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The outcome of short- and long-term psychotherapy 10 years after start of treatment

  • P. Knekt (a1) (a2), E. Virtala (a1), T. Härkänen (a1), M. Vaarama (a1), J. Lehtonen (a1) and O. Lindfors (a1)...



Empirical evidence on whether patients’ mental health and functioning will be more improved after long-term than short-term therapy is scarce. We addressed this question in a clinical trial with a long follow-up.


In the Helsinki Psychotherapy Study, 326 out-patients with mood or anxiety disorder were randomly assigned to long-term psychodynamic psychotherapy (LPP), short-term psychodynamic psychotherapy (SPP) or solution-focused therapy (SFT) and were followed for 10 years. The outcome measures were psychiatric symptoms, work ability, personality and social functioning, need for treatment, and remission.


At the end of the follow-up, altogether 74% of the patients were free from clinically elevated psychiatric symptoms. Compared with SPP, LPP showed greater reductions in symptoms, greater improvement in work ability and higher remission rates. A similar difference in symptoms and work ability was observed in comparison with SFT after adjustment for violations of treatment standards. No notable differences in effectiveness between SFT and SPP were observed. The prevalence of auxiliary treatment was relatively high, 47% in SFT, 58% in SPP and 33% in LPP, and, accordingly, the remission rates for general symptoms were 55, 45 and 62%, respectively.


After 10 years of follow-up, the benefits of LPP in comparison with the short-term therapies are rather small, though significant in symptoms and work ability, possibly due to more frequent use of auxiliary therapy in the short-term therapy groups. Further studies should focus on the choice of optimal length of therapy and the selection of factors predicting outcome of short- v. long-term therapy.


Corresponding author

*Address for correspondence: P. Knekt, National Institute for Health and Welfare, PO Box 30, 00271 Helsinki, Finland. (Email:


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American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders DSM-IV, 4th edn. American Psychiatric Association: Washington, DC.
Andrews, G, Pollock, C, Stewart, G (1989). The determination of defense style by questionnaire. Archives of General Psychiatry 46, 455460.
Antonovsky, A (1993). The structure and properties of the Sense of Coherence Scale. Social Science and Medicine 36, 725733.
Benjamin, LS (1996). A clinician-friendly version of the interpersonal circumplex: Structural Analysis of Social Behavior (SASB). Journal of Personality Assessment 66, 248266.
Bond, M, Perry, JC (2006). Psychotropic medication use, personality disorder and improvement in long-term dynamic psychotherapy. Journal of Nervous and Mental Disease 194, 2126.
de Shazer, S, Berg, IK, Lipchik, E, Nunnally, E, Molnar, A, Gingerich, W, Weiner-Davis, M (1986). Brief therapy: focused solution development. Family Process 25, 207221.
Derogatis, LR, Lipman, RS, Covi, L (1973). SCL-90: an outpatient psychiatric rating scale – preliminary report. Psychopharmacology Bulletin 9, 1328.
Gabbard, G (2004). Long-Term Psychodynamic Psychotherapy: A Basic Text. American Psychiatric Publishing: Washington, DC.
Gabbard, GO, Gunderson, JG, Fonagy, P (2002). The place of psychoanalytic treatments within psychiatry. Archives of General Psychiatry 59, 505510.
Graubard, BI, Korn, EL (1999). Predictive margins with survey data. Biometrics 55, 652659.
Härkänen, T, Arjas, E, Laaksonen, MA, Lindfors, O, Haukka, J, Knekt, P (2013). Estimating efficacy in the presence of non-ignorable non-trial interventions in the Helsinki Psychotherapy Study. Statistical Methods in Medical Research. Published online 1 February 2013. doi:10.1177/0962280212473348.
Härkänen, T, Knekt, P, Virtala, E, Lindfors, O (2005). A case study in comparing therapies involving informative drop-out, non-ignorable non-compliance and repeated measurements. Statistics in Medicine 24, 37733787.
Heinonen, E (2014). Therapists’ Professional and Personal Characteristics as Predictors of Working Alliance and Outcome in Psychotherapy. National Institute for Health and Welfare, Research 123: Helsinki.
Hoglend, P, Bogwald, K-P, Amlo, S, Marble, A, Ulberg, R, Cosgrove Sjaastad, M, Sorbye, O, Heyerdahl, O, Johansson, P (2008). Transference interpretations in dynamic psychotherapy: do they really yield sustained effects? American Journal of Psychiatry 165, 763771.
Holi, MM, Marttunen, M, Aalberg, V (2003). Comparison of the GHQ-36, the GHQ-12 and the SCL-90 as psychiatric screening instruments in the Finnish population. Nordic Journal of Psychiatry 57, 233238.
Horowitz, LM, Alden, LE, Wiggins, JS, Pincus, AL (2000). Inventory of the Interpersonal Problems. The Psychological Corporation: San Antonio, TX.
Huber, D, Zimmermann, J, Henrich, G, Klug, G (2012). Comparison of cognitive–behaviour therapy with psychoanalytic and psychodynamic therapy for depressed patients – a three-year follow-up study. Zeitschrift für Psychosomatische Medizin und Psychotherapie 58, 299316.
Knekt, P, Heinonen, E, Härkäpää, K, Järvikoski, A, Virtala, E, Rissanen, J, Lindfors, O; the Helsinki Psychotherapy Study Group (2015). Randomized trial on the effectiveness of long- and short-term psychotherapy on psychosocial functioning and quality of life during a 5-year follow-up. Psychiatry Research 229, 381388.
Knekt, P, Lindfors, O (editors) (2004). A Randomized Trial of the Effect of Four Forms of Psychotherapy on Depressive and Anxiety Disorders: Design, Methods, and Results on the Effectiveness of Short-Term Psychodynamic Psychotherapy and Solution-Focused Therapy During a One-Year Follow-Up. Social Insurance Institution: Helsinki.
Knekt, P, Lindfors, O, Härkänen, T, Välikoski, M, Virtala, E, Laaksonen, MA, Marttunen, M, Kaipainen, M, Renlund, C; Helsinki Psychotherapy Group (2008). Randomized trial on the effectiveness of long-and short-term psychodynamic psychotherapy and solution-focused therapy on psychiatric symptoms during a 3-year follow-up. Psychological Medicine 38, 689703.
Knekt, P, Lindfors, O, Renlund, C, Sares-Jäske, L, Laaksonen, MA, Virtala, E (2011). Use of auxiliary psychiatric treatment during a 5-year follow-up among patients receiving short- or long-term psychotherapy. Journal of Affective Disorders 135, 221230.
Knekt, P, Lindfors, O, Sares-Jäske, L, Virtala, E, Härkänen, T (2013). Randomized trial on the effectiveness of long- and short-term psychotherapy on psychiatric symptoms and working ability during a 5-year follow-up. Nordic Journal of Psychiatry 67, 5968.
