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Background: Treatment-resistant depression (TRD) accounts for a large fraction of the burden of depression. The interventions currently used are mostly pharmacological and short-term psychotherapies, but their effectiveness is limited. The Tavistock Adult Depression Study found evidence for the effectiveness of long-term psychoanalytic psychotherapy (LTPP) plus treatment as usual (TAU), versus TAU alone, for TRD. Even after a 2-year follow-up, moderate effect sizes were sustained. This study assessed the cost-effectiveness of this LTPP + TAU., Methods: We conducted a within-trial economic evaluation using a Bayesian framework., Results: Quality-adjusted life years (QALYs) were 0.16 higher in the LTPP + TAU group compared with TAU. The direct cost of LTPP was £5500, with no substantial compensating savings elsewhere. Overall, average health and social care costs in the LTPP + TAU group were £5000 more than in the TAU group, employment rates were unchanged, and effects on other non-healthcare costs were uncertain. Accordingly, the incremental cost-effectiveness ratio was ≈£33,000/QALY; the probability that LTPP + TAU was cost-effective at a willingness to pay of £20,000/QALY was 18 %., Limitations: The sample size of this study was relatively small, and the fraction of missing service-use data was approximately 50 % at all time points. The study was conducted at a single site, potentially reducing generalizability., Conclusions: Although LTPP + TAU was found to be clinically effective for treating TRD, it was not found to be cost-effective compared with TAU. However, given the sustained effects over the follow-up period it is likely that the time horizon of this study was too short to capture all benefits of LTPP augmentation., Competing Interests: Declaration of competing interest There are no financial conflicts of interest. In terms of non-financial interests, DT was responsible for writing and developing the TADS treatment manual describing the treatment method used., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Systemic Lupus Erythematosus (SLE) is an autoimmune disease which impairs the quality of life. The objective of study was to evaluate the effectiveness of Brief Group Psychoanalytic Psychotherapy to improve quality of life, depression, anxiety and coping strategies in SLE patients., Methods: In a randomized clinical trial, 80 female SLE patients were allocated into two groups: therapy group (n = 37) and control group (n = 43). Therapy group (TG) attended weekly psychotherapy sessions for 20 weeks; control group (CG) remained on a waiting list. Both groups received standard medical care. Questionnaires and scales were applied by blinded evaluators at baseline (T1) and after 20 weeks (T2): Socioeconomic Status, SLE International Collaborating Clinic/American College of Rheumatology-Damage Index, SLE International Disease Activity, SLE Specific Symptom Checklist, SLE Quality of life, Hospital Anxiety Depression Scale, Coping Strategies Inventory. Intent to treat intra- and inter-group analysis was performed for all variables in T1 and T2 using Qui-square, t-Student, Mann-Whitney and Wilcoxon tests. Analysis of Variance was used to compare categorical variables over time. P < 0.05 was considered significant., Results: The mean age of patients was 42 years; 54% were white, with mean disease duration of  years 12. At baseline, both groups were homogeneous in all variables, including medications. After 20 weeks of psychotherapy TG was significantly different from CG, with lower frequency of symptoms (p = 0.001), lower level of anxiety (p = 0.019) and depression (p = 0.022), better index in five of six domains of quality of life scale (p ≤ 0.005), including total SLEQOL (p < 0.001) and with higher positive planful problem solving strategy (p = 0.017). No change in disease activity score was observed in both groups., Conclusions: Psychoanalytic psychotherapy was effective to improve many domains of quality of life and one positive coping skill and to reduce SLE symptoms, anxiety and depression levels. Brief group psychotherapy can be a useful tool to complement medical care in SLE patients., Trial Registration: Number NCT01840709 .

