New Guided-Activity Workbook Offers Mental Health First Aid to Children During Wildfires in California

Dr. Gil Kliman’s acclaimed series of interactive tools for promoting emotional processing and resilience after traumatic events has a new entry.

Help for children facing anxiety and trauma is an urgent issue. All around the world, the natural disasters of the past year and a half have had an immense impact on young people’s mental health.

HFI Chairman Dr. Gil Kliman has developed a series of Guided Activity Workbooks for young people in the wake of such disasters. In these books, children and adolescents find a safe space to work through their feelings, record their experiences, and begin to make sense of what has happened. The books can also serve as diagnostic tools for mental health professionals to identify signs of trauma that may need more intensive treatment. A recent edition deals with the Covid-19 pandemic.

The latest entry in the series focuses on the California wildfires, and is available HERE through the Children’s Psychological Health Center.

Based on Dr. Kliman’s own Reflective Network Therapy and backed up by decades of experience and evidence-based findings in disaster response, this workbook is for everyone grades K-12 and their families, educators, and caregivers. It encourages learning and healthy emotional expression, introduces young people to appropriate coping and recovery skills, and encourages scientific thinking.

July 16: HFI Presents “Spirituality, Social Justice and Psychoanalysis”

The Harlem Family (Psychoanalytic) Institute


A Public Program Candidates Panel

Spirituality, Social Justice & Psychoanalysis

~ This Friday evening, July 16, at 7 pm ET free Zoom presentation ~

Please register here

The Institute, which trains tomorrow’s psychoanalysts in its small clinical sites in community centers, schools and houses of worship in Harlem and surrounding neighborhoods, knows the social-justice concerns of these diverse communities. The presentation will explore how training people concerned about such key issues, especially clergy, to become Licensed Psychoanalysts can help address them. 

 The Institute, with a very social-justice-concerned faculty, trains clergy and others fighting for social justice and is eager to train more. It sees training such people to become Licensed Psychoanalysts to be of paramount importance. The Institute welcomes applications from individuals with an advanced degree in any discipline.  Graduates of its Licensure-Qualifying Program may sit the NY State psychoanalysis licensing exam.

 Please join us for this July 16 Panel Presentation 

Please register here


Rev. Theodore “Ted” Kwaku Parker

Roman Catholic priest Rev. “Ted” Parker graduated from the Harlem Family Institute with a Certificate in Psychoanalysis in 1999. Born in Brooklyn, NY, he attended schools in Brooklyn, Indiana and Manhattan and was ordained a Catholic priest in May, 1972. He furthered his education with Master’s degrees in History and Anthropology. While a parish priest in Harlem in the late 1990s, his interest in cultural anthropology and African American studies led him to psychoanalysis and studies at the Harlem Family Institute.  

Since moving in 2001 to Detroit, where he has pastored at St. Charles Lwanga Parish, he has been instrumental in establishing the first Street Court in Detroit with the help of Judge Cylenthia Miller (see designed for homeless men and women who have been involved with the justice system. From 2014 to 2016, he taught graduate courses in the Social Justice Program at Marygrove College in Detroit.


Rev. Parthenia “Tina” Caesar

Rev. Parthenia Caesar, DMin, MDiv, MBA BCCC, BCPC, is a psychoanalytic candidate with the National Psychological Association for Psychoanalysis, New York, in the License in Psychoanalysis track, who has also studied at the Harem Family Institute. Founder of Beyond the Walls mentoring services, Westbury, NY, she is also the Pastor and founder of Beyond the Walls Christian Center. Parthenia received her Doctor of Ministry from New York Theological Seminary, her Master of Divinity from Alliance Theological Seminary and her Master of Business Administration from Dowling College. She is also the Operational Risk Officer for a large bank with over three decades of experience in Corporate America focusing on Risk Management and Compliance.


Clergy faculty and candidates of the Harlem Family Institute


Muballigh Muhammad Al-Rahman, PhD, LMFT
Pastor Adrienne Croskey, MDiv, CASAC
Andrea Dixon, LCSW-R
Rev. Sheila Johnson, MPS
Rev. Christopher Jones, MDiv, MA  
Rev. Vanesha Miller, MS
Rev. John Muniz, DMin, MDiv, MBA

Introduced by 

Dr. Fanny Brewster, LP
HFI’s Director of Public Programs

Fanny Brewster, PhD Clinical Director

Please register here

HFI’s 2021 Open House and Fall Training

Thank you to all who joined us at HFI’s OPEN HOUSE online on Saturday May 15, 2021, explaining HFI’s clinical training program for aspiring psychoanalysts and the clinical work we offer the community. If you would still like to apply for training starting this coming fall, please immediately contact Executive Director Michael Connolly (

HFI 2021 Annual Open House set for May 15 on Zoom

Please join us for the Institute’s annual Open House on Saturday May 15 from 1-3 pm to learn about our clinical training programs in the community to become a psychoanalyst. Applicants need to hold at graduate degree in any discipline – allowing individuals from across the humanities, sciences and social sciences to enter the field. Training to become a Licensed or Certified Psychoanalyst usually takes 4-5 years part-time, though swifter advancement is possible.

