The place for psychodynamic therapy and obstacles to its provision

Author/s Susan G. Lazar
Publishing Year 2021 Issue 2021/4
Language Italian Pages 18 P. 605-622 File size 366 KB
DOI 10.3280/PU2021-004004
DOI is like a bar code for intellectual property: to have more infomation click here

Below, you can see the article first page

If you want to buy this article in PDF format, you can do it, following the instructions to buy download credits

Article preview

FrancoAngeli is member of Publishers International Linking Association, Inc (PILA), a not-for-profit association which run the CrossRef service enabling links to and from online scholarly content.

Psychodynamic therapy has been shown to provide specific benefits for patients with personality disorders, chronic depressive and anxiety disorders, and chronic complex disorders. The intensity (i.e., weekly frequency) and duration of psychodynamic therapy have independent positive ef-fects. Obstacles to the provision of psychodynamic therapy include a bias privileging brief treat-ments, especially cognitive-behavior therapy (CBT), seen as a gold standard of treatment despite difficulties with the design and validity of its supporting research and the ability to generalize from it. There are also difficulties with the diagnostic methods of the illnesses studied. Another obstacle to the provision of psychodynamic therapy lies in insurance company protocols, for ex-ample in the United States, that violate the Mental Health Parity Act and focus on conserving in-surers’ costs rather than the provision of optimum treatment to patients.

Keywords: Psychody-namic therapy; Personality disorders; Chronic depressive and anxiety disorders; Chronic complex disorders; Evidence-based psychotherapy

  1. AMA (American Medical Association) (2011). Statement to the Institute of Medicine’s Committee on Determination of Essential Health Benefits, January 14, 2011.
  2. American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Washington, D.C.: APA. DSM-IV-TR: 2000 (trad. it. basata sulla “Versione internazionale con i codici dell’ICD-10” del 1995: DSM-IV. Manuale diagnostico e statistico dei disturbi mentali, 4a edizione. Milano: Masson, 1995).
  3. American Psychiatric Association (2015). Position statement on medical necessity definition.
  4. Barlow D.H., Ellard K.K., Sauer-Zavala S., Bullis J.R. & Carlet J.R. (2014). The origins of neuroticism. Perspectives on Psychological Science, 9, 5: 481-496. DOI: 10.1177/1745691614544528
  5. Bateman A.W. & Fonagy P. (1999). Effectiveness of partial hospitalization in the treatment of borderline personality disorder: A randomized controlled trial. American Journal of Psychiatry, 156, 10: 1563-1569.
  6. Bateman A.W. & Fonagy P. (2003). Health service utilization costs for borderline personality disorder patients treated with psychoanalytically oriented partial hospitalization versus general psychiatric care. American Journal of Psychiatry, 160, 1: 169-171.
  7. Bateman A.W. & Fonagy P. (2008). 8-year follow-up of patients treated for borderline personality disorder: Mentalization-based treatment versus treatment as usual. American Journal of Psychiatry, 165, 5: 631-638.
  8. Bateman A.W. & Fonagy P. (2011). Handbook of Mentalizing in Mental Health Practice. Washington, D.C.: American Psychiatric Publishing.
  9. Bendat M. (2014). In name only? Mental health parity or illusory reform. Psychodynamic Psychiatry, 42, 3: 353-375.
  10. Berghout C.C., Zevalkink J. & Hakkaart-van Roijen L. (2010a). A cost-utility analysis of psychoanalysis versus psychoanalytic psychotherapy. International Journal of Technology Assessment in Health Care, 26, 1: 3-10. DOI: 10.1017/S0266462309990791
  11. Berghout C.C., Zevalkink J. & Hakkaart-Van Roijen L. (2010b). The effects of long-term psychoanalytic treatment on healthcare utilization and work impairment and their associated costs. Journal of Psychiatric Practice, 16, 4: 209-216.
  12. Beutel M.E., Rasting M., Stuhr U., Rüger B. & Leuzinger-Bohleber M. (2004). Assessing the impact of psychoanalyses and long-term psychoanalytic therapies on health care utilization and costs. Psychotherapy Research, 14, 2: 146-160.
  13. Blatt S.J. (1992). The differential effect of psychotherapy and psychoanalysis with anaclitic and introjective patients: The Menninger Psychotherapy-Research Project revisited. Journal of American Psychoanalytic Association, 40, 3: 691-724.
