Abstract
Despite growing evidence for the effectiveness of psychodynamic psychotherapy in general, the place of long-term psychodynamic psychotherapy (LTPP) remains controversial. Outcome studies of LTPP have been lacking for a long time. This chapter reports on the first meta-analysis of the effectiveness of LTPP, defined as lasting at least 1 year or 50 sessions. Findings suggest that LTPP yielded large and stable effects across various diagnoses and particularly in complex mental disorders (i.e., personality disorders, chronic mental disorders, and multiple mental disorders). For overall outcome, the effect sizes did even increase significantly after termination of treatment. The comparison of RCTs versus observational studies revealed no significant differences in outcome. If compared to other methods of psychotherapy that were predominantly less intensive or shorter term, LTPP proved to be significantly superior with regard to overall outcome, target problems, and personality functioning. As could be expected, discussion of findings was contentious but none of the raised concerns identified an issue that would have affected the overall conclusions of the meta-analysis. Nevertheless, further studies are particularly required to confirm the results and to allow for more refined analyses addressing the effects of LTPP both in specific disorders and in comparison to specific forms of therapies.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Gabbard GO, Gunderson JG, Fonagy P. The place of psychoanalytic treatments within psychiatry. Arch Gen Psychiatry. 2002;59:505–10.
Kernberg OF. Psychoanalytic contributions to psychiatry. Arch Gen Psychiatry. 2002;59:497–8.
Fonagy P, Roth A, Higgitt A. Psychodynamic therapies, evidence-based practice and clinical wisdom. Bull Menninger Clin. 2005;69:1–58.
Leichsenring F. Comparative effects of short-term psychodynamic psychotherapy and cognitive-behavioral therapy in depression: a meta-analytic approach. Clin Psychol Rev. 2001;21:401–19.
Leichsenring F, Leibing E. The effectiveness of psychodynamic therapy and cognitive behavior therapy in the treatment of personality disorders: a meta-analysis. Am J Psychiatry. 2003;160:1223–32.
Leichsenring F, Rabung S, Leibing E. The efficacy of short-term psychodynamic psychotherapy in specific psychiatric disorders: a meta-analysis. Arch Gen Psychiatry. 2004;61:1208–16.
Leichsenring F. Are psychoanalytic and psychodynamic psychotherapies effective? A review of empirical data. Int J Psychoanal. 2005;86:1–26.
Gunderson J, Gabbard G. Making the case for psychoanalytic therapies in the current psychiatric environment. J Am Psychoanal Assoc. 1999;47:679–704.
Kopta S, Howard K, Lowry J, Beutler L. Patterns of symptomatic recovery in psychotherapy. J Consult Clin Psychol. 1994;62:1009–16.
Perry J, Banon E, Floriana I. Effectiveness of psychotherapy for personality disorders. Am J Psychiatry. 1999;156: 1312–21.
Shea MT, Elkin I, Imber SD, et al. Course of depressive symptoms over follow-up. Findings from the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Arch Gen Psychiatry. Oct 1992;49:782–7.
Bateman A, Fonagy P. The effectiveness of partial hospitalization in the treatment of borderline personality disorder, a randomized controlled trial. Am J Psychiatry. 1999;156:1563–9.
Bateman A, Fonagy P. Treatment of borderline personality disorder with psychoanalytically oriented partial hospitalization: an 18-month follow-up. Am J Psychiatry. 2001;158:36–42.
Clarkin JF, Levy KN, Lenzenweger MF, Kernberg OF. Evaluating three treatments for borderline personality disorder: a multiwave study. Am J Psychiatry. 2007;164:922–8.
Linehan MM, Tutek DA, Heard HL, Armstrong HE. Interpersonal outcome of cognitive behavioral treatment for chronically suicidal borderline patients. Am J Psychiatry. 1994;151:1771–6.
Linehan MM, Comtois KA, Murray AM, et al. Two-year randomized trial + follow-up of dialectical behavior therapy vs. therapy by experts for suicidal behaviors and borderline personality disorder. Arch Gen Psychiatry. 2006;63:757–66.
Lenzenweger MF, Lane MC, Loranger AW, Kessler RC. DSM-IV personality disorders in the National Comorbidity Survey Replication. Biol Psychiatry. 2007;62:553–4.
Kantojärvi L, Veijola J, Laksy K, et al. Co-occurrence of personality disorders with mood, anxiety, and substance abuse disorders in a young adult population. J Pers Disord. 2006;20:102–12.
