期精神动力学心理疗法证据之间可能存在的区别。相反，他将不同意见归因于证据传播和审查中的偏见，他认为这些偏见源于“心理健康专业人士对过去精神分析的傲慢和权威的挥之不去的反感”，以及“否认非医师培训并对研究采取轻视态度的等级森严的医疗体系”（谢德勒，2010 年，第 98 页）。谢德勒（2010 年）基于几项已发表的荟萃分析，为他对支持精神动力心理治疗的证据的批评一概而论的做法进行了辩护。荟萃分析结论的有效性取决于综合证据的质量、纳入研究的性质以及所采用的统计分析的严谨性。然而，许多荟萃分析的执行并不严格，这可能导致治疗效果估计掩盖了重要的试验间差异，并且不太可能在临床实践中得到复制。
