Journal of Contemporary Psychotherapy

, Volume 42, Issue 4, pp 249–256 | Cite as

The Effectiveness of Brief Versus Intermediate Duration Psychodynamic Psychotherapy in the Treatment of Adjustment Disorder

  • Shulamit Ben-ItzhakEmail author
  • Irit Bluvstein
  • Shaul Schreiber
  • Inbar Aharonov-Zaig
  • Maya Maor
  • Raul Lipnik
  • Miki Bloch
Original Paper


Treatment studies and particularly psychotherapeutic treatment studies of patients suffering from an adjustment disorder are very scarce, leading to insufficient evidence regarding the efficacy of treatment in this population. Whereas timely psychotherapy is known to be of benefit in the treatment of adjustment disorders, the ideal duration of psychotherapeutic interventions is not known. This study examined whether a brief 12-session focused psychodynamic psychotherapy may be as efficient as a longer intermediate-term (1 year) psychodynamic psychotherapy in treating patients suffering from an adjustment disorder. Subjects (n = 66) were randomly assigned to either brief or intermediate psychotherapy. They were assessed by self-report measures and clinician’s evaluation at baseline, end of therapy, and 9 months after therapy was terminated. The results showed a good overall improvement in the whole group. Furthermore, brief psychotherapy was found to be as good as intermediate psychotherapy both at the end of treatment and at follow-up. Although our study was not designed to confirm the efficacy of dynamic psychotherapy in the treatment of adjustment disorders, our results suggest that brief interventions may be good enough in adjustment disorder, thus allowing treatment of a greater number of patients without compromising for the quality and suitability of treatment.


Adjustment disorder Brief psychotherapy Psychodynamic psychotherapy Treatment outcome 



We thank Dr. Yaron Yagil and Mrs. Yael Gottlieb-Litvin for their active role in designing and conducting this study. The study was funded by internal means only.

Conflict of interest

The authors declare that they have no conflict of interest.


