Skip to main navigation menu Skip to main content Skip to site footer
FrancoAngeli Journals

Articles

Online First

The problem of validation of psychotherapy

DOI
https://doi.org/10.3280/pnei2025oa19416
Submitted
febbraio 17, 2025
Published
2025-02-25

Abstract

Some issues concerning the problem of efficacy of psychotherapy are reviewed and discussed. The difference between clinical research and empirical research is examined, also with some philosophical considerations. Clinical research and empirical research are very different: the former is conducted by the psychotherapist in the daily work with patients, while the latter is performed in the experimental laboratory. It is then discussed whether replicability, which is a central characteristic of the scientific method, is possible in psychotherapy. An overview of the history of the psychotherapy research movement is then traced: a first phase has been mainly dedicated to outcome research, while a second phase concerns mostly process research. Finally, some recent research on the efficacy of psychoanalysis is summarized, where it increasingly emerges that psychoanalysis and dynamic psychotherapy are not inferior, but sometimes even superior, to cognitive‐behavioral therapy.

References

  1. Agazzi E. (2006). Epistemologia delle scienze psicologiche. In: M. Giordano (Ed.), Burnout seminario gruppoanalitico nazionale. Da Franco Fornari precursore alle nuove conoscenze scientifiche (pp. 57-83). Milano: FrancoAngeli.
  2. American Psychological Association (2013). Recognition of psychotherapy effectiveness. Psychotherapy, 50(1), 102-109. Doi: 10.1037/a0030276.
  3. Angell M. (2011a, giugno 23). The Epidemic of Mental Illness: Why? [Review of The Epidemic of Mental Illness: Why?, di I. Kirsch, R. Whitaker, & D. Carlat]. The New York Review of Books, 58(11). https://www.nybooks.com/articles/2011/06/23/epidemic‐mental‐illness‐why/ recuperato 23 giugno 2011.
  4. Angell M. (2011b, luglio 14). The Illusions of Psychiatry [Review of The Illusions of Psychiatry, di I. Kirsch, R. Whitaker, D. Carlat, & A.P. Association]. The New York Review of Books, 58(12). https://www.nybooks.com/articles/2011/07/14/illusions‐of‐psychiatry/ recuperato 14 luglio 2011.
  5. Balint M. (1956). Doctor, His Patient and the Illness. London: Pitman Medical Publishing.
  6. Barkham M., Lutz W., & Castonguay L.G. (Ed.). (2021). Bergin and Garfield’s Handbook of Psychotherapy and Behavior Change (7th ed.). New York, NY, USA: John Wiley & Sons.
  7. Bersani F. (2008). La riproducibilità nella scienza: mito o realtà? Psicoterapia e Scienze Umane, 2009, 43(1), 59-76. Doi: 10.3280/PU2009‐001004.
  8. Blatt S.J. (2004). Experiences of depression: Theoretical, clinical, and research perspectives. Washington: American Psychological Association. Doi: 10.1037/10749‐000.
  9. Blatt S.J. (2006). Una polarità fondamentale in psicoanalisi: implicazioni per lo sviluppo della personalità, la psicopatologia e il processo terapeutico. Psicoterapia e Scienze Umane, 40(4), 743-764.
  10. Blatt S.J. (2008). Polarities of Experiences: Relatedness and Self‐definition in Personality Development, Psychopathology and the Therapeutic Process. Washington, DC: American Psychological Association.
  11. Bracken P., Thomas P., Timimi S., Asen E., Behr G., Beuster C., Bhunnoo S., Browne I., Chhina N., Double D., Downer S., Evans C., Fernando S., Garland M.R., Hopkins W., Huws R., Johnson B., Martindale B., Middleton H., Moldavsky D., Moncrieff J., Mullins S., Nelki J., Pizzo M., Rodger J., Smyth M., Summerfield D., Wallace J., & Yeomans D. (2012). Psychiatry beyond the current paradigm. British Journal of Psychiatry, 201(6), 430-434. Doi: 10.1192/bjp.bp.112.109447.