  14. Blatt S.J. (2006). Una polarità fondamentale in psicoanalisi: implicazioni per lo sviluppo della personalità, la psicopatologia e il processo terapeutico. Psicoterapia e Scienze Umane, 40, 4: 743-764.
  15. Blatt S.J, Quinlan D.M., Pilkonis P.A. & Shea M.T. (1995). Impact of perfectionism and need for approval on the brief treatment of depression: The National Institute of Mental Health Treatment of Depression Collaborative Research Program revisited. Journal of Consulting and Clinical Psychology, 63, 1: 125-132.
  16. Brown T.A., Chorpita B.F. & Barlow D.H. (1998). Structural relationships among dimensions of the DSM-IV anxiety and mood disorders and dimensions of negative affect, positive affect, and autonomic arousal. Journal of Abnormal Psychology, 107, 2: 179-192.
  17. Buchheim A., Viviani R., Kessler H., Kächele H., Cierpka M., Roth G., George C., Kernberg O.F., Bruns G. & Taubneret S. (2012). Changes in prefrontal-limbic function in major depression after 15 months of long-term psychotherapy. PLoS One, 7, 3:
  18. Casey P.R. & Tyrer P.J. (1986). Personality, functioning and symptomatology. Journal of Psychiatric Research, 20, 4: 363-374. DOI: 10.1016/0022-3956(86)90039-7.
  19. Clarkin J.F., Foelsch P.A., Levy K.N. & Kernberg O.F. (2001). The development of a psychodynamic treatment for patients with borderline personality disorder: A preliminary study of behavioral change. Journal of Personality Disorders, 15, 6: 487-95.
  20. Clarkin J., Levy K., Lenzenweger M. & Kernberg O.F. (2007). Evaluating three treatments for borderline personality disorder: A multiwave study. American Journal of Psychiatry, 164, 6: 922-928.
  21. Crown W.H., Finkelstein S., Berndt E.R., Ling D., Poret A.W., Rush A.J. & Russell J.-M. (2002). The impact of treatment-resistant depression on health care utilization and costs. Journal of Clinical Psychiatry, 63, 11: 963-971.
  22. Cuijpers P., Smit F., Bohlmeijer E., Hollon S.D. & Andersson G. (2010). Efficacy of cognitive-behavioural therapy and other psychological treatments for adult depression: Meta-analytic study of publication bias. British Journal of Psychiatry, 196, 3: 173-178.
  23. De Maat S., Philipszoon F., Schoevers R., Dekker J. & De Jonghe F. (2007). Costs and benefits of long-term psychoanalytic therapy: Changes in health care use and work impairment. Harvard Review of Psychiatry, 15, 6: 289-300. DOI: 10.1080/10673220701811654
  24. De Maat S., de Jonghe F., Schoevers R. & Dekker J. (2009). The effectiveness of long-term psychoanalytic therapy: A systematic review of empirical studies. Harvard Review of Psychiatry, 17, 1: 1-23. DOI: 10.1080/10673220902742476
  25. Deykin E.Y., Keane T.M., Kaloupek D., Fincke G., Rothendler J., Siegfried M. & Creamer K. (2001). Posttraumatic stress disorder and the use of health services. Psychosomatic Medicine, 63, 5: 835-841. DOI: 10.1097/00006842-200109000-00018
  26. Dossmann R., Kutter P., Heinzel R. & Wurmser L. (1997). The long-term benefits of intensive psychotherapy: A view from Germany. Psychoanalytic Inquiry, 17 (S1): 74-86. DOI: 10.1080/07351699709534159
  27. Driessen E., Van H.L., Don F.J., Peen J., Kool S., Westra D., Hendriksen M., Schoevers R.A., Cuijpers P., Twisk J.W. & Dekker J.J. (2013). The efficacy of cognitive-behavioral therapy and psychodynamic therapy in the outpatient treatment of major depression: A randomized clinical trial. American Journal of Psychiatry, 170, 9: 1041-1050.
  28. Druss B.G. (2017). Cost sharing and mental health care: A cautionary tale from the Netherlands. JAMA Psychiatry, 74, 9: 940-941.
  29. Düehrssen A. (1962). Katamnestische Ergebnisse bei 1004 Patienten nach analytischer Psychotherapie. Zeitschrift für psychosomatische Medizin, 8: 94-113.
