Depression Not So “Treatment-Resistant” After Psychodynamic Psychotherapy

Researcher finds Intensive Short-Term Psychodynamic Psychotherapy reduced depressive symptoms in patients who did not improve with pharmacological treatment.


A recent study published in Psychotherapy suggests that Intensive Short-Term Psychodynamic Psychotherapy (ISTDP) is an effective treatment for treatment-resistant depression (TRD). The study found that ISTDP had positive results, especially for patients who did not experience relief from depressive symptoms while taking antidepressants.

During the randomized controlled trial (RCT), researchers discovered that ISTDP significantly decreased negative affect and emotional repression, both of which are linked to depression. Additionally, participants continued to experience the benefits of treatment even three months after the trial ended.

“The findings show that ISTDP for TRD’s effect is not limited to depressive symptoms, but that negative affect is more broadly reduced. ISTDP can decrease emotional repression, which is consistent with its presumed working mechanisms,” the authors write. “Together, this indicates that ISTDP might be a promising treatment for TRD. This is of considerable relevance, as TRD is a prevalent disorder associated with significant personal and societal costs, for which other psychotherapies have failed to be shown efficacious relative to treatment-as-usual.”

The study was conducted by Rasoul Heshmati of the University of Tabriz alongside Frederik J. Wienicke and Ellen Driessen from Radboud University’s Behavioural Science Institute.

Psychodynamic psychotherapy continues demonstrating significant effectiveness in treating psychological distress or psychiatric disorders, as termed by biomedical models of treatment. A number of randomized control trials have demonstrated this approach’s effectiveness in reducing symptoms of depression and bipolar disorder, anxiety and panic, post-traumatic stress, psychosomatic problems, and so-called personality disorders. Additionally, meta-analytic studies have confirmed the efficacy of these treatments.

Like other approaches to therapy, psychodynamic psychotherapy has many treatment models, including ISTDP. This model is characterized by its confrontational nature and emotion-focus (rather than symptom focus), in which therapeutic interventions promote the experiencing and processing of unconscious emotions to reduce distress and change behavior. Although previous research has demonstrated the effectiveness of this approach, including for “treatment-resistant” depression, there is limited research on the reduction of negative affect and emotional repression – which are among the theoretical mechanisms of change.

The researchers conducted a randomized control trial to test their theoretical assumptions. The trial involved patients who had not experienced a reduction in depressive symptoms after psychopharmacological treatment. The goal of the trial was to assess the effectiveness of ISTDP in reducing symptoms in this group, as well as reducing negative affect and emotional repression.

In 2020, the team enrolled participants who were adults between 18 and 60 years of age with at least a high school education. These participants met the criteria for Major Depressive Disorder, as per the Diagnostic and Statistical Manual of Mental Disorders (DSM), which was assessed through the Mini-International Neuropsychiatric Interview-Plus.

To participate in the study, individuals had to meet the criteria for treatment-resistant depression, meaning they did not respond to at least one open trial of antidepressants. After screening, 86 participants were selected, with 43 assigned to the experimental group (who would receive treatment) and 43 to the control group (who would not receive treatment).

Two experienced psychotherapists who specialize in Intensive Short-Term Dynamic Psychotherapy (ISTDP) delivered a total of 20 individual sessions twice a week for ten weeks. One therapist treated 22 participants, and the other treated 21 participants. The participants’ sociodemographic information, such as age, gender, marital status, education level, employment status, and socioeconomic status, was collected by the researchers. In addition, the Weinberger Adjustment Inventory (WAI) and Positive and Negative Affect Schedule (PANAS) were used to assess the participants’ depressive symptoms, negative affect, and repressed emotion at baseline, post-treatment, and three months after treatment.

Initially, there were no significant differences between the control and experimental groups. However, the participants who underwent ISTDP treatment showed significantly lower levels of depressive symptoms, emotional repression, and negative affect when compared to the control group. The effect size of the treatment was large in all areas, both immediately after treatment and three months after treatment, when compared to the initial baseline. Additionally, the effect size was significant when comparing changes in depression and emotional repression between the post-treatment and 3-month follow-up.

Regarding negative emotions, the effect size was large both immediately after the treatment and three months after the treatment. However, the effect size was medium between these two time points. These findings indicate that ISTDP has a long-lasting positive impact on the participants even after the treatment has concluded.

These results continue to support evidence of psychodynamic psychotherapy’s effectiveness and highlight the importance and relevance of treatment models that are not symptom-focused, many of which have been proven to be ineffective in the treatment of so-called “treatment-resistant depression.”

