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Peter Fonagy's extensive review of the evidence for psychodynamic psychotherapy as an effective treatment for a variety of mental health disorders aims at doing a number of different things: firstly, it outlines the current confusing state of evidence for psychodynamic therapy, indicating the complexity inherent in trying to rely on heterogeneous research studies; secondly, it goes through a variety of mental health diagnoses indicating where there is evidence for the effectiveness of psychodynamic therapy and where there is not; and finally, it suggests that the whole research endeavour of trying to test families of brand-name psychotherapies against headline diagnoses is a mistaken and fruitless endeavour. He suggests instead paying very close attention to exactly what it is in any therapy that works for any particular person with their individual deficits and difficulties that are hidden under an overarching diagnosis.
What is it that is confusing about the state of evidence for psychodynamic therapy? It is not the absence of such evidence, because numerous studies show that psychodynamic therapy appears to work. It is, rather, the small size of such studies that makes them unconvincing on their own, and the problem that comes with the attempt to remedy this by aggregating them all into meta-analyses. These combine the statistically significant results of the studies and subject them to further analysis, leading to a pooled effect size (an indication of how helpful they are as a therapy). This is problematic because small sample sizes can overstate statistical significance, and the pooling of such significance leads to a very different result from that of doing a single study that tests the total sample size of all them. Also small studies that do not show statistical significance are likely not to be published, leading to a bias in the tested effects of the therapy—something that is referred to as the “filing drawer problem”. As an indication of the problem, Fona