  30. Fava G.A., Ruini C. & Belaise C. (2007). The concept of recovery in major depression. Psychological Medicine, 37, 3: 307-317. DOI: 10.1017/S0033291706008981
  31. Field M.J. & Lohr K.N., editors (1990). Clinical Practice Guidelines: Directions for a New Program. Washington, D.C.: National Academies Press.
  32. Fonagy P., editor (1999). An Open Door Review of Outcome Studies in Psychoanalysis. London: International Psychoanalytic Association (Second Edition: 2001).
  33. Gabbard G.O. (2000). Psychotherapy of personality disorders. Journal of Psychotherapy Practice and Research, 9, 1: 1-6 -- (
  34. Grande T., Dilg R., Jakobsen T., Keller W., Krawietz B., Langer M., Oberbracht C., Stehle S., Stennes M. & Rudolf G. (2006). Differential effects of two forms of psychoanalytic therapy: results of the Heidelberg-Berlin study. Psychotherapy Research, 16, 4: 470-485. DOI: 10.1080/10503300600608082
  35. Grilo C.M., Stout R.L., Markowitz J.C., Sanislow C.A., Ansell E.B., Skodol A.E., Bender D.S., Pinto A., Shea M.T., Yen S., Gunderson J.G., Morey L.C., Hopwood C.J. & McGlashan T.H. (2010). An episode of major depressive disorder: A 6-year prospective study. Journal of Clinical Psychiatry, 71, 12: 1629-1635.
  36. Halaris A. (2011). A primary care focus on the diagnosis and treatment of major depressive disorder in adults. Journal of Psychiatric Practice, 17, 5: 340-350.
  37. Hall J., Caleo S., Stevenson J. & Meares R. (2001). An economic analysis of psychotherapy for borderline personality disorder patients. J. Mental Health Policy and Economics, 4, 1: 3-8.
  38. Heinzel R., Breyer F. & Klein T. (1996). Ambulante Psychoanalyse in Deutschland: Eine katamnestische Evaluation Studie (No. 281), Diskussionsbeiträge: Serie 1. Baden-Wurtemmberg, D: Fakultät für Wirtschaftswissenschaften und Statistik, Universität Konstanz.
  39. Høglend P. (1993). Personality disorders and long-term outcome after brief dynamic psychotherapy. Journal of Personality Disorders, 7, 2: 168-181.
  40. Holt-Lunstad J., Smith T.B. & Layton J.B. (2010). Social relationships and mortality risk: A meta-analytic review. PLoS Medicine, 7: e1000316.
  41. Howard K.I., Kopta S.M., Krause M.S. & Orlinsky D.E. (1986). The dose-effect relationship in psychotherapy. American Psychologist, 41, 2: 159-164. DOI: 10.1037/0003-066X.41.2.159
  42. Huber D., Zimmermann J., Henrich G. & Klug G. (2012). Comparison of cognitive-behaviour therapy with psychoanalytic and psychodynamic therapy for depressed patients: A three-year follow-up study. Zeitschrift für Psychosomatische Medizin und Psychotherapie, 58, 3: 299-316.
  43. Katon W. & Sullivan M.D. (1990). Depression and chronic medical illness. Journal of Clinical Psychiatry, 51 (Suppl.): 3-11.
  44. Keller W., Westhoff G., Dilg R., Rohner R. & Studt H.H. (1998). Efficacy and cost effectiveness aspects of outpatient (Jungian) psychoanalysis and psychotherapy. A catamnestic study. In: Leuzinger-Bohleber M. & Target M., editors, Outcomes of Psychoanalytic Treatment: Perspectives for Therapists and Researchers. London: Whurr, 1998, pp. 186-200.
  45. Kessler R.C., Berglund P., Demler O., Jin R., Koretz D., Merikangas K.R., Rush A.J., Walters E.E. & Wang P.S. (2003). The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). Journal of the American Medical Association (JAMA), 289, 23: 3095-3105.
  46. Kessler R.C., Berglund P., Demler O., Jin R., Merikangas K.R. & Walters E.E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch. Gen. Psychiatry, 62, 6: 593-602.
  47. Kessler S. (2014). Mental health parity: The patient protection and affordable care act and the parity definition implications. Hastings Science & Technology Law Journal, 6, 2: 145-166.
  48. Knoepflmacher D. (2016). Psychiatry and psychotherapy, “medical necessity” in psychiatry: Whose definition is it anyway? Psychiatric News, Sept. 4, 2016: --
  49. Kopta S.M., Howard K.I., Lowry J.L. & Beutler L.E. (1994). Patterns of symptomatic recovery in psychotherapy. Journal of Consulting and Clinical Psychology, 62, 5: 1009-1016.
  50. Krueger R.F. (1999). The structure of common mental disorders. Archives of General Psychiatry, 56, 10: 921-926.
  51. Krueger R.F., McGue M. & Iacono W.G. (2001). The higher-order structure of common DSM mental disorders: Internalization, externalization, and their connections to personality. Personality & Individual Differences, 30, 7: 1245-1259. DOI: 10.1016/S0191-8869(00)00106-9
  52. Landerman L., Burns B., Swartz M., Wagner H.R. & George L.K. (1994). The relationship between insurance coverage and psychiatric disorder in predicting use of mental health services. American Journal of Psychiatry, 151, 12: 1785-1790.
  53. Lazar S.G., editor (2010). Psychotherapy is Worth It: A Comprehensive Review of Its Cost Effectiveness. Washington, D.C.: American Psychiatric Publishing.
  54. Leichsenring F. & Rabung S. (2008). Effectiveness of long-term psychodynamic psychotherapy: A meta-analysis. Journal of the American Medical Association (JAMA), 300, 13: 1551-1565.
  55. Leichsenring F. & Rabung S. (2011). Long-term psychodynamic psychotherapy in complex mental disorders: Update of a meta-analysis. British Journal of Psychiatry, 199, 1: 15-22.
  56. Leichsenring F. & Steinert C. (2017a). Is cognitive behavioral therapy the gold standard for psychotherapy? The need for plurality in treatment and research. Journal of the American Medical Association (JAMA), 318, 14: 1323-1324.
  57. Leichsenring F. & Steinert C. (2017b). La terapia cognitivo-comportamentale è veramente la più efficace? Psicoterapia e Scienze Umane, 51, 4: 551-558.
  58. Lenzenweger M.F. (2008). Epidemiology of personality disorders. Psychiatric Clinics of North America, 31, 3: 395-403.
  59. Levy K.N., Meehan K.B., Kelly K.M., Reynoso J.S., Weber M., Clarkin J.F. & Kernberg O.F. (2006). Change in attachment patterns and reflective function in a randomized control trial of transference-focused psychotherapy for borderline personality disorder. Journal of Consulting and Clinical Psychology, 74, 6: 1027-1040. DOI: 10.1037/0022-006X.74.6.1027
  60. Levy K.N., Meehan K.B. & Yeomans F.E. (2010). Transference-focused psychotherapy reduces treatment drop-out and suicide attempters compared with community psychotherapist treatment in borderline personality disorder. Evidence Based Mental Health, 13, 4: 119.
  61. Levy K.N., Ehrenthal J.C., Yeomans F.E. & Caligor E. (2014). Efficacy of psychotherapy: Psychodynamic psychotherapy as an example. Psychodynamic Psychiatry, 42, 3: 377-422.
  62. Linehan M.M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder; Skills Training Manual for Treating Borderline Personality Disorder New York: Guilford (trad. it. dei due libri: Trattamento cognitivo-comportamentale del disturbo borderline. Milano: Raffaello Cortina, 2001).
  63. Linehan M.M. & Heard H.I. (1999). Borderline personality disorder: Costs, course, and treatment outcomes. In: Miller & Magruder, 1999, pp. 291-305.
  64. Lingiardi V. & McWilliams N., editors (2017). Psychodynamic Diagnostic Manual, Second Edition: PDM-2. New York: Guilford (trad. it.: Manuale diagnostico psicodinamico. Seconda Edizione: PDM-2. Milano: Raffaello Cortina, 2018). Prima edizione (PDM-1): 2006.
  65. Luber M.P., Hollenberg J.P., Williams-Russo P., Di Domenico T.N., Meyers B.S., Alexopoulos G.S. & Charlson M.E. (2000). Diagnosis, treatment, comorbidity, and resource utilization of depressed patients in a general medical practice. International Journal of Psychiatry in Medicine, 30, 1: 1-14. DOI: 10.2190/YTRY-E86M-G1VC-LC79
  66. Maier W., Lichtermann D., Klingler T., Heun R. & Hallmayer J. (1992). Prevalences of personality disorders (DSM-III-R) in the community. Journal of Personality Disorders, 6, 3: 187-196.
