The most surprising thing the evidence shows is not that psychodynamic therapy works, but that its effects seem to keep working: for many people, the improvement continues after the last session, as though something set in motion carries on by itself.
Modern research finds psychodynamic therapy genuinely effective for depression and anxiety, with effect sizes broadly comparable to those of other established therapies. A distinctive and much-cited finding is that its benefits often continue to grow after treatment ends. For borderline personality disorder, structured psychodynamic treatments have strong trial evidence. The historical gap in its evidence base, once a fair criticism, has narrowed substantially, though some questions remain open and the comparison with other therapies is still debated.
What the effect sizes show
The clearest single summary came from a 2010 review by the clinical psychologist Jonathan Shedler, published in American Psychologist, which gathered meta-analyses of psychodynamic therapy. Its conclusion was that the effect sizes were substantial, on a par with those reported for therapies widely regarded as evidence-based, including CBT. In plain terms, the average person who completed psychodynamic therapy was better off than a large majority of those who did not receive it.
For the common conditions, the message from the wider literature is consistent. A Cochrane review of short-term psychodynamic psychotherapy for common mental disorders found evidence of benefit for these problems. The days when it was reasonable to say psychodynamic therapy simply lacked evidence are behind us; the honest current position is that it works for the conditions where it has been properly tested.
Benefits that keep growing
The most distinctive claim in the psychodynamic evidence base is what is sometimes called a sleeper effect. Several studies suggest that people who complete psychodynamic therapy do not merely hold onto their gains after treatment ends but continue to improve, so that follow-up measurements months or years later show larger effects than those recorded at the close of therapy. Shedler drew particular attention to this pattern in his 2010 review.
The proposed explanation fits the theory neatly. If psychodynamic therapy works partly by setting in motion an ongoing capacity for self-reflection and insight, then a person may keep applying that capacity long after the sessions stop, so improvement compounds. It is an appealing story and the finding is real in the studies that report it. It should still be held with appropriate care, since it rests on the available trials and, as later pages discuss, has been debated.
Strong evidence for borderline personality disorder
Some of the most robust evidence for any psychodynamic approach concerns borderline personality disorder, a serious and often hard-to-treat condition. Here two structured psychodynamic treatments have been tested in randomised controlled trials with encouraging results.
Mentalization-based treatment
Developed by Bateman and Fonagy, MBT has been shown in trials to reduce self-harm and suicidal behaviour and to improve functioning in borderline personality disorder, with benefits that have held up at follow-up in some studies.
Transference-focused psychotherapy
TFP, a manualised psychodynamic treatment, has trial evidence for improving symptoms and functioning in borderline personality disorder, using the therapy relationship to help integrate a fragmented sense of self.
These results matter for two reasons. They show that psychodynamic thinking, translated into a structured, testable form, can produce genuine and measurable benefit for a demanding condition. And they underline that the strongest evidence attaches to specific, manualised models rather than to psychodynamic therapy applied loosely.
How the evidence gap narrowed
Understanding why psychodynamic therapy was long doubted helps make sense of where it now stands. For much of the twentieth century, the approach was slow to submit itself to the randomised controlled trial, the method that came to define evidence-based practice. Its practitioners were often sceptical that a rich, individual process could be captured by standardised measurement, and while that debate continued, other therapies, CBT above all, built large trial literatures.
The result was a real gap: not strong evidence that psychodynamic therapy failed, but a shortage of the kind of evidence modern medicine trusts. Over the past two decades that has changed markedly. Manualised treatments, meta-analyses, and controlled trials have accumulated, and reviews have brought them together. The criticism that psychodynamic therapy is unevidenced was once fair; it is now largely a historical artefact rather than a current fact.
Psychodynamic therapy has never been shown to work.
This was closer to true decades ago, when the approach had relatively few controlled trials. It is no longer accurate. Meta-analyses and randomised trials now support psychodynamic therapy for depression, anxiety, and borderline personality disorder. The evidence is real, even if it remains thinner than the vast literature behind CBT.
The honest limits
A fair account has to state the caveats plainly. The psychodynamic evidence base, though much improved, is still smaller than that of CBT, and some of its trials are of modest size or quality. The comparison of psychodynamic therapy with other therapies is genuinely debated, and the sleeper effect, while striking, rests on a limited set of studies. There are also conditions, such as specific phobias or OCD, where more targeted approaches have clearer and faster evidence.
A fair summary: psychodynamic therapy is genuinely effective for depression, anxiety, and, in structured forms, borderline personality disorder, with results comparable to other established therapies and the notable feature that benefits may keep growing. It is not a proven best choice for every problem, its evidence base is smaller than CBT's, and some claims remain debated. The research page sorts these into what is settled, mixed, and contested.
Where to go next
This page has weighed how well psychodynamic therapy works. The research page maps the state of the evidence in more detail, and the other pages fill in the how and the what.
Sources
- Shedler J. The Efficacy of Psychodynamic Psychotherapy. American Psychologist. 2010;65(2):98-109.
- Abbass AA, Kisely SR, Town JM, et al. Short-term psychodynamic psychotherapies for common mental disorders. Cochrane Database of Systematic Reviews. 2014;(7):CD004687.
- Bateman A, Fonagy P. Randomized Controlled Trial of Outpatient Mentalization-Based Treatment Versus Structured Clinical Management for Borderline Personality Disorder. American Journal of Psychiatry. 2009;166(12):1355-1364.
This page is educational and is not medical advice. It does not diagnose any condition or replace treatment. Evidence describes averages across groups, not the certainty of any one person's outcome. If you are struggling with your mental health, speak with a qualified professional about which approach is right for you.