  12. Bucci W. (1997). Psychoanalysis and Cognitive Science: A Multiple Code Theory (1st edition). New York: The Guilford Press.
  13. Bucci W. (2019). Il ruolo del linguaggio nella vita emotiva. Psicoterapia e Scienze Umane, 3, 379-404. Doi: 10.3280/PU2019‐003001.
  14. Carere‐Comes T., & Migone P. (Ed.). (2001). Dibattito sulla “Integrazione in psicoterapia”: https://www.psychomedia.it/pm‐lists/debates/sepi.htm recuperato 2003 2001.
  15. Chambless D.L., & Ollendick T.H. (2001). Empirically Supported Psychological Interventions: Controversies and Evidence. Annual Review of Psychology, 52(1), 685-716. Doi: 10.1146/annurev.psych.52.1.685 (see also the web page: www.psychomedia.it/spr‐it/artdoc/chambl98.htm).
  16. Clarkin J.F., Yeomans F.E., & Kernberg O.F. (1999). Psychotherapy for Borderline Personality. New York: Wiley. Internet edition of the Italian translation of pp. 31‐39 of ch. 1: Strategie nella psicoterapia delle personalità borderline: http://www.psychomedia.it/pm/modther/probpsiter/clarki99.htm.
  17. Cuijpers P., Quero S., Noma H., Ciharova M., Miguel C., Karyotaki E., Cipriani A., Cristea I.A., & Furukawa T.A. (2021). Psychotherapies for depression: a network meta‐analysis covering efficacy, acceptability and long‐term outcomes of all main treatment types. World Psychiatry, 20(2), 283-293. Doi: 10.1002/wps.20860.
  18. Dahl H., Kächele H., & Thomä H. (Ed.). (1988). Psychoanalytic Process Research Strategies. Berlin: Springer.
  19. Dazzi N., Lingiardi V., & Colli A. (Ed.). (2006). La ricerca in psicoterapia. Modelli e strumenti. Milano: Raffaello Cortina Editore.
  20. De Girolamo G. (1997). Evidence‐based psychiatry: verso un nuovo paradigma della pratica clinica. Rivista Sperimentale di Freniatria, 121(2), 147‐178.
  21. Etchegoyen R.H. (1986). Los fundamentos de la tecnica psicoanalitica. Buenos Aires: Amorrortu Editores (English translation: The Fundamentals of Psychoanalytic Technique. London: Karnac 1991).
  22. Eysenck H.J. (1952). The effects of psychotherapy: an evaluation. Journal of Consulting Psychology, 16(5), 319-324. Doi: 10.1037/h0063633.
  23. Fonagy P., Gergely G., Jurist E.L., & Target M. (2002). Affect Regulation, Mentalization, and the Development of the Self. New York: Other Press, LLC.
  24. Fornaro M. (2013). Come validare le interpretazioni e le spiegazioni in clinica senza ricorrere alla ricerca empirica. Psicoterapia e Scienze Umane, 4, 601-620. Doi: 10.3280/PU2013‐004002 (also in: Migone, 2021, ch. 9).
  25. Freud S. (1913). On Beginning the Treatment (Further Recommendations on the Technique of Psycho‐Analysis, I). In: The Standard Edition of the Complete Psychological Works of Sigmund Freud (Vol. 12, pp. 121–144).
  26. Greenson R.R. (1967). The Technique and Practice of Psychoanalysis: Volume I. New York: International Universities Press.
  27. Grünbaum A. (1984). The Foundations of Psychoanalysis: A Philosophical Critique. Berkeley, CA: University of California Press.
  28. Holt R.R. (1962). Individuality and generalization in personality psychology. Journal of Personality, 30, 3: 377‐402. A revised edition in: Methods in Clinical Psychology: Assessment, Prediction and Research. New York: Plenum, 1978. Edition of 1978 on Internet with an introduction by Paolo Migone and a preface by Robert R. Holt of 1998: www.priory.com/ital/docum6‐i.htm).