To register for HFI’s Open House, Saturday May 15, please click on this Zoom link.

Since 1991 we have worked to train tomorrow’s diversity-sensitive psychoanalysts by taking training and treatment out to the community in small clinical sites that we operate in Harlem and Northern Manhattan, where our candidates provide free and ultra-low-fee clinical services to children, families, adolescents and adults through both psychotherapy and play therapy.

a man assisting a young child with play therapy

Through play therapy, we offer youngsters a safe space to express their feelings, to learn to use their strengths to manage the challenges they face every day, and to discover new ways to relate to the world.

We have served hundreds of parents and children through our school- and community-based playroom treatment centers, where we offer consistent, long-term therapy and play therapy. Clients meet with their therapist in a safe, pleasant space where they work together to address difficult issues through play or talk.

The candidates studying in our programs – many of African American or Latino heritage, including clergy, from Harlem and the city’s most diverse communities – are able to develop careers as advanced mental-health professionals. The Institute’s more than 90 faculty members come from many of the city’s and nation’s psychoanalytic institutes, drawn by its unique mission. The institute can admit suitable candidates, whether licensed or not, who hold a graduate degree in any discipline. Graduates of our Licensure-Qualifying Program may immediately sit the state exam to become Licensed Psychoanalysts. 

Our founding Trustees included Dr. Margaret Morgan Lawrence, MD, the nation’s first African American woman pediatrician and first African American psychoanalyst, who died in December 2019 aged 105. Our leadership includes Board Chairman Dr. Gilbert W. Kliman, MD, Honorary Dean Dr. Kirkland C. Vaughans, PhD, Executive Director Michael Connolly, MPA, LP, Training Director Dr. David Abrams, PhD, Clinical Directors Jungian psychoanalyst Dr. Fanny Brewster, PhD, MFA, LP, and Ernest P. Smith, LCSW-R, and child & adult psychoanalyst Ann Marie Sacramone, MSEd, LP.

Gilbert Kliman, MD
HFI Board Chairman
Kirkland Vaughans, PhD
Honorary Dean

In addition to taking psychoanalytic training and treatment out to the community, the Institute aims to deepen an understanding of diversity and inclusiveness among tomorrow’s psychoanalysts.  Created in 1991 to help children and families at a small independent elementary school in Harlem, HFI seeks to draw individuals of all cultures and backgrounds as it helps them develop psychoanalytic skills in working with children, parents, adolescents and other adults. It operates small neighborhood therapy sites in schools, community centers and houses of worship in Harlem and Upper Manhattan. It offers evening classes and supervision in faculty members’ offices. It also offers supervised clinical-experience programs for students in graduate programs in psychology, LMSWs and others. The Institute is currently working to develop a bigger Harlem clinical and child-development operation, where it hopes to offer not only individual psychoanalytic work and psychotherapy for adults, adolescents and children, but also group work for pregnant women, mothers & babies, parents & toddlers, Reflective-Network Therapy Nurseries for Preschoolers, and adolescent groups.

David Abrams, PhD
Training Director
Fanny Brewster, PhD
Clinical Director
Ernest P. Smith, LCSW-R
Clinical Director

If you hold a graduate degree in any discipline and would like to become a psychoanalyst equipped to work with children, families, adolescents and adults in Harlem and nearby communities of New York’s great’s diversity, this event will help you get started by learning about the Institute and our training programs.

Ann Marie Sacramone, MSEd, LP
Senior Faculty Member

To register for HFI’s Open House, Saturday May 15, please click on this Zoom link.

HFI, which aims to take psychoanalytic training and treatment out into the community, grew out of a 1980s psychotherapy program created by psychoanalyst Stephen Kurtz, LCSW to help children at the Children’s Storefront School on East 129th St. In addition to Mr. Kurtz and Dr. Lawrence, founding Board members included Robert Coles, MD, the Harvard Medical School psychiatrist who devoted much of his career to researching and writing about the moral and spiritual life of children, including the book “Children of Crisis,” George Getzel, CSW, Tamar Turin Opler, LCSW-R, poet Ned O’Gorman, who founded the Children’s Storefront School, and attorney Elisabeth Radow, the Institute’s first chair, who did a mountain of pro bono legal work to set up the Institute and win its needed New York State approvals.