  67. Manning W.G.Jr, Wells K.B., Duan N., Newhouse J.P. & Ware J.E.Jr. (1986). How cost sharing affects the use of ambulatory mental health services. Journal of the American Medical Association (JAMA), 256, 14: 1930-1934.
  68. Markowitz J.C., Skodol A.E., Petkova E., Cheng J., Sanislow C.A., Grilo K.M., Gunderson J.G. & McGlashan T.H. (2007). Longitudinal effects of personality disorders on psychosocial functioning of patients with major depressive disorder. Journal of Clinical Psychiatry, 68, 2: 186-193.
  69. McHugh R.K., Whitton S.W., Peckham A.D., Welge J.A. & Ottoet M.W. (2013). Patient preference for psychological vs pharmacologic treatment of psychiatric disorders: A meta-analytic review. Journal of Clinical Psychiatry, 74, 6: 595-602. DOI: 10.4088/JCP.12r07757.
  70. Mee-Lee D., Shulman G.D., Fishman M.J., Gastfriend D.R. & Miller M.M., editors (2013). The ASAM Criteria: Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions. 3rd Edition. Carson City, NV: The Change Companies.
  71. Melek S. & Norris D. (2008). Chronic Conditions and Comorbid Psychological Disorders. Seattle, WA: Milliman.
  72. Merrick E.L., Horgan C.M., Garnick D.W., Reif S. & Stewart M.T. (2009). Accessing specialty behavioral health treatment in private health plans. Journal of Behavioral Health Services & Research, 6, 4: 420-435.
  73. Migone P., a cura di (2021). La terapia psicodinamica è efficace? Il dibattito e le evidenze empiriche. Milano: FrancoAngeli.
  74. Miller N.E. & Magruder K.M., editors (1999). Cost Effectiveness of Psychotherapy. A Guide for Practitioners, Researchers and Policymakers. New York: Oxford University Press.
  75. NICE (National Institute for Health and Care Excellence) (2009). Borderline Personality Disorder: Treatment and Management. London: Department of Health.
  76. Pilkonis P.A., Neighbors B.D. & Corbitt E.M. (1999). Personality disorders: Treatments and costs. In: Miller & Magruder, 1999, pp. 279-290.
  77. Ravesteijn B., Schachar E.B., Beekman A.T.F., Janssen R.T.J.M. & Jeurissen P.T.P (2017). Association of cost sharing with mental health care use, involuntary commitment, and acute care. JAMA Psychiatry, 74, 9: 1-9.
  78. Reich J., Yates W. & Nduaguba M. (1989). Prevalence of DSM-III personality disorders in the community. Social Psychiatry and Psychiatric Epidemiology, 24, 1: 12-16. DOI: 10.1007/BF01788194
  79. Rosenbaum S., Kamoie B., Mauery D.R. & Valitt B. (2003). Medical Necessity in Private Health Plans: Implications for Behavioral Health Care. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration.
  80. Rudolf G., Manz R. & Ori C. (1994). Ergebnisse psychoanalytischer Therapie. Zeitschrift für Psychosomatische Medizin und Psychotherapie, 40: 25-40.
  81. SAMHSA (Substance Abuse and Mental Health Services Administration) (2003). Medical Necessity in Private Health Plans Implications for Behavioral Health Care. Rockville (MD): Substance Abuse and Mental Health Services Administration.
  82. Sandell R., Blomberg J., Lazar A., Carlsson J., Broberg J. & Schubert J. (2000). Varieties of long-term outcome among patients in psychoanalysis and long-term psychotherapy: A review of findings in the Stockholm Outcome of Psychoanalysis and Psychotherapy Project (STOPPP). International Journal of Psychoanalysis, 81: 921-942. DOI: 10.1516/0020757001600291
  83. Seligman M.E.P. (1995). The effectiveness of psychotherapy: The Consumer Reports Study. American Psychologist, 50, 12: 965-974.
  84. Shedler J. (2010). The efficacy of psychodynamic therapy. American Psychologist, 65, 2: 98-109.
  85. Shedler J. (2018). Where is the evidence for “evidence-based” therapy? Psychiatric Clinics of North America, 41, 2: 319-329.