  29. Holt R.R. (1989). Freud Reappraised: A Fresh Look at Psychoanalytic Theory. New York: Guilford Publications.
  30. Holt R.R., Kächele H., & Vattimo G. (1994). Psicoanalisi ed ermeneutica (P. Migone, Ed.). Chieti: Metis, 1995.
  31. Jacoby R. (1983). The Repression of Psychoanalysis: Otto Fenichel and the Political Freudians. New York: Basic Books.
  32. Kazdin A.E. (2007). Mediators and Mechanisms of Change in Psychotherapy Research. Annual Review of Clinical Psychology, 3(1), 1-27. Doi: 10.1146/annurev.clinpsy.3.022806.091432.
  33. Klerman G., Weissman M., Rounsaville B., & Chevron E. (1984). Interpersonal Psychotherapy of Depression. New York: Basic Books.
  34. Leichsenring F., & Steinert C. (2017). La terapia cognitivo‐comportamentale è veramente la più efficace? Psicoterapia e Scienze Umane, 51(4), 551-558. Doi: 10.3280/PU2017‐004003.
  35. Leuzinger‐Bohleber M., & Kächele H. (Ed.). (2015). An open door review of outcome and process studies in psychoanalysis (3rd ed.). London: International Psychoanalytic Association.
  36. Leuzinger‐Bohleber M., & Target M. (Ed.). (2018). Outcomes of Psychoanalytic Treatment. London: Routledge.
  37. Levy R.A., Ablon J.S., & Kächele H. (Ed.). (2012). Psychodynamic Psychotherapy Research: Evidence‐Based Practice and Practice‐Based Evidence. New York: Humana. (A version of the Preface by Vittorio Lingiardi and Franco Del Corno is also in: Migone, 2021, ch. 10).
  38. Linehan M. (1993). Cognitive‐Behavioral Treatment of Borderline Personality Disorder. New York: The Guilford Press.
  39. Luborsky L. (1984). Principles Of Psychoanalytic Psychotherapy. A Manual for Supportive‐Expressive Treatment. New York, NY: Basic Books.
  40. Luborsky L., & Crits‐Christoph P. (1990). Understanding Transferance, The CCRT method. New York, NY: Basic Books.
  41. Luborsky L., Rosenthal R., Diguer L., Andusyna T.P., Berman J.S., Levitt J.T., Seligman D.A., & Krause E.D. (2002). The Dodo Bird Verdict Is Alive and Well-Mostly. Clinical Psychology: Science and Practice, 9(1), 2-12. Doi: 10.1093/clipsy/9.1.2 (Commentaries [pp. 13‐34]: D.L. Chambless; B.J. Rounsaville & K.M. Carrol; S. Messer & J. Wampold; K.J. Schneider; D.F. Klein; L.E. Beutler).
  42. Luborsky L., Singer B., & Luborsky L. (1975). Comparative Studies of Psychotherapies: Is It True That «Everyone Has Won and All Must Have Prizes»? Archives of General Psychiatry, 32(8), 995. Doi: 10.1001/archpsyc.1975.01760260059004.
  43. Luyten P., Blatt S.J., & Corveley J. (2006). Minding the Gap Between Positivism and Hermeneutics in Psychoanalytic Research. Journal of the American Psychoanalytic Association, 54(2), 571-610. Doi: 10.1177/00030651060540021301 (Response to commentaries: pp. 627‐632).
  44. Menninger K.A. (1958). Theory of psychoanalytic technique (First Edition). New York, NY: Basic Books.
  45. Migone P. (1986). L’utilità dei manuali per la valutazione dei risultati della psicoterapia. Giornale Italiano di Psicologia, 13(2), 321-327.
  46. Migone P. (1995). Terapia psicoanaliltica (Nuova edizione: 2010). Milano: FrancoAngeli.
  47. Migone P. (1996). La ricerca in psicoterapia: storia, principali gruppi di lavoro, stato attuale degli studi sul risultato e sul processo. Rivista Sperimentale di Freniatria, 120(2), 182-238. (www.psychomedia.it/sprit/artdoc/migone96.htm).
