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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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“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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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“There have been various studies showing the therapeutic efficacy of psychodynamic psychotherapy (see for instance Leichsenring and Leibing, 2007; Haase et al., 2008; Leichsenring and Rabung, 2008; Taylor, 2008).”
BackgroundSolbakken, O. A., Hansen, R. S., Havik, O., & Monsen, J. (2012) · Psychotherapy Research · doi:10.1080/10503307.2012.700871 · Cited by 32
“It is thus a possibility that more severely disturbed patients may experience greater benefits from more extensive treatment directed specifically toward changing rigid, character-related and maladaptive patterns of relating to self and others (Leichsenring & Rabung, 2008 ; McCullough, 1997; Monsen, Odland, Faugli, Da…”
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“The GDG considered that studies such as that conducted by Leichsenring and Rabung (2008) which demonstrated the efficacy of long-term psychodynamic therapy for complex mental disorders had an insufficient focus on depression as a diagnosis and so discounted it.”
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“For clinical trials of therapies, blinding of therapists and participants to treatment allocation is clearly not possible, and in line with a previous meta-analysis (Leichsenring & Rabung, 2008) we did not judge a study as high risk of bias from inadequate blinding for this reason alone.”
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“…change in their samples), in real-world practice clients typically self-regulate: as they feel better, they end treatment (Baldwin et al., 2009; Leichsenring & Rabung, 2008) and as a result, there is often little correlation between time and effectiveness when treatment completers are…”
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“Leichsenring and Rabung (2008, 2009, 2011) reported large within treatment effect sizes (range: 0.97–1.94) in the treatment of “complex depressive disorders” with LTPP. De Maat, de Jonghe, Schoevers, and Dekker (2009) examined the efficacy of LTPP for patients suffering from what the authors called…”
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“No trials directly comparing longer-term psychoanalytic psychotherapy for BN with CBT have been performed, even though a growing number of studies point to the efficacy of this treatment modality for several mental disorders (Leichsenring & Rabung, 2008 ).”
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“These benefits not only endure but also increase over time (Abbass, Hancock, Henderson, & Kisely, 2006; Anderson & Lambert, 1995; Bateman & Fonagy, 2008; Høglend et al., 2008; Leichsenring & Rabung, 2008; Leichsenring, Rabung, & Leibing, 2004; Levy, Ablon, & K€achele, 2012; de Maat et al., 2009).”
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“…once or twice weekly sessions of short-term (consistent with meta-analyses defining long-term psychodynamic psychotherapy as at least 50 sessions; Leichsenring and Rabung, 2008, 2011) psychodynamic psychotherapy organized, aided, and informed (but not prescribed) by a short-term psychodynamic…”
BackgroundThe changing shape of clinical practice: Driven by science or by pragmatics?
Fonagy, P. (2010) · Psychoanalytic Psychotherapy · doi:10.1080/02668731003590139 · Cited by 30
“It is nothing short of miraculous that enough data have been collected for two prestigious systematic reviews to have been published, one by Falk in the Journal of the American Medical Association (Leichsenring & Rabung, 2008 ) and another by Askia de Maat and her colleagues in the Harvard Review of Psychiatry (de Maa…”
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“…treatment (Malouff, Thorsteins- son, & Schutte, 2007), life review therapy in older adults (Lan, Xiao, & Chen, 2017), non-directive counseling (Cuijpers et al., 2012), psychodynamic therapies (Driessen et al., 2015; Leichsenring & Rabung, 2008) and third wave therapies (Churchill et al., 2013).”
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Psychotherapeutic Treatment of Bipolar Depression
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“According to the results, LTPP (defined as lasting at least one year or 50 sessions) yielded large and stable effects in patients with complex mental disorders (defined as personality disorders, multiple mental disorders, and chronic mental disorders).”
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InfluentialPsychodynamic psychotherapy with adolescents and young adults: Outcome in routine practice
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“In accordance to prior research, neither age nor gender correlated with therapy outcome (Clarkin & Levy, 2004; Leichsenring & Rabung, 2008; Lindgren et al., 2010).”
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“Several studies have demonstrated the efficacy of long-term and short-term psychoanalytic treatment in randomized controlled trials (e.g., Gabbard et al., 2002; Leichsenring et al., 2004; Leichsenring and Rabung, 2008, 2011).”
