Hermann Staats

The Göttingen study of psychoanalytic therapy: first results

Results of a naturalistic study of the effectiveness of psychoanalytic therapy are reported. Outcome data are presented for a sample of N = 36 patients who were treated with psychoanalytic therapy. For a sample of n = 23 of these patients, data for 1‐year follow‐up are available at present. According to the results, psychoanalytic therapy yielded signifi cant improvements in symptoms (Symptom Checklist 90‐R, SCL‐90‐R and rating of psychoanalysts), in interpersonal problems (Inventory of Interpersonal Problems, IIP), in quality of life (Questionnaire of Quality of Life, FLZ), in well‐being (Questionnaire of Changes in Experience and Behaviour, VEV) and in target problems defi ned by the patients (Goal Attainment Scaling, GAS). Large effect sizes between 1.28 and 2.48 were found in symptoms (GSI of the SCL‐90‐R), interpersonal problems (IIP‐total), quality of life (FLZ‐total), well‐being (VEV) and target problems (GAS). At 1‐year follow‐up, all improvements proved to be stable or even increased. The self‐reported improvements in symptoms were corroborated by the ratings of the psychoanalysts. At the end of therapy, 77% of the patients showed clinically signifi cant improvements. In the 1‐year follow‐up group, this was true for 80%. Further results are presented and discussed.

Patterns of interpersonal problems and their improvement in depressive and anxious patients treated with psychoanalytic therapy

Interpersonal problems were studied in 121 patients treated with psychoanalytic therapy using the Inventory of Interpersonal Problems. Four characteristic subtypes were identified, which differed in the quality and flexibility of their interpersonal behavior. Independent of the predominant type of interpersonal problems, the psychotherapy treatment led to strong decreases in interpersonal distress and increases in interpersonal differentiation. Psychoanalytic therapy was highly effective for all identified interpersonal subtypes and seems to help patients achieve more satisfactory relationships.

A Comparison of Psychoanalytic Therapy and Cognitive Behavioral Therapy for Anxiety (Panic/Agoraphobia) and Personality Disorders (APD Study): Presentation of the RCT Study Design

OBJECTIVES Anxiety disorders, most notably panic disorders and agoraphobia, are common mental disorders, and there is a high comorbidity with personality disorders. Randomized controlled trails addressing this highly relevant group of patients are missing. DESIGN The multicenter Anxiety and Personality Disorders (APD) study investigates 200 patients with panic disorder and/or agoraphobia with comorbid personality disorder in a randomized control-group comparison of psychoanalytic therapy (PT) and cognitive behavioral therapy (CBT), including 100 patients in each group. Each patient will be examined over a period of six years, regardless of the duration of the individual treatment. The main issues that are addressed in this study are the comparison of the efficacy of PT and CBT in this special patient population, the comparison of the sustainability of the effects of PT and CBT, the comparison of the long-term cost-benefit-ratios of PT and CBT as well as the investigation of prescriptive patient characteristics for individualized treatment recommendations (differential indication). DISCUSSION The APD study compares efficacy, sustainability, and cost-benefit-ratios of CBT and PT for anxiety plus personality disorders in a randomized controlled trail. The study design meets the requirements for an efficacy study for PT, which were recently defined. TRIAL REGISTRATION Current Controlled Trials ISRCTN12449681.