Objective: For chronic depression, the effectiveness of brief psychotherapy has been limited. This study is the first comparing the effectiveness of long-term cognitive-behavioural therapy (CBT) and long-term psychoanalytic therapy (PAT) of chronically depressed patients and the effects of preferential or randomized allocation., Methods: A total of 252 adults met the inclusion criteria (aged 21-60 years, major depression, dysthymia, double depression for at least 24 months, Quick Inventory of Depressive Symptoms [QIDS] >9, Beck Depression Inventory II [BDI] >17, informed consent, not meeting exclusion criteria). Main outcome measures were depression self-rating (BDI) and rating (clinician-rated QIDS [QIDS-C]) by independent, treatment-blinded clinicians. Full remission rates (BDI ≤12, QIDS-C ≤5) were calculated. An independent center for data management and biostatistics analyzed the treatment effects and differences using linear mixed models (multilevel models and hierarchical models)., Results: The average BDI declined from 32.1 points by 12.1 points over the first year and 17.2 points over 3 years. BDI overall mean effect sizes increased from d = 1.17 after 1 year to d = 1.83 after 3 years. BDI remission rates increased from 34% after 1 year to 45% after 3 years. QIDS-C overall effect sizes increased from d = 1.56 to d = 2.08, and remission rates rose from 39% after 1 year to 61% after 3 years. We found no significant differences between PAT and CBT or between preferential and randomized allocation., Conclusions: Psychoanalytic as well as cognitive-behavioural long-term treatments lead to significant and sustained improvements of depressive symptoms of chronically depressed patients exceeding effect sizes of other international outcome studies.

This paper has two aims: first, it seeks to understand the absence of treatment manuals in psychoanalysis. Secondly, it summarizes the treatment manual of the Tavistock Adult Depression Study, which describes the form of psychoanalytic psychotherapy whose effectiveness has been evaluated both in the Tavistock Adult Depression Study (TADS); and in the German Die Langzeittherapie bei chronischen Depressionen (LAC) Studie. Throughout the history of psychoanalysis, opinions about treatment manuals, empirical research and their antecedents have been deeply divided. After tracing the often polarized unfolding of these matters, the paper proposes that emotional and cognitive difficulties as well as scientific ones underpin their persistence. It is suggested that greater familiarity with them may lead to better combinations of outcome research and psychoanalysis: for example, the Tavistock manual seeks to match one account of the objects, aims, values, spirit and methods of psychoanalysis (as well as of connected forms of psychoanalytic psychotherapy); and also to meet what is required of treatment manuals by random allocation controlled trials. It has been a crucial element in the above studies of the outcome of long-term psychoanalytic psychotherapies with chronically depressed patients. After describing the Tavistock Manual, the paper concludes suggesting that, if appropriately constructed, treatment manuals can make a contribution to the advancement of specifically psychoanalytic knowledge., (Copyright © 2015 Institute of Psychoanalysis.)

This paper explores the psychotherapy process in a short-term psychoanalytic treatment (STPP) with a depressed adolescent. The empirical case study draws on both quantitative and qualitative data to examine the development of the psychotherapy process over time. 15 of the 29 audio recorded therapy sessions with a 16-year-old boy were sampled at intervals across the treatment. Session transcripts were coded using the Adolescent Psychotherapy Q-Set (APQ) and data analysed descriptively to compare characteristics of the process across the three treatment phases – beginning, middle, and ending. Descriptive statistics are supported with session extracts. Analysis of the APQ data suggests change in the patient's presentation across the therapy. In the early stages, he appeared withdrawn and made minimal responses to the therapist's attempts to work together; in the middle phase, he became more engaged, more able to talk about feelings, and more active in the sessions; and this was reflected in a less depressed presentation in the final phase. The therapist maintained a consistent therapeutic approach across all phases: supportive, non-judgemental, and working to make sense of the young person's experiences, looking for patterns and inviting curiosity about how things might be understood differently. Despite increased engagement in the therapy, depressive symptoms remained in the clinical range. [ABSTRACT FROM AUTHOR]

