Anna Lazar

Varieties of long-term outcome among patients in psychoanalysis and long-term psychotherapy : A review of findings in the Stockholm outcome of psychoanalysis and psychotherapy project (STOPPP)

This paper reports the main findings of a large-scale study of subsidized psychoanalysis and long-term psychotherapy. More than 400 people in various phases, before, during and after subsidized psychoanalysis or long-term psychodynamic psychotherapy, were followed up for a period of three years with personal interviews, questionnaires and official statistics. Our analyses revealed progressive improvement the longer patients were in treatment--impressively strong among patients in psychoanalysis--on self-rating measures of symptom distress and morale. Improvement, however, was equally weak in both groups on a self-rating measure of social relations. Dosage factors (treatment duration and session frequency in combination) partly accounted for the outcome differences between those referred to psychoanalysis and those referred to long-term psychotherapy. Attitudes and ideals among therapists and analysts concerning the goals and means of psychotherapy were also associated with patient outcome, although in rather complex ways. A significant part of the outcome differences between patients in psychoanalysis and in psychotherapy could be explained by the adoption, in a large group of therapists, of orthodox psychoanalytic attitudes that seemed to be counterproductive in the practice of psychotherapy but not in psychoanalysis. It is suggested that this effect may be a negative transfer of the psychoanalytic stance into psychotherapeutic practice and that this may be especially pronounced when the attitudes are not backed up by psychoanalytic training.

Long-Term Outcome of Long-Term Psychoanalytically Oriented Therapies: First Findings of the Stockholm Outcome of Psychotherapy and Psychoanalysis Study

The scarcity of findings on the effectiveness of psychodynamic long-term psychotherapy and psychoanalysis is a problem, at least in countries where these treatments are the general treatment of choice. In this study, a sample of 405 patients in various stages before, during, and after treatment was drawn from a population of 1,200 patients who had received or were on a waiting list for public subsidized long-term psychoanalytically oriented psychotherapy or psychoanalysis. The average duration was 40 months for the psychotherapies and 51 months for the psychoanalyses. All patients completed a questionnaire, including the Symptom Checklist-90 (SCL-90), Sense of Coherence Scale (SOCS), and Social Adjustment Scale (SAS), on 3 occasions with 12-month intervals. Using a partly within- and between-subjects design, group means were regressed on an ordinal time scale covering 7 stages in the treatment process: before, early during, during, late during, soon after, after, and late after treatment. The slopes indicated small to moderate effect sizes (d = 0.4-0.6) for psychotherapy and moderate to very large effect sizes (d = 0.4-1.5) for psychoanalysis. The largest effect sizes were on the SCL-90 and the lowest on the SAS for both groups. The proportions of patients with more ‘healthy’ scores compared with the worst scoring 10% in a nonclinical norm group increased from roughly 30% to 55% in the psychotherapy group and from 10% to 75% in the psychoanalysis group. The results underscore the importance of long-term follow-up when evaluation of long-term treatments is concerned.

The factor structure of Antonovsky's sense of coherence scale in swedish clinical and nonclinical samples

Abstract Confirmatory and exploratory factor analyses of Antonovskys Sense of Coherence Scale (SOCS) were run on two clinical and two non-clinical Swedish samples (N = 915). Confirmatory factor analyses did not support the hypothesis of a single common factor measured by all SOCS items, nor the three SOC components posited by Antonovsky. Exploratory factor analysis structures were similar enough across samples to propose the existence of three more or less stable factors. Although simple structure was not obtained, the first two factors were basically equivalent to Antonovskys meaningfulness and comprehensibility components, respectively. On the basis of the high-loading items meaningfulness was interpreted as a zest—depression dimension and comprehensibility as intolerance vs tolerance for emotional conflict. The third factor was only distantly related to manageability, with the items involved all reflecting interpersonal trust and mistrust. The validity of these interpretations was supported by differential correlations between these factors and the Depression, Anxiety and Paranoia subscales of SCL-90.

Therapist attitudes and patient outcomes: II. Therapist attitudes influence change during treatment

Abstract Psychotherapists’ beliefs and attitudes in therapeutic matters, according to the Therapist Attitudes Scales (TASC-2) (Sandell et al., 2004), were related to symptom distress, as measured by the Symptom Checklist-90, in 2 groups of patients: one in ongoing psychoanalytical psychotherapy and the other posttreatment. In the posttreatment group, the zero-order correlations with symptom distress were significant for the therapists attitudes toward kindness and insight as curative factors and supportiveness as a therapeutic style and his or her views on the nature of psychotherapy as a form of artistry; however, they were all near zero and nonsignificant in the in-treatment group. To account for correlations among the attitude variables, multiple regression analyses were compared between the groups. The multiple correlation was essentially zero in the latter group, whereas there was a significant multiple correlation of .51 in the former group. Thus Posttreatment outcome was significantly related to the therapists position on the TASC-2 scales. Kindness and Artistry had particularly strong relations with the posttreatment results, with Neutrality acting like a suppressor. The pattern of relations suggested that therapist attitudes functioned as moderators rather than as mediators.

Subjective health and ill health-related behaviour

OBJECTIVE The aim of this study was to investigate the relation between self-rated health measures and ill healthrelated behaviour. DESIGN The study design was based on a self-report questionnaire taken for three consecutive years. METHOD Path analysis was used to test the relations between (a) The Self-rated Health Scale (SRH) and the General Symptom Index (GSI) from the Symptom Checklist-90 (SCL-90), and (b) self-reports on sick leave, health care utilization and medication, in a group of 155 persons who had terminated psychotherapeutic treatment the year before our three-year panel survey. To investigate the potential moderating function of ongoing psychotherapeutic treatment, we repeated each test in a group of 152 patients in the midst of psychotherapeutic treatment. RESULTS Only weak or zero relations were found between the self-rated health measures and ill health-related behaviour. The multi-group analyses indicated between-group differences in model fit. The few significant specific between-group differences all concerned autoregressive relations. CONCLUSIONS Subjective health did not predict ill health-related behaviour. Ongoing psychotherapeutic treatment did not affect the predictive value of subjective health variables. The weak relations found in the current study illuminate paradoxical outcome differences between subjective well-being and ill health-related behaviour. Our findings are discussed in the light of cultural and personality factors.

An individual differences perspective on change in psychotherapy: The case of health care utilization

Abstract The purpose of this study was to explore systematic interindividual variation in change of a number of health care utilization variables (HCUVs) during psychotherapy and identify patient characteristics associated with this variation. Three-wave panel data from 420 patients were analyzed with nonparametric latent class regression followed by chi-square interaction analyses among patient variables. For the various HCUVs, three to six classes were identified, with widely different patterns of change during treatment. Axis I diagnosis, chronicity, functional impairment, gender, and level of education were among the patient characteristics that differentiated the classes. It was concluded that main effects analyses seriously distort heterogeneity of change and that health care utilization, unless it is a specific therapeutic aim, may be irrelevant as an indication of outcome of psychotherapy.