Is Longer-Term Psychodynamic Psychotherapy More Effective than Shorter-Term Therapies? Review and Critique of the Evidence

Faculty of Life and Social Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia.
Psychotherapy and Psychosomatics (Impact Factor: 9.2). 06/2010; 79(4):208-16. DOI: 10.1159/000313689
Source: PubMed


In 2008, Leichsenring and Rabung performed a meta-analysis of 8 studies of longer-term psychodynamic psychotherapy (LTPP). The work was published in the Journal of the American Medical Association (vol. 300, pp 1551-1565), and they concluded that LTPP was more effective than shorter-term therapies.
Given that such claims have the potential to influence treatment decisions and policies, we re-examined the meta-analysis and the 8 studies.
We found a miscalculation of the effect sizes used to make key comparisons. Claims for the effectiveness of LTPP depended on a set of small, underpowered studies that were highly heterogeneous in terms of patients treated, interventions, comparison-control groups, and outcomes. LTPP was compared to 12 types of comparison-controls, including control groups that did not involve any psychotherapy, short-term psychodynamic psychotherapy, and unvalidated treatments. Additionally, the studies failed to protect against threats to bias, and had poor internal validity.
Overall, we found no evidence to support claims of superiority of LTPP over shorter-term methods of psychotherapy.

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    • "Since for patients with comparable severity of depression remission rates under treatment are substantially lower [40], it is less likely that our study patients showed spontaneous remissions within the eight-month observation period. Arguing in favor of specific effects of our study intervention, the efficacy and effectiveness of psychodynamic therapy, which can best be compared to our approach and its superiority over waiting-list controls has been reported in two meta-analyses [41], [42] (But see [43] for a critical discussion). Additionally, fMRI measurement times were scattered throughout the year to minimize seasonal effects in the course of depression. "
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    ABSTRACT: Objective Neurobiological models of depression posit limbic hyperactivity that should normalize after successful treatment. For psychotherapy, though, brain changes in patients with depression show substantial variability. Two critical issues in relevant studies concern the use of unspecific stimulation experiments and relatively short treatment protocols. Therefore changes in brain reactions to individualized stimuli were studied in patients with depression after eight months of psychodynamic psychotherapy. Methods 18 unmedicated patients with recurrent major depressive disorder were confronted with individualized and clinically derived content in a functional MRI experiment before (T1) and after eight months (T2) of psychodynamic therapy. A control group of 17 healthy subjects was also tested twice without intervention. The experimental stimuli were sentences describing each participant's dysfunctional interpersonal relationship patterns derived from clinical interviews based on Operationalized Psychodynamic Diagnostics (OPD). Results At T1 patients showed enhanced activation compared to controls in several limbic and subcortical regions, including amygdala and basal ganglia, when confronted with OPD sentences. At T2 the differences in brain activity between patients and controls were no longer apparent. Concurrently, patients had improved significantly in depression scores. Conclusions Using ecologically valid stimuli, this study supports the model of limbic hyperactivity in depression that normalizes after treatment. Without a control group of untreated patients measured twice, though, changes in patients' brain activity could also be attributed to other factors than psychodynamic therapy.
    PLoS ONE 10/2014; 10(9). DOI:10.1371/journal.pone.0109037 · 3.23 Impact Factor
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    • "Research comparing the effectiveness of brief versus longer psychodynamic psychotherapy is scarce, consequently leading to insufficient evidence for a viable choice between brief and longer-term psychotherapy in the treatment of psychiatric disorders (Knekt et al. 2008a). In addition, Bhar et al. (2010) have critiqued existent studies comparing short versus longer treatment and concluded that ''the question of whether LTPP (longer-term psychodynamic psychotherapies) is more effective than shorter-term psychotherapy remains open''. Furthermore, the need to examine this question under field settings is particularly pertinent (Leichsenring et al. 2004). "
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    ABSTRACT: Treatment studies and particularly psychotherapeutic treatment studies of patients suffering from an adjustment disorder are very scarce, leading to insufficient evidence regarding the efficacy of treatment in this population. Whereas timely psychotherapy is known to be of benefit in the treatment of adjustment disorders, the ideal duration of psychotherapeutic interventions is not known. This study examined whether a brief 12-session focused psychodynamic psychotherapy may be as efficient as a longer intermediate-term (1 year) psychodynamic psychotherapy in treating patients suffering from an adjustment disorder. Subjects (n = 66) were randomly assigned to either brief or intermediate psychotherapy. They were assessed by self-report measures and clinician’s evaluation at baseline, end of therapy, and 9 months after therapy was terminated. The results showed a good overall improvement in the whole group. Furthermore, brief psychotherapy was found to be as good as intermediate psychotherapy both at the end of treatment and at follow-up. Although our study was not designed to confirm the efficacy of dynamic psychotherapy in the treatment of adjustment disorders, our results suggest that brief interventions may be good enough in adjustment disorder, thus allowing treatment of a greater number of patients without compromising for the quality and suitability of treatment.
    Journal of Contemporary Psychotherapy 12/2012; 42(4). DOI:10.1007/s10879-012-9208-6
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    • "But there are more constraints on the extent to which the data can be manipulated in this context than there are in the context of the traditional psychoanalytic case study. Jonathan Shedler's (2010) recent American Psychologist article reviewing the various metaanalyses supporting the efficacy of psychodynamically oriented treatments has been criticized by cognitive therapists who argue that he selectively included some studies and not others, that some of the studies included were not methodologically rigorous, or used inappropriate statistics, and so on (e.g., Beck & Bahr, 2009; Bhar & Beck, 2009; Bhar et al., 2010). "
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    ABSTRACT: Irwin Z. Hoffman's (2009) “Doublethinking our way to ‘scientific’ legitimacy” is an important and thought-provoking paper that tends to evoke passionate and polarized responses. Important threads running throughout his paper include the pitting of objectivist against constructivist perspectives and a concern that the objectivist epistemology underlying most systematic empirical research endangers important psychoanalytic values. In this paper I underscore and elaborate on the importance of certain aspects of Hoffman's paper, while at the same time arguing for a less polarized perspective, by appealing to contemporary developments in the philosophy of science that seek a middle ground between objectivism and constructivism. This middle ground recognizes that science has an irreducibly social, hermeneutic, and political character, and that data are only one element in an ongoing conversation between members of a scientific community. I also argue that the rules and standards of practice are worked out and modified over time by the scientific community, and that it is critical for psychoanalysts to be members of this larger community.
    Psychoanalytic Dialogues 11/2012; 22(6). DOI:10.1080/10481885.2012.733655 · 0.82 Impact Factor
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