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“…is worth noting that this constant growth trend has been detected in meta-analytic studies assessing the effectiveness of long- and short-term psychodynamic psychotherapy (e.g., Abbass, Hancock, Henderson, & Kisely, 2014; de Maat, de Jonghe, Schoevers, & Dekker, 2009; Leichsenring & Rabung, 2008).”
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“…on LPP, suggesting that LPP has advantages in relation to less-structured and less-intensive treatments when the goals of treatment are extended beyond symptomatic relief and targeted at more complex, personality-related problems (de Maat et al., 2009; Leichsenring and Rabung, 2008, 2011).”
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“For long-term psychodynamic psychotherapy (LTPP), less evidence is available. A recent meta-analysis, however, reported large and stable effect sizes for LTPP in patients with complex mental disorders [”
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“Taken together, adding day hospital and subsequent group therapy, the mean effect sizes (EZ GAF = 1,9; GSI = 0,90; IIP = 0,88) were somewhat less than what is reported in most studies of individual psychotherapy for borderline patients (Bateman and Fonagy, 1999; 2001; 2009; Giessen-Bloo, 2006; Leichsenring and Rabung,…”
ResultThe Future of Psychodynamic Psychotherapy
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“Long-term psychodynamic treatment is commonly defined as lasting for at least 1 year or 50 sessions (Crits-Christoph & Barber, 2000; Leichsenring & Rabung, 2008).”
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Wright, D., & Abrahams, D. (2015) · Psychoanalytic Psychotherapy · doi:10.1080/02668734.2015.1035740 · Cited by 19
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“In a high-quality meta-analysis of 23 studies of long-term psychodynamic treatments involving over a thousand patients, Leichsenring and Rabung (2008) found that complex and often comorbid treatment resistant patients receiving at least 50 sessions or a year of long-term psychodynamic psychotherapy showed better outco…”
BackgroundLong term individual art psychotherapy. Art for art's sake: The effect of early relational trauma
Greenwood, H. (2011) · International Journal of Art Therapy · doi:10.1080/17454832.2011.570274 · Cited by 19
“…term therapy is both complex and problematic in the NHS. ‘The place of psychoanalytic and psychodynamic treatments within psychiatry is controversial’ (Leichsenring & Rabung, 2008, p. 1551) and there has always been a lack of research on the outcome of long term psychodynamic psychotherapy (LTPP).”
BackgroundDie Wirksamkeit psychodynamischer Psychotherapie
Shedler, J. (2011) · Psychotherapeut · doi:10.1007/s00278-011-0819-2 · Cited by 32
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“Shedler (2010), largely drawing on the works of Leichsenring (Leichsenring, 2001, 2005; Leichsenring & Leibing, 2003; Leichsenring & Rabung, 2008; Leichsenring, Rabung, & Leibing, 2004), summarized this work.”
BackgroundEvaluating the outcomes of psychotherapies: The Personality Health Index.
Waldron, S., Moscovitz, S., Lundin, J., Helm, F., Jemerin, J., & Gorman, B. (2011) · doi:10.1037/a0024559 · Cited by 18
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“Psychodynamic psychotherapy is perceived as having a weaker evidence base than other forms of psychotherapy, a belief recently challenged by Leichsenring and Rabung (2008) and Shedler (2010).”
BackgroundNeurodiversity and psychotherapy—Connections and ways forward
Pantazakos, T. (2023) · Counselling and Psychotherapy Research · doi:10.1002/capr.12675 · Cited by 22
L’évaluation et l’efficacité des psychothérapies psychanalytiques et de la psychanalyse
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“In the context of psychotherapy research, both do not seem to systematically distort treatment effects (i.e., Benson & Hartz, 2000; Leichsenring & Rabung, 2008; Shadish, Matt, Navarro, & Phillips, 2000).”
BackgroundObstacles to Early Career Psychiatrists Practicing Psychotherapy
Clemens, N. A., Plakun, E. M., Lazar, S. G., & Mellman, L. A. (2014) · Psychodynamic Psychiatry · doi:10.1521/pdps.2014.42.3.479 · Cited by 24
“…a growing body of evidence suggests that psychotherapy from multiple schools is an effective treatment for a range of single-diagnosis and combined comorbid disorders (Leichsenring & Rabung, 2008; Levy, Ehrenthal, Yeomans, & Caligor, 2014, this issue; Milrod et al., 2014; Roth & Fonagy, 2005).”
