Long-term Psychotherapy Research Articles

Working Meaningfully With Older Adults in Psychotherapy: Memory, Autobiography, Self, and the Conversational Model

As the population of older adults increases, a growing number of older people will seek psychotherapy and counselling in the coming years. Therefore, therapists should deepen their understanding of the unique developmental challenges that accompany the later years. While varying approaches and theoretical frameworks exist for how to understand these developmental challenges and work in a way that promotes wellbeing, therapy with older adults remains an under-explored area. This paper outlines my clinical observations while working with a single man in his mid-70s who started seeing me for long-term psychotherapy. It explores the intersection of memory, autobiography, self, and ego integration and contributes to the discussion about how to work meaningfully with older adults. I hypothesise that working with our clients to compose an autobiographical consciousness that can be narrated and witnessed by an empathic other could be an important aspect of ego integration. This is because narrative is a meaning-making tool that facilitates one’s sense of self and promotes the process of reconciliation with the past and direction towards the future. This exploration is situated within the framework of the Conversational Model of psychotherapy developed by Robert Hobson and Russell Meares.

Psychotherapy use among migrants: a register-based longitudinal study

BackgroundMigrants use less mental health services compared with non-migrant populations, but there is very little information on the use of long-term psychotherapy among migrants. Finnish register data allow for studying...

Childhood trauma and differential response to long-term psychoanalytic versus cognitive-behavioural therapy for chronic depression in adults.

Childhood trauma is a major risk factor for chronic depression. It has been suggested that adults with chronic depression who have experienced childhood trauma may require long-term treatment owing to a breakdown of basic trust and related difficulties in developing a productive therapeutic relationship. As empirical studies have been preliminary and scarce, we studied the effects of psychoanalytic therapy (PAT) versus cognitive-behavioural therapy (CBT) for chronic depression in adults with a history of childhood trauma. In this subgroup, we expected a greater symptom reduction in PAT compared with CBT. In a large trial of long-term psychotherapies for chronic depression (LAC-Study; Clinical Trial Register ISRCTN91956346), 210 adults received open-ended CBT or PAT in an out-patient setting and were examined yearly over 5 years on the Beck Depression Inventory - II (BDI-II). Based on a linear mixed model approach, we tested participant-reported childhood trauma based on the Childhood Trauma Questionnaire (CTQ) as a predictor and moderator of treatment outcome. CTQ subscales were examined exploratively. Depressive symptoms decreased over time (b = -4.55, s.e. = 0.90, 95% CI -6.32 to -2.81, T = -5.08; P < 0.001). A significant three-way interaction between childhood trauma, time and therapy group (b = -0.05, s.e. = 0.02, 95% CI -0.09 to -0.01, T = -2.42; P = 0.016) indicated that participants with childhood trauma profited especially well from PATs. Our results indicate differential benefits from PAT compared with CBT among adults with chronic depression and a history of childhood trauma. The results have important implications for differential indication and policy.

PSYCHOSOMATİCS: PSYCHOLOGİCAL CAUSES OF SOMATİC DİSEASES

There is always a balance between the physical and spiritual world of a person. When symmetry is broken in their joint activity, psychological problems arise, which are covered by the name of psychosomatics. In the article, the author considers these issues and notes that the problem of psychosomatics is one of the most pressing and complex problems of our time. The history of psychosomatics is ancient. The humoral theory of temperament of Hippocrates is considered the basis of psychosomatics. The author notes that the term psychosomatics was first used in 1818 by the German physician Heinroth. He analyzed various sources and grouped the causes of psychosomatic diseases and showed that the treatment of somatic diseases is carried out through long-term psychotherapy.

Closure for Survivors of Abusive Relationships

This article presents a five-step clinical approach that describes a process for child sexual abuse survivors, who are now adults, to initiate a statement with their abuser, whereby the survivor can explain the abuse and its impact on their lives. This method may also have applicability for survivors of general child maltreatment. The timing of this intervention needs to be carefully assessed in a partnership between the survivor and clinician. Clinicians might consider this approach if they are conducting long-term psychotherapy with adult survivors of child maltreatment and child sexual abuse, in particular. In addition to delineating steps to be taken, the authors suggest a measurement path. This closure process provides a unique and unduplicated opportunity for personal and professional growth.

