The Impact of Level of Personality Organization on Treatment Response: A Systematic Review

Abstract

This paper provides a systematic review of extant research concerning the association between level of personality organization (PO) and psychotherapy response. Psychotherapy studies that reported a quantifiable association between level of PO and treatment outcome were examined for eligibility. Based on stringent inclusion and exclusion criteria, we identified 18 studies from 13 original data sources. Participants in these studies had a variety of mental disorders, of which mood, anxiety, and personality disorders were the most common. The results of this systematic review converge to suggest that higher initial levels of PO are moderately to strongly associated with better treatment outcome. Some studies indicate that level of PO may interact with the type of intervention (i.e., interpretive versus supportive) in predicting treatment outcome, which suggests the importance of tailoring the level of interpretive work to the level of PO. Yet, at the same time, the limited number of studies available and the heterogeneity of measures used to assess PO in existing research stress the need for further research. Potential implications for clinical practice and guidelines for future research are discussed.

The Psychodynamic Diagnostic Manual Version 2 (PDM-2): Assessing patients for improved clinical practice and research.

“…This position was recently empirically supported by the review conducted by Koelen et al (2012). We found also that expert practitioners of various theoretical orientations (most of whom were not psychodynamically oriented) felt that personality organization is a very important dimension in understanding their patients, and that personality patterns express themselves across the range of personality structure.…”

Operationalizing the Psychodynamic Diagnostic Manual: A preliminary study of the Psychodiagnostic Chart

“…However, the level of personality organization may be the most parsimonious and important factor in considering the response to and type of treatment (Koelen et al, 2012;McWilliams, 2011). Koelen et al (2012) identified 18 studies that suggest that higher initial levels of personality organization are moderately to strongly associated with better treatment outcome. Moreover, the authors found that patients with higher initial levels of personality organization may do better with interpretive versus supportive interventions in predicting treatment outcome.…”

The effectiveness of short- and long-term psychotherapy on personality functioning during a 5-year follow-up

“…Further research is also needed on the patient characteristics that may predict and modify change in personality functioning, and comparison between different outcome domains in short-vs. long-term therapy, in order to define the patient groups particularly in need of long-term therapy. The limited research, based on other outcome dimensions, suggests that the assessment of psychological suitability can be used to improve the fit between the patient and treatment duration (Laaksonen et al, 2013;Lindfors et al, 2014) as well as between the patient and the form of intervention needed (Koelen et al, 2012).…”