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.