Emotional intelligence: on the problem of defining the concept

The article is devoted to substantiate the need to clarify the definition of emotional intelligence (hereinafter referred to as EI). With consideration to the accumulated data on the neurophysiological foundations of EI and psychological trauma, as well as to the methods of psychotherapeutic work of various directions with human emotions and feelings, the introduction of a new element in the definition and structure of EI – emotional sensitivity (hereinafter referred to as ES) – is proposed and argued. ES is considered as the ability to focus attention on your emotions and feelings, be in contact with them, fully experience, be aware of them, immerse yourself into them, live deeply in safe conditions, distance yourself from them if necessary, and return to your experiences again. If the ability to realise one’s emotions and feelings is integrative, affective-cognitive in nature, then ES is the emotional basis of awareness of them, which is proposed to be distinguished separately as an independent and most important element of EI. In general, EI appears as an emotional-cognitive-personal education when the integrative essence of the concept, consisting in the unity of affective and cognitive processes of a person, is emphasised and reflected. In long-term psychotherapy, special and particular attention is given to the development of such an ability as ES. However, due to its important practical significance in people’s daily life, it should be showed in the definitions of EI and remembered in all forms of psychological work with a person.

Psychotherapy duration and work disability: A prospective Finnish register study.

The influence of psychotherapy duration on common mental disorder (CMD) outcomes remains a topic of ongoing debate. Whereas most research has focused on CMD symptom change, the evidence on the psychotherapy duration of subsequent CMD-related work disability and the change in psychotropic drug purchases is scarce. We used a register-based cohort representing 33% of the Finnish population. The participants included working-age individuals (N = 12,047, 76% women, mean age = 36) who initiated long-term psychotherapy, between 2014 and 2017. They were followed from 2011 to 2021 and psychotherapy duration ranged from less than a year to over 3 years. We used an interrupted time series design to analyze the psychotherapy duration-dependent changes in CMD-related work disability (primary outcome, operationalized as depression or anxiety-related sickness absence, SA, days) and the annual number of psychotropic drug purchases or distinct drugs purchased (secondary outcomes). There were no differences in the levels of work disability or drug purchases before the psychotherapy. We observed a decreasing level and trend in all outcomes across all psychotherapy duration groups. The largest decline in level was observed in the <1-year duration group (88% decline for SA and 43%-44% for drug purchases) while the smallest decline was in the 3+ years duration group (73% for SA and 27% for drug purchases). Work disability outcomes and duration varied among individuals, even with similar initial mental health-related work disability or use of auxiliary psychotropic treatments. Compared to longer psychotherapy, shorter psychotherapy was associated with sharper improvements.

Short- and Long-Term Outcomes of an Adventure Therapy Programme on Borderline Personality Disorder: A Pragmatic Controlled Clinical Trial.

Adventure Therapy (AT) is a therapeutic intervention utilizing the natural environment and adventure activities as tools for psychotherapeutic interventions. It has been demonstrated to be appropriate for the intervention of patients with borderline personality disorder (BPD). This study aims to evaluate the response to AT treatment compared with the response to treatment as usual (TAU), based on cognitive behavioural therapy, in the short and long term, assessing clinical, psychosocial, and functional outcomes; quality of life; and physical health levels. This study extends the sample of and is a follow-up to a pilot study published in 2021, with a sample of 30 patients in the AT group and 10 in the control group. It does not allow us to affirm that AT provides better outcomes than TAU, as the positive effects observed immediately after therapy seem to be attenuated in the long term. Therefore, the effectiveness of long-term psychotherapy did not show differences between AT and TAU therapies in the treatment of BPD patients. However, the effects of intangibles observed during therapy by professionals and patients were not reflected in the measurements collected. Therefore, we believe it is necessary to increase the programme duration, complement treatment with a specific physical health programme, assess results with more specific instruments, and/or move towards a qualitative methodology to measure perceived changes in clinical improvement. New studies are needed to evaluate the results of the proposed changes.

The effect of individual short- and long-term psychotherapy on perceived social support: analysis of secondary outcomes of a randomized clinical trial

Purpose Social support is important for maintaining and restoring psychological well-being but the effects of individual psychotherapies on perceived social support are not well known. In this analysis of secondary outcomes from a randomized clinical study, we compared the effects of long-term psychotherapy and two short-term psychotherapies on social support during a 5-year follow-up. Materials and methods Altogether 326 adult outpatients suffering from depressive and/or anxiety disorders were randomly assigned to long-term psychodynamic psychotherapy (LPP, n = 126), short-term psychodynamic psychotherapy (SPP, n = 101) and solution-focused therapy (SFT, n = 97). Outcome was measured by the global index and six subscores of the self-reported Brief Inventory of Social Support and Integration scale (BISSI) at baseline and at 1, 2, 3, 4 and 5 years after the beginning of the therapy. Results Social support improved in all therapy groups and the improvement was relatively stable, lasting several years after the end of therapy. Little difference in improvement was observed either between therapy orientations or durations. Conclusions While no major differences were observed between treatment groups, the slight differences call for further research to verify these findings and to better understand how different therapies may improve perceived social support.

