A meta-analysis published in the October 1 issue of JAMA finds that for patients with complex mental disorders, such as personality and chronic mental disorders, psychodynamic psychotherapy lasting for at least a year is effective and superior to shorter-term therapy.

Psychodynamic psychotherapy focuses on revealing the unconscious content of a client’s psyche in an effort to alleviate psychic tension. Previous research has shown that for many patients with multiple or chronic mental disorders or personality disorders, short-term psychodynamic psychotherapy is insufficient. Other studies recommend long-term psychodynamic psychotherapy (LTPP) for these patients with complex mental disorders. In LTPP, careful attention is given to the therapist-patient interaction, and emphasis is placed on more interpretive or supportive interventions.

In their meta-analysis, Falk Leichsenring, D.Sc. (University of Giessen, Germany) and Sven Rabung, Ph.D. (University Medical Center Hamburg-Eppendorf, Hamburg, Germany) analyzed 23 studies – 11 randomized controlled trials and 12 observational studies – with 1,053 patients receiving LTPP. The researchers examined the effectiveness of LTPP (lasting for at least a year, or 50 sessions) and whether it is superior to shorter psychotherapeutic treatments for complex mental disorders such as personality disorders, chronic mental disorders (lasting a year or longer), and multiple mental disorders.

“In this meta-analysis, LTPP was significantly superior to shorter-term methods of psychotherapy with regard to overall outcome, target problems, and personality functioning. Long-term psychodynamic psychotherapy yielded large and stable effect sizes in the treatment of patients with personality disorders, multiple mental disorders, and chronic mental disorders. The effect sizes for overall outcome increased significantly between end of therapy and follow-up,” write the authors.

Patients with complex mental disorders who were treated with LTPP were, on average, better off than 96% of the comparison group patients with regard to overall effectiveness. Further research is needed, however, to evaluate the cost-effectiveness of LTPP.

Effectiveness of Long-term Psychodynamic Psychotherapy: A Meta-analysis
Falk Leichsenring; Sven Rabung
JAMA (2008). 300[13]: pp. 1551-1565.
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Written by: Peter M Crosta