Is There Specific Evidence to Support Using Psychodynamic Treatment in a Residential Setting Like Austen Riggs?
While most of the studies described in this section utilize subjects from outpatient settings, there are also outcome studies of psychoanalytic hospital-based treatment that have found lasting benefits in both general symptom improvement and interpersonal functioning (Bateman and Fonagy 1999); (Bateman and Fonagy 2001); (Vermote et al. 2009); (Vermote et al. 2010).
Evidence Supporting Psychodynamic Treatment in a Residential Setting
Studies by Chisea and Fonagy (2003); (2004) that were carried out in a setting similar to the Austen Riggs Center demonstrate that approximately six months of psychoanalytically informed residential treatment, followed by planned step-down programs, led to significant long-term clinical improvements. Leichsenring and Rabung (2008) published evidence that patients with complex psychiatric conditions responded well to long-term psychodynamic psychotherapy. They found in their meta-analysis of 23 studies and more than 1,000 patients that the average patient with a complex psychiatric condition who received long-term psychodynamic psychotherapy was better off than almost all of those receiving shorter-term treatments.
The Follow-Along Study, a 15-year, longitudinal, naturalistic study conducted at the Austen Riggs Center, tracked the treatment of nearly 200 seriously suicidal patients with complex psychiatric conditions (Perry et al. 2009). This study showed that 75% of patients no longer suffered from suicide as an issue in their lives at a seven-year follow up. A more recent study, using data from the Follow-Along Study, examined the global treatment outcomes during 16 months of treatment at the Austen Riggs Center (Fowler et al. 2008). Findings showed medium-to-large effect size changes for behavioral functioning, and small-to-medium effect size changes in more enduring personality functioning. These findings provide a clear evidence base for the specific type of treatment that patients receive at the Austen Riggs Center.
More recently, a five-year follow-up from a psychodynamically oriented hospitalization-based treatment (Lowyck 2014), conducted in a setting much like the Austen Riggs Center, found sustained gains in general symptom reduction (e.g., depressive symptoms). These same patients also showed marked and enduring improvement in personality dysfunction, interpersonal relationships, and global functioning five years after formal treatment had ended. Furthermore, this study reported significant long-term reductions in frequency of re-hospitalization and suicide attempts, and marked improvement in occupational functioning.