A history of the European Medical Society for Psycholytic Therapy (EPT) 1964–1974

The emergence of a so-called psychedelic renaissance has been proposed to characterize the revival of research into (psycho-)therapies using psychedelic drugs. In Europe, the most widespread approach employed in the 1960s and 1970s that involved the use of drugs like LSD and psilocybin as an adjunct to psychotherapy was named according to its main theoretical framework, that is, psychoanalysis as psycholytic therapy (psycholysis). Psycholytic therapy involves the use of serial low-dose sessions embedded in conventional long-term psychotherapy. However, this approach seems to be neglected today in favor of the psychedelic peak therapy paradigm with the use of just one or two high dose sessions to induce symptom reduction and personality transformation with a minimum time of psychotherapy. A review of the history and activities of the European Medical Society for Psycholytic Therapy (EPT) shows that it was a significant institution at the time. The EPT was founded as a professional society in 1965 aiming to coordinate European efforts of LSD therapists and enable professional exchange to further the development of psycholytic therapy. It also aimed to disseminate psycholytic therapy as an innovative treatment, and encourage international cooperation to develop standards of therapy and training. Up to now, there is virtually nothing available in the literature about the EPT and its activities. The author reconstructs the history and activities of the EPT based on unique archival resources to learn from past experiences and to help inspire the development of standards for treatment and training in the future.

Sociodemographic Factors as Predictors of the Duration of Long-term Psychotherapy: Evidence from a Finnish Nationwide Register Study

ObjectiveThe role of sociodemographic factors in determining psychotherapy duration has been largely unexplored despite their known association with treatment use. We examined the association between sociodemographic factors and rehabilitative psychotherapy treatment duration, as well as any changes in duration over time.MethodWe used three register-based nationally representative cohorts. Participants included employed Finnish individuals (n = 5572, 77% women, mean age = 37) who started psychotherapy treatment in 2011, 2013 or 2016 and were followed until 2019. We used negative binomial regression to examine the association between sociodemographic factors (age, gender, education, occupational status, income, geographical area of residence, and onset year of treatment) with treatment duration.ResultsThe mean treatment duration was 27 months (with a standard deviation of 12 months). Several sociodemographic factors were associated with treatment duration. Gender and education were found to have the largest impact on treatment duration, with females having a longer duration (IRR 1.08, 95% CI 1.04–1.11) and those with low education having a shorter duration (IRR 0.91, 95% CI 0.85–0.97), resulting in a difference of 2–3 months. Treatment duration also increased in later years, which suggests potentially increasing differences in treatment implementation. At largest, the combined effect of all factors corresponded to a 10-month difference in treatment duration.ConclusionsThe duration of long-term psychotherapy varied across the sociodemographic groups and increased in all studied groups in the 2010s.

How Should Long-Term Psychotherapy Address Ethical Questions During the Palliative Care of a Patient With Serious and Persistent Mental Illness?

This commentary on a case considers the course of a palliative approach to care of a patient with a serious and persistent mental illness. Supposing a psychiatrist and patient mutually agree that the patient's chronic refractory illness should be palliatively managed with long-term psychotherapy, the next step is to forecast possible ethical questions that can arise during the course of such care and to share decision making about how to respond to those questions.

The association of sociodemographic characteristics with work disability trajectories during and following long-term psychotherapy: a longitudinal register study

