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What Happens After Treatment: Can Structural Change be a Predictor of Long-Term Outcome?

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Psychodynamic Psychotherapy Research

Part of the book series: Current Clinical Psychiatry ((CCPSY))

Abstract

The first systematic follow-up study of therapeutic results was delivered by the Berlin Psychoanalytic Institute and reported by Fenichel [1]. This study set a precedent that many psychoanalysts were to follow in subsequent years [2–4] (for a review see [5]). At times, the work of these analysts had far-reaching social impacts; the studies Dührssen [6] performed at the Berlin Central Institute for Psychogenic Illnesses led to the inclusion of psychodynamic (PD) and psychoanalytic (PA) treatments among the forms of therapy covered by health insurance in Germany. From the available literature, it is clear that the PA community has cared about the issue of the long-term effects of treatment from early on.

*This paper is based on Grande T, Dilg R, Jakobsen T, Keller W, Krawietz B, Langer M, Oberbracht C, Stehle S, Stennes M, Rudolf G. Structural change as a predictor of long-term follow-up outcome. Psychother Res 2009;19:344–57.

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References

  1. Fenichel O. Statistischer Bericht über die therapeutische Tätigkeit 1920–1930. In: Radó S, Fenichel O, Müller-Braunschweig C, editors. Zehn Jahre Berliner Psychoanalytisches Institut. Poliklinik und Lehranstalt. Wien: Int Psychoanal Verlag; 1930. p. 13–9.

    Google Scholar 

  2. Alexander F. Five year report of the Chicago Institute for Psychoanalysis, 1932–1937. Chicago: Institute for Psychoanalysis; 1937.

    Google Scholar 

  3. Jones E. Report of the clinic work: 1926–1936. London: Clinic of Psychoanalysis; 1936.

    Google Scholar 

  4. Knight RP. Evaluation of the results of psychoanalytic therapy. Am J Psychiatry. 1941;98:434–46.

    Google Scholar 

  5. Bergin AE. The evaluation of therapeutic outcomes. In: Bergin AE, Garfield SL, editors. Handbook of psychotherapy and behavior change. New York: Wiley; 1971. p. 217–70.

    Google Scholar 

  6. Dührssen A. Katamnestische Ergebnisse bei 1004 Patienten nach analytischer Psychotherapie. Z Psychosom Med Psychoanal. 1962;8:94–113.

    Google Scholar 

  7. Lambert MJ, Ogles BM. The efficacy and effectiveness of psychotherapy. In: Lambert MJ, editor. Bergin and Garfield’s handbook of psychotherapy and behaviour change. New York: Wiley; 2004. p. 139–93.

    Google Scholar 

  8. Rapaport D. The structure of psychoanalytic theory: a systemizing attempt, Psychological issues series, vol. II. New York: International Universities Press; 1960.

    Google Scholar 

  9. Horowitz M, Kernberg OF, Weinshel E, editors. Psychic structure and psychic change: essays in honour of Robert R. Wallerstein. Madison: International Universities Press; 1993.

    Google Scholar 

  10. Kernberg OF. Psychic structure and structural change: an ego psychology–object relations theory viewpoint. In: Shapiro T, editor. The concept of structure. Madison: International Universities Press; 1991. p. 315–37.

    Google Scholar 

  11. Kernberg OF. Psychoanalysis, psychoanalytic psychotherapy, and supportive psychotherapy: contemporary controversies. Int J Psychoanal. 1999;80:1075–91.

    Article  PubMed  Google Scholar 

  12. Moore BE, Fine BD. Psychoanalytic terms and concepts. New Haven: Yale University Press; 1990.

    Google Scholar 

  13. Wallerstein RS. Forty-two lifes in treatment. A study of psychoanalysis and psychotherapy. New York: Guilford; 1986.

    Google Scholar 

  14. Wallerstein RS. Psychoanalysis and psychotherapy: relative roles reconsidered. Annu Psychoanal. 1988;16: 129–51.

    Google Scholar 

  15. Weinryb RM, Rössel RJ. Karolinska psychodynamic profile – KAPP. Acta Psychiatr Scand. 1991;83:1–23.

    Article  Google Scholar 

  16. DeWitt KN, Hartley D, Rosenberg SE, Zilberg NJ, Wallerstein RS. Scales of psychological capacities: development of an assessment approach. Psychoanal Contemp Thought. 1991;14:343–61.