Additionally, it presents evidence against the “treatment-resistant” concept, which assumes that patients cannot experience relief from treatment instead of recognizing the limitations and problems of psychiatric treatment.

Through an emotion-focused treatment that involves a deep connection between participant and therapist and seeks to address some of the underlying issues that lead to distress (as opposed to simply reducing symptoms), many patients who have not experienced well-being or a reduction in psychological distress through pharmacological treatment can heal or feel a sense of relief from their suffering.



Heshmati, R., Wienicke, F. J., & Driessen, E. (2023). The effects of intensive short-term dynamic psychotherapy on depressive symptoms, negative affect, and emotional repression in single treatment-resistant depression: A randomized controlled trial. Psychotherapy. Advanced online publication. (Link)


  1. This idea that any short term talking and listening is useful for anything but very mild issues in well resourced people is garbage – how can short term anything create ‘deep connection between participant and therapist’ this is completely impossible even in longer term therapy. One is client the other therapist = one bares all the other nothing or very little, the power imbalance is insurmountable and the evidence base for all psychotherapy grossly oversold and misrepresented.

    Be great to see a review of these book and an interview with the author
    William M Epstein
    The Illusion of Psychotherapy
    Psychotherapy as religion
    Psychotherapy and the the social clinic in the united states soothing fictions
    Paul Maloney’s the Therapy Industry.

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    • There is the well known fact, or was, that psychodynamic therapy, pastly known as psychoanalytic therapy was only to be applied, was only usefull in persons of “certain intelligence”, imputed as high. And as mentioned relatively prosperous.

      But the underdiscused fact is that such therapy at some point involved, as fars as I know, the submission of the “client” to the mind and opinions of the therapist. To the creed of psychoanalysis, a form of submissive indoctrination. And the therapist in turn was already submitted during training. A chain of subjugations, of annulments of the critical mind, to say the least.

      That is, the success of such therapy in classical form was called successfull when the client accepted the crappy pappy of the therapist, usually done until submission at the risk of psychotic brakes and “deterioration” or “emergence” of new symptoms.

      And in it’s classical form considered all these DSM non-psychotic stuff in a single overarching category: neurosis.

      It was like meassuring improvement or cure of a disease/disorder by repeating convincingly the CREED. Expressing the world in positive terms as the creed specifies them. A rhetorical and hermeneutical improvement, rather than a “clincal” one. “Talk” therapy according to a cult.

      Meassuring depression improvement with metrics that are more correlated with knowing the gospel teachings more than anything that “expresses” a disease or disorder process.

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    • Topher, THANK YOU for pointing out the impossibility of creating any bona fide (much less healthy) “deep connection between participant and therapist” even in “long-term therapy”. There can never be any genuine “deep connection” when one person (the “therapist”) insists that THEY are “the expert” on YOUR LIFE while insisting on keeping their own true feelings and personal life a mystery. And charging a fee AUTOMATICALLY NEGATES “deep connection”. But what it DOES create is THIS: an infantilized “client” who becomes DEPENDENT on “therapy”.

      IT’S A HUGE LOAD OF CRAP that should have been flushed down the toilet YESTERDAY —

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  2. “the criteria for treatment-resistant depression, meaning they did not respond to at least one open trial of antidepressants. ”

    The problem is that there is no consensus on what “treatment resistant” means. The FDA says no response to TWO antidepressants taken for at least 6 weeks and researchers like Dr Lisa Pan used “three maximum-dose, adequate-duration medication treatments” as criteria for “treatment resistant” in her latest study.

    She found metabolic abnormalities in 67 out of 141 “treatment resistant” patients including
    low cerebral folate and low tetrahydrobiopterin. All showed improvement in depression symptom inventories after treatment with folinic acid and sapropterin.

    My son died by suicide because people like you keep quoting nonsense.

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  3. I don’t know….

    Humans are built for connecting to other humans. Therapy is faux connection but it’s arguably better than being shut down and shut up with ever increasing doses of drugs. And yet…

    The talking section of the mental health industry is dangerous too. Emotional abuse and sexual misconduct seem common with few consequences for the expert in such situations. The labels are damning and I think the potential for destruction can be as bad as in psychiatry, especially since the fields are sides of the same coin not really competing for business so much as networking to maximize profits.

    But I benefited from talking to a disillusioned therapist, at one point. From a survivors perspective, having the seeds of genuine rebellion and then genuine growth planted by another human being is worthwhile…

    Even if the other human being is a worker in the psych guild.

    Crazy world, huh?

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  4. Again. It is pretty clear that doing anything in service to your wellness is better than doing nothing when in depression.

