title: The prediction of the level of personality organization on reduction of psychiatric symptoms and improvement of work ability in short- versus long-term psychotherapies during a 5-year follow-up.
abstract: How level of personality organization (LPO) predicts psychiatric symptoms and work ability in short- versus long-term psychotherapies is poorly known. We investigated the importance of the LPO on the benefits of short-term versus long-term psychotherapies.
  
  
  
  A cohort study based on 326 outpatients with mood or anxiety disorder was allocated to long-term (LPP) and short-term (SPP) psychodynamic psychotherapy, and solution-focused therapy (SFT).
  
  
  
  The LPO was assessed by interview at baseline and categorized into neuroses and higher level borderline. Outcome was assessed at baseline and 4-9 times during a 5-year follow-up, using self-report and interview-based measures of symptoms and work ability.
  
  
  
  For patients receiving SPP, improvement in work ability, symptom reduction, and the remission rate were more considerable in patients with neuroses than in higher level borderline patients, whereas LPP or SFT showed no notable differences in effectiveness in the two LPO groups. In patients with neuroses, improvement was more considerable in the short-term therapy groups during the first year of follow-up, and in higher level borderline patients LPP was more effective after 3 years of follow-up. The remission rate, defined as both symptom reduction and lack of auxiliary treatment, was higher in LPP than in SPP for both the LPO groups considered.
  
  
  
  In neuroses, short-term psychotherapy was associated with a more rapid reduction of symptoms and increase in work ability, whereas LPP was more effective for longer follow-ups in both LPO groups. Further large-scale studies are needed.
  
  
  
  Level of personality organization is relevant for selection between short- and long-term psychotherapies. Short-term therapy gives faster benefits for neurotic patients but not for patients with higher level borderline personality organization. Sustained remission from symptoms is more probable after long-term than short-term therapy.
authors.affiliation: National Institute for Health and Welfare, Helsinki, Finland.|Biomedicum Helsinki, Finland.
authors.forename: Paul
authors.identifier: 0000-0002-2648-1338
authors.initials: P
authors.lastname: Knekt
authors.affiliation: National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Olavi
authors.initials: O
authors.lastname: Lindfors
authors.affiliation: Finnish Student Health Service, Turku, Finland.
authors.forename: Matti
authors.initials: M
authors.lastname: Keinänen
authors.affiliation: National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Erkki
authors.initials: E
authors.lastname: Heinonen
authors.affiliation: National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Esa
authors.initials: E
authors.lastname: Virtala
authors.affiliation: National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Tommi
authors.initials: T
authors.lastname: Härkänen
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000534:rehabilitation / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D019964:Mood Disorders / Q000534:rehabilitation / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care; D011614:Psychotherapy, Brief / Q000379:methods*; D064889:Psychotherapy, Psychodynamic / Q000379:methods*; D014937:Work / Q000502:physiology*; D055815:Young Adult
keywords: long-term; personality organization; prediction; psychotherapy; short-term