    Google Scholar 

  17. Wallerstein RS. Scales of psychological capacities. Version 1. Unpublished manuscript; 1996.

    Google Scholar 

  18. Fonagy P, Target M, Steele M, Steele H. Reflective-functioning manual: for application to Adult Attachment Interviews. Version 5.0. London: University-College; 1988.

    Google Scholar 

  19. Shedler J, Westen D. The Shedler–Wetsen Assessment Procedure (SWAP): making personality diagnosis clinically meaningful. J Pers Assess. 2007;89:41–55.

    Article  PubMed  Google Scholar 

  20. Rudolf G, Grande T, Oberbracht C. Die Heidelberger Umstrukturierungsskala. Ein Modell der Veränderung in psychoanalytischen Therapien und seine Operationalisierung in einer Schätzskala [The Heidelberg Structural Change Scale. A model for change in psychoanalytic therapies and its operationalization in an assessment scale]. Psychotherapeutics. 2000;45:237–46.

    Article  Google Scholar 

  21. OPD Task Force, editor. Operationalized psychodynamic diagnostics. Foundations and manual. Seattle: Hogrefe & Huber; 2001.

    Google Scholar 

  22. OPD Task Force, editor. Operationalized Psychodynamic Diagnosis (OPD-2). Manual of diagnosis and treatment planning. Cambridge: Hogrefe & Huber; 2008.

    Google Scholar 

  23. Pfeffer AZ. A procedure for evaluating the results of psychoanalysis: a preliminary report. J Am Psychoanal Assoc. 1959;7:418–44.

    Article  PubMed  CAS  Google Scholar 

  24. Schlesinger N, Robbins F. The psychoanalytic process: recurrent patterns of conflicts and changes in ego functions. J Am Psychoanal Assoc. 1975;23:761–82.

    Article  Google Scholar 

  25. Leuzinger-Bohleber M, Target M. A follow-up study – critical inspiration for our clinical practice? In: Leuzinger-Bohleber M, editor. Outcomes of psychoanalytic treatment. London: Whurr Publishers; 2002. p. 143–73.

    Google Scholar 

  26. Thomä H, Kächele H. Psychoanalytic practice. 1 Principles. Paperback ed. (1994). Berlin/New York: Springer/Aronson; 1987.

    Google Scholar 

  27. Grande T, Rudolf G, Oberbracht C, Pauli-Magnus C. Progressive changes in patients’ lives after psychotherapy: which treatment effects support them? Psychother Res. 2003;13:43–58.

    Article  PubMed  CAS  Google Scholar 

  28. Wallerstein RS. The goals of psychoanalysis. J Am Psychoanal Assoc. 1965;13:748–70.

    Article  PubMed  CAS  Google Scholar 

  29. Sandler J, Sandler A. The second censorship, the three box model, and some technical implications. Int J Psychoanal. 1983;64:413–25.

    PubMed  Google Scholar 

  30. Hill CE, Lambert MJ. Methodological issues in studying psychotherapy processes and outcome. In: Lambert MJ, editor. Bergin and Garfield’s handbook of psychotherapy and behaviour change. New York: Wiley; 2004. p. 84–135.

    Google Scholar 

  31. Ticho GR. On self-analysis. Int J Psychoanal. 1967;48:308–18.

    PubMed  CAS  Google Scholar 

  32. Leuzinger-Bohleber M, Stuhr U, Rüger B, Beutel M. How to study the quality of psychoanalytic treatments and their long term effects on patients well-being. A representative multiperspective follow-up study. Int J Psychoanal. 2003;84:263–90.

    Article  PubMed  Google Scholar 

  33. Wallerstein RS. The generations of psychotherapy research. An overview. In: Leuzinger-Bohleber M, Target M, editors. Outcomes psychoanalytic treatment: perspectives for therapists and researchers. London: Whurr; 2001. p. 30–60.

    Google Scholar 

  34. Grande T, Rudolf G, Oberbracht C, Jakobsen Th, Keller W. Investigating structural change in the process and outcome of psychoanalytic treatment. The Heidelberg–Berlin Study. In: Richardson Ph, Kächele H, Renlund C, editors. Research on psychoanalytic psychotherapy with adults. London: Karnac; 2004. p. 35–61.

    Google Scholar 

  35. Grande T, Dilg R, Jakobsen T, Keller W, Krawietz B, Langer M, et al. Differential effects of two forms of psychoanalytic therapy – results of the Heidelberg–Berlin study. Psychother Res. 2006;16:470–85.

