Long-term outcome and post-treatment effects of psychoanalytic psychotherapy with young adults (original) (raw)
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Young adults in psychoanalytic psychotherapy: Patient characteristics and therapy outcome
Psychology and Psychotherapy-theory Research and Practice, 2006
The aims of this naturalistic study are to present patient characteristics and analyse various outcome measures at termination for psychoanalytic psychotherapies with young adults. Patients (n ¼ 134) between 18 and 25 years were included, of whom 92 received individual and 42 group therapy. One third had a self-reported personality disorder. The patients were considerably more troubled than Swedish norm groups at intake and they showed improvement on all outcome measures during therapy. However, the post therapy means did not fully reach the norm group means. The largest positive changes (pre-versus post-therapy) were with respect to the patients' overall health and functioning. Changes were more moderate in self-reported symptoms, selfconcept, and self-representation, while changes in interpersonal problems and object representations were small. The results of this study are discussed in the context of advantages and disadvantages of naturalistic versus randomized controlled study designs.
Change After Long-Term Psychoanalytic Psychotherapy
Journal of the American Psychoanalytic Association, 2004
Psychoanalytic psychotherapy in clinical practice is traditionally a longterm treatment conducted by well-trained psychotherapists. However, very few studies have been published that evaluate the effects of such treatment. To redress this lack of studies, 55 individuals selected for longterm psychoanalytic psychotherapy (average, 3 years) were invited to participate in a naturalistic study. The psychotherapists had a mean of 15 years of professional experience. The 36 patients who completed psychotherapy manifested a substantial reduction in symptomatic suffering and decreased levels of character pathology, as measured by the Karolinska Psychodynamic Profile (KAPP) and the Karolinska Scales of Personality. Generally, such changes were not found in the individuals who did not engage in treatment. In the therapy group, improvements were found on eight KAPP subscales defining different aspects of character: Intimacy and Reciprocity, Frustration Tolerance, Regression in the Service of the Ego, Coping with Aggressive Affects, Conceptions of Bodily Appearance and their Significance for Self-esteem, Sexual Function, Sexual Satisfaction, and Personality Organization. The results indicate that individuals who engaged in psychotherapy improved their capacity to handle crucial aspects of life and reduced their symptomatic suffering.
International Journal of Psychoanalysis, 2003
How can we study the 'quality of psychoanalytic treatments'? The authors attempt to answer this question by discussing a naturalistic, multi-perspective and representative follow-up study of psychoanalyses and long-term psychoanalytic psychotherapies. We studied a representative sample (n ¼ 401) of all the patients who had terminated their psychoanalytic treatments with members of the German Psychoanalytical Association (DPV) between 1990 and 1993. Between 70 and 80 per cent of the patients achieved (average 6.5 years after the end of treatment) good and stable psychic changes according to the evaluations of the patients themselves, their analysts, independent psychoanalytic and non-psychoanalytic experts, and questionnaires commonly applied in psychotherapy research. The evaluation of mental health costs showed a cost reduction through fewer days of sick leave during the seven years following the end of long-term psychoanalytic treatments. The results achieved using non-psychoanalytical instruments are complemented by the richness of the idiosyncratic findings, gained by the psychoanalytic research instruments.
Journal of Counseling Psychology, 2014
Using a novel approach to assess attachment to therapist from patient narratives (Patient Attachment to Therapist Rating Scale; PAT-RS), we investigated the relationships between secure attachment to therapist, patient-rated alliance, and outcome in a sample of 70 young adults treated with psychoanalytic psychotherapy. A series of linear mixed-effects models, controlling for length of therapy and therapist effects, indicated that secure attachment to therapist at termination was associated with improvement in symptoms, global functioning and interpersonal problems. After controlling for the alliance, these relationships were maintained in terms of symptoms and global functioning. Further, for the follow-up period, we found a suppression effect indicating that secure attachment to therapist predicted continued improvement in global functioning whereas the alliance predicted deterioration when both variables were modeled together. While limited by the correlational design, this study suggests that the development of a secure attachment to therapist is associated with treatment gains as well as predictive of post-treatment improvement in functioning. Future research should investigate the temporal development of attachment to therapist and its interaction with alliance and outcome more closely. To ensure differentiation from patientrated alliance, observer-based measurement of attachment to therapist should be considered.
The Effectiveness of Long-Term Psychoanalytic Therapy: A Systematic Review of Empirical Studies
Harvard Review of Psychiatry, 2009
Background: There is a gap in the research literature on the effectiveness of long-term psychoanalytic therapies (LPT). Aim: To present a systematic review of studies dealing with LPT effectiveness and published from 1970 onward. Methods: A systematic literature search for studies dealing with the effectiveness of individual LPT in ambulatory, adult patients. Data about the overall effectiveness of LPT, its impact on symptom reduction, and its effect on personality changes were pooled both at treatment termination and at follow-up, using effect sizes (ESs) and success rates. Results: We found 27 studies (n = 5063). Psychotherapy yielded large mean ESs (0.78 at termination; 0.94 at follow-up) and high mean overall success rates (64% at termination; 55% at follow-up) in moderate/mixed pathology. The mean ES was larger for symptom reduction (1.03) than for personality change (0.54). In severe pathology, the results were similar. Psychoanalysis achieved large mean ESs (0.87 at termination; 1.18 at follow-up) and high mean overall success rates (71% at termination; 54% at follow-up) in moderate pathology. The mean ES for symptom reduction was larger (1.38) than for personality change (0.76). Conclusion: Our data suggest that LPT is effective treatment for a large range of pathologies, with moderate to large effects. (HARV REV PSYCHIATRY 2009;17:1-23.) These studies can be seen as the first attempts to provide empirical evidence of LPT's effectiveness, but they do not meet contemporary criteria of scientific research. In recent decades, efforts have been made to bring LPT effectiveness research more into line with current standards of evidence-based medicine. Of the recent reviews and overviews in this field, several are especially noteworthy. Bachrach and colleagues 16 performed an extensive review of literature dealing with the effectiveness of psychoanalysis. They discussed at length the methodology, design, and results of six systematic studies, including a total of 550 patients. The authors found success rates (meaning substantial therapeutic benefit) in the 60% to 90% range, and significant effect sizes (ESs). Doidge 17 conducted an overview of the empirical evidence for psychoanalytic psychotherapies and psychoanalysis. He concluded: "There is considerable experimental and clinical data for efficacy of a range of individual psychoanalytic psychotherapies, from short-term psychoanalytic psychotherapy to 1 Harv Rev Psychiatry Downloaded from informahealthcare.com by Vrije Universiteit Amsterdam on 11/29/10 For personal use only.
The journal of the American Academy of Psychoanalysis and Dynamic Psychiatry, 2005
Each of 51 experienced psychiatrist/psychoanalysts was queried about the clinical characteristics of every private psychotherapy patient presently in treatment: 551 patients were included in the study; 88% of patients had an Axis I disorder, 59% had Axis I and Axis II disorders concurrently, and 11% Axis II only. Of these patients, 44% had been prescribed psychotropic medication on a daily basis for at least 2 weeks during the present treatment. Patients treated for the longest time (5 years or more) were the most seriously psychiatrically disturbed. Patients improved with psychotherapy, and the improvement was related to the duration of treatment. The combined impact of diagnosis status, treatment duration, and treatment modalities provided a consistent pattern of treatment effectiveness. This article provides a cross-sectional view of the private practices of senior, analytically trained psychiatrists, covering features of the patients, types of treatment, and some indicators of treatment effects. Despite recent advances in psychoanalytic psychotherapy research (
A Follow-up Study in Psychoanalytic Psychotherapy of Couples
International Journal of Applied Psychology, 2012
During 11 years we have been working on a research involving intervention with families seeking treatment in a counseling center-school and whose complaints are focused on their children. Using psychoanalytic psychotherapy with the couples, we have tried to achieve symptom remission in the children. The purpose of this study is to reflect on the maintenance, over time, o f the psychological changes obtained in this kind of clinical pract ice, wh ich encompasses both couples and families. Based on clinical-qualitative methodology and case study, two cases have been examined, with emphasis on the follow-up sessions for two couples who were undergoing psychoanalytic couple's therapy for thirty-six and thirty months, respectively, with t wo additional fo llo w-up sessions after the therapy was finished. The collection of clinical material to be analy zed according to the psychoanalytic references was made using excerpts fro m the session written notes taken by the therapist herself immed iately after the sessions were over. As a result, this kind of intervention proved effective in clarifying latent marital conflicts and in fostering a healthy environment, one that could contribute to the emotional development of the child.
Http Dx Doi Org 10 1080 10503300500268094, 2007
Effects of psychoanalytic treatment on subjective health and health care utilization were studied in a sample of 420 patients in various stages of psychotherapeutic treatment. Outcome measures, based on a self-report questionnaire taken for three consecutive years, included the Self-Rated Health Scale (SRH), General Symptom Index (GSI) from the Symptom Checklist-90 (SCL-90), and Sense of Coherence Scale (SOCS) as well as self-reports on health care utilization during the past 12 months. The study had a quasi-experimental, accelerated longitudinal design. Individual raw scores of the dependent variables were regressed, one by one, on an eight-step treatment stage scale. Sex, age, and education level were entered in a first block to partial out their possible effects. In contrast to the significant positive developments found on the subjective health measures (SRH, GSI, and SOCS), no significant change was found on the health care utilization variables. The complications in interpreting psychotherapy effects on health and health care utilization are discussed.