Geliebtes Feindbild „klassische Langzeitpsychoanalyse“

ZusammenfassungRief und Hofmann (2009, Nervenarzt 80:593–597) kritisieren die Metaanalyse zur Wirksamkeit von „long-term psychodynamic psychotherapy (LTPP)“ von Leichsenring und Rabung (2008, JAMA 300(13):1551–1565) scharf. Sie bemängeln, dass sich die Metaanalyse nicht auf RCT (randomized controlled trial) -Studien beschränkt, sondern auch naturalistische Studien einbezieht, dass sowohl die eingeschlossenen Behandlungen als auch die Störungsbilder zu heterogen seien und unterstellen, dass etliche RCT -Studien mit für psychoanalytische/psychodynamische Langzeitbehandlungen negativen Ergebnissen zwar durchgeführt worden seien, diese aber nicht publiziert worden seien. Der vorliegende Beitrag nimmt zu diesen Punkten Stellung: Die alleinige Fokussierung auf RCT-Studien gilt als überholt und zur Untersuchung der „effecitveness“ von Psychotherapie ist der Einbezug von naturalistischen Studien notwendig; die Heterogenität der in die Metaanalyse eingeschlossen Behandlungsformen sowie der Patienten spiegelt ebenfalls die bei „Effectiveness-Studien“ interessierende Praxisrealität wider; die Unterstellung der Verheimlichung von RCT-Studien wird zurückgewiesen. Als Fazit ergibt sich, dass die Metaanalyse von Leichsenring und Rabung sorgfältig durchgeführt wurde und die Ergebnisse durch separate Analysen einzelner Subgruppen überprüft wurden, sodass sie sehr wohl als wissenschaftlicher Beleg für die Wirksamkeit psychodynamischer Langzeitbehandlungen bei komplexen psychischen Störungen dienen kann.SummaryRief and Hofmann (2009, Nervenarzt 80:593–597) harshly criticise the meta-analysis on the effectiveness of long-term psychodynamic psychotherapy (LTPP) by Leichsenring and Rabung (2008, JAMA 300(13):1551–1565). They find fault with the inclusion of naturalistic studies in addition to randomised clinical trials. Furthermore, they criticise the heterogeneity of the treatments included and the disorders studied. They suspect that a number of RCTs of LTPP with negative results for LTPP have been done and not been published. This paper comments on the following issues: the strict determination of RCTs is scientifically outdated and in order to investigate the effectiveness of psychotherapy naturalistic studies have to be included; the heterogeneity of studies included in meta-analysis as well as the heterogeneity of the patients studied reflect clinical reality, which is the purpose of effectiveness studies. The accusation of repressing results of LTPP RCTs is unsustainable. All in all, the meta-analysis by Leichsenring and Rabung was done accurately, and the results were controlled for by separate analyses of single subgroups. Therefore, their study does provide evidence of the effectiveness of long-term psychodynamic psychotherapy for patients with complex mental disorders.Rief and Hofmann (2009, Nervenarzt 80:593-597) harshly criticise the meta-analysis on the effectiveness of long-term psychodynamic psychotherapy (LTPP) by Leichsenring and Rabung (2008, JAMA 300(13):1551-1565). They find fault with the inclusion of naturalistic studies in addition to randomised clinical trials. Furthermore, they criticise the heterogeneity of the treatments included and the disorders studied. They suspect that a number of RCTs of LTPP with negative results for LTPP have been done and not been published. This paper comments on the following issues: the strict determination of RCTs is scientifically outdated and in order to investigate the effectiveness of psychotherapy naturalistic studies have to be included; the heterogeneity of studies included in meta-analysis as well as the heterogeneity of the patients studied reflect clinical reality, which is the purpose of effectiveness studies. The accusation of repressing results of LTPP RCTs is unsustainable. All in all, the meta-analysis by Leichsenring and Rabung was done accurately, and the results were controlled for by separate analyses of single subgroups. Therefore, their study does provide evidence of the effectiveness of long-term psychodynamic psychotherapy for patients with complex mental disorders.

Anwendung der Methode des „Zentralen Beziehungskonfliktthemas“ (ZBKT) in der Gruppentherapie

Das zentrale Beziehungskonfliktthema (ZBKT) beschreibt ein Interaktionsmuster. Das Verfahren wurde an Transkripten von Therapiesitzungen entwickelt. Untersucht werden Erzahlungen des Patienten uber seine Interaktion mit anderen Menschen, sogenannte „Beziehungsepisoden “(BEs). Aus diesen werden drei Komponenten, die zusammen ein Schema fur (erwartete) Interaktionen ergeben, inhaltsanalytisch bestimmt: der Wunsch (W) des Erzahlers, die Reaktion eines Anderen, des Objekts dieses Wunsches (RO) und die eigene Reaktion darauf (RS). Als „zentral“ wird das Thema aufgefast, das in verschiedenen BEs haufig wiederholt vorkommt. Fur alle Auswertungsschritte ist ein formalisiertes Vorgehen beschrieben, das die reliable Bestimmung eines ZBKT sichern soll.