Introduction: Short-term psychoanalytic psychotherapy (STPP) is an evidencebased treatment for adolescents with depression, but like all treatment approaches, not all patients benefit from it. Previous investigations of the process of STPP have mostly focused on successful cases, and only a few studies have included the perspectives of young people, their parents, and therapists in the understanding of treatment non-response. Methods: Semi-structured interviews were carried out with young people who were considered "non-responders" to STPP, as well as with their parents and therapists. These cases were analyzed using a descriptive-interpretative approach. Results: The data analysis revealed three themes: (1) Therapy as a safe space; (2) Can short-term psychotherapy ever be enough?; and (3) Therapists making links and connections that did not make sense to the young people. Discussion: This study's findings indicate that "poor outcome" psychotherapy does not necessarily equate to a "poor experience" of psychotherapy, with different stakeholders appreciating the treatment setting as a "safe space." However, they also suggest that some felt that a relatively short-term treatment could not lead to substantial change and that young people in STPP might have a more negative view of their outcomes compared to their parents and therapists. Finally, the findings indicate that some interventions made by clinicians in STPP feel wrong or do not make sense to young people, potentially affecting the therapy process. [ABSTRACT FROM AUTHOR]

Objective: To identify and describe in-session interaction patterns between psychoanalytic therapists and adolescents diagnosed with major depressive disorder, comparing good and poor outcome cases. Method: Audio recordings for 100 psychotherapy sessions from 10 Short-Term Psychoanalytic Psychotherapies were analysed using the Adolescent Psychotherapy Q-Set (APQ). The cases and sessions were evenly divided into two groups (poor outcome and good outcome, 5 patients and 50 sessions per group). Interaction patterns were analysed with an Exploratory Factor Analysis (EFA), while group differences were assessed through t-tests. Results: The EFA revealed three factors: (1) "Open, engaged young person working collaboratively with a therapist to make sense of their experiences", (2) "Directive therapist with a young person fluctuating in emotional state and unwilling to explore", (3) "Young person expressing anger and irritation and challenging the therapist". Factor 1 was significantly more prominent in the good outcome cases, while factor 3, on the contrary, was more significantly related to the poor outcome cases. Factor 2 was equally present in both groups. Conclusion: Besides reinforcing to researchers and clinicians the association between a collaborative psychotherapy process with good outcomes, our findings also provide empirical data regarding the role of anger in adolescent depression and the psychotherapy process. [ABSTRACT FROM AUTHOR]

IntroductionShort-term psychoanalytic psychotherapy (STPP) is an evidence-based treatment for adolescents with depression, but like all treatment approaches, not all patients benefit from it. Previous investigations of the process of STPP have mostly focused on successful cases, and only a few studies have included the perspectives of young people, their parents, and therapists in the understanding of treatment non-response.MethodsSemi-structured interviews were carried out with young people who were considered “non-responders” to STPP, as well as with their parents and therapists. These cases were analyzed using a descriptive-interpretative approach.ResultsThe data analysis revealed three themes: (1) Therapy as a safe space; (2) Can short-term psychotherapy ever be enough?; and (3) Therapists making links and connections that did not make sense to the young people.DiscussionThis study’s findings indicate that “poor outcome” psychotherapy does not necessarily equate to a “poor experience” of psychotherapy, with different stakeholders appreciating the treatment setting as a “safe space.” However, they also suggest that some felt that a relatively short-term treatment could not lead to substantial change and that young people in STPP might have a more negative view of their outcomes compared to their parents and therapists. Finally, the findings indicate that some interventions made by clinicians in STPP feel wrong or do not make sense to young people, potentially affecting the therapy process.

