Effectiveness of Long-term Psychodynamic Psychotherapy: A Meta-analysis
Abstract
THE PLACE OF PSYCHOANALYTIC and psychodynamic treatments within psychiatry is controversial. Although some evidence supports the efficacy of short-term psychodynamic psychotherapy (STPP) for specific disorders, convincing research on the outcome of long-term psychodynamic psychotherapy (LTPP) has been lacking. Evidence suggests that short-term psychotherapy is sufficiently effective for most individuals experiencing acute distress. Evidence, however, also indicates that short-term treatments are insufficient for a considerable proportion of patients with complex mental disorders, ie, patients with multiple or chronic mental disorders or personality disorders. Some studies suggest that long-term psychotherapy may be helpful for these groups of patients. This is true not only of psychodynamic therapy but also of psychotherapeutic approaches that are usually short-term, such as cognitive-behavioral therapy (CBT). Evidence-based treatments for these patient groups are particularly important. Personality disorders, for example, are quite common in both general and clinical populations. They show a high comorbidity with a wide range of Axis I psychiatric disorders and are significantly associated with functional impairments. Furthermore, a high proportion of patients in clinical populations expeFor editorial comment see p 1587. Author Affiliations: Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen (Dr Leichsenring); and Department of Medical Psychology, Univers i ty Medica l Center HamburgEppendorf, Hamburg (Dr Rabung), Germany. Corresponding Author: Falk Leichsenring, DSc, Department of Psychosomatics and Psychotherapy, University of Giessen, Ludwigstrasse 76, 35392 Giessen Germany (falk.leichsenring@psycho.med .uni-giessen.de). Context The place of long-term psychodynamic psychotherapy (LTPP) within psychiatry is controversial. Convincing outcome research for LTPP has been lacking.
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Leichsenring and Rabung found lower effect sizes for personality functioning (0.78) than for symptoms (target problems, 1.54; psychiatric symptoms, 0.91).
“In addition, they also seem to have found lower ESs for personality functioning (0.78) than for symptoms (target problems, 1.54; psychiatric symptoms, 0.91).”
From The Effectiveness of Long-Term Psychoanalytic Therapy: A Systematic Review of Empirical Studies (2009) · cites this paper as [22]
Leichsenring and Rabung's meta-analysis considered 13 studies not included in this review.
“As a result of the different inclusion criteria, Leichsenring and Rabung 22 considered 13 studies not included in our review.”
From The Effectiveness of Long-Term Psychoanalytic Therapy: A Systematic Review of Empirical Studies (2009) · cites this paper as [22]
The effect sizes for psychotherapy found by Leichsenring and Rabung (0.78 to 1.98) were similar to the effect sizes found in this review (0.78 to 0.94).
“However, it is noteworthy that the ESs for psychotherapy found by Leichsenring and Rabung (0.78 to 1.98) were similar to the ESs that we found (0.78 to 0.94).”
From The Effectiveness of Long-Term Psychoanalytic Therapy: A Systematic Review of Empirical Studies (2009) · cites this paper as [22]
Leichsenring and Rabung confirmed the cautious findings that results of psychotherapy were stable at follow-up.
“Finally, Leichsenring and Rabung confirmed our cautious findings that results of psychotherapy were stable at follow-up.”
From The Effectiveness of Long-Term Psychoanalytic Therapy: A Systematic Review of Empirical Studies (2009) · cites this paper as [22]
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“This finding comes at a time when the movement behind gathering evidence for psychodynamic psychotherapy is gathering momentum to the point where it is hard to doubt the value of these methods when administered under reasonably controlled conditions [5, 6].”
Zimmermann, J., Löffler‐Stastka, H., Huber, D., Klug, G., Alhabbo, S., Bock, A., & Benecke, C. (2014) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.1917 · Cited by 71 · see citing works
La psychiatrie biologique : une bulle spéculative ?