Patientencharakteristika in psychoanalytischen Ausbildungsambulanzen und Praxen

ZusammenfassungEs wird häufig angenommen, dass sich Patienten psychoanalytischer Ambulanzen von denjenigen niedergelassener Psychoanalytiker unterscheiden: Ambulanzpatienten gelten als stärker beeinträchtigt, häufiger strukturell gestört, weniger gebildet und sozial weniger gut eingebunden. Im Rahmen der Praxisstudie der Deutschen Psychoanalytischen Gesellschaft (DPG-Praxisstudie) wurden an elf Ambulanzen psychoanalytischer Ausbildungsinstitute und in Praxen kooperierender niedergelassener Psychoanalytiker Basisdaten von insgesamt 5908 Patienten erhoben. In der vorliegenden Arbeit werden diese Patienten anhand soziodemografischer und klinisch relevanter Maße beschrieben und die beiden Patientengruppen miteinander verglichen. Als Ergebnis zeigt sich, dass sowohl die Patienten psychoanalytischer Ambulanzen als auch diejenigen niedergelassener Psychoanalytiker sehr beeinträchtigt und behandlungsbedürftig waren; die Patientengruppen unterschieden sich dabei allerdings kaum. Die beschriebenen Vermutungen zu psychoanalytischen Ambulanzpatienten können demnach nicht bestätigt werden.AbstractIt is often assumed that patients of psychoanalytic outpatient centers differ from those of private psychoanalytic practices: outpatients are assumed to be more severely burdened, more frequently impaired in personality organization, less educated and less socially integrated. In the practice study of the German Psychoanalytic Society (DPG-Practice-Study), basic documentation data of 5908 patients were collected in 11 psychoanalytic outpatient centers and in cooperating private psychoanalytic practices. In this article, these patients are described on the basis of sociodemographic and clinically relevant measures, and the two groups are compared. It is shown that the patients in both groups were strongly impaired and in need of treatment; however, there were no substantial differences between patients of psychoanalytic outpatient centers and those of private practices. Therefore, the described assumptions concerning patients of psychoanalytic outpatient centers cannot be confirmed.

Patient Characteristics in Psychodynamic Psychotherapies.

In Germany, the health insurance system covers different forms of psychotherapeutic treatments, including treatments based on psychoanalytic and psychodynamic thinking. Although there are guidelines for selecting a specific psychodynamic approach for a certain individual, it is currently unclear whether these guidelines inform about the actual allocation of patients to psychodynamic treatments in practice. We investigated whether patients starting therapy in 4 types of psychodynamic approaches differ in sociodemographic and clinical characteristics. Data were derived from 386 cases of the DPG Practice Study, a naturalistic, long-term study that investigates effectiveness and sustainability of psychodynamic psychotherapies in Germany. Hereby, patients’ self-reports, therapists’ reports, and information from structured clinical interviews were considered. Patients in a treatment approach with longer duration and face-to-face setting were slightly more impaired in personality functioning. Apart from that, patients differed only in the degree of education. In analytical psychotherapies with couch setting, patients were more highly educated than in other treatments. We conclude that only few patient characteristics were empirically associated with specific psychodynamic treatment approaches. As possible reasons, we consider that the applied instruments in this study might not include relevant variables for selecting a specific kind of psychodynamic treatment (e.g., rigid defense mechanisms or capacity for introspection). Additionally, the agreement on a treatment is discussed as a dyadic process that is rather influenced by characteristics of the patient-therapist dyad than by characteristics of the patient per se.

Geliebtes Feindbild „klassische Langzeitpsychoanalyse“@@@A favourite adversary: „classic long-term psychoanalysis”: Kommentar zu Rief und Hofmann „Die Psychoanalyse soll gerettet werden. Mit allen Mitteln?“@@@Commentary on Rief and Hofmann’s „Psychoanalysis should be rescued. By all means?”

