A Series of Meta-Analytic Tests of the Efficacy of Long-Term Psychoanalytic Psychotherapy

Abstract

Abstract. Recent meta-analyses come to conflicting conclusions about the efficacy of long-term psychoanalytic psychotherapy (LTPP). Our first goal was to reproduce the most recent meta-analysis by Leichsenring, Abbass, Luyten, Hilsenroth, and Rabung (2013) who found evidence for the efficacy of LTPP in the treatment of complex mental disorders. Our replicated effect sizes were in general slightly smaller. Second, we conducted an updated meta-analysis of randomized controlled trials comparing LTPP (lasting for at least 1 year and 40 sessions) to other forms of psychotherapy in the treatment of complex mental disorders. We focused on a transparent research process according to open science standards and applied a series of elaborated meta-analytic procedures to test and control for publication bias. Our updated meta-analysis comprising 191 effect sizes from 14 eligible studies revealed small, statistically significant effect sizes at post-treatment for the outcome domains psychiatric symptoms, target problems, social functioning, and overall effectiveness (Hedges’ g ranging between 0.24 and 0.35). The effect size for the domain personality functioning (0.24) was not significant ( p = .08). No signs for publication bias could be detected. In light of a heterogeneous study set and some methodological shortcomings in the primary studies, these results should be interpreted cautiously. In conclusion, LTPP might be superior to other forms of psychotherapy in the treatment of complex mental disorders. Notably, our effect sizes represent the additional gain of LTPP versus other forms of primarily long-term psychotherapy. In this case, large differences in effect sizes are not to be expected.

Intraindividual dynamics between alliance and symptom severity in long-term psychotherapy: Why time matters.

“…One obvious explanation for this finding might be that our sample consists of patients with long-term psychotherapy. Given that long-term psychotherapy is indicated for patients with more severe and complex interpersonal problems (Leichsenring et al, 2013; Woll & Schönbrodt, 2020), it might take longer for the influence of alliance to fully unfold in this patient group. Put differently, long-term psychotherapy might “allow” alliance to exert its full effect.…”

“…Therefore, the unfolding effect is driven by the weekly contact in the therapeutic situation. As long-term psychotherapy is less prevalent and not always available in other countries (Leichsenring et al, 2013; Woll & Schönbrodt, 2020), it is important to keep in mind that this dynamic might not generalize to shorter forms of psychotherapy. Specifically, when patients and therapists are aware of shorter therapy durations, the role of alliance (Gaston et al, 1994) and its dynamic might differ.…”

A constructive replication of client change during psychodynamic treatment in an outpatient setting

“…Nevertheless, further research on long-term psychodynamic treatment is 'urgently needed' (Woll & Schönbrodt, 2019, p. 67). Woll and Schönbrodt (2019) and overcome the limitations to external validity inherent in RCTs.…”

Psychodynamic practice in psychiatry

“…Recent meta-analyses and systematic reviews, citing evidence from randomizedcontrolled trials, demonstrate the effectiveness of psychodynamic long-term therapies for common mental disorders, including depression. [9][10][11][12][13][14] Results are generally at least equivalent to other forms of treatment, often with more long-lasting effects and applicable to mild-moderate depression.…”