So it really does work after all

For the last 10 years or so, if what has been reported is to be believed, the only kind of psychotherapy that works is Cognitive Behavioral Therapy (CBT). Almost all of the research looking at therapy has relied on CBT, and it is what is taught in most training programs now. I have discussed the reasons for this before -- CBT is brief in term, relatively easily standardized and taught as it lends itself well to well defined protocols which verge on being recipes and it sort of looks scientific.

Very few of the follow-up reports on CBT are more than a few months after therapy. Anecdotal experience of lots of therapists suggests that CBT can help with symptomatic relief but that very often the problems return and so do the patients. Many of us have seen patients who come to us wanting something more than the brief course of CBT they received earlier; they want something that will help them understand why and how they came to feel as they do so that they can deal better with life. They come because depth therapy offers ... well, depth.

Yesterday came news of a study which finds that  Long-Term Psychotherapy Outdoes Short-Term for Complex Mental Disorders -- and by complex, they mean personality disorders, anxiety, recurrent depression and the like. Reported yesterday in MedPage Today:

Long-term psychodynamic psychotherapy for at least a year was more effective overall than other treatments in helping adult patients with personality disorders, chronic or multiple mental disorders, or complex depressive and anxiety disorders (P=0.002), found Falk Leichsenring, D.Sc., of the University of Giessen, and Sven Rabung, Ph.D., of the University Medical Center Hamburg-Eppendorf in Hamburg, Germany.

Psychodynamic psychotherapy relies more heavily on the therapist-patient than traditional psychoanalysis and aims to allow patients to understand the causes of their mental disorders to help resolve them.

After treatment with the longer-term therapy, patients were better off than 96% of those in the comparison groups, the researchers reported in the Oct. 1 issue of the Journal of the American Medical Association...

The within-group effect size was 0.96, a large effect according to the researchers.

In various subgroup analyses, the researchers said, long-term psychodynamic therapy led to "significant, large, and stable within-group effect sizes across various and particularly complex mental disorders," including personality disorders, chronic mental disorders, multiple mental disorders, and complex depressive and anxiety disorders.

The article goes on to mention the argument that CBT and related kinds of therapy are cheaper for being short term. Depth psychotherapy is rarely short-term, often lasting a year or more. But if patients keep returning for repeated courses of therapy, in the end is that cheaper? And is cost the best measure for using in determining treatment? 

Today the NY Times also has a piece on this study. Interestingly they conflate psychodynamic with psychoanalysis --

The review is the first such evaluation of psychoanalysis to appear in a major medical journal, and the studies on which the new paper was based are not widely known among doctors.

In fact psychodynamic means those therapies which are concerned with the unconscious and the making of the unconcious conscious. This encompasses Freudian and neo-Freudian psychoanalytic approaches as well as Jungian, Adlerian and others.

This one review is not likely to revolutionize the field but it is a solid piece of support for depth psychotherapy. 

© Cheryl Fuller, 2018. All  rights reserved.