Commentary on “Case Presentation: Long-Term Treatment,” by Myron L. Glucksman

The thoughtful research review by Leichsenring, Abbass, Luyten, Hilsenroth, and Rabung is followed in this issue of Psychodynamic Psychiatry by a case report of a successful long-term treatment. Leichsenring, Abbass, Luyten et al. point out that there is no universally accepted definition of long-term psychodynamic psychotherapy. A commonly accepted criterion is continuous psychotherapy for at least one year or 50 sessions, although other criteria have been used by some authors. The clinical discussion by Glucksman is a report of a treatment conducted over 14 years, not one year or 50 sessions. Although Glucksman's approach certainly qualifies as psychodynamic psychotherapy it also included interaction with his dog who served as a helpful co-therapist. This in itself directs attention to the variance that exists in clinical treatment situations as they occur naturalistically in the community.

The researchers observed that short-term psychotherapy may not be adequate treatment for patients with complex mental disorders including personality disorders. Specific aspects of what is meant by “complexity” as revealed in the life story of Dr. Glucksman's patient Margaret are painful to read.

When she began treatment Margaret was a 52-year-old divorced woman who had classical symptoms of severe depression and borderline personality disorder. It was not until two years of psychotherapy had been completed, however, that Margaret's history of sexual abuse emerged. This patient's father regularly forced her to participate in fellatio beginning at age 6. Although she revealed this to her paternal grandmother, the abuse continued and included sexual intercourse which occurred throughout her later childhood stopping only when her menstrual periods began. This patient was unable to seek protection from her mother because her father threatened to kill her if she revealed their sexual relationship. Childhood sexual abuse is far more common than is generally realized even by psychothera