The authors, both professors of psychiatry, trained as psychoanalysts according to the standards of the International Psychoanalytic Association (IPA), recount 30 years of conceptual and empirical research work for the construction of a model of brief and adaptive psychodynamic psychotherapy applicable at the Primary Health Care level. The many milestones of this journey are reviewed, starting with the difficulties and obstacles encountered when pursuing this task within IPA institutions. Once the authors decided to conduct the task outside the analytic institution, they created two training programs for psychodynamic therapists and a research group in psychotherapy, all of which have attained excellence. This effort gave birth to several institutions that are still in operation, such as the Chilean and Latin American chapters of the Society for Psychotherapy Research, the Chilean Congress of Psychotherapy, the PhD Program in Psychotherapy, and finally the Millennium Institute for Research and Personality (MIDAP). In its 8 years of existence, MIDAP has become a national and Latin American reference center for research in Mental Health, aimed at implementing preventive and psychotherapeutic interventions in vulnerable populations at the primary health care and community level. The article ends with a description of the main components and the final process of the construction of the Protocol of Psychotherapeutic Competences for the Treatment of Depression in Primary Health Care level. [ABSTRACT FROM AUTHOR]

Deborah was referred to me for psychoanalytic psychotherapy following a suicide attempt and depression. We began a fascinating journey spanning more than 10 years. During therapy, many questions arose concerning the suicidal episode, which she could not register consciously. I tried to understand the reasons for her depression and the attempted suicide through the unconscious process in the therapeutic relationship and through the music and poetry that she brought to sessions. In this paper I describe the process of listening for the signifiers of semiotic and symbolic language, both metaphoric and metonymic, as revealed in poetry and music according to the theories of Kristeva and Lacan. The poetry enabled the patient to retrieve childhood memories, experience the movement from unconscious to conscious, and mourn through the experience of transference and countertransference in the therapeutic relationship. Also illustrated is the transition from singing the music to more symbolic language, turning the patient's sensory experience into language, and connecting her personal experience with the culture of her past. The patient's mourning and the lost love objects are discussed through the prism of classical and object relations theories. [ABSTRACT FROM AUTHOR]

In this paper we present the main features of a 10‐year, twice‐weekly psychoanalytic psychotherapy with a female subject (Clare) who presented with severe depression, self‐harm and suicidality. Serious traumatic events in her upbringing led to the formation of a pathological defensive structure based on a rigid identification with the aggressor, used as a dysfunctional means of protecting her against the threat of severe anxiety and psychic annihilation. Although the prognosis appeared bleak, her motivation for greater self‐understanding, her resilience and her therapist's commitment to analytic work allowed for a strengthening of the therapeutic alliance. Gradually and painfully, Clare succeeded in recognizing the difference between her cruel primary figures and the figure of a caring and containing psychotherapist, which in turn allowed her a more robust internalization of a benign object. The change in the nature of the transference towards greater trust coincided with improvements in her life, in the quality of her interpersonal relationship and external functioning. Psychiatric medication was gradually withdrawn and Clare found a part‐time job. Improvements were maintained by follow‐up consultations. The positive outcome confirms that long‐term psychoanalytically oriented therapy is an effective approach for the treatment of subjects presenting with severe emotional difficulties. [ABSTRACT FROM AUTHOR]

