Responding to the Mental Health Crisis: Is There a Role for Psychodynamic Treatments?  

The current crisis in mental health is characterized by increased prevalence of mental and substance use disorders as well as challenges in access to care. We are learning of the importance of social determinants, loneliness, and thwarted belonging as contributors to the crisis. Fortunately, the Biden administration is taking the problem seriously, increasing expenditures and fighting for implementation of parity that will improve access to care. 

One element of the response must be increasing access to all treatments with a credible evidence base. Whether we consider mental disorders like major depression, schizophrenia, or PTSD; substance use disorders; medications and other emerging biological treatments, or psychotherapies, evidence-based treatments such as Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT), which are effective for some patients, leave many others to struggle while ignoring the evidence-base supporting psychodynamic approaches to treatment. 

Indeed, as Jonathan Shedler, PhD, has noted when addressing short-term therapies, “the evidence suggests that most patients fail to benefit most of the time.” As demonstrated in over 300 published, peer-reviewed studies, psychodynamic treatments like psychodynamic therapy are evidence-based treatments for a range of individual and complex co-occurring disorders, including for patients who have not found success with other treatments. 

Nevertheless, bias in the field often leads to ignoring the benefit of psychodynamic treatments, their exclusion from teaching curricula for trainees, the barring of psychodynamic clinicians from teaching positions and practice guideline review boards, and thwarting of efforts to gain research support or insurance coverage. Nineteenth century psychodynamic concepts are compared to 21st century psychiatric concepts, as if nothing has changed in over a century. We owe it to our patients to ensure that we follow the evidence impartially, not allowing our field’s biases to interfere with access to evidence-based care. 

In this series we will: