A Meta-Analysis of Psychodynamic Psychotherapy Outcomes: Evaluating the Effects of Research-Specific Procedures Joel M. Town Dalhousie University Marc J. Diener Long Island University-CW Post Allan Abbass Dalhousie University Falk Leichsenring University of Giessen Ellen Driessen VU University of Amsterdam Sven Rabung University Medical Center Hamburg-Eppendorf, and Alpen-Adria-Universita ¨t The aim of this research was to examine the extent to which the use of research-specific procedures in psychodynamic psychotherapy impacts upon treatment effectiveness and which variables moderate this potential relationship. Effects of audio/video recording of sessions, use of treatment manuals, and checks of treatment fidelity were examined. A meta-analysis was conducted on randomized controlled trials of psychodynamic psychotherapy. Forty-six independent treatment samples totaling 1615 patients were included. The magnitude of change between pretreatment and posttreatment aggregated across all studies (45 treatment samples) for overall outcome was large (d  = 1.01), and further improvement was observed between posttreatment and an average 12.8-month follow-up (d  = 0.18). Subgroup analyses comparing studies that used research-specific procedures and those that did not revealed that for posttreatment data no differences in treatment effects were found. However, the use of treatment manuals and fidelity checks were significantly associated with improvement between the end of treatment and follow-up assessment. Within the limitations of analyses, this data offered preliminary evidence that use of research-specific procedures does not contribute in a negative manner to posttreatment outcomes in psychodynamic psychotherapy, and their use contributes to positive differences that emerge with time. These findings, although observational in nature, make a case for reconsidering how dimensions of clinical utility and experimental control may be integrated in psychody- namic psychotherapy to enable further elucidation of principles that evidently work. Keywords: psychodynamic, psychotherapy, meta-analysis, research, moderator Supplemental materials: http://dx.doi.org/10.1037/a0029564.supp Psychotherapy outcome research has evolved to regard the need for adequate specificity and standardization of psychotherapy treatments as essential, despite limitations in the generalizability of the controlled trial methodology (e.g., Blatt & Zuroff, 2005; Roth & Fonagy, 2005). Nevertheless, having a true and accurate picture of the nature of a treatment delivered is relevant for controlled research, naturalistic studies, and practice-based evidence more generally to enable a valid assessment of effectiveness. Psychotherapy research and to a lesser extent clinical and training facilities, therefore, now commonly use manual-based treatments, audio/video recording of sessions, and for- mal checks on treatment fidelity. From here on, audio/video record- ing, treatment manuals, and fidelity checks, as a collective are com- monly described as research-specific procedures. Changes in clinical practice and psychotherapy training (Crits- Christoph, Frank, Chambless, Brody, & Karp, 1995) can be traced to efforts to incorporate these research methods more systematically, moving away from the historical position of less structured methods and theoretical texts lent from psychoanalysis (Matarazzo & Garner, 1992). However, psychodynamic clinicians and teachers, past and present, continue to vary widely in both their attitudes toward these Joel M. Town and Allan Abbass, Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada; Marc J. Diener, Clinical Psychol- ogy Doctoral Program, Long Island University—CW Post Brookville, NY, USA; Falk Leichsenring, Clinic of Psychosomatics and Psychotherapy, Uni- versity of Giessen, Giessen, Germany; Ellen Driessen, Department of Clinical Psychology, Faculty of Psychology and Education, VU University of Amster- dam, Amsterdam, The Netherlands; Sven Rabung, Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Ger- many, and University of Klagenfurt, Klagenfurt, Austria. The authors would like to dedicate this article to the memory of Dr. Leigh McCullough: With grateful appreciation for Dr. McCullough’s pas- sionate support, collaboration, and a lifetime’s achievements in advancing the field of psychotherapy research and clinical theory, practice, and training. Correspondence concerning this article should be addressed to Joel M. Town, Abbie J. Lane Building, 7th Floor, Room 7516, 5909 Veterans’ Memorial Lane, Halifax, Nova Scotia B3H 2N1, Canada. E-mail: joel.town@dal.ca Psychotherapy © 2012 American Psychological Association 2012, Vol. 49, No. 3, 276 –290 0033-3204/12/$12.00 DOI: 10.1037/a0029564 276 This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.