Expanding the Evidence Base for the Cost-Effectiveness of Long-Term Psychoanalytic Treatment

A survey in 1943 by Obendorf was oriented toward answering the multiple question “What type of treatment is best suited to what kind of patient, suffering from what kind of illness, at what point in life, when treated by what kind of analyst, in what manner?” (Galatzer-Levy et al. 2000, p. 53). In recent years, the question of the cost-effectiveness of psychoanalysis and psychoanalytic psychotherapy can be added to these concerns. Despite this long history of posing the right questions, research into the effectiveness of psychoanalytic treatment has been hampered by vexing methodological, technical, theoretical, and ethical 1313 problems, not to mention a diverse array of opposing viewpoints on scientific and empirical research itself (Gerber 2004). Nevertheless, we consider systematic empirical research relevant to the study of psychoanalysis. To overcome some of the daunting difficulties in this area, it is important to choose a theoretical framework, research instruments, and a research design adequate to addressing these questions. Our aim here is to explain the choice of theoretical framework, instruments, and design of a study into the effectiveness of psychoanalytic treatment for which data collection started in January 2005. The project is a collaboration of four mental health institutes and is intended to evaluate the health- and cost-effectiveness of ambulatory government-funded psychoanalytic psychotherapy and psychoanalysis in regular clinical practice in the Netherlands. This will be done by using a routine outcome monitoring system developed for monitoring change in long-term psychotherapeutic treatments. In addition, the project will evaluate the usefulness of the monitoring system for quality assurance purposes.

A theoretical framework accompanying research on the effectiveness of psychoanalytic treatment should provide hypotheses about areas in which patients might benefit from the treatment. Structural