Gonon, F. (2011) · Esprit · doi:10.3917/espri.1111.0054 · Cited by 63 · see citing works
Briggs, S., Netuveli, G., Gould, N., Gkaravella, A., Gluckman, N., Kangogyere, P., Farr, R. R., Goldblatt, M., & Lindner, R. (2019) · The British journal of psychiatry : the journal of mental science · doi:10.1192/bjp.2019.33 · Cited by 62 · see citing works
Four Reasons Why Assisted Dying Should Not Be Offered for Depression
Blikshavn, T., Husum, T. L., & Magelssen, M. (2017) · Journal of Bioethical Inquiry · doi:10.1007/s11673-016-9759-4 · Cited by 60 · see citing works
“In support of this, a recent meta-analysis found large effect sizes on both symptom-oriented measures and psychosocial functioning for long-term psychodynamic psychotherapy for patients with chronic anxiety and depression and high levels of comorbidity (Leichsenring and Rabung 2008).”
ResultToews, I., Anglemyer, A., Nyirenda, J. L., Alsaid, D., Balduzzi, S., Grummich, K., Schwingshackl, L., & Bero, L. (2024) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.mr000034.pub3 · Cited by 60 · see citing works
Pantazakos, T., & Vanaken, G.-J. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1225152 · Cited by 59 · see citing works
“Meta-analytic evidence demonstrates that, in general, principal interventions are pharmaceutical treatment and various forms of psychotherapy, such as cognitive behavioral, interpersonal, and psychodynamic psychotherapy (Leichsenring and Rabung, 2008; Cuijpers et al., 2011; Hoffman et al., 2012; Cipriani et al., 2018).”
BackgroundManagement and treatment of stalkers: problems, options, and solutions.
Mackenzie, R., & James, D. (2011) · Behavioral sciences & the law · doi:10.1002/bsl.980 · Cited by 59 · see citing works
Premature termination in psychotherapy: Strategies for engaging clients and improving outcomes.
Swift, J. K., & Greenberg, R. P. (2014) · American Psychological Association eBooks · doi:10.1037/14469-000 · Cited by 88 · see citing works
Psychoanalytic versus psychodynamic therapy for depression: a three-year follow-up study.
Huber, D., Henrich, G., Clarkin, J., & Klug, G. (2013) · Psychiatry · doi:10.1521/psyc.2013.76.2.132 · Cited by 57 · see citing works
“So our results are consistent with Leichsenring and Rabung’s (2008) conclusion that long-term psychotherapies are associated with improvements in social functioning and with the findings of Grande and colleagues (2006) and Sandell and colleagues (2000) who found no significant differences between psychoanalysis and ps…”
ResultLong‐term outcome and post‐treatment effects of psychoanalytic psychotherapy with young adults
Lindgren, A., Werbart, A., & Philips, B. (2010) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1348/147608309x464422 · Cited by 53 · see citing works
The mental health needs of military service members and veterans.
Lazar, S. (2014) · Psychodynamic Psychiatry · doi:10.1521/pdps.2014.42.3.459 · Cited by 56 · see citing works
Watkins, C. E., Jr. (2011) · The Psychoanalytic Review · doi:10.1521/prev.2011.98.4.557 · Cited by 55 · see citing works
The Practice of Functional Analytic Psychotherapy
Kanter, J. W., Tsai, M., & Kohlenberg, R. J. (2010) · Springer eBooks · doi:10.1007/978-1-4419-5830-3 · Cited by 60 · see citing works
“Furthermore, the average patient receiving LTPP was better off than 96% of the average patients receiving short-term treatments (Leichsenring & Rabung, 2008).”
BackgroundBastos, A. G., Guimarães, L. S. P., & Trentini, C. M. (2013) · Journal of Affective Disorders · doi:10.1016/j.jad.2013.08.036 · Cited by 46 · see citing works
“As seem, most studies about psychodynamic psychotherapy and depression, however, deal with clinical efficacy, and do not address neurocognitive improvement (Berghout and Zevalkink, 2009; Leichsenring and Rabung, 2008; Wampold et al., 2002).”
