Varieties of long-term outcome among patients in psychoanalysis and long-term psychotherapy - A review of findings in the Stockholm Outcome of Psychoanalysis and Psychotherapy Project (STOPPP)

Department of Behavioural Sciences, Linköping University, Sweden.
The International Journal of Psychoanalysis (Impact Factor: 0.86). 11/2000; 81 ( Pt 5)(5):921-42. DOI: 10.1516/0020757001600291
Source: PubMed


This paper reports the main findings of a large-scale study of subsidized psychoanalysis and long-term psychotherapy. More than 400 people in various phases, before, during and after subsidized psychoanalysis or long-term psychodynamic psychotherapy, were followed up for a period of three years with personal interviews, questionnaires and official statistics. Our analyses revealed progressive improvement the longer patients were in treatment--impressively strong among patients in psychoanalysis--on self-rating measures of symptom distress and morale. Improvement, however, was equally weak in both groups on a self-rating measure of social relations. Dosage factors (treatment duration and session frequency in combination) partly accounted for the outcome differences between those referred to psychoanalysis and those referred to long-term psychotherapy. Attitudes and ideals among therapists and analysts concerning the goals and means of psychotherapy were also associated with patient outcome, although in rather complex ways. A significant part of the outcome differences between patients in psychoanalysis and in psychotherapy could be explained by the adoption, in a large group of therapists, of orthodox psychoanalytic attitudes that seemed to be counterproductive in the practice of psychotherapy but not in psychoanalysis. It is suggested that this effect may be a negative transfer of the psychoanalytic stance into psychotherapeutic practice and that this may be especially pronounced when the attitudes are not backed up by psychoanalytic training.

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    • "In contrast, long-term psychodynamic therapies typically aim at deeper insight and structural change in the personality, which is assumed to take place during the course of a lengthy therapeutic relationship (Klug and Huber, 2009). Such changes are often considered in these therapies to be prerequisites for good psychosocial functioning and quality of life, which in turn would be expected to, and have been shown to (Sandell et al., 2000), come forward more slowly. Although comparative randomized clinical trials on short-vs longterm therapies are scarce, one such trial found indirect support for these expectations (Knekt et al., 2008a, 2008b, 2013): this study showed work ability to improve more slowly – albeit ultimately more greatly – in long-term individual as compared to short-term individual therapies. "
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    ABSTRACT: Knowledge is incomplete on whether long-term psychotherapy is more effective than short-term therapy in treating mood and anxiety disorder, when measured by improvements in psychosocial functioning and life quality. In the Helsinki Psychotherapy Study, 326 outpatients with mood or anxiety disorder were randomized to solution-focused therapy (SFT), short-term psychodynamic psychotherapy (SPP), or long-term psychodynamic psychotherapy (LPP), and followed up for 5 years from the start of treatment. The outcome measures comprised 4 questionnaires on psychosocial functioning, assessing global social functioning (Social Adjustment Scale (SAS-SR), sense of coherence (Sense of Coherence Scale (SOC)), perceived competence (Self-Performance Survey), dispositional optimism (Life Orientation Test (LOT)), and 1 questionnaire assessing quality of life (Life Situation Survey (LSS)). Short-term therapies improved psychosocial functioning and quality of life more than LPP during the first year. The only exceptions were LOT and perceived competence, which did not differ between SPP and LPP. Later in the follow-up, SOC and perceived competence showed significantly more improvement in LPP than in the short-term therapy groups. No direct differences between SFT and SPP were noted. Short-term therapy has consistently more short-term effects on psychosocial functioning and quality of life than LPP, whereas LPP has some additional long-term benefits on psychosocial functioning. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    No preview · Article · Jun 2015
    • "As Shedler (2010) points out, the results of psychodynamic psychotherapy , when measured by the effect-size (that is, basically, when commensurate ), are in fact greater than those achieved by anti-depressive medication or by benzodiazepines. Studies of this sort have been on the rise (e.g.Sandell et al., 2000;Target, 1994, 1996;Fonagy et al., 2005;Leichsenring, 2009;Leuzinger-Bohleber et al., 2003;Sandell, 2012). To show the current expansion of this sort of research, we can add rigorous empirical studies of a unique case (K€ achele et al., 2008) and neuroscience studies (Beutel et al., 2010). "
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    ABSTRACT: Current controversies involving clinical, conceptual and empirical research shed light on how psychoanalysis confronts its nature and its future. Some relevant debates in which Wallerstein, Green, Hoffman, Eagle and Wolitzky, Safran, Stern, Blass and Carmeli, and Panksepp have participated are examined regarding the characteristics of their argumentation. Agreements and disagreements are explored to find ways that could have allowed the discussion to progress. Two foci are highlighted in these debates: (a) whether a clinical common ground exists in psychoanalysis and what kind of procedure could contribute to further clarification; (b) complementation of in-clinical and extra-clinical evidence. Both aspects are scrutinized: the possibility of complementing diverse methodologies, and the nature of the shared clinical evidence examined in clinical discussion groups such as those promoted by the IPA Clinical Observation Committee. The importance of triangulation and consilience is brought to bear regarding their contribution to the robustness of psychoanalysis. So as to strengthen a critical perspective that enhances the discipline's argumentative field, psychoanalysis should take into account arguments from different sources according to their specific merits. By doing this, psychoanalysis increases its relevance within the current interdisciplinary dialogue. Copyright © 2015 Institute of Psychoanalysis.
    No preview · Article · Jun 2015 · The International Journal of Psychoanalysis
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    • "ger in order to prevent relapse ( e . g . , Hollon & Ponniah , 2010 ) . Cohort and observational researches also suggest that more durable benefits may relate with longer - term treatments ( Beutel & Rasting , 2002 ; Knekt , Lindfors , Laaksonen et al . , 2008 ; Leichsenr - ing , Biskup , Kreische , & Staats , 2005 ; Leichsenring & Rabung , 2011 ; Sandell et al . , 2000 ) . These findings suggest rising evidence about LTPP clinical import - ance and effectiveness in depression treatment . Huber et al . ( 2012 ) compared psychoanalytic , psychodynamic , and cognitive - behavioral therapies for depression treatment in a process - outcome study based on a prospective , quasi - experimental design with a 1"
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    ABSTRACT: Objective: There are few randomized controlled trials examining the efficacy of long-term psychodynamic psychotherapy (LTPP) in depression treatment. LTPP was compared with fluoxetine treatment and their combination; Methods: 272 depressed patients (aged 26-34, 72% with a first episode of depression) were randomized to receive LTPP (one session/week), fluoxetine treatment (20-60 mg/day) or their combination for 24 months. Beck Depression Inventory (BDI) was the outcome measure. The psychotherapy was not manualized and the treatment took place under real-life conditions in an outpatient psychiatric clinic. Results: Intention-to-treat analyses indicated that all the treatments were associated with significant reductions in the BDI scores (mean reduction of 18.88 BDI points). Furthermore, LTPP and combination therapy were more effective in reducing BDI scores than fluoxetine alone (22.08 and 22.04 vs. 12.53 BDI points). Conclusions: LTPP, pharmacological treatment with fluoxetine and their combination are effective in reducing symptoms of patients with moderate depression. LTPP and combined treatment were more effective compared to fluoxetine alone. These findings have implications for patients with depression who may benefit from long-term psychotherapy or combined treatment, or for depressed patients who do not wish to take medications such as fluoxetine.
    Full-text · Article · Jul 2014 · Psychotherapy Research
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Questions & Answers about this publication

