Long-term Psychoanalytic Psychotherapy Research Articles

A Case of Traumatophilia Through Transgender Embodiment

Virginia is a White trans lesbian woman in her late 30s living in a rural environment in the United States. She is a long-term psychoanalytic psychotherapy patient in a community mental health center. She has a significant trauma history from childhood. Harnessing Avgi Saketopoulou’s concept of traumatophilia, this article analyzes Virginia’s intra and inter-psychic dynamics that result from her material experience in the world. Under a ubiquitous threat of politicized violence within her community, she experiences a constant fear for her and her family’s safety. At the same time, Virginia experiences a sexual attraction for women who have voiced anti-trans bias. In conjunction with her trauma history, this dynamic illustrates Virginia’s traumatophilia forming a tension between her experience of terror in the face of bigotry and her fantasy of inclusion. Detailing the political implications of trans experience as connected to the psychic conflicts manifested within a traumatophilia, the article concludes that trans experience is both implicitly and explicitly political. As such, psychoanalytic practitioners working with trans patients should focus on the ways in which psychic suffering is shaped and conditioned by the social world.

Trajectories of change among highly challenging patients in intensive long-term psychoanalytic psychotherapy.

This study aimed to identify and describe trajectories of change in distress among highly challenging patients who had received long and intensive psychoanalytic psychotherapy. The longitudinal version of the K-means algorithm was applied to the outcome measures data of 74 patients treated in four public mental health centers. The patients were measured five times at 6-month intervals for three outcome measures. For the OQ45 andSymptom Checklist-90, one trajectory was marked by a lower initial distress level. In this trajectory, the improvement occurred in the first half of the measurements, with a plateau thereafter. A second trajectory was characterized by higher initial severity and an improvement, mainly in the second part of the measurements. For the BeckDepression Inventory, one trajectory was marked by lower initial distress. In this group, the improvement occurred throughout the entire period. The remaining patients were characterized by higher initial distress and a decreased level of distress in the last part of treatment. They began to improve only during the third year of therapy. The response to treatment is not uniform in long-term treatment for highly challenging patients. A significant number of patients require a longer period of therapy to ignite improvement.

Cost-effectiveness of long-term psychoanalytic psychotherapy for treatment-resistant depression: RCT evidence from the Tavistock Adult Depression Study (TADS)

BackgroundTreatment-resistant depression (TRD) accounts for a large fraction of the burden of depression. The interventions currently used are mostly pharmacological and short-term psychotherapies, but their effectiveness is limited. The Tavistock Adult Depression Study found evidence for the effectiveness of long-term psychoanalytic psychotherapy (LTPP) plus treatment as usual (TAU), versus TAU alone, for TRD. Even after a 2-year follow-up, moderate effect sizes were sustained. This study assessed the cost-effectiveness of this LTPP + TAU. MethodsWe conducted a within-trial economic evaluation using a Bayesian framework. ResultsQuality-adjusted life years (QALYs) were 0.16 higher in the LTPP + TAU group compared with TAU. The direct cost of LTPP was £5500, with no substantial compensating savings elsewhere. Overall, average health and social care costs in the LTPP + TAU group were £5000 more than in the TAU group, employment rates were unchanged, and effects on other non-healthcare costs were uncertain. Accordingly, the incremental cost-effectiveness ratio was ≈£33,000/QALY; the probability that LTPP + TAU was cost-effective at a willingness to pay of £20,000/QALY was 18 %. LimitationsThe sample size of this study was relatively small, and the fraction of missing service-use data was approximately 50 % at all time points. The study was conducted at a single site, potentially reducing generalizability. ConclusionsAlthough LTPP + TAU was found to be clinically effective for treating TRD, it was not found to be cost-effective compared with TAU. However, given the sustained effects over the follow-up period it is likely that the time horizon of this study was too short to capture all benefits of LTPP augmentation.

"Psychological treatments for persistent depression: A systematic review and meta- analysis of quality of life and functioning outcomes:" Correction to McPherson and Senra (2022).

