Jeanette Broberg

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.

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.

Self-analysis and post-termination improvement after psychoanalysis and long-term psychotherapy

Long-term follow-up studies of long-term psychoanalytically oriented psychotherapy or psychoanalysis are extremely rare, and few have focused on the post-treatment process itself. In the Stockholm Outcome of Psychoanalysis and Psychotherapy project, one of the results was that patients in psychoanalysis continued to improve after termination to a higher degree than patients in long-term psychotherapy. In this study 20 patients selected from the project were interviewed on two occasions, one and two years after termination, in order to explore how they described their post-treatment processes. The interviews were studied qualitatively using a multiple case study design, and categories of different types of post-treatment development were created from these case studies. Results indicate that the variation within treatment groups is large, and that development may continue in several ways after termination. The most striking difference between psychoanalysis and psychotherapy was not, as hypothesized, in the self-analytic function, but in various self-supporting strategies described by former analysands but not by former psychotherapy patients. However, only self-analysis was significantly correlated with post-termination improvement across both treatments. Three patients improving after termination and three deteriorating are described in detail as illustrations. Some methodological constraints of the design limit the generalizeability of results.