Long-term psychotherapy is superior, study finds

Psychotherapy lasting for at least one year is more effective than shorter periods of therapy for people with complex mental disorders, such as personality and chronic disorders, according to a study published today in the Journal of the American Medical Assn. The success of dedicated psychotherapy may matter little, however, because fewer doctors are offering the service and fewer insurers are covering it.

In long-term psychodynamic psychotherapy, the therapist provides continued, close support for the patient while the pair work through problems and interventions. The JAMA study, from researchers in Germany, was an examination of 23 studies on the success of psychotherapy. It found that longer-term therapy (one year or longer) was superior to shorter-term methods in regard to overall outcome and personality functioning. On average, patients with complex mental conditions who were treated long-term were better off than 96% of the patients in the comparison groups.

Psychotherapy, however, is a dying art. In an editorial accompanying the study, JAMA Deputy Editor Richard M. Glass, of the University of Chicago, noted that fewer patients these days have access to this kind of supportive therapy.

"It is ironic and disturbing that this occurs at a time when provision of psychotherapy by psychiatrists in the United States is declining significantly," he said. "The reasons for this merit careful evaluation. To some extent this may reflect the cost-efficacy of treatments for some mental disorders with medications and brief supportive visits. However, this trend appears to be strongly related to financial incentives and other pressures to minimize costs. Is this what is really wanted for patients with disabling disorders that could respond to more intensive treatment?"

In August, a study in the Archives of General Psychiatry found the number of psychotherapy visits nationwide declined from 44.4% in 1996-97 to 28.9% in 2004-05. That study found the number of psychiatrists who provide psychotherapy to all of their patients declined from 19.1% in 1996-97 to 10.8% in 2004-05. The authors of that study concluded that more doctors now are specializing in psychopharmacology -- medication for mental illnesses -- even though studies often show the best results can be achieved with a combination of psychotherapy and medication.

"Therapy provided by medically trained psychiatrists offers the maximum integration of mind and body to our patients," said Dr. Eric Plakun, chairman of the American Psychiatric Assn.'s Committee on Psychotherapy by Psychiatrists.

Recognizing the biological basis, and the often helpful addition of medication, for treating mental illness was a huge, positive step in medicine in the last half of the 20th century. But if that progress comes at the expense of psychotherapy, we'll be back where we started: treating just one aspect of the mind-body connection that is at the core of mental-health functioning.

For information on psychotherapy, see this Web page from the Mayo Clinic.

-- Shari Roan

Photo: An illustration of a therapy session. Credit: Geoff Manasse / Getty Images

Comments

[Duh Fuh]

WOW !!!

Therapist recommending more Therapy. Ground breaking study.

[Michael]

Your article seems to assume that psychotherapy provided by an MD is superior, which is false. Further, psychotherapy provided by psychologists and clinical social workers continues to be provided around the country by legions of dedicated professionals who are frankly grossly underpaind for their extensive education and training.

[B Harris]

What are these complex/chronic mental disorders? I know dynamic psychotherapy doesn't do squat for schizophrenics & may impede their recovery. Any figures on that subject show the recovery rate for analysands and such is much lower than the natural recovery rate for this ailment, which is lower than that of the old 19th century moral treatment hospitals, back when what we call psychodynamic ttreatment was unknown. Nowadays the guys on vitamins seem to do best.

[Vicky Brago-Mitchell]

This is silly. Psychiatrists don't practice much psychotherapy in the US, and haven't for many years, because their charges are too high for any but the very rich to pay, and so many people seek therapy now that insurance companies only cover the much more affordable charges of psychologists and other therapists such as MFTs. Therapists simply form partnerships with psychiatrists for the purpose of prescribing medication.

As for the main point of the article, that long-term therapy works better than short-term...well, duh. The members of the Committee on Psychotherapy by Psychiatrists must feel frustrated at being turned into pill-pushers.

[Bob Keteyian]

Most psychiatrists have little training in psychotherapy compared to other mental health professionals.

[Pat M]

As a psychologist, I do wish this article would note that some of the findings in this study only pertain to psychotherapy with psychiatrists. For example, the statement that "the number of psychotherapy visits declined nationwide" is misleading. This is only the case with regard to psychotherapy visits with a psychiatrist. The mental health field has changed a great deal in the time frame noted; psychiatrists have opted to become focused on pharmacology, while other mental health professionals like myself have practices that are 100% psychotherapy and are very busy.

[Showme Damoney]

Longer-term therapy (one year or longer) was superior to shorter-term methods in regard to overall THERAPISTS' INCOME. DUH!!!

[Tom]

I think this makes sense that psychotherapy works. The only thing I would suggest though is that these days the psychotherapy that is effective seems to be rooted in Family Systems Therapy as practiced by John Bradshaw/Melody Beeattie and not individual therapy by Freud.

[Monica Pignotti]

This is a highly inaccurate report on the meta-analysis, which I have actually read. In fact, few of the comparison conditions in the studies examined were short-term therapies. A good portion of the studies examined were comparisons between various types of long-term therapies or comparison of long term to short term psychodynamic therapy. The effect sizes reported in the meta-analysis were from pre-post treatment changes in LTPP, not comparison effect sizes. The LA Times is not alone in this -- much of the media is misreporting these results, as there is nothing in this meta-analysis that compared long term to short term therapies. They listed the short-term therapies as comparison conditions, but what they reported on were the pre-post therapy changes within the LTPP group of patients.

[Alex]

Actually, complex mental disorders don't have to be just schizophrenia. Someone who suffered chronic abuse or trauma as a child, for example, may be damaged in a such a manner that it may take a long time to learn more healthy ways of relating and being. Medication may help but it is ultimately an ongoing relationship with a psychotherapist that will aid this person in developing new ways of being. (there are other ways, too, of course that don't involve psychotherapy)
For the article to suggest, however, that psychotherapy is a dying art is quite misleading. It IS a dying art among psychiatrists, but not among psychologists and master's degree level therapists. In fact, there are more of these providers than ever before. And, yes, most of these providers are very well qualified.

[advokat77]

i have been in psychotherapy with a psychiatrist for 3 years and have been on lexapro for the same length of time. a psychologist friend recently told me that 3 years is too long a time to treat depression and anxiety. (i would say that i am a "run-of-the-mill" depressed individual, if there is such a thing.) may i hear your thoughts on these issues?