Reports an error in "Psychological treatments for persistent depression: A systematic review and meta-analysis of quality of life and functioning outcomes" by Susan McPherson and Hugo Senra (Psychotherapy, Advanced Online Publication, Jun 27, 2022, np). In the article, there were errors in the abstract. The confidence interval in the sentence Quality of life at follow-up: pooled g = 0.21 should appear as follows: 95% CI, 0.10-0.32. In the sentence The psychological interventions were associated with improvements in patients' functioning at end-of-treatment, the pooled g should appear as g = 0.35. The confidence interval in the sentence Functioning at follow-up resulted in: pooled g = 0.33 should appear as follows: 95% CI, 0.15-0.51. Figure 5 also has been corrected. All versions of this article have been corrected. (The following abstract of the original article appeared in record 2022-76312-001.) To date it is unclear whether psychological therapies have potential to improve quality of life and functioning in patients with persistent depression. This meta-analysis examines the effect of psychological therapies for improving quality of life and functioning in patients with persistent forms of depression. Data sources include Medline and Meta-Analytic Psychotherapy Database (METAPSY), searched 07/2021. Eligible studies were randomized controlled trials where participants had major depressive disorder on entry and met criteria for a persistent form of depression, for example, chronic, treatment resistant or recurrent depression. Standardized mean differences (Hedge's g) were calculated in random-effects meta-analyses. Fourteen studies met inclusion criteria (N = 1898). Psychological interventions were associated with improvements in patients' quality of life at the end of treatment: pooled g = 0.24 (95% confidence intervals [CIs] 0.13-0.34); low to moderate levels of heterogeneity (I² = 0% [95% CI 0%-41.2%]). Quality of life at follow-up: pooled g = 0.21 (95% CI 0.01-0.32); low to high levels of heterogeneity considering the wide CI for I² (I² = 10.36% [95% CI 0%-77.5%]). The psychological interventions were associated with improvements in patients' functioning at end of treatment: pooled g = 0.34 (95% CI 0.21-0.48); low to high levels of heterogeneity considering the wide CI for I² (I² = 0% [95% CI 0%-81.7%]). Functioning at follow-up resulted in: pooled g = 0.33 (95% CI 0.15-0.50); low to high levels of heterogeneity considering the wide CI for I² (I² = 0% [95% CI 0%-86.2%]). This meta-analysis highlights the potential benefits of psychological therapies for improving quality of life and functioning in patients with persistent depression, with strongest long-term effects for mindfulness-based cognitive therapy, interpersonal therapy in combination with antidepression medication, and long-term psychoanalytic psychotherapy. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Psychological treatments for persistent depression: A systematic review and meta-analysis of quality of life and functioning outcomes.

