This article describes a series of studies involving 2,730 participants on the development and validity testing of the Severity Indices of Personality Problems (SIPP), a self-report questionnaire covering important core components of (mal)adaptive personality functioning. Results show that the 16 facets constituted homogeneous item clusters (i.e., unidimensional and internally consistent parcels) that fit well into 5 clinically interpretable, higher order domains: self-control, identity integration, relational capacities, social concordance, and responsibility. These domains appeared to have good concurrent validity across various populations, good convergent validity in terms of associations with interview ratings of the severity of personality pathology, and good discriminant validity in terms of associations with trait-based personality disorder dimensions. Furthermore, results suggest that the domain scores are stable over a time interval of 14-21 days in a student sample but are sensitive to change over a 2-year follow-up interval in a treated patient population. Taken together, the final instrument, the SIPP-118, provides a set of 5 reliable, valid, and efficient indices of the core components of (mal)adaptive personality functioning.

The present study evaluated the clinical significance of long-term psychoanalytic treatment in four groups of about 60 patients in different phases of treatment (before, during, after, follow-up) with normative comparisons on four symptom questionnaires (SCL-90, BDI-II, STAI, IIP-64) and two personality assessment instruments (MMPI-2, Rorschach-CS). In each group, the proportion of patients with clinically elevated scores was calculated by comparing their scores with clinical and nonclinical reference groups for each instrument. The authors also calculated a combined percentage of clinically elevated scores based on the six instruments as a conservative estimate of improvement to nonclinical levels after long-term psychoanalytic treatment. Compared to pretreatment levels, the authors found a significant decrease in the percentage of clinical cases after treatment. For the personality assessment, these results became even more evident at follow-up. It appears that long-term psychoanalytic treatment was clinically significant for patients with chronic mental disorders. In the discussion, the authors point out that the evaluation of clinical significance at group level should be followed by an examination of individual changes over a longer period of time.

[163][164][165][166][167][168][169][170][171][172][173][174][175][176][177][178] Although several countries (e.g., Norway, Belgium, Germany, Canada, The Netherlands) provide government funding for long-term

Symptoms and interpersonal problems did not decrease notably within the first 2 years of psychoanalytic treatment. This is consistent with the idea that significant change takes time for patients with chronic mental disorders and personality pathology. In regular practice, it is advisable to monitor changes routinely in order to identify slow responders more quickly and change the treatment plan, if necessary.

In this study we used a quasiexperimental, cross-sectional design with six cohorts differing in phase of treatment (pretreatment, posttreatment, 2-year posttreatment) and treatment type (psychoanalysis and psychoanalytic psychotherapy) and investigated scores on 39 Rorschach-CS variables. The total sample consisted of 176 participants from four mental health care organizations in The Netherlands. We first examined pretreatment differences between patients entering psychoanalysis and patients entering psychoanalytic psychotherapy. The two treatment groups did not seem to differ substantially before treatment, with the exception of the level of ideational problems. Next, we studied the outcome of psychoanalysis and psychoanalytic psychotherapy by comparing the Rorschach-CS scores of the six groups of patients. In general, we found significant differences between pretreatment and posttreatment on a relatively small number of Rorschach-CS variables. More pre/post differences were found between the psychoanalytic psychotherapy groups than between the psychoanalysis groups. More research is needed to examine whether analyzing clusters of variables might reveal other results.

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The present study investigated mental health characteristics of 170 patients assigned to long-term psychoanalytic psychotherapy (PP) versus psychoanalysis (PA) across treatment and studies. Both univariate and multivariate statistics showed that the main difference between treatments was found in the interpersonal domain. PA patients reported significantly more interpersonal problems (as measured by the Inventory for Interpersonal Problems-64), scored higher on the avoidant coping style and lower on the perceptual thinking index of the Rorschach-Comprehensive System, and scored lower on Aggressiveness and Psychoticism Minnesota Multiphasic Personality Inventory-2 PSY-5 scales compared with PP patients. Compared with psychoanalytic patients in other studies, our patients had similar levels of mental health problems, although not always in the same health areas. Limitations of the study were noted, such as the lack of outcome data and other comparison groups.

A survey in 1943 by Obendorf was oriented toward answering the multiple question "What type of treatment is best suited to what kind of patient, suffering from what kind of illness, at what point in life, when treated by what kind of analyst, in what manner?" (Galatzer-Levy et al. 2000, p. 53). In recent years, the question of the cost-effectiveness of psychoanalysis and psychoanalytic psychotherapy can be added to these concerns. Despite this long history of posing the right questions, research into the effectiveness of psychoanalytic treatment has been hampered by vexing methodological, technical, theoretical, and ethical problems, not to mention a diverse array of opposing viewpoints on scientific and empirical research itself (Gerber 2004). Nevertheless, we consider systematic empirical research relevant to the study of psychoanalysis. To overcome some of the daunting difficulties in this area, it is important to choose a theoretical framework, research instruments, and a research design adequate to addressing these questions. Our aim here is to explain the choice of theoretical framework, instruments, and design of a study into the effectiveness of psychoanalytic treatment for which data collection started in January 2005. The project is a collaboration of four mental health institutes and is intended to evaluate the health-and cost-effectiveness of ambulatory government-funded psychoanalytic psychotherapy and psychoanalysis in regular clinical practice in the Netherlands. This will be done by using a routine outcome monitoring system developed for monitoring change in long-term psychotherapeutic treatments. In addition, the project will evaluate the usefulness of the monitoring system for quality assurance purposes. Theoretical FrameworkA theoretical framework accompanying research on the effectiveness of psychoanalytic treatment should provide hypotheses about areas in which patients might benefit from the treatment. Structural