  48. Migone P. (1998). Quale modello di scienza per la ricerca in psicoterapia? (Editorial). Psichiatria e Psicoterapia Analitica, 17(2), 113-119. (www.psychomedia.it/pm/modther/probpsiter/ruoloter/rt88‐01.htm).
  49. Migone P. (2005). Farmaci antidepressivi nella pratica psichiatrica: efficacia reale. Psicoterapia e Scienze Umane, 39(3), 312-322. (www.psychomedia.it/pm/modther/probpsiter/ruoloter/rt112‐09.htm).
  50. Migone P. (2006). Breve storia della ricerca in psicoterapia. Con una nota sui contributi italiani. In: N. Dazzi, V. Lingiardi, & A. Colli, La ricerca in psicoterapia. Modelli e strumenti (pp. 31-48). Milano: Raffaello Cortina Editore.
  51. Migone P. (2008a). Il problema della «traduzione» di aspetti delle filosofie orientali nella psicoterapia occidentale. Psicoterapia e Scienze Umane, 2010, 44(1), 35-52. Doi: 10.3280/PU2010‐001003.
  52. Migone P. (2008b). Psicoterapia e ricerca “scientifica” (Reply to: Bersani, 2008). Psicoterapia e Scienze Umane, 43(1), 77-94. (www.psychomedia.it/pm/ modther/probpsiter/ruoloter/rt108‐08.htm).
  53. Migone P. (2011). Presentazione dei principali sistemi diagnostici in psichiatria e alcune riflessioni sul problema della diagnosi. Rivista Sperimentale di Freniatria, 135(2), 19-40. Doi: 10.3280/RSF2011‐002003.
  54. Migone P. (2013). La “filosofia” della diagnosi psichiatrica. aut aut, 357, 77-97.
  55. Migone P. (2015). Dipendenza e autonomia: la “polarità fondamentale” di Sidney Blatt. In: M. Fontana (Ed.), La diagnosi e le sue implicazioni nella clinica psicoanalitica (pp. 53-64). Roma: Fioriti.
  56. Migone P. (2017). The influence of pharmaceutical companies. Research in Psychotherapy: Psychopathology, Process and Outcome, 20(2), Article 2. Doi: 10.4081/ripppo.2017.276. (http://researchinpsychotherapy.org/index.php/rpsy/article/view/276/222).
  57. Migone P. (Ed.). (2021). La terapia psicodinamica è efficace? Il dibattito e le evidenze empiriche. Milano: FrancoAngeli.
  58. Migone P. (2024). Psicoanalisi e prove di efficacia. Il Veltro. Rivista della Civiltà Italiana, 67(3/4), 187-207.
  59. Migone P., Merini A., & Galli P.F. (2012). Come gestire la pluralità dei modelli in psicoterapia. Psicoterapia e Scienze Umane, 57(3), 479-500. Doi: 10.3280/PU2023‐003009 (www.psychomedia.it/pm/modther/probpsiter/ruoloter/rt109‐08.htm).
  60. Pauri M. (2000, maggio 17). Intervention at the Meeting with Robert R. Holt and Morris N. Eagle “The scientific status of psychoanalysis” [Video]. https://youtu.be/9pM_bZCIMwI. recuperato 17 maggio 2000.
  61. Popper K. (1957). Conjectures and Refutations (2nd edition). New York: Basic Books. Pressman J.D. (1998). Last Resort: Psychosurgery and the Limits of Medicine. New York: Cambridge University Press.
  62. Rapaport D. (1942‐60 [1967]). The collected papers of David Rapaport (M. M. Gill, Ed.). Basic Books, 1967.
  63. Rosenzweig S. (1936). Some implicit common factors in diverse methods of psychotherapy. American Journal of Orthopsychiatry, 6(3), 412-415. Doi: 10.1111/j.1939‐0025.1936.tb05248.x.
  64. Roth A., & Fonagy P. (1996). What Works for Whom?: A Critical Review of Psychotherapy Research (Second Edition: 2004). New York: The Guilford Press.