[Correction Notice: An Erratum for this article was reported in Vol 59(3) of Psychotherapy (see record 2022-94545-001). In the article, there were errors in the abstract. The confidence interval in the sentence Quality of life at follow-up: pooled g = 0.21 should appear as follows: 95% CI, 0.10-0.32. In the sentence The psychological interventions were associated with improvements in patients' functioning at end-of-treatment, the pooled g should appear as g = 0.35. The confidence interval in the sentence Functioning at follow-up resulted in: pooled g = 0.33 should appear as follows: 95% CI, 0.15-0.51. Figure 5 also has been corrected. All versions of this article have been corrected.] To date it is unclear whether psychological therapies have potential to improve quality of life and functioning in patients with persistent depression. This meta-analysis examines the effect of psychological therapies for improving quality of life and functioning in patients with persistent forms of depression. Data sources include Medline and Meta-Analytic Psychotherapy Database (METAPSY), searched 07/2021. Eligible studies were randomized controlled trials where participants had major depressive disorder on entry and met criteria for a persistent form of depression, for example, chronic, treatment resistant or recurrent depression. Standardized mean differences (Hedge's g) were calculated in random-effects meta-analyses. Fourteen studies met inclusion criteria (N = 1898). Psychological interventions were associated with improvements in patients' quality of life at the end of treatment: pooled g = 0.24 (95% confidence intervals [CIs] 0.13-0.34); low to moderate levels of heterogeneity (I² = 0% [95% CI 0%-41.2%]). Quality of life at follow-up: pooled g = 0.21 (95% CI 0.01-0.32); low to high levels of heterogeneity considering the wide CI for I² (I² = 10.36% [95% CI 0%-77.5%]). The psychological interventions were associated with improvements in patients' functioning at end of treatment: pooled g = 0.34 (95% CI 0.21-0.48); low to high levels of heterogeneity considering the wide CI for I² (I² = 0% [95% CI 0%-81.7%]). Functioning at follow-up resulted in: pooled g = 0.33 (95% CI 0.15-0.50); low to high levels of heterogeneity considering the wide CI for I² (I² = 0% [95% CI 0%-86.2%]). This meta-analysis highlights the potential benefits of psychological therapies for improving quality of life and functioning in patients with persistent depression, with strongest long-term effects for mindfulness-based cognitive therapy, interpersonal therapy in combination with antidepression medication, and long-term psychoanalytic psychotherapy. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Where Is My Mother? Childhood Trauma and the Configuration of the Self

ABSTRACT In this account of a long-term psychoanalytic psychotherapy, a confluence of childhood traumatogenic factors in interaction with the patient’s unconscious fantasy life resulted in dramatic permutations and distortions in the patient’s self- organization. From a different but related perspective, the psychic repercussions of an incompletely mourned and internalized maternal object are also explored. The prevailing psychic script or narrative, deeply embedded and nearly intractable, revolved around the patient’s conscious and unconscious conviction of mortal sin and guilt in response to her mother’s death – imposing on her the penalty of “a life for a life.” During the course of treatment, the patient’s investment in becoming a good mother became a powerful incentive for the recovery of previously inaccessible experience, facilitating a gradual movement toward psychic integration. While the primary transference at the outset of treatment was the therapist’s nonexistence, replicating the patient’s experience of abandonment-obliteration, the development of the therapeutic relationship was essential to the gradual assimilation of dissociated traumatic experience and the enlivenment of the unrepresented maternal object.

Psychoanalytic psychotherapy in Denmark: development, implementation in the public health service and present status

The history of psychoanalysis and psychodynamic psychotherapy in Denmark is briefly described. An important element in developing the psychodynamic thinking in the public mental health service took place in the 1970s where several British psychoanalysts and group analysts helped Danish therapists and analysts starting regular courses in psychoanalytic psychotherapy that were attended by a few hundred psychologists and psychiatrists. The implementation of psychodynamic thinking and practice in the Mental Health System followed over the next two decades, although the Danish welfare system did not economically support patients referred to psychoanalysis, long-term or intensive psychoanalytic psychotherapy. At the new millennium, opposition to psychoanalysis and psychodynamic thinking made it difficult to sustain the relative high level of involvement of psychodynamic practice in both mental health institutions and private practice. The reasons for this are suggested as well as comments on the future.

Personality and outcome in individuals with treatment-resistant depression-Exploring differential treatment effects in the Tavistock Adult Depression Study (TADS).

Although research over the past decades has investigated the impact of the personality dimensions of dependency and self-criticism on treatment outcome, little is known of how these personality features influence responsiveness to treatment in patients with severe, chronic forms of depression. The present study uses data from the Tavistock Adult Depression Study, a randomized controlled trial investigating the effectiveness of long-term psychoanalytic psychotherapy (LTPP) compared with treatment as usual (TAU) for individuals diagnosed with treatment-resistant depression. Patients were rated with the Anaclitic-Introjective Depression Assessment Q-sort, which distinguishes between two more maladaptive (Submissive and Dismissive) and two less maladaptive (Needy and Self-Critical) subdimensions of dependent or anaclitic and self-critical or introjective depression. Multilevel modeling was used to compare individuals' growth curves of depression severity as measured by the Hamilton Rating Scale for Depression over the 18-month treatment period and 2-year follow-up. Rates of clinically significant change were also determined. As expected, depressed patients with more maladaptive dependent and self-critical features did not benefit from LTPP or TAU. Patients with less maladaptive self-critical features benefited from both LTPP and TAU, while those with less maladaptive dependent features showed considerable gains from LTPP but not from TAU, with medium to large effect sizes. Findings of this study are consistent with existing research suggesting the need to modify and tailor treatments in accordance with individuals' pretreatment personality features. Given the time and cost-intensive nature of longer-term treatment, this may be particularly important in patients with treatment-resistant depression. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

