Is Longer-Term Psychodynamic Psychotherapy More Effective than Shorter-Term Therapies? Review and Critique of the Evidence

Abstract

<i>Background:</i> In 2008, Leichsenring and Rabung performed a meta-analysis of 8 studies of longer-term psychodynamic psychotherapy (LTPP). The work was published in the Journal of the American Medical Association (vol. 300, pp 1551–1565), and they concluded that LTPP was more effective than shorter-term therapies. <i>Method:</i> Given that such claims have the potential to influence treatment decisions and policies, we re-examined the meta-analysis and the 8 studies. <i>Results:</i> We found a miscalculation of the effect sizes used to make key comparisons. Claims for the effectiveness of LTPP depended on a set of small, underpowered studies that were highly heterogeneous in terms of patients treated, interventions, comparison-control groups, and outcomes. LTPP was compared to 12 types of comparison-controls, including control groups that did not involve any psychotherapy, short-term psychodynamic psychotherapy, and unvalidated treatments. Additionally, the studies failed to protect against threats to bias, and had poor internal validity. <i>Conclusion:</i> Overall, we found no evidence to support claims of superiority of LTPP over shorter-term methods of psychotherapy.

Effects of Motive-Oriented Therapeutic Relationship in a Ten-Session General Psychiatric Treatment of Borderline Personality Disorder: A Randomized Controlled Trial

“…Albeit most patients in our sample needed further treatment, their pre-post effect sizes are impressive, given the 10-session time frame. This is consistent with some of the literature on the effects of short-term dynamic psychotherapy for PD [18,19]. This phenomenon might be explained by the generic model of psychotherapy change [52], where the initial therapy phase is characterized by remoralization which correlates on average with initial symptom relief.…”

“…In addition to informing about the effects of an individualized relationship intervention as an added therapy ingredient, it is also important to better understand the therapeutic effects of very short treatments for BPD, in particular from a psychodynamic-psychiatric perspective. There is evidence with regard to the effectiveness of short-term psychodynamic treatments in terms of their overall efficacy [17] and for patients with personality disorder (PD) [18,19,20]. Therefore, information on individualizing treatments for BPD, as well as on how to possibly shorten them, seems promising - despite overall treatment recommendation for long-term therapy [8].…”

Méta-analyse et efficacité des psychothérapies : faits et fictions

“…Wampold (Gloagen, Cottraux, Cucherat, et Blackburn, 1998 ;Wampold, Minami, Baskin, et Tierney, 2002), ou plus récemment entre Leichsenring et Bhar au sujet de l'efficacité des psychothérapies psychodynamiques de longue durée (Leichsenring et Rabung, 2008 ;Bhar, Thombs, Pignotti, Bassel, Jewett, Coyne, et Beck, 2010 Quatrièmement, comme nous l'avons déjà laissé entendre, le fait de considérer l'essai contrôlé randomisé comme le dispositif méthodologique privilégié pour étudier l'efficacité des psychothérapies n'est pas exempt de problèmes. En effet, ce type de dispositif méthodologique repose sur des présupposés épistémologiques selon lesquels il est possible d'évaluer objectivement des interventions psychothérapeutiques, conçues comme des techniques, pour des troubles psychiques spécifiques (Freire, 2006).…”

Missed Opportunity to Rectify or Withdraw a Flawed Metaanalysis of Longer-Term Psychodynamic Psychotherapy

“…We eagerly anticipated the response by Leichsenring and Rabung to our sweeping critique [1] of their 2008 metaanalysis [2] in which they claimed longer-term psychodynamic psychotherapy (LTPP) was more effective than shorter-term psychotherapies. Yet, we were disappointed that Leichsenring and Rabung [3] , like Ehrenthal and Grande [4] , dealt with so little of the specifics of our critique.…”