HFI Founder Stephen Kurtz, LCSW, with Founding Trustees Margaret Morgan Lawrence, MD, and Robert Coles, MD

HFI’s current Board Chairman Dr. Gilbert Kliman, MD, was the 2020 recipient of the American Psychoanalytic Association President’s humanitarian award for “his lifetime psychoanalytic leadership in treating and advocating for underserved and traumatized children worldwide,” and the 2020 Rieger Award of the American Academy of Child & Adolescent Psychiatry for his Reflective Network Therapy in the Preschool classroom, which shows significant and regular IQ gains in the children who have participated in the treatment. Dr. Kliman has also created a series of guided-activity workbooks for children, including most recently, “My Pandemic Story” (see below), which has been translated into 13 languages. Dr. Kliman also provides expert-witness testimony to help victims of abuse and trauma pursue actions against their abusers. Intended recipients of such work in future include victims of police and vigilante violence and their families.  

Leading psychoanalyst and HFI Honorary Dean, Dr. Kirkland Vaughans, has drawn wide attention for co-editing with Warren Spielberg, PhD, the seminal, 2014, two-volume book “The Psychology of Black Boys & Adolescents.”

To register for HFI’s Open House, Saturday May 15, please click on this Zoom link:

More information about the Institute and its psychoanalytic training programs is available in its 40-page Catalogue.  

“My Pandemic Story” – Guided Activity Workbook for Children and Teens Now Available

The Covid-19 pandemic has disrupted all of our lives. Children and teenagers are especially vulnerable to the mental and emotional stressors of the crisis: their world has been turned upside down just as they were beginning to discover their own place in it.

The new guided-activity workbook “MY PANDEMIC STORY,” by our own HFI Chairman, leading child psychiatrist Dr. Gilbert Kliman, was created to support young people and their families and educators during these troubled times. Based on Dr. Kliman’s own Reflective Network Therapy and backed up by the authors’ decades of experience and evidence-based findings in disaster response, this workbook is for everyone grades K-12 and their families, educators and caregivers. It encourages learning and healthy emotional expression, introduces young people to appropriate coping and recovery skills, and encourages scientific thinking. 

The Harlem Family Institute is honored to offer this workbook, in cooperation with the Children’s Psychological Health Center, in electronic format for purchase on our website. Pricing starts at $3.99 for an individual copy, with major discounts available on bulk licenses for organizations and educational institutions. For more info and to purchase:

Continuing Education: An Afternoon with Dr. Fanny Brewster – “The Racial Complex: Race, Racism and Cultural Complexes” – Saturday, Feb. 13, 2021

Fanny Brewster, PhD (Psych.), MFA, LP

The Racial Complex:  Race, Racism and Cultural Complexes

Saturday, Feb. 13, 2021, from 1:00-2:30 pm

A person smiling for the camera

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The Harlem Family Institute presents an afternoon with
Fanny Brewster, PhD, MFA, LP

Just as the colored man lives in your cities and even within your houses, so also he lives under your skin, subconsciously.  Naturally it works both ways.  Just as every Jew has a Christ complex, so every Negro has a white complex and every American (white) a Negro complex.

– C.G. Jung Collected Works, Vol. 10, para 963.

As we encounter the issue of race and therefore racism, witnessing the constellation of cultural complexes in actions of racial violence, marching protests and global engagement, it appears important to visit the Jungian concept of psychological complexes.  Jung’s early work on the “color” complex, what I have named the racial complex, has with few exceptions, not been reviewed and investigated for almost one hundred years.  Jung’s early attempt to define ethnicity and culture within the context of a racial complex, had the hallmark of 19th Century colonial-influenced thinking.  As we work within a 21st century consciousness, we are required to deconstruct psychological theories that are relevant specifically to Jungian psychology and in general to the field of Psychoanalysis.  This deconstruction allows us to question, inquire of and re-define both the interior unconscious space of complexes, and the exterior relationship with a differing cultural/ethnic “Other,” in deepening our understanding of racial relationships within the clinical setting.

The program offers 1.5 continuing education credits for Licensed Psychoanalysts. 

Dr. Brewster is a Jungian analyst and Professor at Pacifica Graduate Institute. She is a graduate of the C.G. Jung Institute of New York and is a New York State Licensed Psychoanalyst and Certified School Psychologist. She is a senior faculty member at the Harlem Family (Psychoanalytic) Institute, where she is establishing the Institute’s new Public Programs. She is also the author of several recent books, including:

 The Racial Complex: A Jungian Perspective on Culture and Race, 2019, nominated for the 2020 Gradiva Award; 

Archetypal Grief: Slavery’s Legacy of Intergenerational Child Loss2018; and

 African Americans and Jungian Psychology: Leaving the Shadows, 2017.  