Grant BF, Hasin DS, Stinson FS, et al. Prevalence correlates and disability of personality disorders in the United States. Results from the national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry. 2004;65:948–58.
Olfson M, Fireman B, Weissman MM, et al. Mental disorders and disability among patients in a primary care group practice. Am J Psychiatry. 1997;154:1734–40.
Ormel J, VonKorff M, Ustun TB, Pini S, Korten A, Oldehinkel T. Common mental disorders and disability across cultures. Results from the WHO collaborative study on psychological problems in general health care. JAMA. 1994;272:1741–8.
Lamb WK. A meta-analysis of outcome studies in long-term psychodynamic psychotherapy and psychoanalysis. Dissertation. Ann Arbor: ProQuest; 2004.
Leichsenring F, Rabung S. The effectiveness of long-term psychodynamic psychotherapy: a meta-analysis. JAMA. 2008;300:1551–64.
Thombs BD, Bassel M, Jewett LR, et al. Analyzing effectiveness of long-term psychodynamic psychotherapy (letters and reply). JAMA. 2009;301:930–3.
Gotzsche PC. Why we need a broad perspective on meta-analysis. Br Med J. 2000;21:585–6.
Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF. Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Lancet. 1999;354:1896–900.
Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. JAMA. 2000;283:2008–12.
Gabbard GO. Long-term psychodynamic psychotherapy: a basic text. Washington, DC: American Psychiatric Publishing, Inc.; 2004.
Crits-Christoph P, Barber JP. Long-term psychotherapy. In: Ingram RE, Snyder CR, editors. Handbook of psychological change: psychotherapy processes & practices for the 21st century. Hoboken: Wiley; 2000. p. 455–73.
Berlin JA. Does blinding of readers affect the results of meta-analyses? Lancet. 1997;350:185–6.
Battle CC, Imber SD, Hoehn-Saric R, Nash ER, Frank JD. Target complaints as criteria of improvement. Am J Psychother. 1966;20:184–92.
Derogatis L. The SCL-90 manual I: scoring, administration and procedures for the SCL-90-R. Baltimore: Clinical Psychometric Research; 1977.
Bond M, Gardner S, Christian J, Sigal J. Empirical study of selfrated defense styles. Arch Gen Psychiatry. 1983;40:333–8.
Bond M, Perry JC. Long-term changes in defense styles with psychodynamic psychotherapy for depressive, anxiety, and personality disorders. Am J Psychiatry. 2004;161:1665–71.
Weissman MM, Bothwell S. Assessment of social adjustment by patient self-report. Arch Gen Psychiatry. 1976;33:1111–5.
Cohen J. Statistical power analysis for the behavioral sciences. Hillsdale: Lawrence Erlbaum; 1988.
Hedges LV. Distribution theory for Glass´s estimator for effect size and related estimators. J Educ Stat. 1981;6:107–28.
Rosenthal R. Meta-analytic procedures for social research: applied social research methods. Newburry Park: Sage; 1991.
Hedges LV, Olkin I. Statistical methods for meta-analysis. New York: Academic; 1985.
Huedo-Medina TB, Sanchez-Meca J, Botella J, Marin-Martinez F. Assessing heterogeneity in meta-analysis: Q statistic or I 2 index. Psychol Methods. 2006;11:193–206.
Hedges LV, Vevea JL. Fixed- and random-effects models in meta-analysis. Psychol Methods. 1998;3:486–504.
Quintana SM, Minami T. Guidelines for meta-analyses of counseling psychology research. J Couns Psychol. 2006;34:839–77.
Rosenthal R. The “file drawer problem” and tolerance for null results. Psychol Bull. 1979;86:638–41.
Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50(4):1088–101.
SPSS Inc. SPSS 15.0 command syntax reference. Chicago: SPSS Inc.; 2006.
Rosenberg MS, Adams DC, Gurevitch J. MetaWin: statistical software for meta-analysis. Version 2.0. Sunderland: Sinauer Associates; 1999.
Jadad AR, Moore RA, Carrol D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996;17:1–12.
Bachar E, Latzer Y, Kreitler S, Berry EM. Empirical comparison of two psychological therapies. Self psychology and cognitive orientation in the treatment of anorexia and bulimia. J Psychother Pract Res. 1999;8:115–28.
Barber JP, Morse JQ, Krakauer ID, Chittams J, Crits-Christoph K. Change in obsessive-compulsive and avoidant personality disorders following time-limited supportive–expressive therapy. Am Psychol. 1997;34:133–43.