Les psychothérapies psychodynamiques font l'objet d'un regain d'intérêt dans le traitement de la dépression, mais les études d'efficacité des thérapies psychanalytiques et psychodynamiques de groupe sont encore peu nombreuses. Notre article consiste en une évaluation quantitative des effets d'une intervention psychodynamique brève en groupe de thérapeute menée sur une cohorte de 32 patients volontaires. Les résultats montrent une amélioration significative de l'intensité dépressive et en particulier une plus grande capacité d'initiative du patient, à laquelle correspond un contre-transfert plus positif et plus engagé de la part des thérapeutes. Nous proposons une hypothèse explicative pour discuter nos résultats : l'intervention psychodynamique brève permettrait, par l'augmentation de l'insight, un « dégel » de l'activité psychique et motrice du patient, résultant en une sortie de la crise dépressive au profit de la reprise d'un travail thérapeutique individuel. Depression is a major public health problem, for the treatment of which psychodynamic psychotherapies are receiving renewed interest. However, there are still few studies focusing on the effectiveness of psychoanalytic and psychodynamic group therapies for depressed patients. In this article, we will shed a light on the determinants of the effectiveness of a brief, 4-session psychodynamic intervention (BPI) led by a group of therapists, as inspired by the Lausanne model, on the symptomatology and experience of patients in acute depressive crisis. The patients who accepted to participate in this research were interviewed in a therapeutic setting. The participants, all mental health users most of them (88%) not hospitalized, were informed of the research and consented to it using a free and informed consent form. Our sample consisted of 32 patients with an average age of 43.81 years and a sex ratio of one man for every four women. The therapists involved gathered data by completing several hetero-questionnaires after each therapy session: MADRS, ESM, EFP, HAQ-IT, EDICODE, Counter-Transfer Scale. The SPPS software (V21) was used to analyze the data. The MADRS score dropped by more than 11 points after the four sessions. The depressive symptomatic intensity therefore decreases significantly after the brief psychodynamic intervention. Patients still suffer with severe depression, as evaluated with a Beck scale, but the decrease of more than nearly two standard deviations indicate substantial improvement after four sessions. This improvement also corresponds to a more positive and committed self-reported countertransference of the therapists' towards the patients. Insight increases in patients who have been treated by group BPI sessions. They also show greater behavioral and psychic activity. This effect could be linked to a particular mechanism that we will call "unfreezing", which allows the patient to regain sufficient capacities of psychic elaboration, insight, interhuman communication (affective, relational and psychic) to go forward in his own life. We define the unfreezing as the exit of the depressive inhibition following the sharp increase of the patients' insight, as allowed by the group BPI, which focuses on the discourse and the lived experience of the patient. The unfreezing can be seen in that (1) Though the patient is not completely autonomous, he reports greater activity and more satisfactory human interactions. (2) His speech is more focused and structured, as opposed to the major intellectual inhibition and abulia characteristic of depressive crises. The validity of a consensus between therapists could be called into question because of the weight of countertransference when dealing with patients in acute depressive crisis. However, the BPI system in a group of therapists seems to be an effective therapeutic aid in the "unfreezing" of the psychic processes in depressive patients. Our results point out the importance of jointly aiming at symptomatic improvement and therapeutic alliance, focusing not only on the symptoms, but more specifically on the patient's psychic dynamics. [ABSTRACT FROM AUTHOR]

Randomised controlled trials form a central building block within the prevailing evidence-based mental health paradigm. Both methodology and paradigm have been widely problematised since their emergence in the mid-late twentieth century. We draw on the concept of 'strategic ignorance' to understand why the paradigm still prevails. We present focus group data gathered from 37 participants (service users, public, carers, general practitioners, commissioners) concerning the way they made sense of a randomised controlled trial of psychotherapy for treatment-resistant depression. Thematic analysis of the findings revealed an overall critique of randomised controlled trial methods which we refer to as 'non-strategic ignorance'. Specifically, participants problematised the construct of depression, unseating the premise of the randomised controlled trial; they were sceptical about the purpose and highlighted its failure to show how therapy works or who might benefit; the randomised controlled trial was seen as inadequate for informing decisions about how to select a therapy. Participants assumed the treatment would be cost-effective given the client group and nature of the therapy, irrespective of any randomised controlled trial findings. Each area of lay ('non-strategic') critique has an analogous form within the methodological expert domain. We argue that 'expert' critiques have generally failed to have paradigmatic impact because they represent strategic ignorance. Yet parallel non-strategic critiques have common sense appeal, highlighting the potential power of lay voices. The discussion considers whether the evidence-based mental health paradigm is faced with epistemological problems of such complexity that the conditions exist for a new paradigm in which service user views are central and randomised controlled trials peripheral. [ABSTRACT FROM AUTHOR]

Background: Understanding core psychodynamic models of depression in the transference is a central process of psychodynamic psychotherapy for depressed patients. Aim: This paper reviews updated psychodynamic models of depression such as 1) narcissistic vulnerability and shame, 2) managing conflicted anger and anger directed toward the self, 3) excessive guilt, 4) idealization and devaluation, 5) defenses employed in coping with painful affects, 6) anaclitic or dependent depression, 7) introjective or self-critical depression. This paper also shows clinical implications of these models and important therapeutic tasks for facilitating therapeutic alliance and the ego observational capacities. [ABSTRACT FROM AUTHOR]

