The Effects of Long-Term Psychoanalytic Treatment on Healthcare Utilization and Work Impairment and Their Associated Costs

Berghout, Casper; Zevalkink, Jolien; Roijen, Leona Hakkaart-van

doi:10.1097/01.pra.0000386907.99536.75

Cited by 16 publications

(6 citation statements)

References 22 publications

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“…Furthermore, some reductions continued to increase in the years after therapy, indicating a possible long‐term dynamic effect of therapy. The findings are consistent with Berghout et al's (2010) results regarding the increase in saving during the second year after long‐term psychoanalytic treatment.…”

Section: Discussionsupporting

confidence: 92%

“…Kraft et al (2006), on the basis of 176 participants, found a rise in calculated semiannual cost prior to psychotherapy and a decrease in cost thereafter. Berghout, Zevalkink, and Hakkaart‐Van Roijen (2010), on a sample size of 231, assessed self‐report of sick leave days and health expenditure before psychoanalysis and at two points after it. They found a sustained reduction in sick leave days and health expenditure after psychoanalysis.…”

Section: Introductionmentioning

confidence: 99%

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Psychodynamic psychotherapy is associated with sustained reduction in health care utilization and cost

Yonatan‐Leus

Strauss

Cooper‐Kazaz

2020

Clin Psychology and Psychoth

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Our objective was to examine the effectiveness and efficiency of psychodynamic psychotherapy on the reduction in health care utilization and cost while controlling for age, gender, and year. Health care utilization and cost were examined yearly in 1,675 patients from 2 years before outpatient psychotherapy (i.e., baseline) to three consecutive years after psychotherapy in a naturalistic longitudinal design. A multilevel analytic approach (LMLM) was applied to account for repeated measures effect and missing data. In the year prior to psychotherapy, there was a significant increase in total cost compared with baseline (14.8%) and in use of health care services (primary and specialist doctors' visits and outsourced referrals). In the first year following therapy, there was a significant decrease in total cost (10%) and in use of health care services (all doctors' visits, imaging, and outsourced referrals). The decrease was to baseline levels or lower and was maintained for two additional years. Psychiatric medication usage increased significantly after psychotherapy and remained so. The overall cumulative decrease in total cost per patient over 3 years after therapy was 3,665.92 NIS, equalling a 69% average cost of psychotherapy. Further cost saving can be expected due to the reduction in sick leave, disability, and psychiatric hospitalization. These findings support the notion that providing outpatient psychodynamic psychotherapy can be financially beneficial to health care systems, although further research is required for causal inferences. Also, an increase in health care utilization along with scarce physical findings may indicate unaddressed psychological distress and warrant referral for mental assessment and possible psychotherapy.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Psychodynamic psychotherapy is associated with sustained reduction in health care utilization and cost

Yonatan‐Leus

Strauss

Cooper‐Kazaz

2020

Clin Psychology and Psychoth

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“…A limitation regarding the economic feasibility of long-term psychoanalytic treatment and hence justification for its Maintenance as a community mental health promotion service, is that an evaluation of its cost-benefit profile was not included in the study. Economic benefit has been demonstrated in other research on psychoanalytic psychotherapy (e.g., Berghout et al, 2010;Beutel et al, 2004;De Maat et al, 2007;Leuzinger-Bohleber et al, 2003) and remains a priority for further research. Nevertheless, heartened by the success of the implementation of its demonstration project, the VAPP aims to continue the program, while the VAPP and other psychotherapy groups in Victoria have continued to advocate for inclusion of psychoanalytic psychotherapy in the State public mental health system.…”

Section: Discussionmentioning

confidence: 92%

“…1 Further, systematic outcome studies of long-term psychoanalytic psychotherapy (Kernberg, 2006) have demonstrated economic benefits that justify its wider availability in communities. Substantial reductions of general health care and sick leave use, work absenteeism (Leuzinger-Bohleber et al, 2003), with break-even cost-benefit approximately 3 years post termination (De Maat et al, 2007), as well as increased workplace participation (Berghout et al, 2010;Beutel et al, 2004) have been found. STOPPP research has demonstrated symptom reduction rather than actual health care use, especially in Sweden (Lazar et al, 2006), and examined factors predicting improvement post-treatment (Falkenstrom et al, 2007).…”

Section: Introductionmentioning

confidence: 99%

The Melbourne Study of Psychoanalytic Psychotherapy low‐cost clinic I: Implementation, mental health and life functioning gains