  65. Rubinstein B.B. (1952‐83 [1997]). Psychoanalysis and the philosophy of science: collected papers of Benjamin B. Rubinstein, M.D. (R. R. Holt, Ed). Madison, Conn.: International Universities Press, 1997.
  66. Sackett D.L., Rosenberg W.M.C., Gray J.A.M., Haynes R.B., & Richardson W.S. (1996). Evidence based medicine: what it is and what it isn’t. BMJ, 312(7023), 71-72. Doi: 10.1136/bmj.312.7023.71.
  67. Schafer R. (1976). A New Language for Psychoanalysis. New Haven, CT: Yale University Press.
  68. Schafer R. (1992). Retelling A Life: Narration and Dialogue in Psychoanalysis. New York: Basic Books.
  69. Shedler J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 65(2), 98-109. Doi: 10.1037/a0018378 Also in: Migone, 2021, ch. 2.
  70. Shedler J. (2018). Where Is the Evidence for “Evidence‐Based” Therapy? Psychiatric Clinics of North America, 41(2), 319-329. Doi: 10.1016/j.psc.2018.02.001 Also in: Migone, 2021, ch. 6.
  71. Shedler J., Westen D., & Lingiardi V. (2003). La valutazione della personalità con la SWAP‐200 (Nuova edizione 2014). Milano: Raffaello Cortina Editore.
  72. Smith M.L., Glass G.V., & Miller T.I. (1980). The Benefits of Psychotherapy. Baltimore: The Johns Hopkins University Press.
  73. Spence D.P. (1982). Narrative Truth and Historical Truth: Meaning and Interpretation in Psychoanalysis. New York: W. W. Norton & Company.
  74. Steinert C., Munder T., Rabung S., Hoyer J., & Leichsenring F. (2017). Psychodynamic Therapy: As Efficacious as Other Empirically Supported Treatments? A Meta‐Analysis Testing Equivalence of Outcomes. American Journal of Psychiatry, 174(10), 943-953. Doi: 10.1176/appi.ajp.2017.17010057.
  75. Thomä H. & Kächele H. (1985). Lehrbuch der psychoanalytischen Therapie. 1: Grundlagen. Berlin: Springer (English translation: Psychoanalytic Practice. Vol. 1: Principles. Berlin: Springer, 1987).
  76. Thomä H. & Kächele H. (1988). Lehrbuch der psychoanalytischen Therapie. 2: Praxis. Berlin: Springer (English translation: Psychoanaytic Practice. Vol. 2: Clinical Studies. Berlin: Springer, 1992).
  77. Thomä H. & Kächele H. (2006). Lehrbuch der psychoanalytischen Therapie. 3: Forschung. Berlin: Springer (Italian translation: Trattato di terapia psicoanalitica. 3: La ricerca in psicoanalisi. Urbino: Quattroventi, 2007).
  78. Wachtel P.L. (2010). Beyond “ESTs”: Problematic assumptions in the pursuit of evidence‐based practice. Psychoanalytic Psychology, 27(3), 251-272. Doi: 10.1037/a0020532.
  79. Wallerstein R.S., & Fonagy P. (1999). Psychoanalytic research & IPA: History, present status, future potential. The International Journal of Psychoanalysis, 80(1), 91-109. Doi: 10.1516/0020757991598585.
  80. Westen D. (1999). The scientific status of unconscious processes: Is Freud really dead? Journal of the American Psychoanalytic Association, 47, 4: 1061‐1106. DOI: 10.1177/000306519904700404 (parts of this article are summarized in: Migone, 2021, ch. 5).
  81. Westen D., Novotny C.M., & Thompson‐Brenner H. (2004). The Empirical Status of Empirically Supported Psychotherapies: Assumptions, Findings, and Reporting in Controlled Clinical Trials. Psychological Bulletin, 130(4), 631-663. Doi: 10.1037/0033‐2909.130.4.631 (parts of this article are summarised in: Migone, 2021, ch. 7; see also the web page: www.psychomedia.it/pm/modther/probpsiter/ruoloter/rt98‐05.htm).
  82. Whitaker R. (2010). Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America. New York: Crown.