Clinicians Digest Jan/Feb - Page 8


The JAMA metanalysis, led by German psychologist Falk Leichsenring, which includes Hoglend's work, looked at studies of psychodynamic therapies that lasted for at least a year or for 50 sessions, relied on interpretative or supportive interventions, and involved "careful attention to the therapist-patient interaction, with thoughtfully-timed interpretations of transference and resistance embedded in a sophisticated appreciation of the therapist's contribution" to the relationship. The analysis found that LTPP yielded significantly larger improvements in overall effectiveness, targeted problems, and personality functioning for such disorders as borderline personality, eating disorders, and other chronic or multiple disorders. Moreover, the outcomes continued to improve after therapy ended.

LTPP was especially effective for people with such chronic disorders as anxiety or depression. Interestingly, when it was combined with psychotropic medications, its effectiveness, while still greater than that of the short-term therapies, was lower than it was without medications. Leichsenring suspects that either medications inhibit LTPP in some way, perhaps blocking emotions connected with transference and relationships, or that the clinical trial patients who were taking medications were more severely impaired than the ones who weren't.

The study leaves open the question of whether short-term therapy or LTPP is more cost-effective with patients suffering from complex mental disorders. Leichsenring draws the usual cautious conclusion that although LTPP may be more cost-effective in the long run, research remains to be done on this point.

Resources

New Clients in Healthcare: The Collaborative Psychotherapist (American Psychological Association, 2008). Play Therapy: American Journal of Preventive Medicine 35, no. 3 (September 2008): 284-86; 287-313; and 314-316. Attraction: Why Him? Why Her? (Henry Holt, 2009). Long-Term Psychotherapy: Journal of the American Medical Association 300, no. 13 (October 1, 2008): 1551-65.

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