Psychodynamic psychotherapy improved functioning in schizophrenia over three years

Design

Single-centre, assessor-blinded, parallel-group randomised trial

Population

130 outpatients aged 18-64 with schizophrenia or schizoaffective disorder

Primary outcome

Psychosocial functioning (Mini-ICF-APP) at 24 and 36 months

Effect

Adjusted difference -3.45 (-5.51 to -1.40) at 24 months; -4.07 (-6.19 to -1.94) at 36 months

A single-centre randomised trial in Berlin (Lancet Psychiatry, 1 October 2026) assigned 130 outpatients aged 18-64 with schizophrenia or schizoaffective disorder to a manualised modified psychodynamic psychotherapy (at least 30 sessions) plus usual care, or usual care alone. Outcome assessors were masked; patients and therapists were not.

On the primary outcome, psychosocial functioning on the Mini-ICF-APP scale, the therapy group did better at 24 months (adjusted difference -3.45, 95% CI -5.51 to -1.40) and at 36 months (-4.07, -6.19 to -1.94), where lower scores mean less limitation. Adverse events were similar. Two participants died by suicide, one in each arm; the one in the therapy arm had not started therapy.

The finding matters because psychodynamic approaches are widely used for psychosis with little trial support, and interpersonal difficulty is a part of the illness that medication rarely touches. This is one centre, one manual and an unblinded intervention, so it needs replication before it competes with the better-established options such as cognitive behavioural therapy for psychosis and family intervention.

In practice, this gives some evidence for referral where a stable patient's main problem is relationships and functioning, and a psychodynamically trained therapist with psychosis experience is available.

• Assess interpersonal functioning, not just positive symptoms, at review in stable schizophrenia
• Consider structured psychodynamic therapy where relationships are the main barrier and skilled therapists exist
• Keep CBT for psychosis and family intervention as the first psychological options
• Expect benefit over long courses - the trial gave at least 30 sessions over two years

Why it matters

Interpersonal functioning is where many stable patients stay stuck, and this is randomised evidence for a therapy aimed directly at it.

Don't overread it

One centre, unblinded therapists and patients - this does not yet place it alongside CBT for psychosis in guidelines.

The statistics, in plain English

The between-group differences have confidence intervals that stay clear of zero at both time points, so the effect is unlikely to be chance. Whether a 3-4 point Mini-ICF-APP difference is clinically meaningful depends on the scale's range, which the abstract does not set out, so judge it as a modest functional gain.

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