Psychoanalytische Therapie

[Evidence for Psychodynamic Therapy for Children and Adolescents]

In Germany, cognitive-behavioral therapy, psychodynamic therapy, and systemic therapy are scientifically and legally approved as suitable procedures for treating mental disorders. While all methods have provided empirical evidence of their effectiveness in adults according to defined criteria of the "Scientific Advisory Board for Psychotherapy" (in German: "Wissenschaftlicher Beirat Psychotherapie"), i. e., the official board which decides upon the formal scientific approval of psychotherapeutic approaches in Germany, an evaluation is lacking for the psychodynamic methods in children and adolescents. Against this background, we evaluated the available empirical data for psychodynamic therapy in children and adolescents based on the methods paper of the "Scientific Advisory Board for Psychotherapy" (2019; version 2.9). Published reviews served as the basis for identifying relevant studies, supplemented by a systematic literature search. We identified 91 potentially relevant studies but could not consider the majority of these due to formal exclusion criteria (mainly not disorder-specific, no control group). Up to 26 of the remaining studies provide evidence of efficacy as defined by the "Scientific Advisory Board for Psychotherapy". These cover 10 of the 18 areas of application as defined by the "Scientific Advisory Board for Psychotherapy". According to our evaluation, the reviewed studies provide empirical evidence for the three most relevant areas of application (i. e., affective disorders; anxiety disorders and obsessive-compulsive disorders; hyperkinetic disorders and conduct disorders). Thus, the available evidence supports the suitability of psychodynamic therapy as a method for the treatment of children and adolescents.

Psychoanalysis--on its way down a dead-end street? A concerned commentary

The author discusses the problems when psychoanalysis not only neglects socio-critical issues, diversifies its concepts and sets about to define their common ground with the help of brain research findings and/or of infant observation, but also ignores the implications of attempts to legitimate its scientific status by verifying the outcome of its treatments via nomological and/or qualitative study designs. It is argued that if we reduce psychoanalysis to a mere psychotherapeutic measure we displace the factors essential to neurotic disorders into the blind spot of our field of vision, thus rendering psychoanalysis to be a pseudoscience based on appearances alone. Conceptual clarity, it is argued, cannot be gained from the findings of infant observation or those of brain research. Neither can psychoanalytic treatments be investigated in these manners as long as our current understanding of technical concepts remains highly contradictory. In the author's view present-day psychoanalysis gambles Freud's inheritance away and with it, probably, its own future.

Costs and benefits of long-term psychoanalytic therapy: changes in health care use and work impairment

OBJECTIVE

systematic review regarding the effectiveness of long-term psychoanalytic therapy (LPT) on health care use and work impairment in adult outpatients.

METHOD

a systematic search for studies published between 1970 and 2005. Calculation of the weighted mean changes between pretreatment and treatment termination, and between pretreatment and follow-up. The findings are translated into financial terms, and the costs of treatment are balanced against the financial gains.

RESULTS

seven studies (n = 861) met all the inclusion and none of the exclusion criteria. The mean cost of LPT per patient was 20,900 Euro. During the year preceding treatment termination and the year preceding mean follow-up (2.9 years), the average reduction was 85% and 59%, respectively, in the number of hospital days; 54% and 56%, respectively, in the number of medical consultations; 70% and 19%, respectively, in the number of medication users, and 61% and 67% in days of sick leave. Health care use and sick-leave costs fell by an average of 5,584 Euro , or 66%, between the year preceding the start of psychotherapy and the year preceding treatment termination. At mean follow-up (2.9 years) these costs reductions were still apparent, as the reduction was 5,372 Euro, or 64%, in the year preceding follow-up. The break-even point for benefits and treatment costs was approximately three years after treatment termination. The reduction in work impairment appears to be the main factor (65% to 75%) in these positive results.

CONCLUSIONS

our data suggest that LPT substantially reduces health care use and sick leave. The benefits seem to endure for years after termination and reach the point of counterbalancing the costs of treatment approximately three years after treatment termination.