Bond M, Perry JC. Psychotropic medication use, personality disorder and improvement in long-term dynamic psychotherapy. J Nerv Ment Disord. 2006;194:21–6.
Clarkin JF, Foelsch PA, Levy KN, Hull JW, Delaney MSW, Kernberg OF. The development of a psychodynamic treatment for patients with borderline personality disorder: a preliminary study of behavioral change. J Pers Disord. 2001;15(6):487–95.
Levy KN, Meehan KB, Kelly KM, et al. Change in attachment patterns and reflective function in a randomized control trial of transference-focused psychotherapy for borderline personality disorder. J Consult Clin Psychol. 2006;74:1027–40.
Dare C, Eisler I, Russell G, Treasure J, Dodge L. Psychological therapies for adults with anorexia nervosa: randomised controlled trial of out-patient treatments. Br J Psychiatry. 2001;178:216–21.
Grande T, Dilg R, Jakobsen T, et al. Differential effects of two forms of psychoanalytic therapy: results of the Heidelberg–Berlin study. Psychother Res. 2006;16(4):470–85.
Gregory R, Chlebowski S, Kang D, Remen AL, Soderberg MG, Stepkovitch J, et al. A controlled trial of psychodynamic psychotherapy for co-occurring borderline personality disorder and alcohol use disorder. Psychother Theor Res Pract Train. 2008;45:28–41.
Høglend P, Amlo S, Marble A, et al. Analysis of the patient–therapist relationship in dynamic psychotherapy: an experimental study of transference interpretations. Am J Psychiatry. 2006;163:1739–46.
Høglend P, Bogwald KJ, Amlo S, Marble A, Ulberg R, Sjaastad M, et al. Transference interpretations in dynamic psychotherapy: do they really yield sustained effects? Am J Psychiatry. 2008;165:763–71.
Huber D, Klug G, von Rad M. Die Münchner-Prozess-Outcome Studie: Ein Vergleich zwischen Psychoanalysen und psychodynamischen Psychotherapien unter besonderer Berücksichtigung therapiespezifischer Ergebnisse (The Munich process-outcome study. A comparison between psychoanalyses and psychotherapy). In: Stuhr U, Beutel M, editors. Langzeit- Psychotherapie. Perspektiven für Therapeuten und Wissenschaftler. Stuttgart: Kohlhammer; 2001. p. 260–70.
Huber D, Klug G. Munich psychotherapy study (mps): the effectiveness of psychoanalytic longterm psychotherapy for depression. In: Society for Psychotherapy Research, editor. Book of abstracts. From research to practice. Ulm: Ulmer Textbank; 2006. p. 154.
Knekt P, Lindfors O, Harkanen T, et al. 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. Psychol Med. 2008;38:689–703.
Knekt P, Lindfors O, Laaksonen MA, et al. Effectiveness of short-term and long-term psychotherapy on work ability and functional capacity – a randomized clinical trial on depressive and anxiety disorders. J Affect Disord. 2008;107:95–106.
Korner A, Gerull F, Meares R, Stevenson J. Borderline personality disorder treated with the conversational model: a replication study. Compr Psychiatry. 2006;47:406–11.
Leichsenring F, Biskup J, Kreische R, Staats H. The effectiveness of psychoanalytic therapy. First results of the Göttingen study of psychoanalytic and psychodynamic therapy. Int J Psychoanal. 2005;86:433–55.
Luborsky L, Stuart J, Friedman S, et al. The Penn psychoanalytic treatment collection: a set of complete and recorded psychoanalyses as a research resource. J Am Psychoanal Assoc. 2001;49:217–33.
Monsen J, Odland T, Faugli A, Daae E, Eilertsen DE. Personality disorders and psychosocial changes after intensive psychotherapy: a prospective follow-up study of an outpatient psychotherapy project, 5 years after end of treatment. Scand J Psychol. 1995;36:256–68.
Monsen J, Odland T, Faugli A, Daae E, Eilertsen D. Personality disorders: changes and stability after intensive psychotherapy focusing on affect consciousness. Psychother Res. 1995;5:33–48.
Piper WE, Debbane EG, Bienvenu JP, Garant J. A comparative study of four forms of psychotherapy. J Consult Clin Psychol. 1984;52(2):268–79.
Rudolf G, Manz R, Öri C. Ergebnisse psychoanalytischer Therapien (Outcome of psychoanalytic therapies). Z Psychosom Med Psychoanal. 1994;40(11):25–40.
