Treatment results research on outcome

The psychoanalytic profession has been slow in developing systematic research on treatment process and results, let alone controlled randomized comparison of treatment methods evaluating efficacy and efficiency. The reasons are multiple: the complexity of the psychoanalytic treatment, and the changes in its technique; the long duration of treatment, making systematic research and controlled comparison with other treatment methods difficult; the private nature of psychoanalytic exploration in the context of patients' regression, and the related concerns over disturbing the therapeutic relationship by recording or direct observation. In addition, the general methodology of psychotherapy research evolved to a degree of sophistication applicable to the evaluation of psychoanalytic treatment only in recent decades. With all these reservations, significant progress has been made, and outcome studies are beginning to be available.

The Menninger Psychotherapy Research Project, a naturalistic study comparing psychoanalysis, psychoanalytic psychotherapy, and supportive psychotherapy, showed psychoanalysis to be the most effective of these approaches with patients presenting relatively good ego strength, while patients with severe ego weakness—what nowadays would be described as presenting severe personality disorders or borderline personality organization—improved most with psychoanalytic psychotherapy/38) This research also showed how important supportive elements were throughout all modalities of treatment. (50> A comprehensive review of outcome studies on psychoanalytic psychotherapy and psychoanalysis by Bachrach et al.i5D concluded that the improvement rates are in the range from 60 to 90 per cent, but it also pointed to limitations and problems in the methodology utilized.

Recently, studies regarding the treatment process and outcome of psychoanalysis and psychoanalytic psychotherapy have become more precise in defining the specific treatment variables of psychotherapeutic and psychoanalytic treatments, and several systematic studies on psychoanalytic psychotherapies and psychoanalysis are in progress.(52) A recent study by the Stockholm Outcome of Psychoanalysis and Psychotherapy Project has found, on the basis of a relatively large patient population, that psychoanalytic treatment, in comparison with psychoanalytic psychotherapy, obtained a significantly higher degree long-range symptomatic improvement.^ The extent to which the psychotherapist had years of experience linked with appropriate long-term supervisory experiences, i.e. an 'experiential learning cluster', was related to treatment outcome, in the sense that those therapists with long experiences in doing teaching or supervision of psychotherapy had a significantly better outcome than therapists who only had been in supervision or personal therapy for long periods. It also appeared that the maintenance of a rigid 'psychoanalytic' attitude as part of a psychoanalytic psychotherapy was not as effective as a more flexible shift in techniques in psychotherapy, but not in analysis proper.(54) A manualized psychoanalytic psychotherapy for a specific patient population, namely the psychotherapy research project of the Cornell Personality Disorders Institute's manualized treatment for borderline patients, is presently under way. (36) It has provided evidence for the efficacy of the treatment with severely ill patients, although comparative studies with other treatment modalities, or with 'treatment as usual' still remains to be done.

In summary, process research has predated outcome research on psychoanalysis and derived psychotherapies; major efforts at outcome research are being made, and should contribute to clarify the effects, not only of psychoanalysis proper, but also of the derived psychotherapeutic approaches now being carried out in clinical practice.

Break Free From Passive Aggression

Break Free From Passive Aggression

This guide is meant to be of use for anyone who is keen on developing a better understanding of PAB, to help/support concerned people to discover various methods for helping others, also, to serve passive aggressive people as a tool for self-help.

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