  86. Simon G., Grothaus L., Durham M., VonKorff M. & Pabiniak C. (1996). Impact of visit copayments on outpatient mental health utilization by members of a health maintenance organization. American Journal of Psychiatry, 153: 331-338.
  87. Skodol A.E., Grilo C.M., Pagano M.E., Bender D.S., Gunderson J.G., Shea M-T., Yen S., Zanarini M.C. & McGlashan T.H. (2005a). Effects of personality disorders on functioning and well-being in major depressive disorder. Journal of Psychiatric Practice, 11, 6: 363-368. DOI: 10.1097/00131746-200511000-00002
  88. Skodol A.E., Gunderson J.G., Shea M.T., McGlashan T.H., Morey L.C., Sanislow C.A., Bender D.S., Grilo C.M., Zanarini M.C., Yen S., Pagano M-E. & Stout R.L. (2005b). The Collaborative Longitudinal Personality Disorders Study (CLPS): Overview and implications. Journal of Personality Disorders, 19, 5: 487-504.
  89. Skodol A.E., Grilo C.M., Keyes K.M., Geier T., Grant B.F. & Hasin D.S. (2011). Relationship of personality disorders to the course of major depressive disorder in a nationally representative sample. American J. Psychiatry, 168, 3: 257-264.
  90. Steinert C., Munder T., Rabung S., Hoyer J. & Leichsenring F. (2017). Psychodynamic therapy: As efficacious as other empirically supported treatments? A meta-analysis testing equivalence of outcomes. American Journal of Psychiatry, 174, 10: 943-953.
  91. US Department of Labor (2016). Employee Tenure in 2016. Washington, D.C.: US Department of Labor Statistics.
  92. van Asselt A.D., Dirksen C.D., Arntz A., Giesen-Bloo J.H., van Dyck R., Spinhoven P., van Tilburg W., Kremers I.P., Nadort M. & Severens J.L. (2008). Out-patient psychotherapy for borderline personality disorder: Cost-effectiveness of schema-focused therapy vs. transference-focused psychotherapy. British Journal of Psychiatry, 192, 6: 450-457.
  93. van den Bosch L., Verheul R., Schippers G.M. & van den Brink W. (2002). Dialectical behavior therapy of borderline patients with and without substance use problems: Implementation and long-term effects. Addictive Behav., 27, 6: 911-923.
  94. Wampold B.E., Budge S.L., Laska K.M., Del Re A.C., Baardseth T.P., Fluckiger C., Minami T., Kivlighan D.M.2nd & Gunn W. (2011). Evidence-based treatments for depression and anxiety versus treatment-as-usual: A meta-analysis of direct comparisons. Clinical Psychology Review, 31: 1304-1312.
  95. Wang P.S., Berglund P., Olfson M., Pincus H.A., Wells K.B. & Kessler R.C. (2005a). Failure and delay in initial treatment contact after first onset of mental disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 6: 603-613.
  96. Wang P.S., Lane M., Olfson M., Pincus H.A., Wells K.B. & Kessler R.C. (2005b). Twelve-month use of mental health services in the United States: Results from the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 6: 629-640.
  97. Watson D. & Clark L.A. (1984). Negative affectivity: The disposition to experience aversive emotional states. Psychological Bulletin, 96, 3: 465-490.
  98. Westen D., Morrison Novotny C. & Thompson-Brenner H. (2004). The empirical status of empirically supported psychotherapies: Assumptions, findings, and reporting in controlled clinical trials. Psychological Bulletin, 130, 4: 631-663.
  99. WHO (World Health Organization) (2008). The Global Burden of Disease. Geneva, CH: World Health Organization.
  100. Wickizer T.M. & Lessler D. (2002). Utilization management: Issues, effects, and future prospects. Annual Review of Public Health, 23: 233-254.
  101. Zimmerman M. & Coryell W.H. (1990). Diagnosing personality disorders in the community: a comparison of self-report and interview measures. Archives of General Psychiatry, 47, 6: 527-531.

Susan G. Lazar, Il ruolo della terapia psicodinamica e gli ostacoli alla sua diffusione in "PSICOTERAPIA E SCIENZE UMANE" 4/2021, pp 605-622, DOI: 10.3280/PU2021-004004