Martin Svartberg

Comparative Effects of Short-Term Psychodynamic Psychotherapy: A Meta-Analysis.

In a review of 19 clinically relevant comparative outcome studies published 1978-1988, short-term psychodynamic psychotherapy (STPP) was evaluated as to overall effects, differential effects, and moderating effects vis-à-vis no-treatment controls (NT) and alternative psychotherapies (AP), respectively. Overall, STPP was superior to NT at posttreatment, inferior to AP at posttreatment, and even more so at 1-year follow-up. STPP was inferior to AP in treating depression and, in particular, to cognitive-behavioral therapy for major depression. STPP was equally successful with mixed neurotics. As research quality increased, STPP grew less superior to NT. Furthermore, STPP decreased its overall superiority over NT and increased its overall inferiority to AT on a series of clinically relevant variables. Improvement in research quality from 1978 to 1988 was noted. Evidence, although limited, supported the view that STPP approaches do seem to differ along a few major dimensions.

Different processes for different therapies: therapist actions, therapeutic bond, and outcome.

Therapeutic bond, as a component of the alliance, is considered a common factor in psychotherapy; however, it may operate differently in various treatments. This article investigates therapist actions, particularly affect focus, in the formation of the bond and on reduction of symptoms in short-term dynamic psychotherapy (STDP) and cognitive therapy (CT) for cluster C patients. Forty-six cases (23 STDP and 23 CT) were assessed using the Psychotherapy Process Q-Sort, the Helping Alliance Questionnaire, and the Symptom Checklist 90. These scores were used to determine (a) therapist actions that predict formation of the bond, (b) the relation of the bond to symptom reduction, and (c) how therapist actions and bond interacted to reduce symptoms. Multiple regressions were applied to the total sample and to the STDP and CT cases. Psychotherapy Process Q-Sort items describing avoidance of affects were positively related to the bond in the total sample, STDP and CT. However, the relation between therapist actions, bond, and symptom reduction differed for the two treatments. For STDP, avoidance of affect suppressed the relation of bond to symptom reduction and also negatively influenced symptom reduction. On the other hand, in CT, avoidance of affect was positively related to both the formation of the bond and to symptom reduction. Although the bond is a common factor and important component of the alliance, it appears to operate differently in STDP and CT. A focus on affect is important to the benefits of STDP but interferes with the benefits of CT.

Predicting Patient Change from Therapist Competence and Patient-Therapist Complementarity in Short-Term Anxiety-Provoking Psychotherapy: A Pilot Study.

In this pilot study, therapist competence and patient-therapist complementarity measured by the Structural Analysis of Social Behavior system (SASB; Benjamin, 1974) were examined as to their interrelation and their unique, collective, and interactive contributions to patient change in 20 sessions of short-term anxiety-provoking psychotherapy (STAPP; Sifneos, 1979). Patients were 15 highly educated outpatients, mean age 30 years, with mainly anxiety diagnoses. Therapists were in postgraduate manual-guided STAPP training. Results show that competence in an early session did not relate to patient change. In contrast, patient-therapist complementarity ratings predicted patient change both alone and over and above competence. Predictions were strongest for changes in general distress and dysfunctional attitudes and for shorter term change rather than for longer term change.

Existential loneliness: A review of the concept, its psychosocial precipitants and psychotherapeutic implications for HIV‐infected women

While many of the most urgent psychological issues that women with HIV infection are forced to deal with are existential in nature, and therefore shared by humankind, the assault on their physical and psychological being may trigger these issues in large amounts and may overwhelm their defensive structure. Existential loneliness may be an important existential issue that arises for these women and needs to be given equal consideration alongside other forms of loneliness. In this paper, we review the concept of existential loneliness, discuss methods to measure the concept, delineate some central psychosocial precipitants of existential loneliness among HIV-infected women, and discuss psychotherapeutic implications. We conclude that incorporating an existential philosophical perspective into ones particular therapeutic stance may be especially appropriate with this population.

The role of transference work, the therapeutic alliance, and their interaction in reducing interpersonal problems among psychotherapy patients with Cluster C personality disorders.

The aim of the present study was to examine whether transference work, the therapeutic alliance, and their interaction predicted a reduction in interpersonal problems at treatment termination. Forty-nine patients with Cluster C personality disorders from a randomized controlled trial investigating the effectiveness of short-term dynamic psychotherapy and cognitive therapy were included. Transference work was measured with the Inventory of Therapeutic Strategies (Gaston & Ring, 1992), while the therapeutic alliance was measured with the Helping Alliance Questionnaire (Luborsky, Crits-Christoph, Alexander, Margolis & Cohen, 1983). Less emphasis on transference work predicted overall reduced interpersonal problems, whereas the effects of the therapeutic alliance did not reach statistical significance. An interaction effect was also demonstrated, indicating that greater emphasis on transference work performed on patients with lower therapeutic alliance ratings was associated with a smaller reduction in interpersonal problems at termination. However, the results also indicate that a low dose of transference work may be beneficial in reducing interpersonal problems.