1.  Learn C.G. Jung’s general theory of psychological complexes and its applicability to clinical practice in terms of the Transference relationship.

2.  Learn two characteristics of C.G. Jung’s “color”/ racial complex, its theoretical history and contemporary influence on the development of cultural group process.

3.  Define C.G. Jung’s perspective on the American collective societal issue of racism as described in his Collected Works writings from the 1930s.

Registration: $60
To register: Pay $60 here via the Donate button, and then register here.

To receive CE credits, participants must be visible at all times during the presentation.

Cancellations: Professionals who are unable to attend a course for which they have registered may obtain a 60% refund if they notify the Registrar ( in writing, no later than 24 hours before the class. Less than one day, no tuition will be refunded.

The Harlem Family Institute is recognized by the New York State Education Department’s State Board for Mental Health Practitioners as an approved provider of continuing education for Licensed Psychoanalysts, #P-0048.

BOOK LAUNCH: “White Privilege: Psychoanalytic Perspectives” by Dr. Neil Altman – Saturday, Dec. 12

Dr. Altman will discuss his new book over Zoom on Saturday, Dec. 12, 2020, at 11:30 AM EST, in conversation with integrative arts psychotherapist Eugene Ellis, MA, and child & adult psychoanalyst Ann Marie Sacramone, MSEd, LP.
The book launch will inaugurate the Institute’s new Public Programming, under the leadership of HFI senior Faculty member, Jungian psychoanalyst Dr. Fanny Brewster, PhD, MFA, LP.

In “White Privilege: Psychoanalytic Perspectives,” Dr. Altman examines the significant role race and the concept of unearned “white privilege” plays in society and in clinical practice, suggesting that there are hidden assumptions in the idea that perpetuate the very same prejudicial notions that are purportedly being dismantled.

This book examines in depth the polarized, black-and-white, socially constructed racial categories that rest on fallacious ideas of physical or psychological differences among peoples. Neil Altman also critically examines related concepts including privilege, guilt, and power. He suggests that the polarization of our political positions also contribute to stereotyping between people with different political leanings, foreclosing mutual respect, dialogue and understanding. Finally, Dr. Altman’s book explores in detail the implications for the theory and practice of psychoanalytic psychotherapy.

Drawing on Neil Altman’s rich clinical experience and many years of engaging with racial and societal problems, the book offers a new agenda for understanding and offering analytic practice in contemporary society.

Admission cost: a donation of any amount to the nonprofit Harlem Family Institute

Dr. Neil AltmanPhD, is a member of the faculty at the William Alanson White institute in New York. He is Joint Editor Emeritus of “Psychoanalytic Dialogues: the International Journal of Relational Perspectives,” and a member of the editorial board at “Ricerca Psicoanalitica,” “The Journal of Child Psychotherapy,” “The Journal of Infant, Child, and Adolescent Psychotherapy” and “The International Journal of Applied Psychoanalytic Studies.” He is a member of the Harlem Family (Psychoanalytic) Institute’s Advisory Council.

He is author of “The Analyst in the Inner City: Race, Class, and Culture through a Psychoanalytic Lens” (Routledge, 2010) and “Psychoanalysis in Times of Accelerating Cultural Change: Spiritual Globalization” (Routledge, 2015). He has written numerous articles on clinical work with underserved and marginalized people, as well as his new “White Privilege: Psychoanalytic Perspectives” (Routledge, 2020).

Eugene EllisMA, Dip. PSA accredited, is an integrative arts psychotherapist practicing in the U.K. He has worked for many years with severely traumatized children and their families in the field of adoption and fostering, as well as in private practice. He has a special interest in body-orientated therapies and is also the founder of the Black, African and Asian Therapy Network.

His coming book “The Race Conversation: An essential guide to creating life-changing dialogue,” explores not just the cognitive and historical development of the race construct but also focuses specifically on the nonverbal communication of race, both as a means of social control and as an essential part of navigating oppressive patterns.

He is the author of many articles, including Silenced: the Black Student ExperienceTowards a Rainbow-Coloured Therapeutic CommunityUpdating Psychotherapy training: equality and diversity issues in psychotherapy training and Why strong black people do go counselling (Voice newspaper).

Ann Marie SacramoneMSEd, LP, is Chair of the Schools committee at the American Psychoanalytic Association, and Co-Chair of the Child, Adolescent and Parent Committee at the International Association for Psychoanalysis and Psychotherapy. She is also a senior faculty member at the Harlem Family (Psychoanalytic) Institute

The basis of Ms. Sacramone’s approach to fostering change with clients is based on the developmental processes that we understand through neuroscience, video microanalysis and attachment research. We influence and respond to each other when we interact with each other. Over time, those interactions can change how we think, feel, work, play and have relationships.

