Abstract
BackgroundThe course of self-reported symptoms during medium- versus long-term psychodynamic psychotherapy has rarely been documented for outpatient settings. This observational study describes routine practice of ambulatory treatment in Germany and explores self-reported symptoms of a broad patient sample undergoing one (medium-term) versus two years (long-term) of psychodynamic psychotherapy.MethodsOver four and a half years, longitudinal self-report symptom data were collected from 342 outpatients as part of a standardized documentation system. Self-report data were compared between patients receiving either medium-term or long-term psychodynamic psychotherapy.ResultsRoutine care significantly decreased disease burden as reported by patients by small to medium effect sizes (ES) for depression (ES = 0.58), anxiety (ES = 0.49), obsessive-compulsive disorder (ES = 0.54), somatoform disorder (ES = 0.32), eating disorder (ES = 0.38). The majority of patients completed treatment after one year and showed medium-size changes. For a subgroup of patients with depressive and/or obsessive-compulsive disorder symptoms for whom two years of therapy were deemed necessary, additional benefits were reported during the second year of treatment (ES = 0.61 and ES 0.47, respectively).ConclusionsOur findings suggest that both medium- and long-term psychodynamic psychotherapy decrease self-reported disease burden of patients with depression, anxiety, obsessive-compulsive, somatoform and/or eating disorders. For a subgroup of patients, additional benefits were gained in the second year of treatment.
Highlights
The course of self-reported symptoms during medium- versus long-term psychodynamic psychotherapy has rarely been documented for outpatient settings
Psychotherapy is widely applied in Germany, and physicians specialized in psychosomatic medicine apply this type of treatment in approximately 65 % of their patients [5]
When comparing patients receiving medium- with those receiving long-term therapy, the latter group showed a higher mean of diagnoses, with 4.12 (SD = 2.40) diagnoses for patients in medium-term and 4.85 (SD = 2.63) diagnoses for patients in long-term therapy (p = .027)
Summary
The course of self-reported symptoms during medium- versus long-term psychodynamic psychotherapy has rarely been documented for outpatient settings. As evidence from research into long-term approaches is scarce, Leichsenring and Rabung [14] undertook a meta-analysis on outcomes of long-term psychodynamic psychotherapy from 23 studies Their meta-analysis suggests superiority of long-term over short-term treatment, with large effect sizes for aforementioned subgroups of patients who do not sufficiently benefit from short-term interventions [14]. While this meta-analysis is an important contribution to the field, it again emphasizes the lack of research in this area as only few studies could be included in the analysis. It remains that—even after such great effort to collate data on outcomes from long-term therapy—evidence from realworld psychodynamic psychotherapy in outpatient settings, i.e. where most treatment takes place, remains scarce [17]
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