A meta-analysis of 23 studies reported in the Journal of the American Medical Association finds that people with complex mental disorders who received long-term psychodynamic psychotherapy (LTPP) did much better than 96 per cent of the people who received cognitive behavioural therapy (CBT), short-term psychodynamic therapy, dialectical behavioural therapy, family therapy, and supportive therapy.

The JAMA meta-analysis, led by German psychologist Falk Leichsenring, looked at studies of psychodynamic therapies that lasted for at least a year or for 50 sessions. The analysis found that LTPP yielded significantly larger improvements in overall effectiveness, targeted problems, and personality functioning for such disorders as borderline personality, eating disorders, and other chronic or multiple disorders. Moreover, the outcomes continued to improve after therapy ended.
LTPP was especially effective for people with anxiety or depression. Interestingly, when it was combined with psychotropic medications, its effectiveness, while still greater than that of the short-term therapies, was lower than it was without medications. Leichsenring suspects that medication either inhibits LTPP in some way, or that the clinical trial patients who were taking medications were more severely impaired than the ones who weren’t.

The study leaves open the question of whether short-term therapy or LTPP is more cost-effective with patients suffering from complex mental disorders. Leichsenring draws the usual cautious conclusion that although LTPP may be more cost-effective in the long run, research remains to be done on this point.

Psychotherapy Networker