  1. Altenhofer, A., Schulz, W., Schwab, R., et al. (2007). Psychotherapy of adjustment disorders. Is psychotherapy if limited to 12 sessions sufficiently effective? Psychotherapeutics, 52, 24–34.CrossRefGoogle Scholar
  2. Azocar, F., & Greenwood, G. L. (2007). Adult adjustment disorder: A review of its current diagnostic status: A Brief Report. The Internet Journal of Mental Health, 4, 3.Google Scholar
  3. Barron, F. (1953). An ego strength scale which predicts response to psychotherapy. Journal of Consulting Psychology, 17(5), 327–333.PubMedCrossRefGoogle Scholar
  4. Barrowclough, C., Meier, P., Beardmore, R., & Emsley, R. (2010). Predicting therapeutic alliance in clients with psychosis and substance misuse. Journal of Nervous and Mental Disease, 198(5), 373–377.PubMedCrossRefGoogle Scholar
  5. Baumeister, H., & Kufner, K. (2009). It is time to adjust the adjustment disorder category. Current Opinion in Psychiatry, 22(4), 409–412.PubMedCrossRefGoogle Scholar
  6. Baumeister, H., Maercker, A., & Casey, P. (2009). Adjustment disorders with depressed mood: A critique of its DSM-IV and ICD-10 conceptualization and recommendations for the future. Psychopathology, 42(3), 139–147.PubMedCrossRefGoogle Scholar
  7. Bhar, S. S., Thombs, B. D., Pignotti, M., Bassel, M., Jewett, L., Coyne, J. C., et al. (2010). Is longer-term psychodynamic psychotherapy more effective then shorter-term therapies? Review and critique of the evidence. Psychotherapy and Psychosomatics, 79(4), 208–216.PubMedCrossRefGoogle Scholar
  8. Cabaniss, B. L., Cherry, S., Douglas, C. J., & Schwartz, A. R. (2011). Psychodynamic psychotherapy: A clinical manual. West Sussex: Wiley.Google Scholar
  9. Carta, M. G., Balestrier, M., Murru, A., & Hardoy, M. C. (2009). Adjustment disorder: Epidemiology, diagnosis and treatment. Clinical Practice and Epidemiology in Mental Health,. doi: 10.1186/1745-0179-5-15.PubMedGoogle Scholar
  10. Casey, P. (2001). Adult adjustment disorder: A review of its current diagnostic status. Journal of Psychiatric Practice, 7(1), 32–40.PubMedCrossRefGoogle Scholar
  11. Casey, P. (2009). Adjustment disorder: Epidemiology diagnosis and treatment. CNS Drugs, 23(11), 927–938.PubMedCrossRefGoogle Scholar
  12. Cohen, J. (1977). Statistical power analysis for the behavioral sciences. New York: Academic Press.Google Scholar
  13. Derogatis, L. R. (1983). SCL-90-R: Administration, scoring, and procedures manual-II. In M. D. Towson (Ed.), Clinical Psychometric Research. Baltimore: John Hopkins University Press.Google Scholar
  14. First, M. B., Spitzer, R. L., Gibbon, M. & Williams, J. B.W. (1995). Structured clinical interview for DSM-IV patient edition (SCID-I/P, Version 2.0). Biometrics Research Department. New York: New York State Psychiatric Institute.Google Scholar
  15. Gorschenek, N., Schwab, R., & Eckert, J. (2008). Psychotherapy of adjustment disorders. Psychotherapy, Psychosomatic and Medical Psychology, 58(5), 200–207.CrossRefGoogle Scholar
  16. Guy, W. (1976). Clinical Global Impressions. In ECDEU assessment manual for psychopharmacology, revised. Rockville: MD: National Institute of Mental Health National Institute of Mental Health, pp. 217–22.Google Scholar
  17. Horvath, A. O., & Greenberg, L. S. (1989). Development and validation of the Working Alliance Inventory. Journal of Consulting and Clinical Psychology, 36(2), 223–233.Google Scholar
  18. Knekt, P., Lindfors, O., Harkanen, T., Valikoski, M., Virtala, E., Laaksonen, M. A., et al. (2008a). Randomized trial on the effectiveness of long- and short-term psychodynamic psychotherapy and solution-focused therapy on psychiatric symptoms during a 3-year follow-up. Psychological Medicine, 38(5), 689–703.PubMedCrossRefGoogle Scholar
  19. Knekt, P., Linfors, O., Laaksonen, M. A., Raitasalo, R., Haaramo, P., & Jarvikoski, A. (2008b). Effectiveness of short-term and long-term psychotherapy on work ability and functional capacity—A randomized clinical trial on depressive and anxiety disorders. Journal of Affective Disorders, 107(1–3), 95–106.PubMedCrossRefGoogle Scholar
  20. Laugharne, J., van der Watt, G., & Janca, A. (2009). It is too early for adjusting the adjustment disorder category. Current Opinion in Psychiatry, 22(1), 50–55.PubMedCrossRefGoogle Scholar
  21. Leichsenring, F., & Leibing, E. (2007). Psychodynamic psychotherapy: A systematic review of techniques, indications and empirical evidence. Psychology and Psychotherapy, 80(2), 217–228.PubMedCrossRefGoogle Scholar
  22. Leichsenring, F., Rabung, S., & Leibing, E. (2004). The efficacy of short-term psychodynamic psychotherapy in specific psychiatric disorders: A meta-analysis. Archives of General Psychiatry, 61(12), 1208–1216.PubMedCrossRefGoogle Scholar
  23. Maercker, A., Forstmeier, S., Enzler, A., Krusi, G., Horler, E., Maier, C. & Ehlert, U. (2008). Adjustment disorders, posttraumatic stress disorder, and depressive disorders in old age: findings from a community survey. Comprehensive Psychiatry, 49(2), 113–120.PubMedCrossRefGoogle Scholar
  24. Maina, G., Forner, F., & Bogetto, F. (2005). Randomized controlled trial comparing brief dynamic and supportive therapy with waiting list condition in minor depressive disorders. Psychotherapy and Psychosomatics, 74(1), 43–50.PubMedCrossRefGoogle Scholar
  25. Malan, D. H. (1976). Toward a validation of dynamic psychotherapy: A replication. New York: Plenum.CrossRefGoogle Scholar
  26. Ogrodniczuk, J. S., Joyce, A. S., & Piper, W. E. (2005). Strategies for reducing patient-initiated premature termination of psychotherapy. Harvard Review of Psychiatry, 13, 57–70.PubMedCrossRefGoogle Scholar
  27. Shalev, A. Y., Abramowitz, M. Z. & Kaplan-De-Nour, A. (1994). Structured clinical interview for DSM-IV patient edition (SCID-I/P, Version 2.0; Hebrew Version, 1994). Center for Traumatic Stress, Department of Psychiatry. Jerusalem: Hadassah University Hospital.Google Scholar
  28. Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 65(2), 98–109.PubMedCrossRefGoogle Scholar
  29. Startup, M., Jackson, M. C., & Bendix, S. (2002). The concurrent validity of the Global Assessment of Functioning (GAF). British Journal of Clinical Psychology, 41(4), 417–422.PubMedCrossRefGoogle Scholar
  30. Stirman, S. W., DeRubeis, R. J., Crits-Christoph, P., & Rothman, A. (2005). Can the randomized controlled trial literature generalize to nonrandomized patients? Journal of Consulting and Clinical Psychology, 73(1), 127–135.PubMedCrossRefGoogle Scholar
  31. Strain, J., & Diefenbacher, A. (2008). The adjustment disorders: The conundrums of the diagnoses. Comprehensive Psychiatry, 49(2), 121–130.PubMedCrossRefGoogle Scholar
  32. Veit, C. T., & Ware, J. E. (1983). The structure of psychological distress and well-being in general populations. Journal of Consulting and Clinical Psychology, 51(5), 730–742.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Shulamit Ben-Itzhak
    • 1
    Email author
  • Irit Bluvstein
    • 2
    • 4
  • Shaul Schreiber
    • 2
    • 4
  • Inbar Aharonov-Zaig
    • 2
  • Maya Maor
    • 3
  • Raul Lipnik
    • 2
  • Miki Bloch
    • 2
    • 4
  1. 1.Psychological DivisionSourasky Medical CenterTel AvivIsrael
  2. 2.Department of PsychiatrySourasky Medical CenterTel AvivIsrael
  3. 3.Gender Studies ProgramBen-Gurion UniversityBe’er ShevaIsrael
  4. 4.Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael

Personalised recommendations