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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

  • P. Knekt (a1) (a2), O. Lindfors (a3), T. Härkänen (a2), M. Välikoski (a3), E. Virtala (a2), M. A. Laaksonen (a2), M. Marttunen (a3), M. Kaipainen (a4), C. Renlund (a3) and the Helsinki Psychotherapy Study Group (a1) (a2) (a3) (a4) (a5)...

Insufficient evidence exists for a viable choice between long- and short-term psychotherapies in the treatment of psychiatric disorders. The present trial compares the effectiveness of one long-term therapy and two short-term therapies in the treatment of mood and anxiety disorders.


In the Helsinki Psychotherapy Study, 326 out-patients with mood (84.7%) or anxiety disorder (43.6%) were randomly assigned to three treatment groups (long-term psychodynamic psychotherapy, short-term psychodynamic psychotherapy, and solution-focused therapy) and were followed up for 3 years from start of treatment. Primary outcome measures were depressive symptoms measured by self-report Beck Depression Inventory (BDI) and observer-rated Hamilton Depression Rating Scale (HAMD), and anxiety symptoms measured by self-report Symptom Check List Anxiety Scale (SCL-90-Anx) and observer-rated Hamilton Anxiety Rating Scale (HAMA).


A statistically significant reduction of symptoms was noted for BDI (51%), HAMD (36%), SCL-90-Anx (41%) and HAMA (38%) during the 3-year follow-up. Short-term psychodynamic psychotherapy was more effective than long-term psychodynamic psychotherapy during the first year, showing 15–27% lower scores for the four outcome measures. During the second year of follow-up no significant differences were found between the short-term and long-term therapies, and after 3 years of follow-up long-term psychodynamic psychotherapy was more effective with 14–37% lower scores for the outcome variables. No statistically significant differences were found in the effectiveness of the short-term therapies.


Short-term therapies produce benefits more quickly than long-term psychodynamic psychotherapy but in the long run long-term psychodynamic psychotherapy is superior to short-term therapies. However, more research is needed to determine which patients should be given long-term psychotherapy for the treatment of mood or anxiety disorders.

