Open Door Review III

50<2(0&*066!2*&!&$::0%0*($2($)*!$*!(#0!(#0%210B($7!&42&!h!2*! 091$%$72

'%#2%&(_!;>![+,-]^>!F0C)D0*#0$(!B*&!O$::0%0*C$0%B*D!$*!&0%!(#0%210B($67#0*!O42&0>!'$*0!091$%$67#0! R*(0%6B7#B*D!Y)*!1647#)2*2<4($67#0*!B*&!1647#)(#0%210B($67#0*!V0%J*&0%B*D61%)C0660*!~50<2(0&*066!2*&! O$::0%0*($2($)*!$*!(#0!"#0%210B($7!O42&>!=*!'91$%$72!S$0k0*?!/647#)6)C$2! >-001(3\! Process-outcome research investigates not only treatment effectiveness; rather, what is really happening in the sessions and to which extent the captured patient-therapist interactions impact outcome. Therapeutic alliance was found to demonstrate the strongest association between process and outcome (Orlinsky et al. 1994; Norcross & Wampold 2011). The relevance on pre-treatment patient variables were emphasized in order to investigate differential treatment response (Blatt & Felsen 1993; Blatt & Shahar 2004; Clarkin & Levy 2004) and the importance of therapist variables for treatment outcome was demonstrated empirically (Luborsky et al. 1997; Wampold, 2001; Beutler et al. 2004). The present study is a process-outcome study on psychodynamic and psychoanalytic long- term psychotherapy in which 29 audio-taped treatment processes from three psychotherapy archives were investigated. Empirical rater-based research instruments were applied at four measure points (four sessions) in each treatment. The Psychotherapy Process Q-Set (PQS; Jones 2000; Ablon et al. 2012) was used to capture therapeutic process and treatment adherence, therapeutic alliance was measured with the California Psychotherapy Alliance Scales (CALPAS; Gaston & Marmar 1993), and psychic structure was assessed with the Differentiation-Relatedness-Scales (DR-S; Diamond et al. 2012). The latter was also used to capture therapeutic change in terms of level of self- and object- representations with repeated measurements. Pre-treatment patient variables were identified based on Blatt's personality theory of psychological dimensions “relatedness” and “self-definition“ which defines the distinction between anaclitic (dependent) and introjective (self-critical) personality configurations (Blatt & Ford 1994). A therapist variable was introduced in order to assess therapeutic style through differentiating between a „relational-oriented“ and a „differentiation-oriented“ style according to the same dimensions. Through matching patient and therapist variables, different dyads of “therapeutic match” were captured. The main research questions where, whether there are differences in therapeutic process, alliance and outcome between treatments of anaclitic and introjective patients. In addition, hypotheses assume that alliance quality is associated with and predicts therapeutic change. Hypotheses suggest that there are process variables which distinguish between treatments with and those without clinical significant change overall patients and that specific therapeutic techniques are related to positive outcome. We assumed that a more complementary therapeutic match in terms of therapeutic stance and patient personality facilitate therapeutic change better than those which demonstrate more similarity. @)15-1.*$#\! Although, there is a small sample size, the findings are consistent with Blatt's theory (Blatt 2008). Results suggest e.g. that anaclitic patients feel more comfortable in relying upon therapists than introjective patients and that dealing with their self-image is very characteristic for introjective and not for anaclitic patients. No differences were found in terms of outcome between patient groups and between treatment groups. An association between therapeutic alliance and therapeutic change was

PNP

.01230/1.40/5&&'67894/0/571.8/5&&/6648./1.40&

Made with FlippingBook HTML5