ZusammenfassungRief und Hofmann (2009, Nervenarzt 80:593–597) kritisieren die Metaanalyse zur Wirksamkeit von „long-term psychodynamic psychotherapy (LTPP)“ von Leichsenring und Rabung (2008, JAMA 300(13):1551–1565) scharf. Sie bemängeln, dass sich die Metaanalyse nicht auf RCT (randomized controlled trial) -Studien beschränkt, sondern auch naturalistische Studien einbezieht, dass sowohl die eingeschlossenen Behandlungen als auch die Störungsbilder zu heterogen seien und unterstellen, dass etliche RCT -Studien mit für psychoanalytische/psychodynamische Langzeitbehandlungen negativen Ergebnissen zwar durchgeführt worden seien, diese aber nicht publiziert worden seien. Der vorliegende Beitrag nimmt zu diesen Punkten Stellung: Die alleinige Fokussierung auf RCT-Studien gilt als überholt und zur Untersuchung der „effecitveness“ von Psychotherapie ist der Einbezug von naturalistischen Studien notwendig; die Heterogenität der in die Metaanalyse eingeschlossen Behandlungsformen sowie der Patienten spiegelt ebenfalls die bei „Effectiveness-Studien“ interessierende Praxisrealität wider; die Unterstellung der Verheimlichung von RCT-Studien wird zurückgewiesen. Als Fazit ergibt sich, dass die Metaanalyse von Leichsenring und Rabung sorgfältig durchgeführt wurde und die Ergebnisse durch separate Analysen einzelner Subgruppen überprüft wurden, sodass sie sehr wohl als wissenschaftlicher Beleg für die Wirksamkeit psychodynamischer Langzeitbehandlungen bei komplexen psychischen Störungen dienen kann.SummaryRief and Hofmann (2009, Nervenarzt 80:593–597) harshly criticise the meta-analysis on the effectiveness of long-term psychodynamic psychotherapy (LTPP) by Leichsenring and Rabung (2008, JAMA 300(13):1551–1565). They find fault with the inclusion of naturalistic studies in addition to randomised clinical trials. Furthermore, they criticise the heterogeneity of the treatments included and the disorders studied. They suspect that a number of RCTs of LTPP with negative results for LTPP have been done and not been published. This paper comments on the following issues: the strict determination of RCTs is scientifically outdated and in order to investigate the effectiveness of psychotherapy naturalistic studies have to be included; the heterogeneity of studies included in meta-analysis as well as the heterogeneity of the patients studied reflect clinical reality, which is the purpose of effectiveness studies. The accusation of repressing results of LTPP RCTs is unsustainable. All in all, the meta-analysis by Leichsenring and Rabung was done accurately, and the results were controlled for by separate analyses of single subgroups. Therefore, their study does provide evidence of the effectiveness of long-term psychodynamic psychotherapy for patients with complex mental disorders.Rief and Hofmann (2009, Nervenarzt 80:593-597) harshly criticise the meta-analysis on the effectiveness of long-term psychodynamic psychotherapy (LTPP) by Leichsenring and Rabung (2008, JAMA 300(13):1551-1565). They find fault with the inclusion of naturalistic studies in addition to randomised clinical trials. Furthermore, they criticise the heterogeneity of the treatments included and the disorders studied. They suspect that a number of RCTs of LTPP with negative results for LTPP have been done and not been published. This paper comments on the following issues: the strict determination of RCTs is scientifically outdated and in order to investigate the effectiveness of psychotherapy naturalistic studies have to be included; the heterogeneity of studies included in meta-analysis as well as the heterogeneity of the patients studied reflect clinical reality, which is the purpose of effectiveness studies. The accusation of repressing results of LTPP RCTs is unsustainable. All in all, the meta-analysis by Leichsenring and Rabung was done accurately, and the results were controlled for by separate analyses of single subgroups. Therefore, their study does provide evidence of the effectiveness of long-term psychodynamic psychotherapy for patients with complex mental disorders.

