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Long-Term Psychotherapy Beats Short-Term

Study Shows Greater Effectiveness for Long-Term Psychodynamic Psychotherapy
By Caroline Wilbert
WebMD Health News
Reviewed by Louise Chang, MD

Sept. 30, 2008 -- Long-term psychodynamic psychotherapy (LTPP) is more effective than short-term therapy for patients with complex mental disorders such as personality disorders, according to a new report.

The report's authors, including Falk Leichsenring, DSc, of the University of Giessen in Germany and Sven Rabung, PhD, of the University Medical Center Hamburg-Eppendorf in Hamburg, Germany, analyzed data from 23 existing studies, involving a total of 1,053 patients treated with long-term psychodynamic psychotherapy. In all the studies, LTPP lasted at least a year.

According to the American Psychiatric Association, psychodynamic psychotherapy is a "treatment to help patients understand themselves more fully. This approach may involve uncovering -- and learning to deal more effectively with -- unconscious conflicts. It may also involve assisting patients to understand how certain types of adverse childhood experiences have left them feeling incomplete, anxious, or plagued with low self-esteem that interferes with realistic adult functioning."

The report, published in The Journal of the American Medical Association, concluded that patients with complex mental disorders who completed LTPP were better off than 96% of patients in comparison groups. Complex mental disorders included personality disorders, chronic mental disorders lasting at least a year, complex depressive or anxiety disorders, or those with two or more 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," the study says.

In an accompanying editorial, Richard M. Glass, MD, deputy editor of The Journal of the American Medical Association, argues that LTPP is being used less these days, at least in part because it is not as cost-effective as medication with brief supportive visits.

"This trend appears to be strongly related to financial incentives and other pressures to minimize costs," he writes. "Is that what is really wanted for patients with disabling disorders that could respond to more intensive treatment?"

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