Evaluation of results

As discussed above, randomized, controlled trials suggest that psychodynamic therapy has little or no therapeutic effect additional to that of comparison conditions, in contrast to the more structured cognitive and behaviour therapies, which have consistently demonstrated positive treatment outcomes. Psychody-namic therapists have responded by pointing out that there are difficulties in evaluating the outcome, because:

• Neurotic disorders often remit spontaneously.

• Specific effects of psychotherapeutic technique are difficult to distinguish from non-specific benefits of regular individual attention.

• The content of treatment sessions is difficult to standardize because it varies with the individual characteristics of patient and therapist.

• Benefits of a subtle kind may not be detectable by standard questionnaires.

However, these considerations have not prevented CBT from being demonstrated to be effective. Perhaps the only valid response is that the outcome criteria are not agreed between the two broad schools of psychotherapy; many psycho-dynamic patients do not fit into a formal diagnostic category, and may wish for therapy for personal development rather than symptom relief. In either case, it is becoming increasingly hard to justify expenditure of limited NHS psychiatric resources on individual psychodynamic therapy, although it is still available in the private sector.

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