The Sequence of Recovery in Long-Term Dynamic Psychotherapy

Psychotherapy has generally been found both efficacious and effective in producing improvement, but the sequence of recovery across different measures is less studied. A total of 53 patients with mood, anxiety, and/or personality disorders were enrolled in an effectiveness study of long-term dynamic psychotherapy of whom 49 gave some follow-up data. Follow-up interviews over a median of 5 years systematically rated 16 measures of Axis I disorders, symptoms, and functioning. Linear models estimated the rate and amount of improvement and time to recovery for each subject initially not well on each measure. The proportion recovering on each measure varied from 0% to 66.7% with self-destructive symptoms and working half-time leading, followed by self-reported measures of distress and defensive functioning, working full-time and satisfaction, then by observer-rated depression and anxiety, attaining a global assessment of functioning of 61, Axis I disorders, and social role functioning. Participants recovering on satisfaction had higher net proportions of other measures attaining recovery (46.9% versus 2.5%, p < 0.0001) compared with those not satisfied. Sustained recovery unfolds sequentially across a variety of symptoms and functioning measures and is associated with patient satisfaction.