    I genuinely appreciate istdp researchers trying to use actual/observable clinical experience to inform both psychodynamic theory and test helpfulness. They are more better than their other analytic comrades in that regard.

    It is why I tried istdp for 1.5 years in fact. Has it made a big impact in my life? No. Maybe I had “therapy resistant depression.”

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    • Well, it has no basis. It would be like saying just because some chiromancers that publish in chiromancing magazines, where chiromancy is unquestionable, publish positive results for chiromancy.

      Psychoanalysis was a cult, and according to Lacan, both epistemologist and psychoanalyst was a pseudoscience.

      There was no way to provide a testable hypothesis for falsiiying psychoanalysis.

      Psychodynamics was a way to wash the names and “sins” of psychoanalysis without addressing those flaws.

      So any report on improvement published has at least to contend with unfalsifiability and publishing bias.

      And the “issue” reviewers that give the green light a given submitted aspirant paper, to not question their income…they will quash critical negative papers, and promote positive ones. Withing limits…

      Even if some negative ones where published. Where is the causality on that after all?. Lacking epistemic bases as in beyond doubt facts, that are empirical, generalizable, blah blah blah!,

      And psychodynamic reasoning is based in hypotheses, not on facts. They are not even theories in the scientific sense. Any reasoning with psychodynamic premises and methodology falls prey to the fact we can’t go to an alien planet to see if aliens are wide blacked eye of gray skin.

      Not even if we had one in central park on public display, genetic analysis, testimony, all that…

      Or we can’t force an angel, a demon or a ghost to participate in an experiment and permit, allow, seek collaboration for a clear picture, video or interview, if its is ok, with them: i.e. falsifiability…

      That is: the mind is a black box. Black boxes inner workings can’t be mathematically infered from the relationship between input and outputs. So, any idea about how they work are hypotheses. And on top of that, psychodynamic hypothesis are unempirical: i.e. unfalsifiable. Can’t be figured out with experiments!.

      And if the inner workings can’t be figure out empirically, the benefits of INTERVENING on them have more problems than what’s reported here: correlations, absent causality…


      It’s the Chinesse Room all over again!. As the great Yogi Berra might have said…

      And when I say mathematically can’t be infered, I mean it has been proven, mathematically, beyond doubt, that the inner behaviour of black boxes can’t be done regardless how many googoolplex experiments are done CORRELATING inputs with outputs.

      Which is what clinical psychology, and the subvariant of psychodynamics does: correlations. And psychiatry does too, but psychiatry is PROVABLY false, according to just 2, two, authoritative paragraphs of the DSM. As is the ICD, on the psychiatry realm.

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  5. Geez Louise!!! Who would’ve guessed that talking with someone can actually help you feel better???

    Here’s my five-point no-drug, no-fee, and definitely no-“diagnoses” “treatment plan”:

    1. People need to be seen
    2. People need to be heard
    3. People need to have their feelings and concerns taken seriously
    4. People need to know that somebody actually gives a damn about THEM
    5. People need to know THAT THEY AREN’T ALONE

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  6. I keep reading here and so many other places in the hopes of finding something that will mean I don’t need my bipolar meds. Still not seeing it, and I think it’s because women, after centuries, still aren’t being listened to. I just saw a study the other day talking about how female hormones contribute to mood. Um, yeah. I get men have bipolar and MDD too, but isn’t it obvious that women’s bodies should be studied for more than the purpose of shoving psych meds down our throats? Those issues started showing up for me at 8… when I first started my period. It’s great that talking helps others, but none of that helps when there is an actual biological basis. I do really well on my meds. I can’t remember my last episode. But I’d rather have an actual cure that addresses the actual problem…and it sure isn’t a nice chat

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  7. Wow! Why are there so many haters? I’m curious as to why those that have such strong feelings about the effectiveness of therapy of any kind, are Reading these articles in the first place? Seems to me they don’t possess an open mind on the subject. The point of research is to discover something new, no?
    Personally, I found the article fascinating and as one long diagnosed with treatment resistant depression, it gave me hope that perhaps there is a new avenue of treatment. Anyone who has suffered from long-term depression should welcome any possible alternative that may help them. At minimum, this sort of research shouldn’t be discouraged. Those of us currently suffering are well aware of the unlikelyness of finding effective treatment. Still, that doesn’t mean it’s not worth trying and, for me, I’d gladly take 3 months out of the abyss if that’s the best I could get. It’s still better than the alternative. Thank you, Mr Luiggi-Hernandez for this illuminating report.

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