If You Still Think Psychodynamic Therapy Is not “Evidence-Based,” You Haven’t Looked at the Evidence:

Twenty years ago, saying “psychodynamic psychotherapy is evidence-based” was a good way to get dismissed as “old school” or “outdated.” Today, if someone still says that, they are not describing the data and evidence, they are describing their own bias and perhaps knowledge gap.

Over the last 20–30 years, the empirical picture has flipped. Meta-analyses of short-term psychodynamic psychotherapy show strong, durable effects across psychiatric disorders, with outcomes comparable to other branded “gold standard” treatments like CBT. For anxiety disorders, psychodynamic therapies reliably outperform control conditions and hold their own against other active treatments.

When you look at complex and chronic conditions, the story gets even more uncomfortable for the “no evidence” narrative. Long-term psychodynamic psychotherapy has been shown to be superior to less intensive treatments for personality disorders and other complex presentations, especially when you focus on overall functioning, relational patterns, and personality organization and not just short-term symptom checklists.

Meanwhile, manualized psychodynamic treatments have fully entered the randomized controlled trial era. For example, Transference-Focused Psychotherapy, rooted in Otto Kernberg’s work, has multiple controlled studies demonstrating benefits for borderline personality disorder, including reductions in suicidality and aggression and improvements in reflective functioning. Glen Gabbard’s and Kernberg’s contemporary texts explicitly integrate this research base and treat psychodynamic psychotherapy as a scientific, testable, and teachable method and not an antique ideology.

Here is the controversial part: at this point, insisting that psychodynamic psychotherapy “isn’t evidence-based” is not a scientific position. It is a branding preference.

If your organization claims to be evidence-based yet excludes psychodynamic approaches from its “approved” lists, that’s not neutral. That is a policy choice shaped by history, marketing, and reimbursement structures, not by the actual state of the evidence.

And it might be time to start saying that out loud and not burying our heads in the sand anymore about the realities of psychodynamic therapy.