Clinicians Digest Jan/Feb - Page 7

The Benefits of Long-Term Therapy

For many years, CBT and other short-term, solution-oriented, narrowly focused therapies have been amassing strong empirical track records for their efficacy, while long-term psychodynamic psychotherapy (LTPP) has come to be regarded as somehow quaint and inefficient. Now a metanalysis of 23 studies reported in the October 1 Journal of the American Medical Association finds that people with complex mental disorders who received LTPP did much better than 96 percent of the people who received cognitive-behavioral therapy (CBT), short-term psychodynamic therapy, dialectical behavioral therapy, family therapy, and supportive therapy.

The reassessment of LTPP has been facilitated by researchers who've isolated and tested abstract concepts central to LTPP, such as transference, and clarified how early, emotionally charged memories color adult relationships. In the May 2007 European Journal of Psychotherapy, for example, Susan Anderson of New York University and Inga Reznik demonstrated that adults retain feelings and inferences from their early bond with their parents, and that these ghostly transferences affect the nature and quality of their adult lives. This finding was reinforced by neuroimaging reviews conducted by psychoanalytically oriented researchers Drew Westen and Glen Gabbard, which suggest that the brain actually overlays new experiences and relationships onto older ones.

Such research has demonstrated that certain psychodynamic constructs exist in some form, but ­hasn't demonstrated whether LTPP actually works, or whether it's better than short-term therapies. However, in studies reported in the October 2006 American Journal of Psychiatry and the March 2007 Psychotherapy Research, Norwegian psychiatrist Per Hoglend showed that clients with more severe disorders did better in long-term therapies that focused on transference and on the therapeutic relationship than clients in short-term therapies did.

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