    Article  Google Scholar 

  36. Rudolf G, Grande T, Dilg R, Jakobsen Th, Keller W, Oberbracht C, et al. Structural changes in psychoanalytic therapies – the Heidelberg–Berlin Study on Long-Term Psychoanalytic Therapies (PAL). In: Leuzinger-Bohleberm M, Target M, editors. Longer-term psychoanalytic treatment – perspectives for therapists and researchers. London: Whurr Publishers; 2002. p. 201–22.

    Google Scholar 

  37. Dilling H, Mombour W, Schmidt MH, Schulte-Markwort E, editors. Internationale Klassifikation psychischer Störungen ICD-10, Kapitel V (F). Forschungskriterien [International classification of mental disorders. ICD-10, chapter V (F). Research criteria]. Bern: Huber; 1994.

    Google Scholar 

  38. Derogatis L. Symptom Checklist-90-Revised: administration, scoring, and procedures manual. 3rd ed. Minneapolis: National Computer Systems; 1994.

    Google Scholar 

  39. Franke G. SCL-90-R: Die Symptom-Checkliste von Derogatis (The Derogatis Symptom Checklist) (2nd ed. (2 Aufl)). Göttingen: Beltz; 2002.

    Google Scholar 

  40. Brockmann J, Schlüter T, Brodbeck D, Eckert J. Die Effekte psychoanalytisch orientierter und verhaltenstherapeutischer Langzeittherapien [Effects of psychoanalytically oriented and of behavioural long-term therapies. A comparative study]. Psychotherapeutics. 2002;47:347–55.

    Article  Google Scholar 

  41. Schauenburg H, Strack M. Measuring psychotherapeutic change with the Symptom Checklist 90R – SCL 90 R. Psychother Psychosom. 1999;6:199–207.

    Article  Google Scholar 

  42. Horowitz LM, Strauß B, Kordy H. IIP-D: Inventar zu Erfassung interpersonaler Probleme (IIP-D: Inventory of Interpersonal Problems) (2nd ed. (2 Aufl)). Göttingen: Beltz; 2000.

    Google Scholar 

  43. Huber D, Henrich G, Klug G. The Inventory of Interpersonal Problems (IIP): sensitivity to change. Psychother Res. 2007;17:474–81.

    Article  Google Scholar 

  44. Rüger U, Dahm A, Kallinke D. Faber-Haarstrick: Kommentar Psychotherapierichtlinien (The Faber-Haarstrick Commentary on Psychotherapy Guidelines) ((6th ed.) 6 Aufl). München, Jena: Urban & Fischer Verlag; 2003.

    Google Scholar 

  45. Rudolf G. Die therapeutische Arbeitsbeziehung (The psychotherapeutic working alliance). Berlin: Springer; 1991.

    Book  Google Scholar 

  46. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. New York: Academic; 1977.

    Google Scholar 

  47. Cierpka M, Grande T, Rudolf G, van der Tann M, Stasch M, OPD Task Force. The operationalized psychodynamic diagnostics system: clinical relevance, reliability and validity. Psychopathology. 2007;40:209–20.

    Article  PubMed  CAS  Google Scholar 

  48. Stasch M, Schmal H, Hillenbrand E, Cierpka M. Fokusorientierte Interventionen mit der OPD in der stationären Psychotherapie. Effekte auf Ergebnis und Verlauf der Behandlung (Focal interventions based on the OPD in inpatient treatment. Effects on outcome and process). Z Psychosom Med Psychother. 2007;53:309–23.

    PubMed  Google Scholar 

  49. Schneider G, Mendler TM, Heuft G, Burgmer M. Validität der Konfliktachse der Operationalisierten Psychodynamischen Diagnostik (OPD-1) – empirische Ergebnisse und Folgerungen für die OPD-2 (Validity of axis III „conflicts“of Operationalized Psychodynamic Diagnostics (OPD-1) – empirical results and conclusions for OPD-2). Z Psychosom Med Psychother. 2008;54:46–62.

    PubMed  Google Scholar 

  50. Böker H, Schopper C, Straub M, Himmighoffen H, Endrass J, Küchenhoff B, et al. Automutilistisches Verhalten bei Patientinnen mit affektiven Störungen: Untersuchung der Persönlichkeitsstruktur und Affektregulation mittels Operationalisierter Psychodynamischer Diagnostik (OPD) (Automutilistic behaviour in female patients with affective disorders: investigation of personality structure and affect regulation by means of Operationalized Psychodynamic Diagnostics (OPD)). Psychother Psychosom Med Psychol. 2007;57:319–27.

