Patient experiences of long-term psychodynamic psychotherapy for mood and personality disorders: A systematic review and meta-aggregation of qualitative studies.

Understanding patients' experiences of psychotherapy is critical for enhancing treatments for mental health disorders. Despite increasing interest in patients' lived experience of long-term psychodynamic psychotherapy, this current literature has not been comprehensively synthesized. The purpose of this systematic review and meta-aggregation is to integrate and evaluate qualitative research on adults' experiences of long-term psychodynamic psychotherapy for complex mood disorders, with the aim of guiding clinical practice and future research. A systematic review and meta-aggregation of 10 qualitative studies was conducted. Participants were adults with complex mood disorders. Sixty-four findings were organized into five themes: (a) initial challenges in starting therapy, (b) nonlinear processes of change, (c) unique dynamics in group mentalization-based treatment, (d) the subjective value of gaining new perspectives, and (e) ambivalent emotions surrounding termination of therapy. Analyses drew on psychodynamic theory and process-outcome research, emphasizing mechanisms such as mentalizing, the therapeutic alliance, and insight-driven change. Patients described early engagement difficulties, gradual and unpredictable progress, pivotal group interactions in mentalization-based treatment, transformative self-insights, and mixed feelings at the end of therapy. More targeted qualitative and mixed methods research is needed to explore the subjective role of these mechanisms, as well as the potential role of intersession experiences and group processes in explaining treatment outcome in long-term psychodynamic psychotherapy. Limitations (e.g., limited studies, overrepresentation of mentalization-based treatment) point to the need for more diverse and comparative research. Overall, these findings underscore the value of mentalizing, alliance building, and fostering insight in treatment. (PsycInfo Database Record (c) 2025 APA, all rights reserved).