Evidence Mounts for Benefits of Long-Term Psychodynamic Treatment

What role should long-term psychodynamic psychotherapy (LTPP) play in the treatment of patients with mental illness, particularly those with complex mental disorders?

A recently published meta-analysis offers evidence that LTPP is an effective treatment for those with personality disorders, chronic mental disorders, multiple mental disorders, and complex and depressive anxiety disorders.¹ Twenty-three studies that involved 1053 patients 17 years or older met inclusion criteria; these were prospective studies in which LTPP was administered for at least 1 year or 50 sessions.

LTPP yielded large and stable effect sizes in patients with personality disorders, multiple mental disorders, and chronic mental disorders. After a comparative analysis of controlled trials, a between-group effect size of 1.8 indicated that patients with complex mental disorders, on average, were better off than 96% of the patients in comparison groups after treatment (P = .002). The authors found that LTPP offered significant, large, and stable within-group effect sizes across various and particularly complex mental disorders (range, 0.78 to 1.98).

The authors comment that short-term psychotherapy does not benefit a sizeable proportion of patients with chronic mental disorders or personality disorders. Their meta-analysis found that LTPP affords significantly superior outcomes compared with short-term methods of psychotherapy in overall effectiveness, target problems, and personality functioning. This evidence of benefit is important, they note, because LTPP costs more than short-term therapy. They recommend further research into the effects of LTPP in persons with specific mental disorders that includes a cost-effectiveness analysis.

References:

1. Leichsenring F, Rabung S. Effectiveness of long-term psychodynamic psychotherapy: a meta-analysis. JAMA. 2008;300:1551-1565. n