This paper reports the main findings of a large-scale study of subsidized psychoanalysis and long-term psychotherapy. More than 400 people in various phases, before, during and after subsidized psychoanalysis or long-term psychodynamic psychotherapy, were followed up for a period of three years with personal interviews, questionnaires and official statistics. Our analyses revealed progressive improvement the longer patients were in treatment--impressively strong among patients in psychoanalysis--on self-rating measures of symptom distress and morale. Improvement, however, was equally weak in both groups on a self-rating measure of social relations. Dosage factors (treatment duration and session frequency in combination) partly accounted for the outcome differences between those referred to psychoanalysis and those referred to long-term psychotherapy. Attitudes and ideals among therapists and analysts concerning the goals and means of psychotherapy were also associated with patient outcome, although in rather complex ways. A significant part of the outcome differences between patients in psychoanalysis and in psychotherapy could be explained by the adoption, in a large group of therapists, of orthodox psychoanalytic attitudes that seemed to be counterproductive in the practice of psychotherapy but not in psychoanalysis. It is suggested that this effect may be a negative transfer of the psychoanalytic stance into psychotherapeutic practice and that this may be especially pronounced when the attitudes are not backed up by psychoanalytic training.

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The aims of this naturalistic study are to present patient characteristics and analyse various outcome measures at termination for psychoanalytic psychotherapies with young adults. Patients (n = 134) between 18 and 25 years were included, of whom 92 received individual and 42 group therapy. One third had a self-reported personality disorder. The patients were considerably more troubled than Swedish norm groups at intake and they showed improvement on all outcome measures during therapy. However, the post therapy means did not fully reach the norm group means. The largest positive changes (pre- versus post-therapy) were with respect to the patients' overall health and functioning. Changes were more moderate in self-reported symptoms, self-concept, and self-representation, while changes in interpersonal problems and object representations were small. The results of this study are discussed in the context of advantages and disadvantages of naturalistic versus randomized controlled study designs.

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