Koskinen, S, Lundqvist, A, Ristiluoma, N (editors) (2012). Health, Functional Capacity, and Welfare in Finland 2011. National Institute for Health and Welfare (THL): Helsinki.
Laaksonen, MA, Knekt, P, Lindfors, O (2013). Psychological predictors of the recovery from mood or anxiety disorder in short-term and long-term psychotherapy during a 3-year follow-up. Psychiatry Research 208, 162173.
Laaksonen, MA, Lindfors, O, Knekt, P, Aalberg, V (2012). Suitability for Psychotherapy Scale (SPS) and its reliability, validity, and prediction. British Journal of Clinical Psychology 51, 351375.
Lee, J (1981). Covariance adjustment of rates based on the multiple logistic regression model. Journal of Chronic Diseases 34, 415426.
Leichsenring, F, Abbass, A, Luyten, P, Hilsenroth, M, Rabung, S (2013). The emerging evidence for long-term psychodynamic therapy. Psychodynamic Psychiatry 41, 361384.
Leichsenring, F, Salzer, S, Beutel, ME, Herpertz, S, Hiller, W, Hoyer, J, Huesing, J, Joraschky, P, Nolting, B, Poehlmann, K, Ritter, V, Stangier, U, Strauss, B, Tefikow, S, Teismann, T, Willutzki, U, Wiltink, J, Leibing, E (2014). Long-term outcome of psychodynamic therapy and cognitive–behavioral therapy in social anxiety disorder. American Journal of Psychiatry 171, 10741082.
Liang, K-Y, Zeger, S (1986). Longitudinal data analysis using generalized linear models. Biometrika 73, 1322.
Lindfors, O, Knekt, P, Heinonen, E, Härkänen, T, Virtala, E; Helsinki Psychotherapy Study Group (2015). The effectiveness of short- and long-term psychotherapy on personality functioning during a 5-year follow-up. Journal of Affective Disorders 173, 3138.
Malan, D (1976). The Frontier of Brief Psychotherapy: An Example of the Convergence of Research and Clinical Practice. Plenum Medical Book Co.: New York.
Migon, H, Gamerman, D (1999). Statistical Inference: An Integrated Approach. Arnold: London.
Perry, JC, Bond, M (2009). The sequence of recovery in long-term dynamic psychotherapy. Journal of Nervous and Mental Disease 197, 930937.
Rhebergen, D, Batelaan, NM, de Graaf, R, Nolen, WA, Spijker, J, Beekman, AT, Penninx, BW (2011). The 7-year course of depression and anxiety in the general population. Acta Psychiatrica Scandinavica 123, 297306.
Rubin, DB (1987). Multiple Imputation for Nonresponse in Surveys. John Wiley: New York.
SAS Institute Inc. (2011). SAS/STAT ® 9.3: User's Guide. SAS Institute Inc.: Cary, NC.
Shedler, J (2010). The efficacy of psychodynamic psychotherapy. American Psychologist 65, 98109.
Smit, Y, Huibers, MJ, Ioannidis, JP, van Dyck, R, van Tilburg, W, Arntz, A (2012). The effectiveness of long-term psychoanalytic psychotherapy – a meta-analysis of randomized controlled trials. Clinical Psychology Review 32, 8192.
Social Insurance Institution (2012). Rehabilitative Psychotherapy. Instructions for Applying Reimbursement for Psychotherapy ( Accessed 22 October 2012.
Steinert, C, Hofmann, M, Kruse, J, Leichsenring, F (2014). The prospective long-term course of adult depression in general practice and the community. A systematic literature review. Journal of Affective Disorders 152–154, 6575.
Town, JM, Diener, MJ, Abbass, A, Leichsenring, F, Driessen, E, Rabung, S (2012). A meta-analysis of psychodynamic psychotherapy outcomes: evaluating the effects of research-specific procedures. Psychotherapy (Chicago) 49, 276290.
Tuulio-Henriksson, A, Heino, P, Toikka, T, Autti-Rämö, I (2014). Social Insurance Institution-subsidized rehabilitation psychotherapy for persons with dysfunction in work and studying actualizes in different length. [Kelan työ- ja opiskelukykyä tukeva kuntoutus toteutuu eri kestoisena.] (in Finnish). Kuntoutus 3, 517.
Verbeke, G, Molenberghs, G (editors) (1997). Linear Mixed Models in Practice: A SAS-Oriented Approach. Springer: New York.
Vittengl, JR, Clark, LA, Jarrett, RB (2009). Deterioration in psychosocial functioning predicts relapse/recurrence after cognitive therapy for depression. Journal of Affective Disorders 112, 135143.
Weissman, MM, Bothwell, S (1976). Assessment of social adjustment by patient self-report. Archives of General Psychiatry 33, 11111115.
Wilczek, A, Weinryb, RM, Gustavsson, PJ, Barber, JP, Schubert, J, Asberg, M (1997). Symptoms and character traits in patients selected for long-term psychodynamic psychotherapy. Journal of Psychotherapy Practice and Research 7, 2334.
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