In her practice, Ms. Sacramone views that influence, response and change as a  therapeutic process. She practices that process in ways that lead to the vital growth of the client.  Part of that vital growth is the development of rich and fulfilling relationships in love and work. Ms. Sacramone treats adults and children.  In addition to her private practice, she has designed innovative models for school and community interventions that help both children and adults.

She has published and presented widely on psychoanalytic perspectives and applications in large social groups.A selected list can be found here.

Dr. Fanny BrewsterPhD, MFA, LP, is a Jungian analyst in private practice in Philadelphia. She holds a Doctorate in Clinical Psychology from Pacifica Graduate Institute, is a graduate of the C.G. Jung Institute of New York and is a New York State Licensed Psychoanalyst and Certified SchoolPsychologist. She is a senior faculty member at the Harlem Family (Psychoanalytic) Institute, where she is establishing the Institute’s new Public Programs. 

She is the author of several recent books, including The Racial Complex: A Jungian Perspective on Culture and Race,” 2019; Archetypal Grief: Slavery’s Legacy of Intergenerational Child Loss,” 2018; and African Americans and Jungian Psychology: Leaving the Shadows,” 2017.

The Harlem Family Institute Stands in Solidarity With Victims of Police Abuse in France


by Dr. Gilbert W. Kliman, MD, Chairperson

At The Harlem Family Institute, we hold in our hearts and minds that all of us in the world must unite against systemic racism.  We are in solidarity with victims of abuse as we recognize the social responsibility of all people of all races for the behavior of their police officers. We help psychoanalysts rise above being bystanders.  We recognize that all persons are the aggressors, bystanders and ultimately the police of a complexly interactive world.  As psychoanalysts of many colors at this unique place called The Harlem Family Institute, we have a special mission: It is to deepen and extend conscious responsibility to as many citizens of the planet as possible.

As Chairperson of The Harlem Family Institute, a New York psychoanalytic training institute, I know that at this Institute we have great knowledge about the great social damage done by lynching, beating and killing of black persons. These seemingly old abuses still occur, conspicuously by wrongful police action. But here at The Harlem Family Institute we know these abuses are also widely present in other societal forms. They greatly affect children directly and indirectly for generations to come.  The ways of affecting children are often unconscious.  We want to raise consciousness of the complex processes, to combat the abuse of human beings by human beings.

Our unique psychoanalytic institute is established to train people of all ethnicities, people of all colors and diversity more generally to become psychoanalysts. We train as well as treat oppressed people.  We offer forensic expert training in our acquired knowledge about the effects and actions of racism in this continuing crisis.  In our forensic and other community-oriented psychoanalytic trainings, we use our specially acquired knowledge. We often benefit from our clients’ gifts of their voices. Thus, we use recorded evidence of wrongdoings against children of color and those in poverty, not just adults.  We teach about the way the evil playbooks of racism travel through time, across generations. 

We support those who take leadership in expressing the ultimate consciousness of responsibility borne by all citizens of France and, by extension, the world.

Gilbert W. Kliman, MD


The Harlem Family Institute

New York

Four Challenges for Children Amid Our World’s Traumas

A Letter to Children by Gilbert W. Kliman, MD, HFI Board Chairman*
Saturday June 6, 2020

The Harlem Family Institute knows that recently there was a great day for space when Spacex launched two astronauts to the International Space Station from Florida, but it wasn’t such a good day for the Earth.

In fact, it was another bad day for all of us on the ground. That is the truth. Children, families, and whole populations in our own and many nations are facing four mental-health challenges. They are called crises because all are dangerous. All four crises require children to face very painful truths.

The latest of the crises is continuing clarity of evidence that black people are being killed by police. The whole world’s children see this painful truth for themselves. The truth is on modern videos made by witnesses to the murders. Protests and riots are happening as thousands of people see those videos and are outraged. After four hundred years have passed since the United States was founded with African American slaves as cruelly used helpers, the effects of that cruel history are still with us. Some estimates are that a black man in the United States has a one-in-one-thousand chance of being killed by a policeman, and that is a greater cause of death than many diseases. This injustice cannot be tolerated by white, black or any citizens, yet it keeps happening. That is the truth.

A second challenge is that millions of mostly older people they love are getting sick, and many are dying from a Covid-19 pandemic. Many of us know that the pandemic is a crisis that has been warned against for decades, but our current government was unprepared. It ignored the warnings, even used denial and avoidance of scientific truth. An awful mental-health aspect of the children’s need to cope is very hard on adults. That is the children must ultimately recognize that this pandemic crisis was foreseeable, preventable and that hundreds of thousands of deaths could have been reduced by honestly acting grownups. That painful recognition of adult shortcomings is required so we can prevent future pandemics. That is the truth.