[A favourite adversary: "classic long-term psychoanalysis". Commentary on Rief and Hofmann's "Psychoanalysis should be rescued. By all means?"].

ZusammenfassungRief und Hofmann (2009, Nervenarzt 80:593–597) kritisieren die Metaanalyse zur Wirksamkeit von „long-term psychodynamic psychotherapy (LTPP)“ von Leichsenring und Rabung (2008, JAMA 300(13):1551–1565) scharf. Sie bemängeln, dass sich die Metaanalyse nicht auf RCT (randomized controlled trial) -Studien beschränkt, sondern auch naturalistische Studien einbezieht, dass sowohl die eingeschlossenen Behandlungen als auch die Störungsbilder zu heterogen seien und unterstellen, dass etliche RCT -Studien mit für psychoanalytische/psychodynamische Langzeitbehandlungen negativen Ergebnissen zwar durchgeführt worden seien, diese aber nicht publiziert worden seien. Der vorliegende Beitrag nimmt zu diesen Punkten Stellung: Die alleinige Fokussierung auf RCT-Studien gilt als überholt und zur Untersuchung der „effecitveness“ von Psychotherapie ist der Einbezug von naturalistischen Studien notwendig; die Heterogenität der in die Metaanalyse eingeschlossen Behandlungsformen sowie der Patienten spiegelt ebenfalls die bei „Effectiveness-Studien“ interessierende Praxisrealität wider; die Unterstellung der Verheimlichung von RCT-Studien wird zurückgewiesen. Als Fazit ergibt sich, dass die Metaanalyse von Leichsenring und Rabung sorgfältig durchgeführt wurde und die Ergebnisse durch separate Analysen einzelner Subgruppen überprüft wurden, sodass sie sehr wohl als wissenschaftlicher Beleg für die Wirksamkeit psychodynamischer Langzeitbehandlungen bei komplexen psychischen Störungen dienen kann.SummaryRief and Hofmann (2009, Nervenarzt 80:593–597) harshly criticise the meta-analysis on the effectiveness of long-term psychodynamic psychotherapy (LTPP) by Leichsenring and Rabung (2008, JAMA 300(13):1551–1565). They find fault with the inclusion of naturalistic studies in addition to randomised clinical trials. Furthermore, they criticise the heterogeneity of the treatments included and the disorders studied. They suspect that a number of RCTs of LTPP with negative results for LTPP have been done and not been published. This paper comments on the following issues: the strict determination of RCTs is scientifically outdated and in order to investigate the effectiveness of psychotherapy naturalistic studies have to be included; the heterogeneity of studies included in meta-analysis as well as the heterogeneity of the patients studied reflect clinical reality, which is the purpose of effectiveness studies. The accusation of repressing results of LTPP RCTs is unsustainable. All in all, the meta-analysis by Leichsenring and Rabung was done accurately, and the results were controlled for by separate analyses of single subgroups. Therefore, their study does provide evidence of the effectiveness of long-term psychodynamic psychotherapy for patients with complex mental disorders.Rief and Hofmann (2009, Nervenarzt 80:593-597) harshly criticise the meta-analysis on the effectiveness of long-term psychodynamic psychotherapy (LTPP) by Leichsenring and Rabung (2008, JAMA 300(13):1551-1565). They find fault with the inclusion of naturalistic studies in addition to randomised clinical trials. Furthermore, they criticise the heterogeneity of the treatments included and the disorders studied. They suspect that a number of RCTs of LTPP with negative results for LTPP have been done and not been published. This paper comments on the following issues: the strict determination of RCTs is scientifically outdated and in order to investigate the effectiveness of psychotherapy naturalistic studies have to be included; the heterogeneity of studies included in meta-analysis as well as the heterogeneity of the patients studied reflect clinical reality, which is the purpose of effectiveness studies. The accusation of repressing results of LTPP RCTs is unsustainable. All in all, the meta-analysis by Leichsenring and Rabung was done accurately, and the results were controlled for by separate analyses of single subgroups. Therefore, their study does provide evidence of the effectiveness of long-term psychodynamic psychotherapy for patients with complex mental disorders.