Psychodynamic therapy in Canada in the era of evidence-based practice

Abbass, Allan; Tasca, Giorgio A.; Vasiliadis, Helen‐Maria; Spagnolo, Jessica; Kealy, David; Hewitt, Paul L.; Hebert, Catherine; Drapeau, Martin; Doidge, Norman

doi:10.1080/02668734.2020.1803390

Cited by 7 publications

(14 citation statements)

References 64 publications

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“…Second, following from the previous point, although psychoanalytic therapy is currently accessible as a psychological treatment in the public health systems of most developed countries, it is significantly outweighed by the availability of other forms of psychotherapy (mainly, cognitive-behavioral treatment) with a more robust evidence base. 81 - 86 In these countries, psychoanalysis is offered mainly in private practice rather than the public health care sector, where it is usually available in a time-limited form and performed by trainees.…”

Section: Discussionmentioning

confidence: 99%

Mapping the psychoanalytic literature on bipolar disorder: a scoping review of journal articles

Stefana¹,

Fusar‐Poli²,

D’Imperio³

et al. 2023

Brazilian Journal of Psychiatry

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Objective: To provide a review of journal articles discussing clinical cases or vignettes of psychoanalysis or psychoanalytic psychotherapy of patients affected by bipolar disorder. Methods: A thorough search of journal articles was performed in five databases to identify studies published from 1990-2021. Results: Twenty-four articles were included in this review, comprising a total of 29 case reports. The most common theoretical approach adopted by the authors was “object relations.” Two main sets of clinical-theoretical considerations and recommendations emerge: the applicability of analytic treatment to patients with bipolar disorder – taking into account their analyzability and practical arrangements for conducting therapy – and theoretical speculations on the nature and development of the illness, as well as on the conceptualization of its different phases. Conclusion: Our findings reveal that there is some psychoanalytic literature providing insight into the psychological dynamics and treatment of patients with bipolar disorder. Elaboration of this literature may help improve our understanding and provide more accurate and comprehensive descriptions of the intrapsychic and interpersonal dynamics of these patients, yielding potentially valuable information for clinical and research purposes, particularly with regard to reducing interpersonal conflict, and increasing insight and engagement with lifestyle changes and other behaviors likely to promote health and stability.

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Section: Discussionmentioning

confidence: 99%

Mapping the psychoanalytic literature on bipolar disorder: a scoping review of journal articles

Stefana¹,

Fusar‐Poli²,

D’Imperio³

et al. 2023

Brazilian Journal of Psychiatry

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“…Third, the availability of psychoanalytic psychotherapy as a treatment offered within the public health systems (where patients with BD are usually treated) of most developed countries is nowadays significantly lower than those of other forms of psychotherapy with a more substantial evidence base (Abbass et al, 2020;Kadish and Smith, 2020;Migone, 2020;Parth et al, 2020;Plakun, 2020;Yakeley, 2020). In addition, when offered within the public health care sector, psychoanalytic psychotherapy is usually time limited and conducted by trainees.…”

Section: Discussionmentioning

confidence: 99%

Probing the impact of psychoanalytic therapy for bipolar disorders: A scoping review

Stefana¹,

D’Imperio²,

Dakanalis³

et al. 2022

International Forum of Psychoanalysis

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No systematic review has been conducted to provide an overview of the effectiveness of psychoanalysis on outcomes for bipolar depression and mania. The present study undertakes a scoping review on the effectiveness of psychoanalysis for bipolar disorder (BD), provides a summary of the evidence base, and identifies issues for future research in this area. A thorough search of journal articles in MEDLINE, PEP-Web, PsycINFO, Scopus, and Web of Science was carried out to obtain available studies of psychoanalytic treatment for BD published 1990-2021. We searched for either quantitative or singlecase studies. Twenty-six single case reports from 21 articles and no quantitative studies met a prior inclusion criteria. Qualitative analysis suggests efficacy and cost-effectiveness but thus far there is no scientific evidence in support of psychoanalysis. Although these pilot findings suggest that psychoanalysis may impact symptoms and global functioning in patients with BD, the underlying evidence is poor and should be confirmed by experimental studies.

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“…The Commentators conclude their ‘policy concerns’ section by suggesting that some interventions may be invalidated by the CPG depicting them as being ‘unsupported by evidence’, with the sentence ‘the evidence contradicts this’ and cite as evidence a review article. 3 But in this review of clinical practice in Canada, the evidence that Abbass and colleagues cite states that ‘meta-analyses uniformly demonstrate that individual short-term psychodynamic psychotherapy is as effective as CBT for the spectrum of common mental disorders’ . 3 They also specify that this does not apply to long-term psychodynamic psychotherapy, which they state, ‘is effective with complex patient presentations [and that] research in Canada has shown that long-term psychodynamic therapy, and psychoanalysis, in particular, is provided to severely ill patients with major, longstanding psychosocial disturbances, who have failed prior treatments and who have multiple diagnoses’ .…”

Section: Policy ‘Concern(s)’?mentioning

confidence: 99%

“…3 They also specify that this does not apply to long-term psychodynamic psychotherapy, which they state, ‘is effective with complex patient presentations [and that] research in Canada has shown that long-term psychodynamic therapy, and psychoanalysis, in particular, is provided to severely ill patients with major, longstanding psychosocial disturbances, who have failed prior treatments and who have multiple diagnoses’ . 3 Conspicuously, there is no mention of mood disorders. In other words, the evidence for the effectiveness of psychological treatments as outpatient monotherapy includes ‘six therapies (CBT, IPT, Problem-solving therapy, Behavioural activation therapy, Nondirective supportive therapy, and Short-term psychodynamic therapy) [each of which] have now been tested in at least 10 (non-blinded) RCTs and shown to be more effective than wait-list control’ .…”

Section: Policy ‘Concern(s)’?mentioning

confidence: 99%

An Evidence-Based Perspective on The 2020 Royal Australian and New Zealand College of Psychiatrists Clinical Practice Guidelines

Malhi

Bell

Bassett

et al. 2022

Australas Psychiatry

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Objective To rebut the claims made in an opinion piece by Anaf and colleagues regarding the recommendations for psychotherapy within the 2020 RANZCP Mood Disorders Clinical Practice Guidelines (CPG). Conclusions The CPG attaches importance to psychological interventions and recommends their administration as first-line in the treatment of depression. The concerns raised by Anaf and colleagues have no basis and are readily dismissed by referring to the guidelines. Therefore, we strongly encourage clinicians to formulate their own views by reading the guidelines for themselves.

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Psychodynamic therapy in Canada in the era of evidence-based practice

Cited by 7 publications

References 64 publications

Mapping the psychoanalytic literature on bipolar disorder: a scoping review of journal articles

Mapping the psychoanalytic literature on bipolar disorder: a scoping review of journal articles

Probing the impact of psychoanalytic therapy for bipolar disorders: A scoping review

An Evidence-Based Perspective on The 2020 Royal Australian and New Zealand College of Psychiatrists Clinical Practice Guidelines

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