Based on data from psychoanalytic long-term psychotherapies, the predictive value of three measures of pre-post change for retrospective patient assessments of outcome at 1-year and 3-year follow-up was investigated. Pre-post changes were measured using the Global Severity Index (GSI), the Inventory of Interpersonal Problems (IIP) total score, and the Heidelberg Structural Change Scale (HSCS). In line with psychoanalytic theory, it was assumed that structural changes cause especially persistent changes and would, therefore, be most suitable to predict the follow-up criterion. This expectation was confirmed: Pre-post changes in GSI and IIP were only weakly associated with assessments at 1-year follow-up and not at all with assessments at 3-year follow-up. In contrast, correlations between changes in HSCS and outcome assessments were highly significant at both occasions.
The endurance of psychotherapeutic effects after conclusion of inpatient treatment is examined in a follow-up study of 49 patients with psychosomatic, neurotic, and personality disorders. The perspective is not symptomatological but rather relates to the concrete changes occurring in the lives of the patients after treatment. The investigators hypothesized that the probability of progressively coping with life demands depends on the extent to which patients have gained insight into their central psychological problems. Using the Heidelberg Structural Change Scale (HSCS) to gauge the extent to which patients succeed in gaining cognitively and emotionally definitive insight into their intrapsychic conflicts and the structural vulnerabilities determining their condition, the authors were able to confirm their hypothesis. The HSCS, compared with other measures, offered the only possibility of predicting progressive (i.e., symptomatic) changes. The authors concluded that the demands of external life present opportunities for therapy success to be realized as progressive changes and that these changes can form a basis for further positive development.
For psychodynamic psychotherapies structural change seems to be a relevant paradigm of outcome in addition to symptom relief. In longer and more frequent psychoanalytic therapies more structural change occurs compared to shorter psychodynamic psychotherapies. Beside the amount and length of treatment, the different therapy targets - working through vs. supportive - seem to be important.
EinleitungWirksamkeitsstudien für Psychotherapien werden aus Gründen ihrer zeitlichen und organisatorischen Durchführbarkeit vor allem an kurz dauernden Behandlungen über wenige Monate mit einer begrenzten Anzahl von durchschnittlich 15-40 Sitzungen vorgenommen. In diesem überschau-baren Rahmen lassen sich randomisierte, kontrollierte Studien bei umschriebenen Störungsbildern leichter durchführen.Langzeitpsychotherapien, die sich in der Regel über mehrere Jahre erstrecken und in der analytischen Psychotherapie 100-300 Sitzungen (oder mehr) umfassen und durchschnittlich drei bis vier Jahre dauern, sind aus nahe liegenden Gründen schwer zu beforschen. Solche Studien können nur sehr schlecht unter Laborbedingungen als randomisiert-kontrollierte Studien durch-
ForschungsforumForum der Psychoanalyse 1 · 2008 47
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