The Long-Term Effectiveness of Psychodynamic and Analytical Psychotherapy in Routine Care: Results from a Pragmatic Study over Six Years

Introduction: This pragmatic study evaluates the long-term effectiveness of two forms of psychoanalytically oriented therapy, Psychodynamic Psychotherapy (PP) and Analytical Psychotherapy (AP), in routine care in Germany. Methods: Four hundred and twenty-eight patients diagnosed with various DSM-IV mental disorders were treated with PP or AP and provided annual self-reports of their mental health over a six-year period. We used propensity score methods and piecewise linear latent growth curve models to estimate treatment effects on symptom distress, personality dysfunction, interpersonal problems, and general life satisfaction. Results: We identified distinct trajectories of change for the two treatments. In particular, symptom distress, personality dysfunction, interpersonal problems, and general life satisfaction improved substantially and persistently in both treatments, with PP showing faster initial improvements and AP maintaining gradual progress over time. AP showed greater long-term effectiveness, particularly for patients with more severe problems at baseline. Conclusion: Both psychoanalytically oriented treatments in routine care showed substantial and sustainable effects, even after the end of treatment. While less intensive and expensive PP shows faster effects and comparable effectiveness for patients with low to moderate baseline problems, our findings indicate the value of AP for complex cases. Future research should explore treatment mechanisms, cost-effectiveness, and implications for health policy.