Johan Schubert

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.

Effect of chronic lithium treatment on monoamine metabolism in rat brain

Lithium chloride was administered chronically in two dose levels to rats giving serum lithium concentrations of about 0.4 and 0.7 meq/l. Treatment with the lower lithium dose did not affect monoamine metabolism in the brain. With the higher dose, accumulation of labelled 5-HT and 5-HIAA in the brain during intravenous infusion of 3H-tryptophan was increased. The effect was also present in the spinal cord following transection of 5-HT neurons, thus occurring independently of nerve impulse activity. The disappearance of labelled 5-HT from brain after intravenous injection of 3H-tryptophan was reduced in lithium-treated animals, indicating that lithium diminishes release of 5-HT from its storage sites. Brain tryptophan was augmented by lithium, whereas levels of free and total tryptophan in serum as well as its catabolism, reflected by liver tryptophan pyrrolase activity, were unaltered. Accumulation and disappearance of labelled dopamine and noradrenaline formed from 14C-tyrosine in brain were not changed by lithium treatment. It is concluded that chronic treatment of rats with lithium within the low dose range recommended for man affects 5-HT, but not catecholamine synthesis and turnover in brain.

Accumulation and disappearance of 3H-5-hydroxytryptamine formed from 3H-tryptophan in mouse brain; Effect of LSD-25

Abstract 3H-Tryptophan was administered intravenously to conscious mice by injection or constant rate infusion. Endogenous tryptophan and 5-hydroxytryptamine levels were not significantly altered by this treatment. 3H-5-HT formed in vivo from the labelled precursor was identified by paper chromatography. Following a pulse-injection of 3H-tryptophan the level of 3H-5-HT in brain rapidly increased reaching a peak within 30 min. Pretreatment of the animals with the tryptophan hydroxylase inhibitor, p-chlorophenylalanine or reserpine, markedly reduced the accumulation of 3H-5-HT. Following the initial peak, the content of 3H-5-HT declined over several hours at a rate that seemed to be exponential between 30 and 180 min after precursor administration with a half-life of about 60 min. Treatment with p-chloro-phenylalanine 60 min after precursor administration did not accelerate the rate of disappearance of 3H-5-HT indicating that the decline of 3H-5-HT content is predominantly determined by turnover of the amine. The procedures were used to study the effect of LSD-25 on mouse brain serotonin metabolism. Following LSD-25 treatment the rates of accumulation and disappearance of 3H-5-HT after 3H-tryptophan administration were markedly reduced. The contents of labelled tryptophan and endogenous tryptophan and 5-HT levels were not altered by drug treatment. The results indicate that LSD-25 reduces both synthesis and turnover of 5-HT in brain. The LSD-25 analogue BOL 148 showed no effect on brain 5-HT metabolism. Possible mechanisms of action of LSD-25 are discussed.

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.

Accumulation and disappearance of 3H-5-hydroxytryptamine formed in vivo from 3H-tryptophan in various regions of the rat brain

Abstract 3H-Tryptophan was administered i.v. to conscious rats. Rates of accumulation and disappearance of 3H-5-hydroxytryptamine in seven regions of the central nervous system were determined. Following infusion of the precursor, the specific activity of accumulated 3H-5-HT was highest in the brain stem and lowest in the cerebellum. The disappearance rates of 3H-5-HT from the various brain regions were determined between 60 and 180 min after precursor injection. The decline of 3H-5-HT seemed to be exponential for all regions and was not influenced by tryptophan hydroxylase inhibition. The rate constants for 3H-5-HT disappearance varied about 2-fold between regions and were lowest in the cerebellum and spinal cord. The results indicate that 5-HT synthesis is highest in the brain stem whereas in regions outside the brain stem 5-HT synthesis is lower, and approximately the same in various regions, except for the cerebellum.

Effect of amphetamines on tryptophan concentrations in mice and rats

(±)‐Amphetamine and some of its analogues were administered intraperitoneally to mice and rats and the concentrations of tryptophan in tissues were analysed by fluorimetric and microbiologic techniques. The concentration of tryptophan in brain was markedly increased by (±)‐amphetamine and reached a maximum about 80 min after drug administration. The effect was dose‐dependent with a threshold dose below 1 mg/kg. (+)‐Amphetamine was significantly more potent than p‐chloroamphetamine and p‐hydroxyamphetamine, indicating that the changes in tryptophan concentrations might be related to the central stimulating effect of the drugs. (±)‐Amphetamine delayed the disappearance from brain of intravenously administered [3H]tryptophan. Inhibition of monoamine oxidase by nialamide (100 mg/kg) and tryptophan hydroxylase by H 22/54 (500 mg/kg) had no effect on the tryptophan concentration in brain.

Professional values and their development among trainees in psychoanalytic psychotherapy1

Forty-six psychotherapy students in three groups at one training institute for psychoanalytic psychotherapy in Sweden were asked to fill out a questionnaire about important influences on their professional development during their three-year training and afterwards. The questionnaire was distributed on three occasions during the training program and on one later occasion. Twenty-one students responded to the questionnaire on all four occasions. Working with patients in therapy, getting supervision, and participating in personal psychotherapy were viewed as the three most important influences on the students. The importance attributed to specialist literature and technical skills seemed to increase over time during the training, while the influences of experiences in personal life and personal qualities decreased. These changes in reported views were reversed in the initial years after graduation. Concerning assets, the students valued the ability to be containing and emphatic as the most important, but in their first years as licensed psychotherapists assigned more importance to the ability to create contact. The training program led to a change over time in a higher rating for the importance of technical and methodological attributes and less emphasis on personal characteristics and experiences. Most of the changes reported during training tended to be reversed afterwards.

The development of therapeutic attitudes during and after psychotherapy training

The aim of this study was to explore changes in psychotherapeutic attitudes of students during training in psychodynamic psychotherapy and the first few years after it. Forty-six students were asked to answer a therapeutic identity questionnaire at three times during training and at one time after it. Twenty-one students completed the questionnaire on all four occasions. The questionnaire assessed attitudes on nine scales relating to beliefs about curative elements in psychotherapy, therapeutic style, and basic assumptions about psychotherapy and human nature. At the beginning of training, students had a clear psychoanalytical orientation, similar to that of their supervisors. From the last year of training, after supervision had ended, and continuing during the post-training period, students distanced themselves from the psychoanalytical orientation and their supervisors toward a more eclectic position. This development may reflect the formation of an autonomous therapeutic identity.

Psychotherapy and antidepressant medication: Scope, procedure and interaction: A survey of psychotherapists’ experience

In two opinion surveys, a total of 130 psychotherapists and psychotherapy students were asked to respond to questions about different aspects of treatment with psychotherapy combined with antidepressant medication. Their answers show that, at psychotherapy units belonging to regional psychiatry, an average of half the patients and at non-regional psychotherapy units nearly a quarter of the patient group were prescribed antidepressant medication. Usually medication is initiated before psychotherapy and more patients terminated than started medication during psychotherapy. The psychotherapists’ experience of combined treatment was either positive, negative or mixed, the latter depending on which patients and which psychic problems were being treated. The reported specific effects on the psychotherapeutic work are presented as well as various aspects of how the medication prescription was performed. Regarding opinions of the interaction between psychotherapy and medication, some psychotherapists considered that the treatments were difficult to combine and should be kept separate, whereas the majority of the psychotherapists advocated an integration of the treatments. On the basis of the survey responses, this paper discusses different aspects of how the prescribing of medication during psychotherapy can be understood and carried out.