PurposeThis register-based study examined the trajectories of depression or anxiety disorder-related work disability during and following long-term psychotherapy and identified sociodemographic factors that indicate membership in different trajectory groups.MethodsData were drawn from national registers (Statistics Finland, Social Insurance Institution of Finland). Participants included a random sample of Finnish working-age individuals (18–55 years) who started psychotherapy treatment between 2011 and 2014 and were followed for 5 years: 1 year before and 4 years after the onset of psychotherapy (N = 3 605 individuals; 18 025 person-observations across five time points). Group-based trajectory modeling was applied to assign individuals to work disability trajectories by the number of annual mental health-related work disability months. Multinomial logistic regression was used to examine the associations between trajectory group membership and baseline sociodemographic factors of age, gender, occupational status, and geographical area of residence.ResultsFour mental health-related work disability trajectories were identified: stable very low (72%), decrease (11%), persistent low (9%) and persistent high (7%). Those with older age, female gender, lower occupational status, and living in sparsely populated geographical areas were more likely to belong to the most unfavorable trajectory group of persistent high work disability. The presence of multiple risk characteristics substantially increased the probability of belonging to the most adverse trajectory group.ConclusionsSociodemographic factors were associated with the course of mental health-related work disability in association with psychotherapy. Rehabilitative psychotherapy does not function as an equal support resource for work ability in all parts of the population.

The difference between shorter- versus longer-term psychotherapy for adult mental health disorders: a systematic review with meta-analysis

BackgroundThe optimal psychotherapy duration for mental health disorders is unclear. Our aim was to assess the beneficial and harmful effects of shorter- versus longer-term psychotherapy for adult mental health disorders.MethodWe searched relevant databases and websites for published and unpublished randomised clinical trials assessing different durations of the same psychotherapy type before June 27, 2022. Our methodology was based on Cochrane and an eight-step procedure. Primary outcomes were quality of life, serious adverse events, and symptom severity. Secondary outcomes were suicide or suicide-attempts, self-harm, and level of functioning.ResultsWe included 19 trials randomising 3,447 participants. All trials were at high risk of bias. Three single trials met the required information size needed to confirm or reject realistic intervention effects. One single trial showed no evidence of a difference between 6 versus 12 months dialectical behavioral therapy for borderline personality when assessing quality of life, symptom severity, and level of functioning. One single trial showed evidence of a beneficial effect of adding booster sessions to 8 and 12 weeks of internet-based cognitive behavioral therapy for depression and anxiety when assessing symptom severity and level of functioning. One single trial showed no evidence of a difference between 20 weeks versus 3 years of psychodynamic psychotherapy for mood- or anxiety disorders when assessing symptom severity and level of functioning. It was only possible to conduct two pre-planned meta-analyses. Meta-analysis showed no evidence of a difference between shorter- and longer-term cognitive behavioural therapy for anxiety disorders on anxiety symptoms at end of treatment (SMD: 0.08; 95% CI: -0.47 to 0.63; p = 0.77; I2 = 73%; four trials; very low certainty). Meta-analysis showed no evidence of a difference between shorter and longer-term psychodynamic psychotherapy for mood- and anxiety disorders on level of functioning (SMD 0.16; 95% CI -0.08 to 0.40; p = 0.20; I2 = 21%; two trials; very low certainty).ConclusionsThe evidence for shorter versus longer-term psychotherapy for adult mental health disorders is currently unclear. We only identified 19 randomised clinical trials. More trials at low risk of bias and at low risk of random errors assessing participants at different levels of psychopathological severity are urgently needed.Systematic review registrationPROSPERO CRD42019128535.

Narcissistic Personality Disorder: Patterns, Processes, and Indicators of Change in Long-Term Psychotherapy.

Change in treatment of narcissistic personality disorder (NPD) has been considered difficult to attain. Aspects of narcissistic pathology, including interpersonal enhancement, avoidance, aggressivity, and control, have contributed to challenges in forming a therapeutic alliance and pursuing treatment towards attainable goals for change and remission. This study, based on a qualitative review of therapists' case reports of individual psychotherapy with eight patients diagnosed with NPD, is the first to identify and explore patterns, processes, and indicators of change in pathological narcissism. All patients showed significant improvement in personality and life functioning, including engagement in work or education and long-term close relationships, with remission of the NPD diagnosis. The process of change was gradual, with some noticeable changes occurring in specific life contexts. Additional factors indicating and contributing to change included patients' motivation and commitment to psychotherapy, reflective ability, emotion regulation, sense of agency, and interpersonal and social engagement.