BackgroundThe impact of Covid-19 on access to psychological services
Purrington, J., & Beail, N. (2021) · Advances in Mental Health and Intellectual Disabilities · doi:10.1108/amhid-03-2021-0017 · Cited by 16
The Digital Phenotyping Project: A Psychoanalytical and Network Theory Perspective
Potier, R. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.01218 · Cited by 24
“…Ansermet and Magistretti, 2011; Bazan et al., 2013), followed by evidence of treatment effectiveness from their evaluation (Leichsenring et al., 2004; Leichsenring, 2005; Thurin et al., 2006; Shedler and Westen, 2007; Leichsenring and Rabung, 2008; Shedler, 2010; Fonagy et al., 2015; Thurin, 2017).”
BackgroundYears of Clinical Experience and Therapist Professional Development: A Literature Review
Dawson, G. C. (2018) · Journal of Contemporary Psychotherapy · doi:10.1007/s10879-017-9373-8 · Cited by 16
“Surprisingly, research encompassing multiple settings, therapist therapeutic orientation, and client presenting problems has found no association between years of clinical experience and client outcomes (Okiishi et al. 2006; Chow et al. 2015; Leichsenring and Rabung 2008).”
BackgroundShahar, G. (2016) · Psychodynamic Psychiatry · doi:10.1521/pdps.2016.44.3.395 · Cited by 19
Mentalization, Emotion Regulation, Countertransference
Hoffman, L. (2015) · Journal of Infant Child and Adolescent Psychotherapy · doi:10.1080/15289168.2015.1064258 · Cited by 16
“Although the NIMH website does cite the work of Leichsenring and Leibing (also, see Leichsenring & Rabung, 2008) who have empirically demonstrated the effectiveness of psychodynamic techniques), and the website does acknowledge that “sometimes ideas from psychodynamic therapy are interwoven with…”
MethodSalomonsson, B., & Sandell, R. (2011) · Infant Mental Health Journal · doi:10.1002/imhj.20291 · Cited by 52
Brunet, L. (2010) · Filigrane Écoutes psychothérapiques · doi:10.7202/039290ar · Cited by 16
Ogrodniczuk, J. S., Kealy, D., & Howell-Jones, G. (2009) · Journal of Psychiatric Practice · doi:10.1097/01.pra.0000364286.63210.db · Cited by 15
Ong, Q.-E. O., Ong, J. W., Ang, M. Q., Vehviläinen-Julkunen, K. M., & He, H.-G. (2023) · Patient Education and Counseling · doi:10.1016/j.pec.2023.107678 · Cited by 21
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Pretreatment and process predictors of nonresponse at different stages of inpatient psychotherapy
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“Patients with comorbid personality disorders, responding late and having difficulties in maintaining treatment gains, may need a more specific and longer treatment (e.g., Leichsenring & Rabung, 2008).”
BackgroundSolomonov, N., & Barber, J. P. (2015) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796015000815 · Cited by 15
“There is also some indirect evidence that LTDP is superior to other psychotherapies in treating complex patients with chronic depression and previous treatment failures (Leichsenring & Rabung, 2008, 2010; Fonagy et al. in press).”
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“…an evidence base for psychoanalytic therapy has become increasingly important from an accountability perspective (cf. Leichsenring & Klein, 2014; Leichsenring & Rabung, 2008, 2011; Levy & Ablon, 2009; Shedler, 2010), the importance of basing psychoanalytic supervision efforts upon an evidence…”
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“In addition to effi cacy studies, effectiveness research supports the use of long-term psychodynamic therapies in decreasing symptomatic distress, improving interpersonal problems, social adjustment and self-esteem (Leichsenring & Rabung, 2008).”
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“Thus, there has been excessive focus on carefully crafted ‘meta-analyses’ (Driessen et al., 2010; Leichsenring & Rabung, 2008; Leichsenring, Rabung, & Leibing, 2004).”
RESEARCH AND PSYCHOANALYSIS Still Time to Bridge the Great Divide
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A clinical science approach to training first year clinicians to navigate therapeutic relationships.
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Metadata
- 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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