Psychotherapy lasting for at least one year is more effective than shorter periods of therapy for people with complex mental disorders, such as personality and chronic disorders, according to a study published today in the Journal of the American Medical Assn. The success of dedicated psychotherapy may matter little, however, because fewer doctors are offering the service and fewer insurers are covering it.

In long-term psychodynamic psychotherapy, the therapist provides continued, close support for the patient while the pair work through problems and interventions. The JAMA study, from researchers in Germany, was an examination of 23 studies on the success of psychotherapy. It found that longer-term therapy (one year or longer) was superior to shorter-term methods in regard to overall outcome and personality functioning. On average, patients with complex mental conditions who were treated long-term were better off than 96% of the patients in the comparison groups.

Psychotherapy, however, is a dying art. In an editorial accompanying the study, JAMA Deputy Editor Richard M. Glass, of the University of Chicago, noted that fewer patients these days have access to this kind of supportive therapy.

"It is ironic and disturbing that this occurs at a time when provision of psychotherapy by psychiatrists in the United States is declining significantly," he said. "The reasons for this merit careful evaluation. To some extent this may reflect the cost-efficacy of treatments for some mental disorders with medications and brief supportive visits. However, this trend appears to be strongly related to financial incentives and other pressures to minimize costs. Is this what is really wanted for patients with disabling disorders that could respond to more intensive treatment?"

In August, a study in the Archives of General Psychiatry found the number of psychotherapy visits nationwide declined from 44.4% in 1996-97 to 28.9% in 2004-05. That study found the number of psychiatrists who provide psychotherapy to all of their patients declined from 19.1% in 1996-97 to 10.8% in 2004-05. The authors of that study concluded that more doctors now are specializing in psychopharmacology -- medication for mental illnesses -- even though studies often show the best results can be achieved with a combination of psychotherapy and medication.

"Therapy provided by medically trained psychiatrists offers the maximum integration of mind and body to our patients," said Dr. Eric Plakun, chairman of the American Psychiatric Assn.'s Committee on Psychotherapy by Psychiatrists.

Recognizing the biological basis, and the often helpful addition of medication, for treating mental illness was a huge, positive step in medicine in the last half of the 20th century. But if that progress comes at the expense of psychotherapy, we'll be back where we started: treating just one aspect of the mind-body connection that is at the core of mental-health functioning.