Open Door Review III

O0Y0<)190*(!):!2*!2�%0*70E672<0!:)%!&$::0%0*($2($)*!30(Z00*! 1647#)&4*29$7!1647#)(#0%214!2*&!1647#)2*2<46$6!

HB30%_!O>_!H0*%$7#_!S>_!S26(*0%_!i>_!G!I![+,-+^>!"#0!@B*$7#!/647#)(#0%214!Q(B&4?!@B6(!2<!A0Y4_!Q>!=3<)*!G!H>!IJ7#0<0!['&6>^_! '(A?-"*A+@$)?&'(A?-",-%#@:A&3%(%@#?- ![11>!.-Eg\^>!a0Z!e)%M?!HB92*2! /%066>! >-001(3! The aim is to provide an adherence scale of high discriminant ability for differentiation between the psychoanalytic pole and the psychodynamic pole of psychotherapeutic technique. In this study, the psychoanalytic pole is represented by psychoanalytic psychotherapy and the psychodynamic pole by psychodynamic psychotherapy according to the nomenclature of German guidelines for psychotherapy. The assessment of treatment integrity is an essential quality criterion for outcome and process outcome studies. Adherence to a treatment manual in RCTs as well as in effectiveness studies is viewed as a strategy to assure internal, statistical and construct validity. The problem of differentiation between the psychoanalytic pole and the psychodynamic pole follows from the broad overlap between them, both in theoretical conceptualizations and practical implementation. Therefore, the scale development is performed in a bilateral way by integrating both a theoretical and an empirical approach. The development of the adherence instrument is embedded in a theoretical and empirical framework by applying the literature about psychodynamic versus psychoanalytic techniques and by also applying real-world therapy sessions. Audiotaped psychodynamic and psychoanalytic therapy sessions are sampled from the Munich Psychotherapy Study (MPS; Huber, Henrich, Clarkin, & Klug, 2013; Huber, Zimmermann, Henrich, & Klug, 2012) within which unmanualized treatment conditions (psychodynamic psychotherapy, psychoanalytic psychotherapy, cognitive-behavioral therapy) were compared. First step was an extensive literature research which provides the ground for item formulation. In total 36 items were formulated reflecting therapist’s techniques and attitudes prototypical either for psychodynamic psychotherapy or for psychoanalytic psychotherapy (e.g. “Therapist encourages to free association” or “Therapist intervenes supportive [commending, approving, and advising]”). These items are to be regarded as dimensional in the sense of “rather psychodynamic” or “rather psychoanalytic” and not as categorical. In a second step a group discussion was performed to discuss the discriminating power of all items. Six experts (three female and three male training analysts) participated in the discussion. Three chair- men focused the discussion to extract those items which presumably present prototypical therapist’s technique or attitude of one of the therapeutic approaches and furthermore can discriminate between them reliably. The discussion resulted in 22 items, 11 presented the psychodynamic pole and 11 presented the psychoanalytic pole. In a third step “expert therapy sessions” were selected. Twelve blinded experts (seven training analysts and five training psychodynamic therapists) after having carefully listened to audiotaped therapy sessions, rated whether it was a psychoanalytic or a psychodynamic session. Sessions were sampled from the middle part of the treatment. We choose two consecutive sessions to enhance assessment of aspects of the treatment process itself. Thus, five middle part sequences of psychodynamic and five psychoanalytic psychotherapy middle part sequences were rated. Each sequence was listened to and assessed by varying pairs of expert raters. Sessions are defined as “expert therapy sessions” if the two raters and the therapy label of the MPS were identical.

PPT

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