A Series of Meta-Analytic Tests of the Efficacy of Long-Term Psychoanalytic Psychotherapy

Abstract. Recent meta-analyses come to conflicting conclusions about the efficacy of long-term psychoanalytic psychotherapy (LTPP). Our first goal was to reproduce the most recent meta-analysis by Leichsenring, Abbass, Luyten, Hilsenroth, and Rabung (2013) who found evidence for the efficacy of LTPP in the treatment of complex mental disorders. Our replicated effect sizes were in general slightly smaller. Second, we conducted an updated meta-analysis of randomized controlled trials comparing LTPP (lasting for at least 1 year and 40 sessions) to other forms of psychotherapy in the treatment of complex mental disorders. We focused on a transparent research process according to open science standards and applied a series of elaborated meta-analytic procedures to test and control for publication bias. Our updated meta-analysis comprising 191 effect sizes from 14 eligible studies revealed small, statistically significant effect sizes at post-treatment for the outcome domains psychiatric symptoms, target problems, social functioning, and overall effectiveness (Hedges’ g ranging between 0.24 and 0.35). The effect size for the domain personality functioning (0.24) was not significant ( p = .08). No signs for publication bias could be detected. In light of a heterogeneous study set and some methodological shortcomings in the primary studies, these results should be interpreted cautiously. In conclusion, LTPP might be superior to other forms of psychotherapy in the treatment of complex mental disorders. Notably, our effect sizes represent the additional gain of LTPP versus other forms of primarily long-term psychotherapy. In this case, large differences in effect sizes are not to be expected.

A Mind's Eye View: Processing Psychoanalytic Treatment Through Artwork

While visual images have often been used in clinical assessments and diagnosis, this paper will explore how we may now utilize their unique capabilities to communicate unconscious, primary process material, to monitor and enhance ongoing long-term psychoanalytic psychotherapy within the framework of expressive analysis. This paper presents several clinical vignettes that illustrate this monitoring process and demonstrates how the clinical work can be deepened with the exposure and integration of creative images as the patient and analyst process these visual metaphors within the expressive analytic session. A variety of sensory motor systems and perceptions are monitored and explored. These examples will follow the expressive analytic model, clearly focusing on transference and resistance, while also bringing in more contemporary life issues through visual metaphors.

The Effectiveness of Psychoanalysis and Psychoanalytic Psychotherapy: A Literature Review of Recent International and Australian Research

