Information for GP's and other Health Professionals considering psychoanalytic treatment for their patients.
These services are provided by specialist practitioners, including psychiatrists, clinical psychologists, psychologists, social workers and other health professionals who have completed the internationally accredited training in psychoanalysis.
You may have patients who would benefit from this intensive treatment.
The brochure is designed to help patients understand something about the nature of psychoanalytic treatment and the conditions for which is indicated. It also provides contact details for arranging a psychoanalytic consultation to explore the possibility of this treatment.
Evidence Base for Psychoanalysis
Although establishing the efficacy of psychoanalysis and long-term psychoanalytic psychotherapy is difficult, there is a growing body of evidence from studies meeting appropriate quality standards that indicate that psychoanalysis is an effective treatment, and that initial post-treatment effects tend to improve during follow-up (Sandell, 2012).
In the Stockholm Outcome of Psychotherapy and Psychoanalysis Project (STOPPP) (Sandell, 1999) patients receiving intensive psychoanalytic treatment not only demonstrated positive change at the conclusion of treatment but continued to show improvement at three-year follow-up.
Although randomized controlled trials may be considered the gold standard for medical outcome research, they may not be the most appropriate design for psychoanalytic outcome studies (de Jonge, 2012; de Maat, 2009). Notwithstanding, the few available have revealed encouraging outcomes of psychoanalytic treatment. For example, a randomized controlled trial (Bateman & Fonagy, 2001) randomly assigned individuals with a diagnosis of borderline personality disorder to a psychoanalytically oriented day-hospital treatment or psychiatric treatment as usual. The patients with borderline pathology made considerable gains relative to the controls and such improvements were not only maintained in the 18 months following discharge, but increased over time, even though the day hospital group received less treatment than the control group.
The Sheffield Psychotherapy Project (Shapiro et al, 1995) also found evidence for the effectiveness of psychodynamic treatment of major depression. There is also impressive outcome data for psychoanalytic treatment for panic disorder (Milrod, Busch & Cooper, 1997; Leichsenring & Rabung 2008).
A study by Leuzinger-Bohleber et al (2002) which involved a large-scale follow-up (at 6.5 years after the completion of treatment) found that 80% patients showed good outcomes in relation to depression and anxiety. Savings were also demonstrated in relation to the use of hospital and outpatient medical treatment of physical symptoms. This study also highlighted the maintenance of treatment gains and the other non-symptom improvements that were conducive to wellbeing including psychological changes at the level of self-understanding, and interpersonal-relational and work-related domains.
Meta-analytic studies, which pool single studies into larger groups of patients, also support the contention that psychoanalysis demonstrates significant change at treatment completion, with continued improvements evident at follow-up. See, for example, deMaat (2009, 2013), Lamb (2004), Leichsenring & Rabung (2008, 2011), and Smit (2012).
The specific domains of personality function that improve with treatment include global psychiatric symptom reduction, target complaints, interpersonal relationships, social and work adjustment, life satisfaction, with attendant reductions in health care utilization and costs (deMaat, 2009, 2012; Leichsenring & Rabung, 2008, 2011).
Results drawn from pooling all outcome effectiveness studies of psychoanalysis lead to the conclusion that if patients are well chosen, between 60%-90% show significant positive gain and achieve clinically significant change. Psychoanalysis is therefore comparable in its effectiveness with a range of commonly used medical treatments (e.g., the 5-year survival for colon cancer varies between 6% -74%; for breast cancer, 22% - 100%).
Although the characteristics distinguishing psychodynamic/psychoanalytic psychotherapy from psychoanalysis have not been consensually delineated within the psychoanalytic research community, comparison studies favour psychoanalysis. It is not yet understood whether the effect is general or specific to psychoanalysis, given that positive outcome has generally been found to be a function of treatment duration. However, studies of the effectiveness of cognitive behavioural therapy (CBT) found that CBT was more effective when CBT therapists recruited psychodynamic processes into their treatment (Ablon & Jones, 1998, 1999, 2002), suggesting the specific effectiveness of psychodynamic processes.
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