  • Guilherme Canta added an answer in History of Ideas:
    What exactly has been the influence of psychoanalysis on Western culture and how can it be assessed?
    It is commonly held that freudian ideas (his theories on human mind and behavior) and his psychoanalytic "method" - albeit both empirically not grounded - have had an immense influence not only on clinical psychology and psychotherapy, but on several domains of the Western culture as well, possibly on the Western concept itself of human nature. In the same way, apparently, as a new religion. Only, I am not aware of a comprehensive appraisal of such influence, not ideological but rather historical, an appraisal not stemming from the psychoanalytic movement, but external to it. Thanks in advance to all those who will help me to find references to works and authors, in history of ideas or elsewhere, pointing to this problem, or have themselves good answers.
    Guilherme Canta
    Probably I have not been clear about my points and I'm sorry for that.

    1 - I agree and acknowlege that the notions about child development have been corrected. I was only stressing the fact that Freud was probably the first to give attention to the importance of child development and early relations. His work was mainly derived from recolections of patients and few observations of children. A correct observational setting was not used by him and proper observational studies only came later, but I only stressed the fact that he gave relevant attention to child development. He also stressed the impact of traumatic events during childhood and their impact in development. A considerable amount of research concerning the impact of traumatic events and psychopathology (e.g., depression, schizophrenia) has been produced recently.

    Although not directly connected to Freud or Psychoanalysis these studies follow the idea of the impact of traumatic eventsand the relevance of chidhood experiences in later devolpment and pathology.
    Was Freud the first to defend this ? Or if you prefer, was he the most popular in the defense of this ideas. Was he not responsible to introduce them in western culture? I thought that was the main question.

    2 - Your question was asking for the impact in western culture and as you say, Freud was not the first, but was the first with impact. But I would not reduce it only to popularity, the complexity of the theory and

    You may say that Freud did not produce empirical evidence. I think that this only became the standard in the 1960's for clinical purposes. Most of the previous contributions did not have to pass by that evaluation and were based on direct experience of the clinicians. Can we judge him by something that was not a standard at his time? Can we use our standards to judge clinical work in 1900-1910?

    We certainly can judge psychoanalysis for that. But I do not agree with you regarding the lack of evidence.
    Concerning this subject there are some recent and relevant papers available through ResearchGate:

    I think these are good quality studies, published in peer-reviewed journals, that provide evidence for the effectiveness of psychoanalysis or psychoanalitically informed psychotherapy.

    I see it as a normal process that in scientific discovery ideas evolve, some are rejected and some are revised. It would be strange if 100 years later all of Freud ideas or even the majority had stood the test. It is a natural process that most if not all have been somehow changed. But can we learn something from them? I belive we can and I believe we can find some influences of those ideas in culture.

    I hope that I made my ideas clearer and that we can engage in a stimulating debate.
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      ABSTRACT: After decades of ignoring or minimising the prevalence and effects of negative events in childhood, researchers have recently established that a broad range of adverse childhood events are significant risk factors for most mental health problems, including psychosis. Researchers are now investigating the biological and psychological mechanisms involved. In addition to the development of a traumagenic neurodevelopmental model for psychosis, the exploration of a range of psychological processes, including attachment and dissociation, is shedding light on the specific aetiologies of discrete phenomena such as hallucinations and delusions. It is argued that the theoretical, clinical and primary prevention implications of our belated focus on childhood are profound.
      Full-text · Article · Feb 2012 · The British journal of psychiatry: the journal of mental science

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