Out-patient psychodynamic psychotherapy services: an analysis of patient discharge data

To investigate the functioning of a specialist out-patient Psychodynamic Psychotherapy Service by studying demographic characteristics of patient referrals and referral sources. To investigate the effect of number of treatment sessions on outcome; and to discuss the results in the light of some prevailing stereotypes about psychotherapeutic treatment.

Analysis of discharge data on a cohort of patients discharged from a psychotherapy clinic.

An out-patient psychotherapy clinic serving the West Sector of the City of Glasgow.

All patients discharged between mid 1993 and 1998.

The clinic served all General Practices within eight postal code areas in West Glasgow (catchment population 260,000). Over a five year period 1648 patients were discharged from the clinic; 68% of referrals were from General Practitioners, 18% from Psychiatrists and the remainder from Clinical Psychologists, Consultant Physicians and Surgeons. A wide range of diagnostic conditions were encountered with personality disorder being diagnosed in more than one-third of patients seen. Successful outcome, assessed by patients' subjective ratings on a four point scale at termination of treatment, showed a 50% improvement rate achieved between 7-12 treatment sessions in the Non Personality Disorder group, and between 12-20 treatment sessions in the Personality Disorder group. In total the proportion of not improved and improved ratings was 61% and 39% respectively. Four hundred (73%) of the not improved group received, five sessions or less.

The results indicated that the Psychotherapy Service treated a large number of patients, many from middle to high areas of deprivation, and that improvement could be effected over relatively short time periods. The data did not conform to existing stereotypes such as psychotherapy being confined to the treatment of "worried well", affluent groups. It took twice as many sessions to achieve a 50% improvement rate in patients with a diagnosis of personality disorder compared with patients without such a diagnosis.