Sandell R, Blomberg J, Lazar A, Carlsson J, Broberg J, Schubert J. Varieties of long-term outcome among patients in psychoanalysis and long-term psychotherapy: a review of findings in the Stockholm outcome of psychoanalysis and psychotherapy project (STOPPP). Int J Psychoanal. 2000;82:921–42.
Stevenson J, Meares R. An outcome study of psychotherapy for patients with borderline personality disorder. Am J Psychiatry. 1992;149:358–62.
Svartberg M, Stiles T, Seltzer MH. Randomized, controlled trial of the effectiveness of short-term dynamic psychotherapy and cognitive therapy for Cluster C personality disorders. Am J Psychiatry. 2004;161:810–7.
Vinnars B, Barber JP, Noren K, Gallop R, Weinryb RM. Manualized supportive-expressive psychotherapy versus nonmanualized community-delivered psychodynamic therapy for patients with personality disorders: bridging efficacy and effectiveness. Am J Psychiatry. 2005;162:1933–40.
Wilczek A, Barber JP, Gustavsson JP, Asberg M, Weinryb RM. Change after long-term psychoanalytic psychotherapy. J Am Psychoanal Assoc. 2004;52:1163–84.
Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. Br Med J. 2003;327:557–60.
Begg C. Publication bias. In: Cooper H, Hedges LV, editors. The handbook of research synthesis. New York: Russel Sage Foundation; 1995. p. 399–409.
Roth A, Fonagy P. What works for whom: a critical review of psychotherapy research. 2nd ed. New York: Guilford Press; 2005.
Glass RM. Psychodynamic psychotherapy and research evidence. Bambi survives Godzilla? JAMA. 2008;300:1587–9.
Carey B. Psychoanalytic therapy wins backing. Though endangered as passé, it can be effective, a study finds. The New York Times: A18; 2008.
Beck AT, Bhar SS. Analyzing effectiveness of long-term psychodynamic psychotherapy (letter to the editor). JAMA. 2009;301:931.
Kriston L, Hölzel L, Härter M. Analyzing effectiveness of long-term psychodynamic psychotherapy (letter to the editor). JAMA. 2009;301:930–1.
Roepke S, Renneberg B. Analyzing effectiveness of long-term psychodynamic psychotherapy (letter to the editor). JAMA. 2009;301:931–2.
Thombs BD, Bassel M, Jewett LR. Analyzing effectiveness of long-term psychodynamic psychotherapy (letter to the editor). JAMA. 2009;301:930.
Giesen-Bloo J, van Dyck R, Spinhoven P, et al. Outpatient psychotherapy for borderline personality disorder: randomized trial of schema-focused therapy vs transference-focused psychotherapy. Arch Gen Psychiatry. 2006;63:649–58.
Brockmann J, Schlüter T, Eckert J. Langzeitwirkungen psychoanalytischer und verhaltenstherapeutischer Langzeittherapien (Long-term outcome of long-term psychoanalytic and behavioral long-term therapy). Psychotherapeutics. 2006;51:15–25.
Puschner B, Kraft S, Kächele H, Kordy H. Course of improvement over 2 years in psychoanalytic and psychodynamic outpatient psychotherapy. Psychol Psychother Theor Res Pract. 2007;80:51–68.
Leichsenring F, Rabung S. Analyzing effectiveness of long-term psychodynamic psychotherapy (letter in reply). JAMA. 2009;301:932–3.
Shadish WR, Matt G, Navarro AM, Phillips G. The effects of psychological therapies under clinically representative conditions: a meta-analysis. J Consult Clin Psychol. 2000;126:512–29.
Chambles DL, Hollon SD. Defining empirically supported therapies. J Consult Clin Psychol. 1998;66:7–18.
Leichsenring F, Rabung S. Long-term psychodynamic psychotherapy in complex mental disorders: update of a meta-analysis. Br J Psychiatry. 2011;199:15–22.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2012 Springer Science+Business Media, LLC
About this chapter
Cite this chapter
Rabung, S., Leichsenring, F. (2012). Effectiveness of Long-Term Psychodynamic Psychotherapy: First Meta-Analytic Evidence and Its Discussion. In: Levy, R., Ablon, J., Kächele, H. (eds) Psychodynamic Psychotherapy Research. Current Clinical Psychiatry. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60761-792-1_3
Download citation
DOI: https://doi.org/10.1007/978-1-60761-792-1_3
Published:
Publisher Name: Humana Press, Totowa, NJ
Print ISBN: 978-1-60761-791-4
Online ISBN: 978-1-60761-792-1
eBook Packages: MedicineMedicine (R0)