Is Psychodynamic Psychotherapy “Evidence-Based?” What Does “Evidence-Based” Mean?

Evidence-based treatment means an approach towards mental health care that has been studied using systematic, empirical research. A specific therapy is tested with a particular group—people experiencing anxiety, depression, or other concerns—and researchers measure whether it leads to change– usually measuring symptom reduction. Evidence-based tends to favor things that can be measured and quantified. Certain measurements try to get at capturing  a decrease in worry, improved mood, or increased motivation. There is data to support these outcomes, and studies often compare results across different treatments, or a group that did not engage in any treatment. Ideally, research also looks at whether these changes last over time.

Cognitive Behavioral Therapy (CBT) is often what people think of when they hear evidence-based therapy. There are many studies supporting its effectiveness in reducing symptoms of anxiety and depression. CBT is also relatively easy to study because it is manualized—meaning therapists follow a structured set of interventions. In research settings, this often involves a clearly defined group, a specific protocol, and a limited time frame (for example, 6–10 weeks). CBT offers useful tools for helping clients to reduce symptoms. 

At the same time, many people find that the benefits can be difficult to sustain, or that the research itself focuses on shorter-term outcomes. Or what if you don’t fit neatly into one of the groups that the research is based on?  In practice, it’s common for people to return to therapy after having already engaged in CBT, DBT, or ACT. They may have felt better for a time, and then symptoms return. Life becomes complicated again. The tools that once helped are not as effective, or they begin to encounter parts of themselves that those approaches are not designed to address. DBT, CBT, ACT and IFS are often wonderful at helping us get a basic structure and ways to cope to get through the day without overwhelming symptoms. 

In some ways, “evidence-based” has become closely associated with “manualized.” While helpful, this can lead to therapy starting to feel standardized—almost “cookie cutter.” There can be an implicit idea that treatment must be delivered in a specific way in order to count as evidence-based, and if a client isn’t getting better it is because they are not using enough coping skills, they are not trying hard enough. 

But psychotherapy is not a standardized process because no two people are exactly alike. You are a unique individual. The therapy process is a deeply personal one, involving thoughts, emotions, and experiences that are often difficult to articulate—and even more difficult to measure. One part of ourselves might completely see why a thought is irrational, or that we are struggling with emotional regulation, or that a behaviour isn’t in line with our values, and yet… we’re still suffering and confounded by what is happening inside of us. 

Psychodynamic psychotherapy is a distinct form of talk therapy, that may also integrate other depth oriented nonverbal ways of engaging in therapy, that focuses on how unconscious processes, early experiences, and recurring patterns shape a person’s emotional life, behavior, and relationships. It emphasizes self-awareness, emotional depth, and understanding the meaning behind one’s experience—not only reducing symptoms.

The psychotherapy that is heavily rooted in behavioral perspectives, such as CBT, have long held that psychodynamic therapy was assumed to lack scientific support. That is not accurate.

In his 2010 paper, “The Efficacy of Psychodynamic Psychotherapy,” Jonathan Shedler synthesized decades of research, including meta-analyses and randomized controlled trials. Findings show that psychodynamic psychotherapy is an evidence-based treatment, with outcomes comparable to other therapies such as CBT. Importantly, the research also shows that psychodynamic therapy sets in motion psychological processes that lead to ongoing change—even after therapy has ended. Patients often continue to improve over time, rather than simply maintaining gains made during treatment. Patients not only reduce symptoms of depression and anxiety, but they engage in a process of change at a deeper level that facilitates experiences of greater aliveness. 

Studies also indicate that psychodynamic psychotherapy supports changes in underlying psychological structures, including personality functioning, emotional awareness, and relational patterns. These deeper shifts are associated with more lasting outcomes. 

While other modalities—CBT, ACT, DBT, IFS—are also evidence-based, they are often more structured and intervention-focused. In these approaches, a model is applied to a person’s experience, and specific skills or strategies are introduced to reduce symptoms. This can be helpful, particularly in providing language and tools for managing distress. At times, however, it can also require a person to fit their experience into the framework of the treatment.

Psychodynamic psychotherapy aims to work differently. It invites a more open-ended process, often through free association—speaking freely without a set agenda. As Jonathan Shedler notes, learning to “truly speak freely” can be challenging and may take time. It takes support and caring from a skilled psychotherapist. It can feel unstructured at times, but it also allows for a fuller exploration of one’s internal world with an empathetic and experienced psychotherapists accompanying you along the way. 

This reflects a central difference: psychodynamic psychotherapy is not only aimed at reducing symptoms, but at helping a person experience life more fully. Symptom relief is not the only end goal, but part of a broader process of psychological growth and change.

You may be seeking the potential for lasting change in Portland, Oregon, but not sure how psychodynamic psychotherapy can help. Speaking with a psychodynamic psychotherapist is the first step in exploring how this evidence-based mental health treatment may help support reducing your distressing symptoms and supporting lasting change. Better yet– ask how skills you’ve learned through CBT, DBT, ACT can be integrated into your psychodynamic psychotherapy, because the whole of your being is welcome. 

Jonathan Shedler, The Efficacy of Psychodynamic Psychotherapy, American Psychologist (2010)