The purpose of this review was to determine the effectiveness of psychoanalysis and psychoanalytic psychotherapy, both generally and in Australian settings. A systematic search for papers on research conducted internationally and in Australia within the last 5 years was undertaken using the Academic Search Complete, PsycINFO databases. From the 1,231 records retrieved from the two databases, 26 papers included studies that met the selection criteria. None of these papers contained research from Australia. Evidence from a small number of studies provides tentative support for the effectiveness of psychoanalysis in the treatment of patients with some depressive, anxiety, and personality disorders. The variable quality of this research, and the absence of control conditions in most studies, however, means that making more definitive statements about the effectiveness of psychoanalysis difficult at this time. The findings of studies on long-term psychoanalytic psychotherapy suggest that (a) favourable outcomes may be able to be achieved for people with a range of conditions, including mood, anxiety, sexual dysfunction, and personality disorders; (b) the outcomes achieved seem to be equivalent to those gained through the use of other psychotherapies; and (c) the effects of long-term psychoanalytic psychotherapy may endure long after the termination of treatment. Short-term psychoanalytic psychotherapy may be effective for the treatment of depressive disorders. The quality of studies in this area prevents the drawing of more definitive conclusions with respect to other conditions. Given that researchers often use the terms psychoanalytic and psychodynamic interchangeably, however, practitioners should be cognisant of the work on the effectiveness of psychodynamic psychotherapies. This work is supportive of the use of psychodynamic psychotherapy for depressive disorders, some anxiety disorders (most notably, generalised anxiety disorder), somatic symptoms and some somatoform disorders (e.g., hypochondriasis), and some personality disorders (mainly borderline and Cluster C personality disorders). The benefits of psychoanalytic and psychodynamic psychotherapies typically seem to endure well beyond the termination of treatment. In general, the outcomes achieved with these treatments appear to be equivalent to those gained through other psychotherapies. More definitive conclusions about the value of psychoanalysis and psychoanalytic psychotherapy cannot be drawn at this time. For a variety of reasons (e.g., the challenges associated with researching treatments that occur over long periods of time) there has been insufficient research conducted on the effectiveness of these psychotherapies, especially psychoanalysis. More research is required to strengthen the evidence base on the effectiveness of psychoanalysis and psychoanalytic psychotherapy.

Can the Effectiveness of the Psychoanalytic Therapies Truly Be Proven?: The Effectiveness of the Psychoanalysis and Psychoanalytic Psychotherapy

The nature of psychoanalysis and long-term psychoanalytic psychotherapy makes it difficult to perform efficacy study including randomized controlled trial (RCT). Several RCTs are focused on the effectiveness of psychoanalytic psychotherapy; and more RCTs are conducted across multiple disorders for short-term psychoanalytic psychotherapy. As a result, there were more studies on psychoanalytic psychotherapy, as compared with that of cognitive behavioral therapy or pharmacotherapy. Moreover, psychoanalytic psychotherapy yielded significant benefits in terms of psychiatric symptoms but also the aspects of quality of life, adaptive capacities, and the reduction of maladaptive interpersonal behaviors. The psychotherapies of various types applying psychoanalytic theories were generally effective. Consequently, it can be inferred that long-term and intensive psychoanalysis is also effective.

Pragmatic randomized controlled trial of long-term psychoanalytic psychotherapy for treatment-resistant depression: the Tavistock Adult Depression Study (TADS).

This pragmatic randomized controlled trial tested the effectiveness of long-term psychoanalytic psychotherapy (LTPP) as an adjunct to treatment-as-usual according to UK national guidelines (TAU), compared to TAU alone, in patients with long-standing major depression who had failed at least two different treatments and were considered to have treatment-resistant depression. Patients (N=129) were recruited from primary care and randomly allocated to the two treatment conditions. They were assessed at 6-monthly intervals during the 18 months of treatment and at 24, 30 and 42 months during follow-up. The primary outcome measure was the 17-item version of the Hamilton Depression Rating Scale (HDRS-17), with complete remission defined as a HDRS-17 score ≤8, and partial remission defined as a HDRS-17 score ≤12. Secondary outcome measures included self-reported depression as assessed by the Beck Depression Inventory - II, social functioning as evaluated by the Global Assessment of Functioning, subjective wellbeing as rated by the Clinical Outcomes in Routine Evaluation - Outcome Measure, and satisfaction with general activities as assessed by the Quality of Life Enjoyment and Satisfaction Questionnaire. Complete remission was infrequent in both groups at the end of treatment (9.4% in the LTPP group vs. 6.5% in the control group) as well as at 42-month follow-up (14.9% vs. 4.4%). Partial remission was not significantly more likely in the LTPP than in the control group at the end of treatment (32.1% vs. 23.9%, p=0.37), but significant differences emerged during follow-up (24 months: 38.8% vs. 19.2%, p=0.03; 30 months: 34.7% vs. 12.2%, p=0.008; 42 months: 30.0% vs. 4.4%, p=0.001). Both observer-based and self-reported depression scores showed steeper declines in the LTPP group, alongside greater improvements on measures of social adjustment. These data suggest that LTPP can be useful in improving the long-term outcome of treatment-resistant depression. End-of-treatment evaluations or short follow-ups may miss the emergence of delayed therapeutic benefit.

