Effectiveness of short-term psychodynamic group therapy in a public outpatient psychotherapy unit

Abstract

Background: Short-term psychodynamic group therapy in heterogeneous patient groups is common in the public Danish psychiatric system but is in need of evaluation.

Aim: To investigate improvement in 39-session psychodynamic group therapy using three criteria: 1) effect size (Cohen's d), 2) statistically reliable improvement, and 3) clinical significant change (CSC).

Methods: Pre-post treatment naturalistic design based on 236 outpatients with diagnoses of mood (9.7%), neurotic (50.8%), and personality disorders (39.4%). Symptom change was evaluated on the SCL-90-R Global Severity Index (GSI) and subscales. Analyses were conducted on the total sample and after exclusion of 32 GSI pre-treatment no-cases.

Results: The total sample GSI effect size was 0.74 indicating a moderate to large effect size (ranging from 0.67 in depressed to 0.74 in neurotic and personality disorder patients), which increased to 1.02 after exclusion of pre-treatment no-cases (ranging from 0.98 to 1.11 in depressed and personality disorder patients, respectively). However, in the GSI pre-treatment case sample, 43.1% were unchanged or deteriorated, 27% reliably improved and 29.9% obtained CSC status (ranging from 23.8% of the neurotic to 42.9% of the depressed patients).

Conclusion: Short-term psychodynamic group therapy is associated with medium to large or large effect sizes. However, even though many of the patients reliably improve, a substantial part of the patients are still, after therapy, within the pathological range compared with Danish norms.

Clinical implications: Patients referred to public outpatient treatment settings may need alternative or longer treatment than 39 sessions of psychodynamic group therapy over 3 months.