BackgroundWang, Q., Zhang, W., & An, S.-B. (2023) · Internet Interventions · doi:10.1016/j.invent.2023.100690 · Cited by 51 · see citing works
Boldrini, T., Tanzilli, A., Pontillo, M., Chirumbolo, A., Vicari, S., & Lingiardi, V. (2019) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2019.00429 · Cited by 55 · see citing works
Lindfors, O., Knekt, P., Heinonen, E., Härkänen, T., & Virtala, E. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.10.039 · Cited by 50 · see citing works
Bhar, S., Thombs, B., Pignotti, M., Bassel, M., Jewett, L., Coyne, J., & Beck, A. (2010) · Psychotherapy and Psychosomatics · doi:10.1159/000313689 · Cited by 49 · see citing works
“p. 103]. Yet, a recent meta-analysis by Leichsenring and Rabung [”
BackgroundWiswede, D., Taubner, S., Buchheim, A., Münte, T. F., Stasch, M., Cierpka, M., Kächele, H. U., Roth, G., Erhard, P., & Kessler, H. (2014) · PLoS ONE · doi:10.1371/journal.pone.0109037 · Cited by 50 · see citing works
“Arguing in favor of specific effects of our study intervention, the efficacy and effectiveness of psychodynamic therapy, which can best be compared to our approach and its superiority over waiting-list controls has been reported in two meta-analyses [41,42] (But see [43] for a critical discussion).”
ResultThe state of the evidence base for psychodynamic psychotherapy for children and adolescents.
Palmer, R., Nascimento, L., & Fonagy, P. (2013) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2012.12.001 · Cited by 48 · see citing works
Moldovan, R., Cobeanu, O., & David, D. (2013) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.1814 · Cited by 46 · see citing works
Review of Psychodynamic Psychotherapy Neuroimaging Studies
Abbass, A. A., Nowoweiski, S. J., Bernier, D. C., Tarzwell, R., & Beutel, M. E. (2014) · Psychotherapy and Psychosomatics · doi:10.1159/000358841 · Cited by 63 · see citing works
Shlonsky, A., Noonan, E., Littell, J. H., & Montgomery, P. (2010) · Clinical Social Work Journal · doi:10.1007/s10615-010-0307-0 · Cited by 46 · see citing works
Psychotherapy-based supervision models in an emerging competency-based era: a commentary.
Falender, C., & Shafranske, E. P. (2010) · Psychotherapy · doi:10.1037/a0018873 · Cited by 46 · see citing works
Lilliengren, P., Johansson, R., Lindqvist, K., Mechler, J., & Andersson, G. (2016) · Psychotherapy · doi:10.1037/pst0000024 · Cited by 45 · see citing works
“Although this is a common procedure in meta-analyses (e.g., Abbass et al., 2012; de Maat et al., 2009; Driessen et al., 2010; Keefe et al., 2014; Leichsenring & Rabung, 2008; Town et al., 2012), it should also be noted that treating assessment points as independent may overestimate effects somewhat…”
MethodResultThe cost-effectiveness of psychotherapy for the major psychiatric diagnoses.
Lazar, S. (2014) · Psychodynamic Psychiatry · doi:10.1521/pdps.2014.42.3.423 · Cited by 44 · see citing works
“Leichsenring and Rabung (2008) found that long-term psychodynamic psychotherapy is significantly more effective and provides greater improvements in symptoms and personality functioning as compared to briefer treatments for such patients.”
BackgroundLenzenweger, M. (2010) · Journal of the American Psychoanalytic Association · doi:10.1177/0003065110386111 · Cited by 43 · see citing works
Analyzing effectiveness of long-term psychodynamic psychotherapy.