Effectiveness of Psychoanalytic Psychotherapy and Behavioral Therapy Treatment in Children with Attention Deficit Hyperactivity Disorder and Oppositional Defiant Disorder

The study compares the effectiveness of long-term psychoanalytic psychotherapy without medication with behavioral therapy and/or medication treatment. Seventy-three children with attention-deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) participated in a controlled trial. The primary outcome was symptom reduction 38 months after the pre-treatment assessment. Secondary outcomes were significantly lower scores for Conners Parent and Teacher Rating Scale, Child Behavior Checklist and Teacher Report Form scores. Both treatment groups demonstrated significant symptom reduction, with no significant differences in effectiveness between the two groups. Teacher ratings as well as parent ratings showed a significant decline over time on the ADHD index scores, on oppositional behavior and hyperactivity/impulsivity levels and on internalizing and externalizing problem scores. Both groups demonstrated similar main effects of time. There were no significant interactions between group and time. The findings of this study support psychoanalytic psychotherapy without medication as being as effective as behavioral treatment with methylphenidate in symptom reduction and problem reduction on ADHD/ODD related rating scales.

Comparing a 5-month trial of enhanced cognitive behavioural therapy to a 24-month trial of psychoanalytic psychotherapy for the treatment of bulimia nervosa

Bulimia nervosa is characterised by binge eating and inappropriate compensatory behaviours in the context of severe weight and/or shape concern. Despite empirical evidence supporting the efficacy of several psychological treatments...

Does psychoanalytic psychotherapy offset use of mental health services and related costs in severe borderline personality disorder? – A case study

Aims and methods: To show that long-term psychoanalytic psychotherapy can offset costs of psychiatric care when offered to a patient affected by borderline personality disorder with a severe presentation and co-morbid psychopathologies. Costs of mental health services were calculated for a nine-year period. Cost offset was calculated comparing the five years preceding therapy with the four years during and post-therapy. Results: In this case study the provision of long-term psychoanalytic psychotherapy has consistently and progressively reduced use of mental health services and related costs during the intervention and post-intervention period. Significant reduction in use of services and savings of approximately £5000 were obtained for the post-intervention year. Limitations: The research findings are limited by the lack of control conditions over confounding factors. Besides, cost-effectiveness could not be established. Clinical implications: Long-term psychoanalytic psychotherapy is rarely available in the modern National Health Service (NHS) and is unlikely to be offered to patients with severe character pathology. Although specialist tertiary services have been created to cater for this group, patients who cannot engage with these services risk not to be adequately treated. This case study suggests that long-term psychoanalytic psychotherapy could be used as a viable and cost-saving alternative for some of these patients.

Irene: das sensações às emoções

Este artigo relata uma psicoterapia psicanalítica de longo prazo com uma menina autista de 8 anos. O relato do tratamento divide-se em 4 períodos: no primeiro, o tratamento visará à retomada das bases da imagem do corpo de uma menina ainda muito agitada e retraída; no seguinte, há um início de construção do espaço transicional, com a emergência de trocas verbais. Na terceira etapa vê-se o acesso ao espelho e uma melhor comunicação das experiências vividas. E na última verificam-se a consolidação da imagem do corpo bem como o desenvolvimento do jogo e da simbolização.

