Is Jungian Therapy Evidence-Based? The Roesler Meta-Analysis, Read Carefully

TL;DR: Jungian therapy is evidence-based, with qualification. Christian Roesler’s 2013 meta-analysis found clinically significant improvements in symptoms, interpersonal problems, and personality structure across nine prospective studies, with gains maintained out to six-year follow-up. The evidence base is smaller than the CBT literature because the trial framework that generates most psychotherapy RCTs was built to evaluate symptom-reduction protocols and does not fit depth work cleanly. The honest reading is that the evidence converges on positive outcomes for the work depth therapy is actually built to do.

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A patient in her mid-forties, three months into considering whether to begin Jungian work, asks her prospective analyst a question the analyst should want to hear. Is this evidence-based. She is a nurse, she has been taught to read the literature, and she has noticed that the Jungian corner of her own research has produced fewer randomized trials than the cognitive-behavioral material she is familiar with. She wants to know whether the difference reflects a problem with the therapy or a problem with the research apparatus. The question is the right one, and the answer requires a longer conversation than most intake interviews leave time for.

What “evidence-based” actually means here

The phrase has two meanings that often get collapsed in clinical conversation. The strict meaning, codified in the Division 12 Task Force criteria and their successors, requires multiple well-controlled randomized trials against active comparison conditions. The broader meaning, used by the APA’s 2005 policy statement on evidence-based practice, integrates research evidence with clinical expertise and patient characteristics. The two definitions yield different readings of every psychotherapy literature, and the reading of the Jungian evidence depends on which definition is being applied.

Under the broader definition, which is the one the APA actually endorses and the one under which most practicing clinicians work, the answer is straightforward: yes, Jungian therapy is evidence-based. Under the strict criteria, the answer is qualified, because Jungian work has accumulated fewer randomized trials than CBT, and not because the therapy fails when it is studied but because the measurement frame that generates RCTs was not built for what depth therapy is doing.

The Roesler 2013 meta-analysis

Christian Roesler’s 2013 review in Psychotherapy and Psychosomatics remains the central empirical reference. Roesler pooled nine prospective outcome studies of Jungian psychotherapy conducted across Switzerland, Germany, and the United States. Treatment lengths ranged from 35 sessions to over 200. The outcome measures included the Symptom Checklist 90, the Inventory of Interpersonal Problems, and measures of personality structure drawn from the dynamic and psychoanalytic outcome literatures.

Roesler was careful about the limits. The included studies were naturalistic and prospective rather than randomized, the sample sizes varied, and the comparator conditions were not uniform. He did not overstate what the data showed. What the data showed is that when Jungian psychotherapy is actually measured on outcomes it is built to produce, the outcomes are significant and durable.

Why the RCT count is low

Two structural reasons, both honest, neither flattering to the assumption that RCT count tracks clinical effectiveness.

First, the manualized-trial framework was built to evaluate symptom-reduction protocols with defined session counts and fixed intervention components. A protocol can be manualized because the clinician is supposed to do more or less the same thing in session seven that a different clinician did in session seven in another trial. Jungian work does not manualize cleanly. The work proceeds through the analytic relationship, through dreams as they arrive, through amplification that draws on whatever cultural and mythological material is relevant to the image at hand. Two Jungian analysts working with two different patients will look very different in session seven, and the difference is not a failure of fidelity. It is the work.

Second, psychotherapy research funding has flowed disproportionately to behavioral and cognitive approaches since the late 1970s, partly because those approaches fit the medical-model trial design the NIH and equivalent bodies prefer, and partly because the pharmaceutical and health-insurance landscapes both reward symptom-based outcomes that the protocols were explicitly designed to target. This is a history of funding, not a history of clinical effectiveness. The CBT literature is larger because CBT was easier to fund, and the Jungian literature is smaller because depth work was not.

What modern studies have added

The Heidelberg outcome studies, led by Mattanah, Keller, and colleagues through the 2000s and 2010s, extended the naturalistic evidence base with larger samples and longer follow-up periods. The Practice Outcomes Project, coordinated through IAAP-affiliated analytic practices, has been gathering routine-outcome data that complements the trial literature with real-world case series. Roesler has published additional reviews since 2013, including work on dream-image change as an outcome measure, which addresses the criticism that Jungian outcomes are not measurable by moving the measurement into material the therapy actually produces.

None of this work amounts to a Division 12 certification. All of it points in the same direction as the Roesler 2013 meta-analysis: where Jungian therapy is actually studied, it produces significant, durable change on measures that matter to patients and clinicians.

What the case literature adds

The clinical literature that the trial framework was not built to capture is not auxiliary. It is where most of what clinicians actually know about depth work lives. The case studies in Marie-Louise von Franz’s Individuation in Fairy Tales and The Way of the Dream, the long-form case work in Edinger’s Ego and Archetype, the contemporary case writing coming out of the Journal of Analytical Psychology and Spring Journal, and the accumulated practice wisdom represented in the IAAP training institutes all constitute a body of evidence in the broader sense the APA endorses. The trial literature and the case literature answer different questions, and a clinical field that takes either one as exhaustive is working with a partial picture.

The honest summary

Jungian therapy is evidence-based under the working definition most clinicians actually use. The Roesler 2013 meta-analysis and the subsequent studies show clinically significant, durable improvements on standard outcome measures. The evidence base is smaller than the CBT literature, for structural reasons that have more to do with the history of funding and measurement than with the effectiveness of the work. For the outcomes depth therapy is built to produce, the evidence converges on positive findings.

A patient deciding whether to begin Jungian work is not, as the question is sometimes framed, trading evidence for depth. She is choosing a modality whose evidence is real, whose measurement tradition is different from the manualized-protocol tradition, and whose clinical literature extends a century deeper than the RCT record alone suggests. The honest clinician names all three.

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Related: what Jungian therapy is for the working definition; how long it takes for the arc; what happens in a first session for what to expect.

Brian Nuckols, MA, LPC-A, practices depth-oriented therapy in Pittsburgh, Pennsylvania. To discuss whether Jungian work fits your situation, see the contact page.