Beck, A., & Bhar, S. (2009) · Journal of the American Medical Association (JAMA) · doi:10.1001/jama.2009.179 · Cited by 43 · see citing works
Long-term effects of transference interpretation in dynamic psychotherapy of personality disorders
Høglend, P., Dahl, H., Hersoug, A., Lorentzen, S., & Perry, J. C. (2011) · European psychiatry · doi:10.1016/j.eurpsy.2010.05.006 · Cited by 42 · see citing works
“An increasing body of studies indicates that various forms of psychotherapy may be effective for patients with PD [10,22,23,31], but numerous challenges remain.”
BackgroundResultPsychodynamic psychotherapy and research evidence: Bambi survives Godzilla?
Glass, R. (2008) · Journal of the American Medical Association (JAMA) · doi:10.1001/jama.300.13.1587 · Cited by 42 · see citing works
McWilliams, N. (2011) · Journal of Personality Assessment · doi:10.1080/00223891.2011.542709 · Cited by 36 · see citing works
“…both long and short term (Abass, Hancock, Henderson, & Kisely, 2006; Anderson & Lambert, 1995; de Maat, de Jonghe, Schoevers, & Dekker, 2009; Leichsenring & Rabung, 2008; Sandell et al., 2000; Seligman, 1995, Smith, Glass, & Miller, 1980), the evidence-based treatments that are increasingly…”
A comprehensive review of psychodynamic treatments for eating disorders
Abbate-Daga, G., Marzola, E., Amianto, F., & Fassino, S. (2016) · Eating and Weight Disorders · doi:10.1007/s40519-016-0265-9 · Cited by 39 · see citing works
“Second, psychodynamic psychotherapies have proven to be beneficial across different mental disorders with either short- or long-term formats [21–23]; therefore, their effectiveness should be carefully assessed in the field of EDs as well.”
BackgroundThe Efficacy of Psychotherapy: Focus on Psychodynamic Psychotherapy as an Example
Levy, K. N., Ehrenthal, J. C., Yeomans, F. E., & Caligor, E. (2014) · Psychodynamic Psychiatry · doi:10.1521/pdps.2014.42.3.377 · Cited by 40 · see citing works
“Third, there are findings from meta-anal- yses, particularly of within-group effects that have found large effects for longer-term treatments (de Maat, de Jonghe, Schoevers, & Dekker, 2009; Leichsenring & Rabung, 2008, 2011).”
BackgroundWöller, W., Leichsenring, F., Leweke, F., & Kruse, J. (2012) · Bulletin of the Menninger Clinic · doi:10.1521/bumc.2012.76.1.69 · Cited by 39 · see citing works
“Although psychodynamic psychotherapy has been shown to be effective with a variety of disorders (Leichsenring, 2001, 2009; Leichsenring & Rabung, 2008; Leichsenring, Rabung, & Leibing, 2004; Shedler, 2010), existing meta-analyses (e.g., Bisson et al., 2007; Bradley, Greene, Russ, Dutra, & Westen,…”
Self-citationPromising Psychotherapies for Personality Disorders
Hadjipavlou, G., & Ogrodniczuk, J. S. (2010) · Canadian journal of psychiatry. Revue canadienne de psychiatrie · doi:10.1177/070674371005500403 · Cited by 39 · see citing works
Psychoanalysis in modern mental health practice.
Yakeley, J. (2018) · Lancet psychiatry · doi:10.1016/s2215-0366(18)30052-x · Cited by 38 · see citing works
Contreras, P., Kallivayalil, D., & Herman, J. (2017) · Women & Therapy · doi:10.1080/02703149.2016.1205908 · Cited by 37 · see citing works
“…survivor’s relational and identity challenges will require a strong therapeutic relationship that is consistent (e.g., with the same provider), predictable, and sustained over a long period of time (see for example, Leichsenring & Rabung, 2008; Wilczek, Barber, Gustavsson, Åsberg, & Weinryb, 2004).”
