Commentary: The value of long-term psychodynamic psychotherapy

Commentary

The value of long-term psychodynamic psychotherapy

Long-term psychodynamic psychotherapy, which helps patients understand causes of psychological distress that would otherwise remain outside their awareness, has long been under siege from third-party payers. That it survives at all may be a tribute to its value, but the evidence supporting its effectiveness has been so thin that — as a treatment — it has been more often tolerated than appreciated by those who bear its cost.

But in October 2008, the Journal of the American Medical Association published a first-of-its-kind meta-analysis that demonstrated the value of this treatment, especially for patients with complex mental disorders, such as personality disorders and difficult-to-treat anxiety and mood disorders. The authors reviewed 23 studies of traditional psychodynamic psychotherapy where treatments lasted at least one year or 50 sessions. About half were randomized controlled trials; the rest were observational trials that did not compare patient outcomes with those of a control group. Together, the studies enrolled just over 1,000 patients.

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