Background:While the general effectiveness of psychodynamic inpatient psychotherapy has been established, very few studies have specifically investigated the effectiveness of psychodynamic inpatient treatment of depression, though depressed patients represent the largest group of inpatients. Method :This study investigated two naturalistic samples of depressed patients regarding treatment outcome as well as clinical and treatment characteristics. Patients were treated in a psychoanalytical psychosomatic hospital unit. Data was collected from 2000 to 2002 (N=234) and from 2008 to 2010 (N=514). Data was acquired at admission and discharge. Results:The findings reveal high pre-post effect sizes for symptom reduction (SCL-90-R), general functioning (GAF) and medium changes of interpersonal problems (IIP). The improvement on the IIP was significantly higher for patients with comorbid personality disorder. Based on therapist ratings, the sample treated from 2008-2010 showed higher levels of impairment on several levels: chronic, complex, functional (GAF) and structural (OPD). Conclusion:Findings indicate that patients show substantial short-term benefit following psychoanalytic inpatient psychotherapy, as practiced under naturalistic conditions. Open questions remain regarding the long-term nature of these benefits and the possible influence of placebo-effects. [ABSTRACT FROM PUBLISHER]

The psychometric properties of the Helping Alliance Questionnaire-I were analyzed at two times in short-term psychoanalytic supportive psychotherapy for outpatient depression. Exploratory factor analysis conducted in 142 patients generated a model that was confirmed in a different validation sample (n=106) using confirmatory factor analysis. Two factors were found to have satisfactory psychometric properties and a consistent structure over time: relationship and internal change. The authors conclude that reporting on the HAQ-I with separate scores for these individual aspects of alliance offers a more precise assessment and is preferable to using a single general alliance score. [ABSTRACT FROM AUTHOR]

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The study aims to explore the process of overcoming depression as experienced by young adult psychotherapy patients. Seventeen patients in individual or group psychotherapy with diagnoses within the depression spectrum were interviewed at termination of psychotherapy and at 1.5 years' follow-up. Grounded theory analysis of transcripts resulted in 15 distinct categories, organized into five general domains: experiences of positive change, in-therapy contributions to positive change, extra-therapeutic contributions to positive change, obstacles in therapy and negative experienced outcomes. Exploration of interplay between these domains resulted in a process model for the way out of depression. The positive changes experienced extended beyond symptom relief. The patients emphasised finding out how they wanted to live and how they started forming their lives in that direction. Obstacles in therapy interplayed with the experience of being stuck in depression. These findings are related to age-specific challenges on the threshold of adulthood. [ABSTRACT FROM AUTHOR]

Abstract: The authors show the results related to the longitudinal study of a six-months pregnant, depressive woman until four months postpartum. She has accepted a short psychoanalytical psychotherapy. The originality of that study is triple: longitudinal studies during that perinatal period are seldom if we consider previous researches reviewed; psychological evaluation at eight-months time interval using multidimensional clinical methodology based on behavioural and psychoanalytical frame of reference has never been undertaken. Indeed, we simultaneously have used therapy data, scales and questionnaires related to health psychology to appreciate behavioural changes (SF 36 quality of life scale, Carver''s Brief Cope, General Health Questionnaire 12, EPDS perinatal depression scale), and a projective technique (Rorschach test) to evaluate intrapsychic changes; to give the reader the opportunity to account precisely for changes related to psychoanalytical psychotherapy. Results clearly shows usefulness of that type of psychotherapy from a preventive perspective to face perinatal depression. Indeed, psychoanalytic following allows to reduce significantly perinatal depressive state to improve adaptative coping strategies and life quality and finally to favour intrapsychic reorganization. That last point was clearly demonstrated by the comparison of data at time 1 and 2 of research. Future researches are suggested to give more consistence to the conclusions related to that single case study. [Copyright &y& Elsevier]