Treatment manuals for long-term psychodynamic psychotherapy and psychoanalysis

An essential component of any clinical trial is the need to deliver treatment in a fashion that is uniform and that can be replicated. The advent of treatment manuals in psychotherapy research has been an important step towards meeting the standard of uniform treatment. Defining long-term psychodynamic treatments as those lasting a year or longer, there are only three published manuals for long-term psychodynamic psychotherapy: supportive-expressive psychotherapy (SE), transference focused psychotherapy (TFP), and mentalization-based treatment (MBT). This article reviews and compares these treatment manuals across six dimensions: 1) frame of reference and conceptualization of disorder(s) treated, 2) mechanisms of change, 3) treatment frame and format, 4) therapist stance and therapeutic relationship, 5) specifics of clinical technique and 6) ratings of adherence and competence. Despite the disparate nature of the three manualized treatments, a number of core features are shared by SE, TFP and MBT. The successful manualization of the three long-term psychodynamic psychotherapies reviewed suggests that psychoanalytic treatments could also be manualized.