What is the difference between short-term and long-term psychodynamic psychotherapy?

While there is no standardized definition of short-term versus long-term psychodynamic psychotherapy, there is a general consensus by experts that they differ in the number of total sessions as well as duration of treatment. In long-term psychodynamic psychotherapy, the patient and therapist will typically meet for more than one year with at least 40 sessions in each year. On the other hand, in short-term psychodynamic psychotherapy, psychotherapy will be less than one year and less than 40 sessions.

Given the significant time commitment of psychotherapy, one may wonder what the advantages are of being engaged in long-term psychotherapy. It is true that many people will notice substantial improvement in a shorter course of psychodynamic psychotherapy but long-term psychodynamic psychotherapy provides a unique opportunity in treatment. Through maintaining a long-term relationship with a psychotherapist, the depth of understanding of one’s experiences and patterns in relationships is deepened. For example, by having an in-depth understanding of one’s background, a therapist may be more able to assist a patient understand their current patterns in behavior. Additionally, the patient’s experience of the relationship with the therapist and the manner of interaction can be helpful in understanding oneself. In depth understanding of the relationship with the therapist may take an extended period of time.

When the patient and therapist choose to meet more than twice per week, the type of treatment is often defined as psychoanalysis. As is frequently denoted in popular media, the patient is lying on a couch with the psychoanalyst sitting in a chair behind him or her. By changing the positioning of the therapist and patient, an important process in psychodynamic psychotherapy, free association, is encouraged. In free association, the patient is asked to say whatever comes to their mind without filtering or judgement. This process often leads to a better understanding of the most challenging parts of one’s lives and thought processes. Psychoanalysis is often a large time commitment but for some people may be well-suited to developing a more in depth understanding of one’s own life and difficulties.

What is the evidence supporting either short-term or long-term psychodynamic psychotherapy?

Although the effectiveness of short-term psychodynamic psychotherapy is more researched than long-term treatment, there is a growing body of literature that long-term psychotherapy is effective in certain types of mental disorders. As described in other sections, short-term psychodynamic psychotherapy may help to resolve acute distress in roughly 70% of patients.¹ Conversely, approximately 60% of patients with more chronic disorders recover from symptoms with short-term psychodynamic psychotherapy.¹ This leaves close to 40% of people with more chronic forms of distress without improvement in their symptoms, indicating many people will not improve simply with a course of short-term psychotherapy. When looking at the people who do not improve substantially with short-term psychotherapy, it has been thought that those with complex mental disorders are less likely to respond. Some of these patients who may be less likely to respond include those with multiple mental disorders, chronic mental disorders, or those with personality disorders. Those with multiple mental disorders, such as depression and anxiety, often report significantly greater problems in social and occupational functioning.^2,3 They may therefore suffer greatly in their work or in their relationships with peers or loved ones. Personality disorders may represent another group of people who would benefit from long-term psychodynamic psychotherapy. Personality disorders (see Personality Disorder section) are defined as longstanding maladaptive patterns in relationships, behaviors, or thoughts that lead to problems in work or in relationships. Personality disorders typically develop at a young age and are associated with significant long-term distress. Long-term psychotherapy is more likely to be necessary for successful and enduring treatment for this population.

In these more severe types of mental disorders, clinical research has shown that long-term psychodynamic psychotherapy is an effective treatment.⁴ In an analysis by Leichsenring and Rabung in 2014, the results of ten prior studies on long-term psychodynamic psychotherapy in people suffering from complex mental disorders were studied by combining the individual studies into one larger study, a meta-analysis. The authors defined complex mental disorders as those with personality disorders, multiple disorders at the same time, or chronic mental disorders. The study found that long-term psychodynamic psychotherapy was more effective than short-term psychodynamic therapy. This study suggests that those with complicated mental disorders or more chronic conditions, such as borderline personality disorder or co-morbid anxiety and depression, may benefit from long-term psychodynamic psychotherapy. As there is limited research in the area of long-term psychodynamic psychotherapy for other conditions, further evidence may emerge that this form of psychotherapy is effective for other types of mental disorders.

What should I take into consideration when considering long-term psychodynamic psychotherapy?

When thinking whether long-term psychodynamic psychotherapy is a feasible form of treatment, it is important to take a few factors into consideration. First, the nature of long-term psychodynamic psychotherapy is that it is a prolonged treatment with a duration of more than one year of weekly treatment. For some with moderate or severe disorders, or those who find the process of self-exploration goes beyond symptom reduction to relationship enrichment and a sense of greater life satisfaction, it may be the recommended form of treatment. Others may find meeting with a therapist weekly provides a critical source of support. For others, the opportunity to meet with a therapist for a long period of time provides an invaluable experience in which they develop a deep understanding of one’s patterns in relationships and thought processes, freeing them to make broader and richer life choices. One might also learn how one’s upbringing helps to define who they are. Another important consideration is the cost of treatment. Insurance companies may choose to cover treatment fully or for a limited amount of time. For others with more resources, they may prefer not to navigate the complex system of insurances and pay privately. Finally, another consideration is one’s commitment to treatment. Long-term psychodynamic psychotherapy can be an immensely rewarding experience. Those able to commit to weekly appointments will find greater depth in psychotherapy and may find the therapy of value beyond measure.