All members of the German Society for Analytical Psychology, the umbrella organization of Jungian psychoanalysts (DGAP) were asked to participate in this retrospective study. 78% anwered our request, 24.6% participated.
On the basis of their notes, the participating therapists in private practice documented all their cases (including dropouts) finished in 1987 and 1988 with a basic questionnaire regarding clinical and socio-demographic data and setting characteristics at the onset of therapy and gave a retrospective global assessment of their patients' state at the end of therapy.
Based on the applications for payment of the former therapists, in a consensus rating a retrospective ICD-10 classification was carried out by two independent raters and additionally the severity of disease before treatment was assessed using the Schepank method of impairment severity index (BSS, 1987, 1994).
In 1994 111 former patients, who finished either psychoanalysis or long-term-psychotherapy in 1987 or 1988 and who agreed to take part could be included in the study sending back a complete follow-up questionnaire consisting different self-assessments of life satisfaction, well-being, social functioning, personality traits, interpersonal problems, self rated health care utilization and some psychometric tests (SCL-90R, VEV, Gießen-Test). In 33 cases (regional sample of Berlin) a follow-up interview was carried out and an actual health status was rated by two independent psychologists trained in psychoanalysis.
Additionally objective data on utilization of health care services were recorded from health insurance companies (number of work disability days and inpatient hospital days) 5 years before and after therapy. In this comparison only those cases were included with complete pre and post data. Thus, for this calculation the sample was reduced to 47 (work disability) respective 58 (hospital days). Both subgroups did not differ from the entire sample in socio-demographic data, pre treatment characteristics or criteria of treatment success.
The selection of the follow-up sample was controlled by comparing the included patients with the total of 358 therapist documented therapies finished in 1987 and 1988 with respect to central socio-demographic and clinical characteristics. The selection of therapists participating in the study was controlled by an independent survey of all DGAP members with respect to central therapist's and setting characteristics. There was no difference in both comparisons.
The effectiveness of Jungian psychoanalysis and psychotherapy was determined on the basis of 5 different perspectives and different success criteria. 76% of the patients examined had had psychoanalysis so that empirical proof of the effectiveness of long-term analyses could be demonstrated after an average of 6 years. Even after 5 years, the improvement in the patients' state of health and attitude toward the disease still resulted in a markedly constant reduction of health insurance claims (work disability days, hospitalization days, doctor's visits and drug intake) in a large number of the patients treated and thus in a reduction of costs. Cost effectiveness aspects increasingly play an important role as success criteria especially for health adminstrations. As we have demonstrated in this retrospective study, psychotherapy apparently also has a long-lasting effect on the patients' health care utilization. The complete recording of these data (in Germany) requires great care and a methodologically confirmed approach toward the interpretation of these data (Richter et al. 1994). However, when these prerequisites are provided, convincing arguments for the effectiveness of psychotherapy or psychoanalysis together with the clinical results can be found even for a retrospective design.