Of all the specific forms of psychodynamic
therapy, interpersonal psychotherapy (IPT) has
received the most research attention. Futhermore,
the application of IPT to major depressive disorder
has been studied extensively. Recently, Cuijpers et
al. (2011) presented results from a large meta-
analysis of controlled trials using IPT to treat
depression. Their review evaluated results from 38
studies that included over 4,000 patients, both
adults and adolescents. These studies compared
IPT to no treatment, IPT to other forms of psycho-
therapy, and IPT to medication. Based on their
results, the authors concluded that IPT showed
moderate to large effects over no treatment for
acute major depression, and IPT in combination
with medication showed some advantage over
treatment with medication alone. IPT did not
show a consistent advantage over other forms of
psychological treatment (typically cognitive-
behavioral therapy), and IPT showed somewhat
less efficacy than medication alone (i.e., selective
serotonin reuptake inhibitors, SSRIs).
Based on these and other results, we offer the
tentative conclusion that there appears to be at least
modest support for the effectiveness of psychody-
namic psychotherapy, particularly with adults. How-
ever, the strength of the efficacy evidence depends
on the specific disorder, and a number of thorny
methodological issues continue to plague research
on psychodynamic therapy (e.g., appropriate out-
come measures, length of treatment). Clearly, addi-
tional well-designed investigations are warranted.
Interpretation and Insight
A wide range of current psychotherapies depend to
some extent on the patient’s achieving insight
through therapist interpretation. Psychoanalysis
seems to retain its total commitment to insight as
the supreme means for solving problems in living.
When understanding is complete enough, it is
believed that the patient’s symptoms will be ame-
liorated or even disappear entirely.
This emphasis on the pursuit of understanding
has great appeal to many people. For example,
although many people who are sad may seek the
therapeutic goal of happiness, most of them are not
content just to become happy—they also want to
know why they are sad. The commitment of
psychoanalysis and its psychotherapeutic heirs to
insight and understanding is their greatest asset,
but it also contains the seeds of their failures. Espe-
cially in the case of psychoanalysis, reconstruction
of the personality through insight and understand-
ing can lead to a nearly interminable and sometimes
exhausting examination of the past and analysis of
motives. Although one can hardly fault psychoanal-
ysis for teaching the importance of the past“shap-
ing”the present, there can be too much of a good
thing. At times, it almost seems that the patient can
use the need for understanding and the pursuit of
the past as reasons for not coming to grips with
current problems. The endless analysis of conflicts
and motives and of their childhood origins can eas-
ily replace the need to find solutions and behavioral
alternatives to problems in living. Learning the rea-
sons for one’s problems may be important (and ulti-
mately efficient if one is to attain generalized rather
than piecemeal solutions), but the failure to empha-
size alternative ways of behaving can be a major
shortcoming of traditional psychoanalysis.
Psychoanalysis often appears to involve a tacit
assumption that more adaptive behavior will occur
automatically once insight is achieved by the
working-through process—that behavioral change
will surely follow insight. However, the evidence
for this assumption is exceedingly sparse. In fact, it
has been argued for some time that the true course
of events follows a reverse pattern—that insight is
brought about by behavioral change (Alexander &
French, 1946).
One of the chief methods used by psychody-
namic clinicians to facilitate patient insight is the
interpretation of transference. A review of empirical
studies that examined transference interpretation in
psychodynamic psychotherapy (Henry et al., 1994)
offers the following general conclusions:- The frequency of interpretations made is not
related to better outcome. Indeed, some studies
have found that a higher frequency of inter-
pretation is related to poorer outcome.
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