The third mental-health challenge is that millions of previously employed people are suddenly unemployed. This crisis about money is because of the pandemic. As should have been expected and prepared for by the U.S. and other governments, many children whose caregivers lack money are hungry. They are at increased risk of malnutrition and are seeing their parents and caregivers depressed, irritable and helpless in the face of economic hardships. The U.S. and other governments have passed emergency laws to help the millions of suddenly unemployed. But the laws aren’t enough and often don’t even work to provide financial help to the unemployed. Lines for food distribution sometimes are miles long, filled with hungry people, many of them unable to feed their vulnerable children. That is the truth.

The fourth mental-health challenge is that preventable climate change threatens the lives of all future generations. Again, this dreadful stress was foreseeable, a preventable crisis. Damage to our planet and its many forms of life could have been reduced by honestly acting grownups. To help children with these enormous stressors, there is one necessary remedy without which little else will work. The remedy is that adult acceptance and advancement of scientific knowledge and honest adult leadership are required about both the pandemic and climate change. Adult honesty and facing facts will help children become more resilient and mentally healthier. That is the truth.

While the world’s politicians struggle to bring justice, food and economic stability to our nation — and while pandemic scientists search for better tests, treatments, cures and vaccines — parents, teachers and caregivers everywhere have the opportunity to improve their children’s knowledge and mental health. At the same time, our children deserve to know that their planet can probably be saved by listening to historians, honest leaders and climate scientists. Adults cannot seem to do this listening very well, especially at governmental levels. Children will have to grow up in a world whose races, resources, climate and all its living creatures have literally been threatened by the mistakes, ignorance, deliberate denials, greed, political motives and even selfish dishonesty of grownup leaders. That is the truth.

Unaccustomed as adults are in helping children face painful truths, we must do just that. With small children we can begin with pediatric doses of truth. We need the spread of truth from protests, government, school and family sources in order to inspire trust in children. Children will usually be frightened by protests. Usually and fortunately, most will have enough food and be the least physically sickened by the new virus. They will suffer mentally as they see hunger, violent protests, lose loved ones, often becoming orphaned and especially losing grandparents. Surviving grownups will have to help the children mourn while growing up. In some nations, children will grow up caring for bereaved younger siblings. That is not an easy psychological task. That is the truth.

Children are beginning to know that they will live through the epidemic and yet be living in a planet damaged by racism, dishonesty, injustices, food shortages, inequalities and climate change. We hope they rise to the challenge of becoming mentally active, curious, and educated. By mastering severe world-wide stresses, children can grow up to lead the world into political, scientific and medical progress. We will need their help as well as current adult world-wide cooperation to overcome our planet’s problems. That is the truth.

There are many other crises, injustices and challenges that adults aren’t solving or where they aren’t even listening to the victims. Children will have a hard job to make up for crises their parents couldn’t understand and solve. We at the Harlem Family Institute hope and try our hardest to help children do better. That is also the truth.

* Dr. Kliman received the American Psychoanalytic Association President’s 2020 Humanitarian Award for his lifetime psychoanalytic leadership in treating and advocating for underserved and traumatized children worldwide.

Studies of Treatment Effectiveness

Studies of Treatment Effectiveness: Comparing
Psychodynamic Therapies with CBT and Medication

Mark Winborn, PhD, NCPsyA

In recent years there has been a great deal of publicity and advertising regarding the benefits of medication and cognitive behavioral therapy (CBT) as cost effective approaches to treating emotional issues and various forms of mental disturbance. Additionally, sources that advocate for the use of “cost-effective” treatments often point to psychodynamic treatment as outdated, ineffectual and not cost-effective.

However, the information being disseminated to the public doesn’t accurately portray the effectiveness of either medication or CBT, nor does it accurately represent the available research on psychodynamic therapy as a robust, contemporary treatment that is both clinically effective and cost-effective. The psycho-pharmaceutical industry and insurance companies have vested monetary interest in misrepresenting the scientific findings for these various treatments. In this brief position paper, the available scientific literature for medication interventions, CBT, and psychodynamic psychotherapy will be contrasted and reviewed.

Large-Scale Studies of Treatment Effectiveness:
In a large-scale review of meta-analyses (a statistical method of combining multiple studies to create a larger subject pool) Shedler (2010) was able to compare the “effect size” of three broad kinds of treatments: (i) using only medication to treat depression, (ii) using CBT and other behavioral treatments, and (iii) using psychodynamic therapy to treat a range of symptoms. The comparison was made across dozens of studies and thousands of patients. An effect size represents a statistical method for comparing the results of studies that utilize different research designs and outcome evaluation tools. Typically, an effect size of .50 is good and an effect size of 1.0 is extremely good.

