If you're going to invest your time, money and emotional energy talking to someone week after week, you probably want to know whether there's evidence that it actually helps. Right? I'm interested in this because I've been a sceptic too. I've questioned myself, my work, my fees and so on. Therapy asks a lot of us, so it's only fair to wonder, even quietly, in the dead of night...does this stuff actually work?!

The short answer is yes. Spoiler alert. Psychotherapy works, and psychodynamic and psychoanalytic therapies have a substantial (and growing) evidence base. Phew!

So, what does the research show?

Research into psychotherapy more broadly has consistently shown meaningful benefits. Large-scale reviews over the years (including Smith, Glass and Miller, 1980; Robinson, Berman and Neimeyer, 1990; and Lipsey and Wilson, 1993) have found moderate to large overall effects across hundreds of studies. In other words, talking therapies, as a whole, are effective for a lot of people.

Psychodynamic therapy has sometimes been stereotyped as less “evidence-based” than approaches such as CBT. This is mainly because Cognitive Behavioural Therapists and researchers were faster to conduct the type of research and present the types of results (largely quantitative) that could easily be shown through numbers and slideshows. This led to more widespread funding and implementation. Various other talk therapies, including us psychodynamic folk, were slower on the uptake. Again, that scepticism for turning complex, long-term human experiences into quick numerical and actionable insights seemed to overly simplify moments that we know often even defy the limits of language itself. But, in time, the research was conducted, and the results were pretty formidable.

Therapy is rarely simply about removing a symptom; it stretches us to try to understand the patterns beneath it. To better understand our whole selves and move through the world in a more authentic way.

A Cochrane review by Abbass and colleagues (2006), which brought together 23 randomised studies and over 1,400 participants, found that short-term psychodynamic psychotherapy led to improvements in depression, anxiety, general psychological distress, and social functioning. Many of these gains were still present in follow-up reviews, after the therapy had ended.

A systematic review by de Maat and colleagues (2009), which included 27 studies and over 5,000 people, found large average effects for long-term psychoanalytic therapies. Interestingly, outcomes continued to improve long after someone physically stops coming to the therapy room, with effect sizes increasing from 0.78 at the end of treatment to 0.94 at follow-up for people with moderate or mixed difficulties. Long-term psychoanalytic therapy has also been studied in chronic depression. In the LAC Depression Study, Leuzinger-Bohleber and colleagues followed 252 adults receiving either long-term psychoanalytic therapy or CBT. Both groups showed substantial and sustained improvement over time, with no significant difference in outcomes between the two approaches.

And, does therapy work?

These studies form part of an increasingly large body of evidence that talking therapies can and do help people feel significantly better, both during and after therapy. Psychodynamic therapy can reduce distress and support meaningful, lasting change. None of this means psychodynamic therapy is right for everyone, or that longer therapy is always better. Therapy research is complex. Studies differ in who they include, how they measure change, and what they compare treatments against. And some of the earlier research has clear limitations. What the evidence does challenge, though, is the idea that psychodynamic therapy is simply “talking” or lacking a scientific foundation. A recent Royal Institution lecture I attended, The Real Science of Psychoanalysis, featured neuropsychologist Mark Solms putting this research and numbers into perspective, which is part of what inspired this blog.

Some of the effect sizes seen in psychotherapy research are of a magnitude comparable to improvements we would readily regard as clinically meaningful in physical medicine, such as the response to treatment for diabetes.

In other words, talking therapy is not producing a merely “soft” or subjective effect. An effect size of around 0.8 is already considered large in psychiatric research, and some psychodynamic and psychoanalytic studies report effects above 1.0 and, in some long-term studies, substantially higher. This is huge, and has me really excited, because if, like me, you’ve been wondering whether therapy is really worth the time, money and emotional effort, this evidence says it can lead to real, measurable change. That deserves to be shouted about.

So perhaps the question is no longer simply “Does therapy work?”

The evidence clearly shows it can. It's what might change for you if you stop coping with the painful patterns alone, and start trying to understand them with the help of another.