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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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“…effective at all (Leichsenring, 2005 [48] ); following up with a, 4) meta-analysis of the effectiveness of long-term psychodynamic psychotherapy (Leichsenring and Rabung, 2008 [50] ); and 5) its update (Leichsenring and Rabung, 2011 [51] ); and 6) the recent paper showing the emerging evidence…”
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Psychodynamic therapy: a poorly defined concept with questionable evidence
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“…and unconscious, such as psychodynamically informed treatments which continue to demonstrate significantly positive outcomes for clients (Drisko & Simmons, 2012; Fonagy, Roth, & Higgitt, 2005; Hoglend, 2003; Leichsenring & Rabung, 2008; Leichsenring, Rabung, & Leibing, 2004; Shedler, 2010).”
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BackgroundConsidering Psychodynamic Therapy for Older Adults
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“Loewald (1989) writes that confusion and disorganization are necessary parts of learning.”
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“A recent meta-analysis of numerous studies, however, provides compelling evidence of the effectiveness of long-term psychotherapy for the treatment of various mental illnesses (Leichsenring and Rabung 2008).”
BackgroundIs there room for criticism of studies of psychodynamic psychotherapy?
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“Although some meta-analysts have concluded that LTPP is superior to shorter forms of psychotherapy (Leichsenring & Rabung, 2008, 2011), these claims have been strongly disputed (e.g., Bhar et al., 2010; Pignotti & Albright, 2011).”
Methoden Psychoanalyse und psychoanalytische Psychotherapie – Unterschiede und Gemeinsamkeiten
Rössler-Schülein, H., & Löffler-Stastka, H. (2013) · Neuropsychiatrie (Deisenhofen) · doi:10.1007/s40211-013-0077-3 · Cited by 8
Technique and therapeutic process from a supportive-expressive relational psychodynamic approach.
Diener, M., & Pierson, M. M. (2013) · Psychotherapy · doi:10.1037/a0032404 · Cited by 8
Effet placebo et antidépresseurs : une revue de la littérature éclairée par la psychanalyse
Keller, P.-H., Giroux-Gonon, A., & Gonon, F. (2013) · L Évolution Psychiatrique · doi:10.1016/j.evopsy.2013.02.004 · Cited by 10
Patients' experiences of forensic psychotherapy
Yakeley, J., & Wood, H. B. (2011) · Psychoanalytic Psychotherapy · doi:10.1080/02668734.2010.519160 · Cited by 8
“Although there is increasing evidence to suggest that psychoanalysis and psychoanalytic therapy do work (Fonagy, 2002; Knekt et al., 2008; Leichsenring & Rabung, 2008) there is still much debate as to the mechanism of action.”
BackgroundComplexité des psychothérapies et de la recherche clinique dans les services d’oncologie
Bacqué, M. (2010) · doi:10.1007/s11839-010-0281-3 · Cited by 8
“Paradoxalement, les premières séances sont parfois douloureuses en raison d’une prise de conscience ; cependant, dans le moyen et le long termes, les patients évoquent un sentiment de mieux-être, comme le montre la métaanalyse de Leichsering et Rabung, publiée dans JAMA en 2008 [10] ;”
BackgroundCoyne, J., Bhar, S., Pignotti, M., Tovote, K., & Beck, A. (2010) · Psychotherapy and Psychosomatics · doi:10.1159/000317537 · Cited by 8
Curar a Homossexualidade? A psicopatologia prática do DSM no Brasil
Dunker, C., & Kyrillos, F. (2010) · doi:10.5020/23590777.10.2.425-446 · Cited by 8
“…final e ao cabo não é a redução ou a ausência de eficácia o que justificaria a exclusão de práticas psicanalíticas; pelo contrário, as “psicoterapias psicodinâmicas de longo termo” mostraram-se muito mais eficazes do que qualquer outra forma de tratamento psicológico (Leichsenring & Rabung, 2008).”
Jiang, X., Lu, X., Pu, M., & Li, X. (2025) · Frontiers in Public Health · doi:10.3389/fpubh.2025.1502506 · Cited by 7
The Depression Conundrum and the Advantages of Uncertainty
Celie, J. E., Loeys, T., Desmet, M., & Verhaeghe, P. (2017) · Frontiers in Psychology · doi:10.3389/fpsyg.2017.00939 · Cited by 8
Reduced Contact Cognitive-Behavioral Interventions for Adult Depression: A Review
Beshai, S., Wallace, L. M., McDougall, K. H., Waldmann, K., & Stea, J. N. (2016) · The Journal of psychology · doi:10.1080/00223980.2015.1087376 · Cited by 7
“The aim of the treatment is to identify these unconscious drives and how they are affecting current relationships and functioning (Leichsenring & Rabung, 2008).”
BackgroundTrauma and psychosis: A review and framework for psychoanalytic understanding
Kirshner, L. A. (2015) · doi:10.1080/0803706x.2013.778422 · Cited by 7
“…to meet the stringent criteria of contemporary science, but mainly for neurotic and personality disorders, not for the treatment of psychosis (see Leichsenring & Rabung, 2008, for a comprehensive review).3 This exclusion has left a gap in attending to the unique life histories of individual…”
BackgroundPsychotherapy provision in the UK: time to think again.
Lousada, J., Weisz, J., Hudson, P., & Swain, T. (2015) · Lancet psychiatry · doi:10.1016/s2215-0366(15)00082-6 · Cited by 7
Waldron, S., Gazzillo, F., & Stukenberg, K. W. (2015) · Psychoanalytic Inquiry · doi:10.1080/07351690.2015.987602 · Cited by 7
“…psychoanalysis and long-term psychoanalytic therapy lead to substantial improvements in quality of life (see Bachrach et al., 1991, for review; and for more contemporary reviews and meta-analyses see also Abbass et al., 2014; Leichsenring and Rabung, 2008, 2011; Shedler, 2010; Leichsenring, 2010).”
BackgroundBrown, K. M., & Tracy, D. K. (2014) · British Journal of Psychotherapy · doi:10.1111/bjp.12074 · Cited by 6
Zilcha‐Mano, S., & Barber, J. P. (2014) · Contemporary Psychoanalysis · doi:10.1080/00107530.2014.880309 · Cited by 10
[Effectiveness of psychodynamic psychotherapy in children and juveniles - results of a pilot study].
Krischer, M., Trautmann-Voigt, S., Kaspers, S., Voigt, B., Flechtner, H., & Lehmkuhl, G. (2013) · Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie · doi:10.1024/1422-4917/a000216 · Cited by 7
The study of men in short-term and long-term psychodynamic psychotherapy: A brief research note.
Watkins, C. (2012) · Psychoanalytic Psychology · doi:10.1037/a0025183 · Cited by 7
When it comes to evaluating psychodynamic therapy, the devil is in the details.
Anestis, M., Anestis, J. C., & Lilienfeld, S. (2011) · American Psychologist · doi:10.1037/a0021190 · Cited by 7
“The eight studies pooled by Leichsenring and Rabung (2008), for instance, had 15–30 patients in the treatment group and power to find a moderate effect size (e.g., 0.50) of 0.23–0.48 (Bhar et al., 2010; Thombs et al., 2009).”
BackgroundMethodInfluentialBerger, T., Brakemeier, E., Klesse, C., & Schramm, E. (2009) · Der Nervenarzt · doi:10.1007/s00115-008-2624-x · Cited by 12
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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