Treatment Outcomes                                                                                         Effect Size

  • Anti-Depressants (74 studies)                                                                         0.31
  • Cognitive Behavioral Therapy (33 studies)                                                    0.68
  • Psychodynamic Treatment – General Symptoms (12 studies)                    0.97
  • Psychodynamic Treatment – Personality Disorders (14 studies)                1.46
  • Psychodynamic Treatment – Complex Disorders (7 studies)                      1.80

An effect size of 0.31 for anti-depressants does demonstrate a statistically significant effect associated with anti-depressant medications. However, it also demonstrates that the effect of anti-depressants is actually much smaller than either CBT or psychodynamic psychotherapy. Similarly, the overall size of the treatment effect of psychodynamic psychotherapy is significantly larger than for either CBT or medication. In addition, the table above demonstrates that the treatment effect for psychodynamic psychotherapy is even larger when the patient population being studied has more severe psychological issues, such as a diagnosis of a personality or a complex disorder (i.e. a diagnosis involving several categories of disruption).

Treatment Effect after Treatment Concludes:
However, the effectiveness (and cost-effectiveness) of any treatment cannot be evaluated by the degree of change at the conclusion of the study. In CBT and and/or antidepressant treatment the treatment effect begins to decline almost immediately after the treatment is discontinued. Average time to relapse to pre-treatment level of functioning was 3.6 months and approximately 71% total relapse in a combination of CBT and medication (see Rush et. al. 2006).

In contrast, several studies demonstrate that the treatment effect of psychodynamic psychotherapy does not begin to diminish over time. In fact, it continues to grow stronger over time. In other words, psychodynamic therapy does more than provide short-term symptom relief – it also results in positive changes to the patient’s psychological structure. Growth in post-treatment effect is shown below:
                                                                                                         Effect Size
Post-Treatment Psychodynamic (9 months)                              1.51 – 2.21
(Depending upon diagnostic group – see Abbass et. al., 2006)

Clearly, the effect size for psychodynamic treatments across various patient population continues to increase at 9 months follow-up after treatment (showing an average increase in effect size of 0.65) rather than declining precipitously as it does with CBT and medication interventions. However, the treatment effect of psychodynamic treatment continues to grow long after treatment concludes:

  • Leischsenring (2013) demonstrated an increase of effect size from 1.03 at the conclusion of treatment to an effect size of 1.25 after 23 months.
  • A study by de Maat et. al. (2009) showed that the treatment effect of psychodynamic treatment had grown an additional 0.22 for mild to moderate symptom groups at 3.2 years. The same study demonstrated that the effect grew an additional 0.08 after 5 years for severe personality disorders.
  • Another study (Bateman & Fonagy, 2008) examined the effect of intensive psychodynamic treatment (partial hospitalization based) on a group of patients diagnosed with borderline personality disorder (a very difficult condition to treat). 18 months after the conclusion of treatment, 57% of those patients no longer met the criteria for borderline personality disorder that compares favorably to the control group for this study for whom 13% no longer met criteria for borderline personality when followed up at 18 months post-treatment. The control group received “treatment as normal” consisting of medication management and CBT. However, what is most astonishing is that when the participants in the study were followed up at 8 years post-treatment it was discovered that 87% of the psychodynamic treatment group no longer met the criteria for borderline personality, while the percentage of improvement for the control group remained unchanged at 13%.

Shedler’s findings are consistent with a more recent meta-analysis conducted by Town et. al. (2012) 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 (46 treatment samples) for overall outcome was large (effect size 1.01), and further improvement (an additional effect increase of 0.18) was observed between posttreatment and an average follow-up of 12.8-months.

Again, these studies demonstrate that the positive effect of psychodynamic treatment consistently increases across time following the conclusion of treatment and that this effect is more pronounced as the severity and complexity of the patient’s symptoms increases. The increase of treatment effectiveness and the greatly diminished chance of relapse in comparison to CBT and medication needs to be taken into consideration when assessing cost-effectiveness of various treatments.

Looking further into CBT:
In several large-scale implementations of CBT as the treatment of choice in state sponsored programs in Scotland and Sweden there was no discernable beneficial effect over the long-term. A follow-up evaluation (see Durham et. al. 2005) of the participants in 10 large-scale studies of CBT conducted by the National Health Service of Scotland concluded: “The positive effects of CBT found in the original trials were eroded over longer time periods. No evidence was found for an association between more intensive therapy and more enduring effects of CBT. The cost-effectiveness analysis showed no advantages of CBT over non-CBT.”

