In October 2023, the Anna Freud Centre, a mental health charity and research organisation based in London, United Kingdom, was commissioned by the Royal Australian and New Zealand College of Psychiatrists (RANZCP) to conduct a comprehensive review of the evidence for long-term psychodynamic psychotherapy (LTPP) in treating mood disorders. In recognising the limitations of quantitative evidence when taken on its own, the need for a mixed-methods research paradigm that elevated the value of lived experience perspectives was identified. Furthermore, qualitative components of this review benefitted from being co-produced with a lived experience specialist. The review included:

1. A meta-analysis of published randomised controlled trials (RCTs).
2. A meta-synthesis of qualitative studies.
3. A co-produced primary interview study exploring the experiences of consumers, providers, and carers of LTPP in Australia and New Zealand/Aotearoa.

The results were consolidated into a report submitted to the RANZCP on 11 October 2024. 

The key findings outlined below underscore the potential of LTPP as an effective and meaningful treatment for depression with effectiveness on parity with other specialist treatments. While the results are promising, they have not yet undergone peer review. Further research is needed to strengthen the evidence base and ensure the reliability of these results. 

To uphold the scientific integrity of the findings, efforts are underway to publish these studies in high-quality, peer-reviewed journals.

Key Findings

Meta-Analytic Findings

• Effectiveness: LTPP demonstrated very large within-group effect sizes in reducing depression symptoms and improving other symptom domains.
• Comparative Outcomes: Between-group comparisons showed LTPP to be non-inferior to other active specialist treatments, including time-limited psychotherapies, for depressive symptoms.
• Evidence Quality: A respectable evidence base supports the use of LTPP. However, further high-quality, allegiance-controlled RCTs are needed to refine and confirm these effects.

Qualitative Findings from meta-synthesis and co-produced primary interview study

• Perceived Benefits: Across published literature and the interview study, participants consistently described LTPP as helpful, meaningful, and sometimes life-saving.
• Therapeutic Process: Participants highlighted the demanding and non-linear nature of LTPP. Challenges in therapy were often seen as significant, transformative moments and central mechanisms of change.
• Long-Term Nature: A recurring theme was the importance of the “long-term” aspect of LTPP, defined as exceeding 12 months. Participants frequently emphasized that the meaningful changes they experienced were not achievable within shorter timeframes. Many contrasted these outcomes with their prior experiences of pharmacotherapy or time-limited psychotherapy, noting that LTPP offered a unique opportunity for profound transformation.

For more information, please see the Mood disorders hub. The full report can be accessed by members here.