Corresponding author
*Address for correspondence: Dr P. Knekt, National Public Health Institute, Mannerheimintie 166, 00300 Helsinki, Finland. (Email:
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Anderson EM, Lambert MJ (1995). Short-term dynamically oriented psychotherapy: a review and meta-analysis. Clinical Psychology Review 15, 503514.
APA (1994). Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association: Washington, DC.
Barber JP, Ellman J (1996). Advances in short-term dynamic psychotherapy. Current Opinion in Psychiatry 9, 188192.
Beck AT, Steer RA, Garbin MG (1988). Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation. Clinical Psychology Review 8, 77100.
Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J (1961). An inventory for measuring depression. Archives of General Psychiatry 4, 561571.
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.
Brockman B, Poynton A, Ryle A, Watson JP (1987). Effectiveness of time-limited therapy carried out by trainees. Comparison of two methods. British Journal of Psychiatry 151, 602610.
Busch FN, Milrod BL, Singer MB (1999). Theory and technique in psychodynamic treatment of panic disorder. Journal of Psychotherapy Practice and Research 8, 234242.
Busch FN, Rudden M, Shapiro T (2004). Psychodynamic Treatment of Depression. American Psychiatric Publishing: Washington, DC.
Carey V, Zeger SL, Diggle P (1993). Modelling multivariate binary data with alternating logistic regressions. Biometrika 80, 517526.
Castonguay LG, Arnow BA, Blatt SJ, Jones EE, Pilkonis PA, Segal ZV (1999). Psychotherapy for depression: current and future directions in research, theory, practice and public policy. Journal of Clinical Psychology 55, 13471370.
Crits-Christoph P (1992). The efficacy of brief dynamic psychotherapy: a meta-analysis. American Journal of Psychiatry 149, 151158.
de Shazer S (1991). Putting Difference to Work. W. W. Norton & Company: New York, NY.
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.
Durham RC, Murphy T, Allan T, Richard K, Treliving LR, Fenton GW (1994). Cognitive therapy, analytic psychotherapy and anxiety management training for generalised anxiety disorder. British Journal of Psychiatry 165, 315323.
Gabbard GO (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.
Gallagher-Thompson D, Hanley-Peterson P, Thompson LW (1990). Maintenance of gains versus relapse following brief psychotherapy for depression. Journal of Consulting and Clinical Psychology 58, 371374.
Gallagher-Thompson D, Steffen AM (1994). Comparative effects of cognitive-behavioral and brief psychodynamic psychotherapies for depressed family caregivers. Journal of Consulting and Clinical Psychology 62, 543549.
Gingerich WJ, Eisengart S (2000). Solution-focused brief therapy: a review of the outcome research. Family Process 39, 477498.
Hamilton M (1959). The assessment of anxiety states by rating. British Journal of Medical Psychology 32, 5055.
Hamilton M (1960). A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry 23, 5662.
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.
Hersen M, Bellack AS, Himmelhoch JM, Thase ME (1984). Effects of social skill training, amitriptyline, and psychotherapy in unipolar depressed women. Behavior Therapy 15, 2140.
Hoglend P, Perry JC (1998). Defensive functioning predicts improvement in major depressive episodes. Journal of Nervous and Mental Disease 186, 238243.
Johnson LD, Miller SD (1994). Modification of depression risk factors: a solution-focused approach. Psychotherapy: Theory, Research, Practice, Training 31, 244253.
Keller MB (2003). Past, present, and future directions for defining optimal treatment outcome in depression: remission and beyond. Journal of the American Medical Association 289, 31523160.
Kernberg OF (1996). A psychoanalytic theory of personality disorders. In Major Theories of Personality Disorder (ed. Clarkin J. F. and Lenzenweger M. F.), pp. 106140. The Guilford Press: New York, NY.
Knekt P, Lindfors O (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. Studies in social security and health 77. The Social Insurance Institution: Helsinki ( Accessed 16 June 2006.
Lambert MJ, Okiishi JC, Finch AE, Johnson LD (1998). Outcome assessment: from conceptualization to implementation. Professional Psychology: Research and Practice 29, 6370.
Lee J (1981). Covariance adjustment of rates based on the multiple logistic regression model. Journal of Chronic Diseases 34, 415426.
Leichsenring F (2001). Comparative effects of short-term psychodynamic psychotherapy and cognitive-behavioral therapy in depression: a meta-analytic approach. Clinical Psychology Review 21, 401419.
Leichsenring F, Rabung S, Leibing E (2004). The efficacy of short-term psychodynamic psychotherapy in specific psychiatric disorders: a meta-analysis. Archives of General Psychiatry 61, 12081216.
Liang K-Y, Zeger SL (1986). Longitudinal data analysis using generalized linear models. Biometrika 73, 1322.
Malan DH (1976). The Frontier of Brief Psychotherapy: An Example of the Convergence of Research and Clinical Practice. Plenum Medical Books: New York, NY.
McKeel AJ (1996). A clinician's guide to research on solution-focused brief therapy. In Handbook of Solution-Focused Brief Therapy (ed. Miller S. D., Hubble M. and Duncan B. L.), pp. 251271. Jossey-Bass Publishers: San Francisco, CA.
McLean PD, Hakstian AR (1979). Clinical depression: comparative efficacy of outpatient treatments. Journal of Consulting and Clinical Psychology 47, 818836.
Migon HdS, Gamerman D (1999). Statistical Inference: An Integrated Approach. Arnold: London.
Piper WE, Debbane EG, Bienvenu JP, Garant J (1984). A comparative study of four forms of psychotherapy. Journal of Consulting and Clinical Psychology 52, 268279.
Piper WE, McCallum M, Joyce AS, Azim HF, Ogrodniczuk JS (1999). Follow-up findings for interpretive and supportive forms of psychotherapy and patient personality variables. Journal of Consulting and Clinical Psychology 67, 267273.
Rosenthal R, Rosnow RL (1991). Essentials of Behavioral Research: Methods and Data Analysis, 2nd edn. McGraw Hill: New York, NY.
SAS Institute Inc. (1999). SAS Online Doc. SAS/STAT User's Guide, Version 8. SAS Institute Inc: Cary, NC.
Schaefer BA, Koeter MW, Wouters L, Emmelkamp PM, Schene AH (2003). What patient characteristics make clinicians recommend brief treatment? Acta Psychiatrica Scandinavica 107, 188196.
Sifneos PE (1978). Short-term anxiety provoking psychotherapy. In Short-term Dynamic Psychotherapy (ed. Davanloo H.), pp. 3542. Spectrum: New York, NY.
Svartberg M, Stiles TC (1991). Comparative effects of short-term psychodynamic psychotherapy: a meta-analysis. Journal of Consulting and Clinical Psychology 59, 704714.
Wampold BE, Minami T, Baskin TW, Callen Tierney S (2002). A meta-(re)analysis of the effects of cognitive therapy versus ‘other therapies’ for depression. Journal of Affective Disorders 68, 159165.
Wampold BE, Mondin GW, Moody M, Stich F, Benson K, Ahn H (1997). A meta-analysis of outcome studies comparing bona fide psychotherapies: empirically, ‘all must have prizes’. Psychological Bulletin 122, 203215.
Verbeke G, Molenberghs G (1997). Linear Mixed Models in Practice: A SAS-oriented Approach. Springer: New York, NY.
WHO (2000). Cross-national comparisons of the prevalences and correlates of mental disorders. WHO International Consortium in Psychiatric Epidemiology. Bulletin of the World Health Organization 78, 413426.
Wiborg IM, Dahl AA (1996). Does brief dynamic psychotherapy reduce the relapse rate of panic disorder? Archives of General Psychiatry 53, 689694.
Wilczek A, Barber JP, Gustavsson JP, Asberg M, Weinryb RM (2004). Change after long-term psychoanalytic psychotherapy. Journal of the American Psychoanalytic Association 52, 11631184.
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Psychological Medicine
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