A New Interpersonal Experience during Long-Term Psychotherapy: Counselors' Perspectives

&lt;p&gt;人際經驗是個體發展自我形象與環境評估的關鍵因素。大部分尋求長期心理治療的個案，其困擾多與過去負面的人際經驗所帶來的關係議題有關。若個體在成長過程經常遭受拒絕，會發展出「世界不能控制、別人不可預測、不可信任」的觀點。因此，本研究旨在探討長期心理治療歷程，個案的他人表徵與自我概念之轉變，以及討論心理師在協助個案改變的相關促成與阻礙因素。本研究以質性研究方式進行，以六位長期心理治療取向為主的資深心理師作為研究對象，以一對一的方式與每位受訪者進行一次深度訪談。訪談內容著重探討個案他人表徵及自我概念的改變，並深入了解長期心理治療關係對於個案發展新的人際關係經驗之影響。以紮根理論的資料分析概念進行資料分析，透過逐字稿編碼，由訪談者的實務工作現場所呈現之資料建構出歸納式結論。研究結果發現：心理師所討論的個案改變包括三個面向：（1）治療前後期的他人表徵轉變，（2）治療前後期的自我概念轉變，以及（3）促進與阻礙個案人際經驗改變的因素。本研究據此提出結論：長期心理治療有助於個案創造正向的他人表徵與自我概念，並使個案有機會能夠體驗到正向的關係新經驗。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;Interpersonal experience is the key factor for people to develop other-representation and to evaluate the environment. Most long-term psychotherapy clients&amp;rsquo; issues stem from past negative experiences in interpersonal relationships. Individuals who have frequently experienced rejection during their growth process are susceptible to adopting the viewpoint that &amp;quot;the world is uncontrollable, and people are unpredictable and untrustworthy.&amp;quot; Hence, the main purpose of this research is to explore the difference in other-representation, the transformation of self-concept during the long-term psychotherapy, and how counselors assist clients in changing their old pattern of other-representation and improving the self-concept. This is done to create new positive interpersonal relationship experiences. &lt;br /&gt;This study used semi-structured interviews to collect data from 6 counselors who primarily conducted long-term psychotherapy for clients. Each psychologist was individually interviewed once. The contents of the interviews focused on changes of other-representation, self-concept, and the influences of long-term counseling relationships on clients&amp;rsquo; development of new interpersonal relationship experiences. After data collection, the verbatim transcription of each interview was analyzed in a phenomenological approach. The study aims to obtain the effectiveness of long-term psychotherapy on the change of clients&amp;rsquo; interpersonal relationship experience. The main findings of this study were as follows: (1) changes in other-representation; (2) changes in self-concept; (3) the factors that promote or interfere with the changes of clients. This study suggests that long-term psychotherapy can be conducive to creating positive other-representation and self-concept, and developing satisfying relationship patterns.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Occupational Grade, Mental Distress, and the Use of Psychotherapy.

Previous studies have shown that manual workers use less psychotherapy than non-manual workers. However, little is known about the match between the use and the need of psychotherapy in different occupational grades. Our study investigates how the prevalence of mental distress corresponds to psychotherapy use rate in different occupational grades by gender. The data were collected from the Rise of Mental Vulnerability Study (use of psychotherapy) and the FinHealth 2017 Study (prevalence of mental distress). Adjusting for age, we calculated General Health Questionnaire (GHQ-12) caseness (a measure for mental distress), a 3-year psychotherapy use rate, and the ratio between GHQ caseness and the psychotherapy use rate in 3 occupational grades (upper non-manual employees, lower non-manual employees, and manual workers) for men and women separately. In men, for 1 person having used psychotherapy there were 10 persons experiencing mental distress in upper non-manual workers, 14 in lower non-manual workers, and 31 in manual workers. In women, for 1 person having used psychotherapy, there were 6 persons experiencing mental distress in upper non-manual workers, 9 in lower non-manual workers, and 18 in manual workers. At the population level, manual employees use considerably less long-term psychotherapy than upper non-manual workers although their level of mental distress is high. This indicates a mismatch between symptoms and therapy, which was higher for men in all occupational grades.

Role of Cognitive Control in Psychotherapy: An Integrated Review.

Cognitive control (CC), including shifting, updating, and inhibiting functions, may play an integral role in various aspects of psychotherapy; however, research on this is limited. This review aims to link the disparate lines of evidence on CC as they relate to psychotherapy processes, techniques, and outcomes. A systematic search of the literature on neuropsychological domains relating to psychotherapy in adults with anxiety/depression yielded 18 eligible studies. The review also uses a narrative format to explore other potential links between CC and psychotherapy that are underinvestigated, and highlights the need for research and application to evidence-based practice of psychotherapy. Findings suggest that CC may predict psychotherapy outcomes and also improve as a function of psychotherapy. Analog sample studies suggest a possible link between CC and techniques for regulation of cognition and emotion, such as reappraisal, mindfulness, and cognitive restructuring. CC may also play an integral role in the regulation of behavior. Study of CC in the context of psychotherapy may potentially explain individual differences in psychotherapy outcomes and mechanisms of action of various psychotherapy techniques and processes. Such an understanding may have possible implications for "best fit" matching clients to therapies and modifying psychological interventions to account for poorer CC abilities. CC may be enhanced through training and further research is warranted on the impact of such training in facilitating better long-term psychotherapy outcomes.

