PPRNet Clinical summary: Is Psychotherapy Orientation Important for Work Disability Outcomes?

Depression and anxiety disorders cause most of the mental health-related disability worldwide. Nearly a third of workers with mental health problems are prescribed sick leave. Psychotherapy research has been criticized for being overly focused on symptom reduction and not paying enough attention to other important factors like quality of life, interpersonal issues, and work functioning. Most controlled studies of psychotherapy focus on short-term therapies, which are modestly effective in reducing symptoms. When therapy orientations are compared to each other in these studies, few differences in outcomes emerge. Despite the effects of psychotherapy on mental health symptoms, few studies have looked at the effectiveness of psychotherapy on work disability, and even less is known about the effectiveness of various psychotherapy orientations on work disability. In this large population-based study, Selinheimo and colleagues examined the associations between changes in work disability and long-term psychotherapy across the six most common psychotherapy orientations in Finland. The psychotherapy orientations included solution-focused therapy, cognitive-behavioural therapy, cognitive-analytic therapy, crisis and trauma-focused therapy, psychodynamic psychotherapy, and integrative psychotherapy. In Finland, rehabilitative psychotherapy is the primary publicly funded program for individuals at risk of work disability. The social security system subsidizes the therapy and allows for up to 80 sessions per year. Patients initially get a first-line treatment of pharmacotherapy, but if the disability persists, they are referred to psychotherapy. For this study, the authors randomly selected 33% of patients (N = 10,172) from the national register of those receiving psychotherapy for work disability. After the baseline period, the level and trend of sickness absence (the primary outcome) showed a similar decrease of 76% to 82% across all orientations of psychotherapy (i.e., 19 to 27-day decrease in work disability). Psychotherapy orientations showed no significant differences in their level of sickness absence at the end of the follow-up period in year four.

Practice Implications 

This large population-based study showed no differences between psychotherapy orientations in reducing work disability. Because this was not a highly controlled study, it is possible that clinicians who claimed a particular orientation used an expanded repertoire of clinical interventions (i.e., they practiced eclectically). Also, some therapies that are typically delivered as brief interventions (solution-focused therapy) were offered longer term in this context, which allowed for a longer duration. It is likely that common factors across the therapies, such as developing and maintaining a therapeutic alliance, may explain the similar effectiveness of the various treatment orientations on work disability outcomes.

Selinheimo, S., Gluschkoff, K., Kausto, J. et al. (2025). Is psychotherapy orientation important for depressive and anxiety disorder-related work disability outcomes? A prospective nationwide register study. BMC Psychiatry, 25, 680. https://doi.org/10.1186/s12888-025-07140-4