    Article  PubMed  Google Scholar 

  51. Grande T, Rudolf G, Oberbracht C, Jakobsen T. Therapeutische Veränderungen jenseits der Symptomatik. Wirkungen stationärer Psychotherapie im Licht der Heidelberger Umstrukturierungsskala (Therapeutic changes beyond symptoms. The effects of inpatient psychotherapy in light of the Heidelberg Structural Change Scale). Z Psychosom Med Psychother. 2001;47:213–33.

    PubMed  CAS  Google Scholar 

  52. Stiles WB, Elliot R, Llewelyn SP, Firth-Cozens JA, Margison FR, Shapiro DA, et al. Assimilation of problematic experiences by clients in psychotherapy. Psychotherapy. 1990;27:411–20.

    Article  Google Scholar 

  53. Stiles WB, Meshiot CM, Anderson TM, Sloan WW. Assimilation of problematic experiences: the case of John Jones. Psychother Res. 1992;2:81–101.

    Article  Google Scholar 

  54. Stiles WB, Shapiro DA, Harper H, Morrison LA. Therapist contributions to psychotherapeutic assimilation: an alternative to the drug metaphor. Br J Med Psychol. 1995;68:1–13.

    Article  PubMed  Google Scholar 

  55. Schneider G, Schmitz-Moormann S, Bär O, Driesch G, Heuft G. Psychodynamische Therapiefoki in einer stationären multimodalen Therapie – Zusammenhänge zu den Selbstauskunftsskalen und individuellen Therapiezielen (Psychodynamic therapy foci in inpatient psychotherapy – relations to self-assessment scales and individual therapeutic goals). Z Psychosom Med Psychother. 2006;52:259–73.

    PubMed  Google Scholar 

  56. Grande T. Zur Beurteilung der Leistung einzelner OPD-Rater und Standards für die Verwendung der OPD in der empirischen Forschung (Qualification of OPD-raters and the use of the OPD in empirical research). In: Dahlbender RW, Buchheim P, Schüssler G, editors. Lernen an der Praxis. OPD und Qualitätssicherung in der Psychodynamischen Psychotherapie (Learning from practice. OPD and quality assurance in psychodynamic psychotherapy). Bern: Huber; 2004. p. 245–50.

    Google Scholar 

  57. Beutler LE, Hamblin DL. Individualized outcome measures of internal change: methodological considerations. J Consult Clin Psychol. 1986;54:48–53.

    Article  PubMed  CAS  Google Scholar 

  58. Lambert MJ, Hill CE. Assessing psychotherapy outcomes and processes. In: Bergin AE, Garfield SL, editors. Handbook of psychotherapy and behavior change. New York: Wiley; 1994. p. 72–113.

    Google Scholar 

  59. Menninger KA. Theory of psychoanalytic technique. New York: Basic Books; 1958.

    Book  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Heidelberg, Germany

    Tilman Grande Ph.D. & Gerd Rudolf

  2. Head of the Department of Psychosomatics, Kliniken im Theodor-Wenzel-Werk, Berlin, Germany

    Wolfram Keller

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  1. Tilman Grande Ph.D.
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  2. Wolfram Keller
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  3. Gerd Rudolf
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Correspondence to Tilman Grande Ph.D. .

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Editors and Affiliations

  1. Massachusetts General Hospital, Harvard Medical School, Department of Psychiatry, Parkman St., Boston, 02114, Massachusetts, USA

    Raymond A. Levy

  2. Massachusetts General Hospital, Harvard Medical School, Department of Psychiatry, Morrimac Street 101, Boston, 02114, Massachusetts, USA

    J. Stuart Ablon

  3. and Psychoanalysis, International Psychoanalytic University, Department of Clinical Psychology, Stromstr. 3, Berlin, 10555, Germany

    Horst Kächele

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Grande, T., Keller, W., Rudolf, G. (2012). What Happens After Treatment: Can Structural Change be a Predictor of Long-Term Outcome?. In: Levy, R., Ablon, J., Kächele, H. (eds) Psychodynamic Psychotherapy Research. Current Clinical Psychiatry. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60761-792-1_9

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