Fink! Still at Large: A Recently Published Report Found That the Characteristics of Therapists Are Important in Determining the Effectiveness of Short- and Long-Term Therapy. Do You Think These Results Should Be Applied in the Training and Supervision of Future Therapists?

Article excerpt

The study, conducted by Dr. Erkki Heinonen and colleagues, randomly assigned 326 outpatients who were suffering from mood or anxiety disorders to either short-term or long-term psychotherapy. Each patient was followed for up to 3 years.

Patients with severe personality disorder, bipolar I disorder, or psychotic disorder were excluded.

The treatments differed in this way: the brief, solution-focused therapy helped patients change by building solutions. Sessions occurred every second or third week, up to a maximum of 12 sessions, and did not go beyond 8 months. Short-term psychodynamic psychotherapy was described as a "transference-based therapeutic approach" that helps patients by working through specific intrapsychic and interpersonal conflicts. Sessions were scheduled over 20 sessions for 5-6 months. Finally, long-term psychodynamic psychotherapy was an open-ended, transference-based therapeutic approach that helped patients explore intrapsychic and interpersonal conflicts, reported Dr. Heinonen of the National Institute for Health and Wel-fare in Finland.

The therapies were provided by volunteer therapists to the outpatients aged 20-46 who had at least 2 years of work experience in a particular form of therapy (J. Affect. Disord. 2012;138:301-12). Six of the therapists provided solution-focused therapy, 11 did short-term psychodynamic psychotherapy, and 40 provided long-term psychodynamic psychotherapy.

The results were not particularly startling but were interesting nonetheless.

The investigators found that therapists who were active, engaging, and extroverted got faster symptom reduction for patients who were in shortterm therapy. Therapists who were more cautious and nonintrusive were able to generate greater benefits for patients who were doing longterm therapy during the 3-year follow-up, wrote Dr. Heinonen.

As I read the article, I reviewed my failures over 52 years and wondered to what extent my personality factored into the equation.

A Painful Miscalculation

One interesting clinical example involved the first patient who successfully committed suicide in my practice and who was in therapy with me. For decades, I have wondered what I missed that allowed this woman to kill herself.

The patient, a severely depressed and obese woman who was in her 40s, begged me to be her psychiatrist. She was an ER nurse in my internship and called me during my first year of residency. Filled with energy and therapeutic zeal and highly narcissistic, I took her on as a private patient. I thought the treatment was going well, until her family called to say that she had overdosed on barbiturates that had lodged in her fat cells and led to her demise.

Obviously, my guilt was enormous, and I was schooled only in long-term therapy - even though Dr. Heinonen and company would suggest that my own personality at the time was better suited for a short-term approach. In light of the severity of her depression, I should have been more watchful for signals of suicide, but I was too inexperienced at that time in my career.

This is a case in which a better analyzed, more cautious psychiatrist might have been a better fit for this patient and could have saved her life.

Implications for Training

For those of us who are in the business of educating residents, we must begin to look at the personal characteristics of the residents and see whether they would do better with short-term or long-term therapy. Supervision of residents should make that possible. The residents could assess their own traits in how they relate to others. And the supervisor should be able to assess how the resident relates to him or her.

Instead of trying to train the resident to be a clone of the supervisor, we should recognize that we might be able to direct residents in a way that will make doing psychotherapy enjoyable and fruitful for them. …