10.Q. Workshop: Imbalance in use and impact of public psychotherapy – A Finnish working-age population register study

Abstract Mental disorders are globally among the leading causes of disability in the working-age population. Psychotherapies have proven to be effective in the improvement of mental health. The current evidence on the benefits of psychotherapies is mainly based on randomized control trials and patient-reported outcomes, whereas the potential impact of long-term psychological therapy on work disability and income is not so well known. This emphasizes the need for longitudinal studies on the effects of psychological therapies in a ‘real-world study setting’, and on the distribution of the availability and the use of psychological therapies in different populations. In Finland, rehabilitative psychotherapy is the major single form of publicly provided psychological therapy. It is targeted at those aged 16 to 67 who are at risk of disability or not being able to study because of mental health problems. It is granted an annual period (maximum three years), a maximum of 80 sessions per year and 200 sessions per 3 years. From 2011 on this psychotherapy has been statutorily granted to all at risk of work disability due mental health disorders. The number of annual users has increased from 15 757 (2010) to 56 682 (2020). This workshop presents the results from a research project investigating the use and real-world effects of long-term psychotherapy in the Finnish working-age population in the 2010s. It shows 1) whether the use of psychotherapy is associated with subsequent work disability and labour market outcomes (income, employment), 2) how the use of long-term psychotherapy differed between socio-demographic groups in the 2010s in Finland, and 3) the extent to which state-subsidized psychotherapy is linked to the distinctive profiles of mental health problems in the population. The five presentations offer new results from the Rise of Mental Vulnerability in Work Life Study drawn from the national registers. The presentations are mostly based on three randomly selected population cohorts which each included 33% of the 18-64-year-old permanent Finnish residents at the baseline. These data were sampled (sampling years: 2010, 2013, 2016) by and derived from the Population Register maintained by Statistics Finland and included information on various socio-demographic characteristics (e.g., gender, occupation class, region, income). These were linked to the national health registers. Information on reimbursed psychotherapy and mental health indicators (sickness absence, psychotropic drugs, disability benefits) were obtained from the Social Insurance Institution of Finland and complemented by the disability pension data from the Finnish Centre for Pensions. The data provide a unique opportunity to observe how the use of state-subsidized long-term psychotherapy was distributed across population groups in the 2010s, and to the extent to which disability trajectories and economic outcomes have developed in different groups during and after psychotherapeutic treatment. Key messages • Psychotherapy is likely to decrease the risk of work disability and improve labour market outcomes. • The provision of long-term psychotherapy is related to social inequality in the working population.

Occupational class, gender, mental distress and use of psychotherapy

Abstract Introduction Previous studies have shown the effects of occupational class and gender on mental distress and use of psychotherapy. However, less is known about the mental distress-based use of psychotherapy in different occupational classes. Objectives The aim of our study is to show how the prevalence of mental distress and the use of long-term psychotherapy correlates in different occupational classes by gender. Methods Data were drawn from the Rise of Mental Vulnerability Study (psychotherapy) and FinHealth 2017 Study (mental distress). Adjusting for age, we calculated GHQ caseness, psychotherapy use rate, and the ratio between GHQ caseness and psychotherapy use rate in three occupational classes (upper non-manual employees, lower non-manual employees, and manual workers) separately for men and women. Age-adjustment was performed through regression analysis by using model generated predicted values of GHQ caseness and psychotherapy use rate at the average sample age of 40. Results In the group of upper non-manual men there were 10 persons with severe mental distress for every single person having used psychotherapy. For lower non-manual men and manual male workers the numbers were 14 and 31, respectively. In the group of upper non-manual women there were six persons with severe mental distress for every person having used psychotherapy. For lower non-manual women and manual female workers these numbers were nine and 18, respectively. Conclusions We found differences in the mental distress-based use of state-subsidized long-term psychotherapy between occupational classes. For upper non-manual workers, the use of therapy best meets their mental distress. The opposite is true for manual workers. We also found differences between men and women, but these findings should be confirmed with larger datasets.