Long-term outcomes of psychodynamic residential treatment for severely disturbed young adults: a naturalistic study at a Swedish therapeutic community.
OBJECTIVE
This study examined the long-term effectiveness of a treatment model at a Swedish therapeutic community for young adults with severe personality disorders, combining milieu therapy and inpatient long-term psychodynamic psychotherapy.


METHODS
Data were collected for the 56 residents between 1994 and 2008 at intake, termination and 2-year follow-up. Patient residency ranged from 2 to 60 months, with average psychotherapy duration of 30 months. Self-rated outcome was measured using the Symptom Checklist-90-R. Expert-rated outcomes comprised the Global Assessment of Functioning, the Strauss-Carpenter Outcome Scale and the Integration/Sealing-over Scale. A series of mixed-model analyses of variance with one fixed factor (time) was performed to examine the outcomes for the total sample of completers. Effect sizes for within-group change and percentages of improved, unchanged and deteriorated patients were calculated for patients participating in the data collection on all three time points.


RESULTS
All outcome measures showed significant improvement on a group level from intake to discharge. Most patients had maintained the therapeutic gains at the 2-year follow-up. The effect sizes were high and the Reliable Change Index provided evidence of good outcome for 92% of the patients at follow-up. The expert ratings gave somewhat larger effect sizes than the patients' self-ratings.


CONCLUSIONS
The effect sizes and success rates are at a comparable level with corresponding studies of long-term treatments of personality disorders. Most patients had a substantial individual improvement from intake to termination and follow-up. This indicates the effectiveness of this highly specialized and intensive treatment approach for severely disturbed young adult patients.
Department of Psychology, Stockholm University, and Child and Adolescent Psychiatry, Stockholm County Council, Sweden.
Andrzej
A
Werbart
David
D
Forsström
Madeleine
M
Jeanneau
D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010554:Personality Disorders / Q000175:diagnosis / Q000628:therapy*; D011613:Psychotherapy / Q000379:methods*; D012114:Residential Treatment; D012720:Severity of Illness Index; D013548:Sweden; D013808:Therapeutic Community; D016896:Treatment Outcome; D055815:Young Adult