Symptom improvement and its temporal course in short-term dynamic psychotherapy - a growth curve analysis

Using hierarchical linear model procedures, growth curve analyses were performed to examine the course, rate, and correlates of symptom improvement during short-term anxiety-provoking psychotherapy (STAPP) and a 2-year posttermination period. The Symptom Checklist-90 was used to measure general symptomatology. The sample consisted of 15 patients who were found suitable for STAPP. Most had a diagnosis of anxiety. Therapists were in postgraduate manual-guided STAPP training. Results showed that three of four patients made a reliable and clinically significant symptom improvement over the course of treatment. Patients improved at a steady rate during treatment as well as after treatment. Average improvement was large and significant during treatment, while small and marginally significant after treatment. Improvement rates varied significantly over the course of treatment and were faster for patients less rigid in their personality functioning. —J Nerv Ment Dis 183:242-248, 1995

Self-Concept Improvement During and After Short-Term Anxiety-Provoking Psychotherapy: A Preliminary Growth Curve Study

Using hierarchical linear model procedures (Bryk & Raudenbush, 1987, 1992) growth curve analyses were performed to examine the course, rate, and correlates of self-concept development during 20 sessions long short-term anxiety-provoking psychotherapy (STAPP; Sifneos, 1992) and a two-year posttermination period. The control coefficient from the SASB Introject Questionnaire (Benjamin, 1984) were used to capture aspects of client self-concept. The sample consisted of 13 clients suitable for STAPP and with mainly anxiety diagnoses. Therapists were in postgraduate manual-guided STAPP training. Results showed that self-concept improvement during as well as after treatment occurred at a steady yet significantly variable rate among clients. Clients showed significant growth toward self-freeing after termination of therapy. This growth was faster for clients with greater initial symptom improvement. This finding is discussed in relation to Howards three-phase model of psychotherapy outcome.

Change in defense mechanisms during short-term dynamic and cognitive therapy in patients with cluster C personality disorders.

The aims of this study were to examine whether a change in overall defensive functioning during treatment a) would predict change in symptom distress during the course of treatment and follow-up and b) would be greater in short-term dynamic therapy than in cognitive therapy. Patients (N = 50) who met criteria for cluster C personality disorders were randomized to 40 weekly sessions of short-term dynamic therapy or cognitive therapy. Video recordings of a pretreatment interview and therapy session 36 were evaluated using the Defense Mechanisms Rating Scales. Symptom distress was measured using the revised version of Symptom Checklist-90. Change in overall defensive functioning during treatment predicted change in symptom distress from pretreatment to 2 years after treatment. Both treatment groups showed significant changes in defensive functioning toward greater adaptability but without any significant differences between the short-term dynamic therapy and cognitive therapy groups in a sample of patients with cluster C personality disorders.

The effects of common and specific factors in short-term anxiety-provoking psychotherapy : A pilot process-outcome study

This study attempted to identify the necessary and sufficient change factors in short-term anxiety-provoking psychotherapy (STAPP). Twenty patients were randomly assigned to either STAPP or a form of nondirective therapy almost devoid of psychodynamic elements but with common factors of psychotherapy intact. Both treatments were 20 sessions long, were manualized, and therapists in both conditions were experienced clinicians receiving manual-guided supervision. Most patients had a diagnosis of anxiety. Results showed that patients in both treatments improved greatly symptomatically and that no further gains were made after termination. Treatments were equally effective. The therapeutic alliance was a strong predictor of symptom improvement. The findings underscore the importance of common factors pertaining to the therapeutic relationship, and they may open to question, to some degree, the therapeutic effectiveness of psychodynamic technique factors in STAPP. The way in which specific and common factors can be brought together under the umbrella of the concept of affect attunement is discussed.

Cognitive Change Before, During, and After Short-Term Dynamic and Nondirective Psychotherapies: A Preliminary Growth Modeling Study

As part of a randomized clinical trial, in this preliminary study we investigated the shape, rate, and determinants of change in surface cognitions before, during, and after short-term anxiety-provoking psychotherapy (n = 11) and nondirective psychotherapy (n = 10). Cognitions were assessed repeatedly with the Automatic Thoughts Questionnaire (S. D. Hollon & P. C. Kendall, 1980), and data were analyzed using growth-modeling procedures. Both treatments were 20 sessions long, manualized, and conducted by experienced therapists receiving manual-guided supervision. Results showed that patients in both conditions changed significantly after pretherapy evaluation and diagnostic interviews as well as during the 2nd half of therapy. Patients with major depression did not change after the pretherapy interviews, whereas anxiety patients changed substantially and significantly faster than the depressed patients. This differential response pattern is discussed in light of self-schema theory. Lessons to be learned from this study regarding the design of future studies are highlighted.