People with complex mental disorders such as personality
disorders should consider long-term psychotherapy as the therapy proved more
effective than short-term therapy in a report by German researchers appearing
in the Oct. 1 issue of The Journal of the American Medical Association.
The report was based on the analysis of 23 existing studies,
involving a total of 1,053 patients treated with psychodynamic psychotherapy given
as often as three times a week, in many cases for more than a year.
The American Psychiatric Association defines Psychodynamic
psychotherapy as the treatment in which the patients are helped to understand
themselves more fully. This approach may involve uncovering – and learning to
deal more effectively with – unconscious conflicts. It may also involve
assisting patients to understand how certain types of adverse childhood
experiences have left them feeling incomplete, anxious, or plagued with low
self-esteem that interferes with realistic adult functioning.
Analyzing how this therapy worked for the people involved in
the studies, German researchers found that “long-term psychodynamic
psychotherapy was significantly superior to shorter forms of psychotherapy applied
in the control groups. This was true with regard to overall effectiveness,
target problems, and personality functioning,” Falk Leichsenring, a professor
of psychotherapy research in the department of psychosomatic medicine and
psychotherapy at the University of Giessen in Germany, said.
More exactly, patients with complex mental disorders who
completed LTPP were better off than 96 percent of patients in comparison
groups. On the other hand, insurance companies don’t want to pay for long-term
therapy, perhaps believing medications and short-term therapy are most
cost-effective options.
Complex mental disorders included personality disorders, chronic
mental disorders lasting at least a year, complex depression or anxiety
disorders, or those with two or more mental disorders.
The analysis comes a little too late, according to JAMA
Deputy Editor Richard M. Glass, of the University of Chicago in an editorial
accompanying the study, considering today’s trends in psychotherapy. A study
published earlier this year in the Archives of General Psychiatry by
researchers at Johns Hopkins Bloomberg School of Public Health in Baltimore found
the number of psychotherapy visits nationwide declined from 44.4 percent in
1996-97 to 28.9 percent in 2004-05. Also the number of psychiatrist who provide
psychotherapy to all of their patients declined from 19.1 percent in 1996-97 to
10.8 percent in 2004-05.
Dr. Glass believes “this trend appears to be strongly
related to financial incentives and other pressures to minimize costs. Is that
what is really wanted for patients with disabling disorders that could respond
to more intensive treatment?”
The blame could belong to both patients and psychiatrists. Psychiatrists
nowadays get reimbursed by insurance companies at a lower rate for a 45-minute
psychotherapy visit than for three 15-minute medication visits. On the other
hand, most patients consider taking a pill easier and more comfortable than
psychotherapy, which involves more time or the regular participation of family
members.
Therefore, many doctors are now choosing psychopharmacology
(medication for mental illnesses) instead of psychotherapy. However, several
studies have showed that best results can be achieved only with a combination
of psychotherapy and medication.