Psychotherapy Works Best Over the Long Term

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Leichsenring and his colleague, Sven Rabung, from University Medical Center Hamburg-Eppendorf, reviewed the medical literature to find studies that compared long-term psychodynamic therapy lasting a year or more to other forms of therapy. They found 23 studies with 1,053 patients. Eleven of the studies were randomized, controlled trials, and 12 were observational studies.

Overall effectiveness, resolution of the target problem, and personality functioning were superior in the long-term psychodynamic therapy groups than in the comparison groups, according to the analysis.

The bottom line: "Long-term psychodynamic psychotherapy is superior to short-term treatments in patients with complex mental disorders," Leichsenring said.

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But the problem, according to Goodstein, is that insurance companies often don't want to pay for long-term therapy, perhaps believing medications and short-term therapy are more cost-effective options.

For someone who's just started having symptoms -- considered an acute problem -- short-term therapy may be helpful, according to Goodstein. But, for those who've had mental health symptoms chronically, short-term therapy may boost them to a "barely livable level" but not to a good quality of life.

So, what's the ideal number of visits? It really depends on the individual and their specific problem, but Leichsenring said, "there is evidence that most patients with acute distress benefit sufficiently from 25 sessions. For patients with chronic distress, about 50 sessions are required to achieve a response rate of 70 percent. For patients with personality disorders, there is evidence that about 200 sessions, or 2 years of treatment, are required to achieve recovery in 75 percent of the patients."

More information

To learn more about psychotherapy, including psychodynamic psychotherapy, visit the America Psychiatric Association's Healthy Minds Web site.

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