Dean,

Tonge,

Beaufoy

et al. 2023

Appl Psychoanal Studies

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The Melbourne Study of Psychoanalytic Psychotherapy examined the implementation, lived experience, and perceived therapeutic gains of psychoanalytic psychotherapy in a low‐cost, private‐sector community clinic. A first in Australia, this 8‐year demonstration project allowed naturalistic study of the impact and process of intensive, long‐term, time‐limited psychoanalytic psychotherapy delivered to self‐referred adults by clinicians with a common theoretical frame of practice. Presented in three papers, the research employed the RE‐AIM planning and evaluation framework, using complementary quantitative and qualitative methods, to study the psychotherapy service in terms of Reach, Effectiveness, Adoption, Implementation and Maintenance. This first paper reports the Reach of the program to be 67% for those presenting for assessment for psychoanalytic psychotherapy, with Adoption of the full 2‐year treatment program being 60%. Improvements in mental health and life functioning provided quantitative evidence of Effectiveness for those completing the 2‐year treatment program, with Maintenance at 8‐month follow‐up. Patient age, gender and personality characteristics did not modify these improvements. In‐depth qualitative exploration of patient and psychotherapist perspectives regarding the psychotherapy is reported in the second paper highlighting expectations, experience and benefits of the psychotherapy. The third companion paper presents the qualitative findings concerning factors experienced as facilitating or challenging therapeutic progress. Each of the three related papers amplifies understandings of how low‐cost, long‐term but time‐limited psychoanalytic psychotherapy can be implemented in the community with adults otherwise unable to afford such treatment, and discusses lessons learned.

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“…The ethical dilemma is akin to a situation where there is a limited supply of penicillin in the midst of an epidemic of pneumonia: does one give half the recommended dose to everybody or a full recommended dose to half? Fortunately, limited services and medication are sufficient for some, but many others are recurrently and chronically ill and need more intensive and/or extended psychotherapy, to include those with chronic depression (Blatt, Quinlan, Pilkonis, & Shea, 1995;Buchheim et al, 2012;Fava, Ruini, & Belaise, 2007;Huber, Zimmerman, Henrich, & Klug, 2012) and those with borderline personality disorder (Bateman & Fonagy, 2008;Stevenson & Meares, 1999) as well as other patient groups (Berghout, Zevalkink, & Hakkaart-vanRojen, 2010a, 2010bBeutel, Rasting, Stuhr, Rüger, & Leuzinger-Bohleber, 2004;De Maat, de Jonghe, Schoevers, & Dekker, 2009;De Maat, Philipszoon, Schoevers, Dekker, & De Jonghe, 2007;Howard, Kopta, Krause, & Olinski, 1986;Leichsenring & Rabung, 2008, 2011Sandell et al, 2000).…”

Section: How Will Ecps Make Their Choices?mentioning

confidence: 99%

Obstacles to Early Career Psychiatrists Practicing Psychotherapy

Clemens¹,

Plakun²,

Lazar³

et al. 2014

Psychodynamic Psychiatry

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Though psychiatric residents are expected to be competent psychotherapists on graduation, further growth in skill and versatility requires continued experience in their ongoing career. Maturity as a psychotherapist is essential because a psychiatrist is the only mental health provider who, as a physician, can assume full responsibility for biopsychosocial patient care and roles as supervisor, consultant, and team leader. Graduating residents face an environment in which surveys show a steady and alarming decline in practice of psychotherapy by psychiatrists, along with a decline in job satisfaction. High educational debts, practice structures, intrusive management, and reimbursement policies that devalue psychotherapy discourage early career psychiatrists from a practice style that enables providing it. For the early-career psychiatrist there is thus the serious risk of being unable to develop a critical mass of experience or a secure identity as a psychiatric psychotherapist. Implementation of parity laws and the Affordable Care Act (ACA) will affect the situation in unpredictable ways that call for vigilance and active response. Additional service and administrative demands may result from the ACA, creating ethical dilemmas about meeting urgent patient needs versus biopsychosocial standards of care. The authors recommend 1) vigorous advocacy for better payment levels for psychotherapy and freedom from disruptive management; 2) aggressive action against violations of the parity act, 3) active preparation of psychiatric residents for dealing with career choices and the environment for providing psychotherapy in their practice, and 4) post-graduate training in psychotherapy through supervision/consultation, continuing education courses, computer instruction, and distance learning.

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The Effects of Long-Term Psychoanalytic Treatment on Healthcare Utilization and Work Impairment and Their Associated Costs

Cited by 16 publications

References 22 publications

Psychodynamic psychotherapy is associated with sustained reduction in health care utilization and cost

Psychodynamic psychotherapy is associated with sustained reduction in health care utilization and cost

The Melbourne Study of Psychoanalytic Psychotherapy low‐cost clinic I: Implementation, mental health and life functioning gains

Obstacles to Early Career Psychiatrists Practicing Psychotherapy

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