Effectiveness of Long-Term Psychodynamic Psychotherapy: First Meta-Analytic Evidence and Its Discussion

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.