Similarly, between 2008-2012 there was a countrywide implementation of CBT as the preferred psychological treatment in Sweden. The Swedish government invested more than a billion Swedish crowns (approximately $500 million US dollars) during the course of the implementation with 40,000 -50,000 individuals receiving CBT treatment in each year of the program. Karolinska Institut (a medical university) conducted an evaluation of the program in two studies. The final conclusion of the research team enlisted to evaluate the program was: “The widespread adoption of the [CBT] method has had no effect whatsoever on the outcome of people disabled by depression and anxiety,” (see Miller, 2012).

Session Frequency and Duration of Treatment:
Another criticism of psychodynamic therapies is the tendency for some therapies to take place at a frequency of greater than once per week and to have a longer duration. However, there is evidence for additional effectiveness in psychodynamic therapy when session frequency increases and the duration is longer. A study in Stockholm (Sandell et al., 2000) followed 400 patients over a three-year period. Two groups were treated in 3–4 times weekly psychoanalysis or 1–2 times weekly psychoanalytically oriented therapy. Although both groups improved significantly, treatment duration and session frequency were positively correlated with long-term clinical outcome.

In a review by Leischsenring (2004, 2008, 2013), there is evidence from randomized controlled treatment trials which supports the efficacy of both short-term (STPP) and long-term psychodynamic psychotherapy (LTPP) for specific mental disorders. However, in series of meta-analyses, LTPP was shown to be superior to shorter forms of psychotherapy, especially in complex mental disorders. Their data on dose-effect relations suggest that for many patients with complex mental disorders, including chronic mental disorders and personality disorders, short-term psychotherapy is not sufficient. The meta-analysis presented by Leischsenring supports long-term psychodynamic psychotherapy in these populations. In Leischsenring’s reviews he has found LTPP to have a 0.65 larger effect size than STPP.

This review supports psychodynamic therapy as an effective form of therapy that is actually more effective over the long term than either medication or CBT. Additionally, because the gains associated with psychodynamic psychotherapy are more stable, the likelihood of relapse is diminished and therefore it has significant additional cost savings over time than CBT and medication where the likelihood of relapse remains high.

Abbass, A. A., Hancock, J. T., Henderson, J., & Kisely, S. (2006). Short-term psychodynamic psychotherapies for common mental disorders. Cochrane Database of Systematic Reviews, Issue 4, Article No. CD004687. doi:10.1002/14651858.CD004687.pub3.

Bateman, A., & Fonagy, P. (2008). 8-year follow-up of patients treated for borderline personality disorder: Mentalization-based treatment versus treatment as usual. American Journal of Psychiatry, 165: 631–638.

de Maat, Sde Jonghe, FSchoevers, R, & Dekker, J. (2009). The effectiveness of long-term psychoanalytic therapy: a systematic review of empirical studies. Harvard Review of Psychiatry, 17(1): 1-23.

Durham, RC, Chambers, JA, Power, KG, Sharp, DM, et al. (2005). Long-term outcome of cognitive behaviour therapy clinical trials in central Scotland. Health Technology Assessment 9(42):1-174.

Leichsenring, F., Rabung, S., & Leibing, E. (2004). The efficacy of short-term psychodynamic psychotherapy in specific psychiatric disorders: A meta-analysis. Archives of General Psychiatry, 61, 1208–1216

Leichsenring, F., & Rabung, S. (2008). Effectiveness of long-term psychodynamic psychotherapy: A meta-analysis. Journal of the American Medical Association, 300, 1551–1565.

Leischsenring, F., Abbass, A., Luyten, P., Hilsenroth, M. and Rabung, S. (2013) The Emerging Evidence for Long-Term Psychodynamic Therapy. Psychodynamic Psychiatry, 41: 361-384.

Miller, S. (2012, May 13). Revolution in Swedish mental health practice: The cognitive behavioral therapy monopoly gives way. Retrieved from

Rush, AJ, Trivedi, MH, and Wisniewski, SR. et al. (2006). Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am J Psychiatry. 163:1905–1917.

Sandell, R., Blomberg, J., Lazar, A., Carlsson, J., Broberg, J., & Schubert, J. (2000). Varieties of long-term outcome among patients in psychoanalysis and long-term psychotherapy: A review of findings in the Stockholm Outcome of Psychoanalysis and Psychotherapy Project (STOPP). International Journal of Psycho-Analysis, 81, 921–942.

Shedler, J. (2010) The Efficacy of Psychodynamic Psychotherapy, American Psychologist, Vol. 65, No. 2, 98–109.

Town, J., Diener, M., Abbass A., Leichsenring, F., Driessen, E., & Rabung S. (2012) A Meta-Analysis of Psychodynamic Psychotherapy Outcomes. Psychotherapy, Vol. 49, No. 3, 276-90.

Additional Bibliographies of Research on the Effectiveness of Psychoanalytic Therapies:

British Psychoanalytic Council –

American Psychoanalytic Association –