BackgroundLearning psychotherapy in the digital age.
Manring, J., Greenberg, R., Gregory, R., & Gallinger, L. (2011) · Psychotherapy · doi:10.1037/a0022185 · Cited by 37 · see citing works
Textbook of Psychotherapeutic Treatments
Gabbard, G. (2008) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781585623648 · Cited by 37 · see citing works
Future directions in examining the self in psychological disorders
Kyrios, M., Moulding, R., Bhar, S., Doron, G., Nedeljkovic, M., & Mikulincer, M. (2016) · Cambridge University Press eBooks · doi:10.1017/cbo9781139941297 · Cited by 36 · see citing works
Is Psychoanalysis Still Relevant to Psychiatry?
Paris, J. (2017) · The Canadian Journal of Psychiatry · doi:10.1177/0706743717692306 · Cited by 43 · see citing works
Levy, K. N., & Anderson, T. (2013) · Clinical Psychology Science and Practice · doi:10.1111/cpsp.12035 · Cited by 35 · see citing works
The good, the bad, and the ugly: a 50-year perspective on the outcome problem.
Wampold, B. (2013) · Psychotherapy · doi:10.1037/a0030570 · Cited by 35 · see citing works
Objective measures of subjective experience: the use of therapist notes in process-outcome research.
Bucci, W., Maskit, B., & Hoffman, L. (2012) · Psychodynamic Psychiatry · doi:10.1521/pdps.2012.40.2.303 · Cited by 35 · see citing works
Berzoff, J., & Drisko, J. W. (2015) · Clinical Social Work Journal · doi:10.1007/s10615-015-0544-3 · Cited by 39 · see citing works
Psychoanalytic and Psychodynamic Therapies for Depression: The Evidence Base
Taylor, D. (2008) · Humana Press eBooks · doi:10.1007/978-1-60761-792-1_6 · Cited by 34 · see citing works
Essential psychotherapies : theory and practice
Gurman, A. S., & Messer, S. (2011) · Choice Reviews Online · doi:10.5860/choice.33-5386 · Cited by 34 · see citing works
“To illustrate that the provision of long-term therapy in the United States is a possible option, we note that psychoanalysis is included in government health care coverage in Germany and has achieved considerable evidential support (Leichsenring & Rabung, 2008; Shedler, 2010).”
BackgroundWeerasekera, P., Manring, J., & Lynn, D. J. (2010) · Academic Psychiatry · doi:10.1176/appi.ap.34.1.5 · Cited by 34 · see citing works
“A recent meta-analysis found large effect sizes for patients with complex mental health problems treated with longterm psychodynamic therapy (38).”
BackgroundEmotions and Knowledge in Expert Work: A Comparison of Two Psychotherapies1
Crǎciun, M. (2018) · American Journal of Sociology · doi:10.1086/695682 · Cited by 33 · see citing works
“Other meta-analyses have echoed these findings (Connolly Gibbons, Crits-Christoph, and Hearon 2008; Cuijpers et al. 2008; Leichsenring and Rabung 2008; Driessen et al. 2013; Leichsenring and Schauenburg 2014).”
Result
- Authors
- Leichsenring, F.
- Affiliations
- American Medical Association (US)
- Corresponding author
- Leichsenring, Falk
- ORCID
- Leichsenring, Falk
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2008-10-01
- Volume
- 300
- Issue
- 13
- Pages
- 1551
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W1538112934
- Cited by
- 65
- References
- 0
- Citations by year
- 2023: 1 · 2022: 1 · 2021: 3 · 2020: 2 · 2019: 3 · 2017: 1 · 2016: 1 · 2015: 4 · 2014: 7 · 2013: 9 · 2012: 5
- FWCI
- 10.05
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Keywords
- long-term psychodynamic psychotherapy, treatment effectiveness, personality disorders, complex mental disorders, chronic mental illness, comorbidities, functional disability, outcomes research, evidence-based treatment
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