title: A quality-based review of randomized controlled trials of psychodynamic psychotherapy.
abstract: OBJECTIVE
  The Ad Hoc Subcommittee for Evaluation of the Evidence Base for Psychodynamic Psychotherapy of the APA Committee on Research on Psychiatric Treatments developed the Randomized Controlled Trial Psychotherapy Quality Rating Scale (RCT-PQRS). The authors report results from application of the RCT-PQRS to 94 randomized controlled trials of psychodynamic psycho-therapy published between 1974 and May 2010.
  
  
  METHODS
  Five psychotherapy researchers from a range of therapeutic orientations rated a single published paper from each study.
  
  
  RESULTS
  The RCT-PQRS had good interrater reliability and internal consistency. The mean total quality score was 25.1 (SD=8.8). More recent studies had higher total quality scores. Sixty-three of 103 comparisons between psychodynamic psychotherapy and a nondynamic comparator were of "adequate" quality. Of 39 comparisons of a psychodynamic treatment and an "active" comparator, six showed dynamic treatment to be superior, five showed dynamic treatment to be inferior, and 28 showed no difference (few of which were powered for equivalence). Of 24 adequate comparisons of psychodynamic psychotherapy with an "inactive" comparator, 18 found dynamic treatment to be superior.
  
  
  CONCLUSIONS
  Existing randomized controlled trials of psychodynamic psychotherapy are promising but mostly show superiority of psychodynamic psychotherapy to an inactive comparator. This would be sufficient to make psychodynamic psychotherapy an "empirically validated" treatment (per American Psychological Association Division 12 standards) only if further randomized controlled trials of adequate quality and sample size replicated findings of existing positive trials for specific disorders. We do not yet know what will emerge when other psychotherapies are subjected to this form of quality-based review.
authors.affiliation: Columbia College of Physicians and Surgeons, New York State Psychiatric Institute, New York, 10032, USA. gerbera@childpsych.columbia.edu
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Gerber
authors.forename: James H
authors.initials: JH
authors.lastname: Kocsis
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Milrod
authors.forename: Steven P
authors.initials: SP
authors.lastname: Roose
authors.forename: Jacques P
authors.initials: JP
authors.lastname: Barber
authors.forename: Michael E
authors.initials: ME
authors.lastname: Thase
authors.forename: Patrick
authors.initials: P
authors.lastname: Perkins
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Leon
mesh_terms: D006801:Humans; D018024:Peer Review, Health Care / Q000379:methods*; D011613:Psychotherapy / Q000379:methods / Q000706:statistics & numerical data*; D016032:Randomized Controlled Trials as Topic