Abstract
Despite evidence from randomized controlled trials of long-term psychodynamic psychotherapy's (LTPP's) efficacy in treating depression, qualitative research on patient perspectives remains limited. This study aims to provide a deeper understanding of patient experiences, including perceived therapeutic mechanisms, challenges, and benefits, in LTPP. A qualitative study using naturalistic, semistructured interviews was conducted with 12 adult patients (six male, six female) from Australia and New Zealand/Aotearoa. Participants had received an average of 7.8 years of LTPP. Interviews were analyzed using reflexive thematic analysis to identify core themes related to treatment access, engagement, therapeutic change, and outcomes. Six themes were developed (a) experiences with prior treatments, (b) initial challenges in engaging with LTPP, (c) the centrality of the therapeutic relationship, (d) gaining self-insight, (e) experiences of internal change, and (f) the emotional and financial costs of long-term therapy. Participants described LTPP as a challenging yet transformative treatment, facilitating affect regulation, self-compassion, and improved interpersonal functioning. Participants attributed benefits to their LTPP treatments and emphasized the importance of a stable therapeutic relationship and insight in subjective improvement. However, they also described the process as emotionally painful and resource intensive. These findings indicate that patient experiences of LTPP are broadly consistent with psychodynamic theories of change and underscore the importance of integrating patient perspectives into psychotherapy research and policy.