Attachment Styles and Outcome of Psychoanalytic Psychotherapy for Children and Adolescents

Background: Until now few studies have proven that an attachment style can be changed in the course of psychotherapy and that the attachment style has an impact on the therapy outcome. In particular, there is a lack of studies about these relationships in long-term psychoanalytic psychotherapy with children and adolescents. Sampling and Methods: Seventy-one children with mental disorders receiving long-term outpatient psychodynamic psychotherapy were assessed 4 times using the Heidelberg Attachment Style Rating for Children and Adolescents. The measurements were conducted at the beginning of treatment, at the 25th treatment session, at the end of treatment and 1 year after the completion of treatment. Results: The results showed a significant change in attachment style during treatment. The proportion of children and adolescents with a secure attachment style increased from 23% to 63%. There was no significant difference in the attachment style between patients with good and poor treatment outcome, but a significant relationship between secure attachment and the number of treatment sessions could be demonstrated. Conclusions: A reorientation towards a secure main attachment style over the course of psychotherapy is possible. However, attachment style seems to be not a moderator but a mediator for the outcome of psychoanalytic psychotherapy in children and adolescents.

Designs for Studying the Effectiveness of Long-Term Psychoanalytic Treatments

Long-Term Psychoanalytic Treatments (LTPT) include both long-term psychoanalytic psychotherapy (LTPP) and psychoanalysis (PsAn). Current opinion seems to be that there is some evidence for the effectiveness of LTPP, but none for that of PsAn. This may be due in part to researchers not balancing the level of evidence of randomized controlled studies (RCTs), cohort studies, and pre-post studies with patients' acceptance of these various research designs used in studying the effectiveness of LTPT. After a review of the merits of eight possible control conditions for LTPT in RCTs and cohort studies, and a consideration of the limitations and merits of pre-post studies, it was found that RCTs pair high levels of evidence with limited degrees of patient acceptance, especially where PsAn is concerned. Cohort studies appear to provide at most a moderate level of evidence. Their acceptability is hardly better than that of RCTs, as it depends on the acceptability of control conditions similar to those of RCTs. The acceptability of pre-post studies is much better, but they can provide, at most, a moderate level of evidence. Apart from randomization, they can meet all methodological criteria for high-quality research (often they do not, but there are ways to correct this). In summary, in the long-term treatment of complex mental disorders with LTPT, RCTs often pair a high level of evidence with limited patient acceptance of the method. Compared to RCTs, cohort studies show a lower level of evidence without much gain in acceptability. Pre-post studies pair the highest level of acceptability with the lowest level of evidence of the three designs. Limited acceptability is not to be confused with no acceptability, nor moderate level of evidence with none.

Umstrukturierung als Ergebnisparadigma der psychodynamischen Psychotherapie - Ergebnisse aus der Praxisstudie Analytische Langzeittherapie

Psychodynamic psychotherapies have proved to lead to relevant symptomatic improvement. An unresolved question, however, is what amount of psychodynamic change can be expected beyond symptom relief. For theoretical and methodological reasons rooted in the psychodynamic approach, this question has been difficult to answer until now. In the German study PAL (long-term psychoanalytic psychotherapy), 32 patients in psychoanalytic therapy and 27 patients in psychodynamic psychotherapy were studied from the perspective of therapists, patients and researchers through three years post-treatment. In this paper we study the aspect of psychodynamic change of dysfunctional relations, unconscious conflicts and structural aspects as diagnosed by the Operationalized Psychodynamic Diagnostic method. Structural change is rated by the Heidelberg Structural Change Scale. A comparison of the two forms of therapy shows more structural change in long-term psychoanalytic psychotherapy compared to the shorter psychodynamic psychotherapy. A comparison of patients with a high level and a low level of structural change revealed that the highly changed patients showed greater symptom relief and greater satisfaction with therapy, and that their therapists perceived a better overall result of treatment. For psychodynamic psychotherapies structural change seems to be a relevant paradigm of outcome in addition to symptom relief. In longer and more frequent psychoanalytic therapies more structural change occurs compared to shorter psychodynamic psychotherapies. Beside the amount and length of treatment, the different therapy targets - working through vs. supportive - seem to be important.