Tilman Grande

Die Heidelberger Umstrukturierungsskala

ZusammenfassungIm Rahmen des Projekts „Praxisstudie analytische Langzeittherapie” wurde von der Heidelberger Arbeitsgruppe ein Instrument entwickelt, welches dazu dient, im Verlauf von analytischen Psychotherapien die Stufen der Umstrukturierung der Patientenpersönlichkeit zu erfassen. Das Instrument ist im formalen Aufbau angelehnt an die Skala APES von Stiles (1992); abweichend davon sind die Entwicklungsstufen der Veränderung nicht auf allgemeine Problemaneignung, sondern auf ein spezifisch psychoanalytisches Prozessmodell bezogen. Die Skala und das in ihr eingearbeitete Prozessmodell wird dargestellt und theoretisch begründet; ferner werden die Ergebnisse einer Reliabilitätsuntersuchung und erste Erfahrungen bei ihrer Anwendung im Rahmen stationärer Psychotherapien und psychoanalytischer Langzeittherapien dargestellt. Es wird hervorgehoben, dass es sich nicht nur um ein Forschungsinstrument handelt, sondern auch um ein praxisnahes Werkzeug zur Planung und Evaluation psychodynamischer Behandlungen und somit um einen Beitrag zur Qualitätssicherung in diesem Bereich.SummaryAs a part of a project for „Practical studies about long-term psychoanalytic therapies” an instrument was developed of the Heidelberg Group for measuring the stages of re-structuring of the patient’s personality in the course of analytic therapies. The instrument relies in its formal structure on the APES-Scale of Stiles (1992). In our scale, however, the stages of development not to the general requirement of problems, but rather to an specific model of the psychoanalytic process. The scale and the included model are presented and theoretically founded. Furthermore, results of the reliability and first experiences with application in in-patient therapies are described. It should be emphasized that our scale is not only an instrument of research, but also a of practice for planing and evaluating of psychodynamic treatments and therefore a contribution to quality assurance in this field.

PROGRESSIVE CHANGES IN PATIENTS' LIVES AFTER PSYCHOTHERAPY: WHICH TREATMENT EFFECTS SUPPORT THEM?

The endurance of psychotherapeutic effects after conclusion of inpatient treatment is examined in a follow-up study of 49 patients with psychosomatic, neurotic, and personality disorders. The perspective is not symptomatological but rather relates to the concrete changes occurring in the lives of the patients after treatment. The investigators hypothesized that the probability of progressively coping with life demands depends on the extent to which patients have gained insight into their central psychological problems. Using the Heidelberg Structural Change Scale (HSCS) to gauge the extent to which patients succeed in gaining cognitively and emotionally definitive insight into their intrapsychic conflicts and the structural vulnerabilities determining their condition, the authors were able to confirm their hypothesis. The HSCS, compared with other measures, offered the only possibility of predicting progressive (i.e., symptomatic) changes. The authors concluded that the demands of external life present opportunities for therapy success to be realized as progressive changes and that these changes can form a basis for further positive development.

Structural change as a predictor of long-term follow-up outcome

Abstract Based on data from psychoanalytic long-term psychotherapies, the predictive value of three measures of pre–post change for retrospective patient assessments of outcome at 1-year and 3-year follow-up was investigated. Pre–post changes were measured using the Global Severity Index (GSI), the Inventory of Interpersonal Problems (IIP) total score, and the Heidelberg Structural Change Scale (HSCS). In line with psychoanalytic theory, it was assumed that structural changes cause especially persistent changes and would, therefore, be most suitable to predict the follow-up criterion. This expectation was confirmed: Pre–post changes in GSI and IIP were only weakly associated with assessments at 1-year follow-up and not at all with assessments at 3-year follow-up. In contrast, correlations between changes in HSCS and outcome assessments were highly significant at both occasions.

Self-report and observer ratings of personality functioning: a study of the OPD system.

Recent considerations around DSM–5 criteria of personality disorders (PDs) demand new concepts of assessing levels of personality functioning. Of special interest are multiperspective approaches accounting for clinicians’ as well as patients’ points of view. The study investigates observer-rated and self-assessed levels of personality functioning measured by the level of structural integration as defined by the Operationalized Psychodynamic Diagnosis System (OPD). Both perspectives were positively related. The combination of both measures was most efficient in discriminating among 3 diagnostic groups of varying degrees of personality dysfunction. Future studies should take into account expert ratings as well as self-report data.

A longitudinal study of emotional experience, expressivity, and psychopathology in psychotherapy inpatients and psychologically healthy persons†

The authors investigated changes of emotional experience and expressivity in 34 inpatients undergoing psychodynamic therapy and in 29 healthy persons who were assessed at parallel time intervals. Participants completed 2 measures of psychopathology (Symptom Checklist-90 Revised and Inventory of Interpersonal Problems-64) and took part in relationship episode interviews. The emotional experiences they reported and their nonverbal emotional expressivity during the interviews were assessed by independent raters. Regardless of when they were assessed, the patients reported a greater number of emotions and a greater variety of emotions. Psychopathology in the patient group decreased in the course of treatment, but there were no systematic changes in the emotional domain. The findings challenge the common notion of psychopathology being associated with impaired awareness and expression of emotions.

What Happens After Treatment: Can Structural Change be a Predictor of Long-Term Outcome?

The first systematic follow-up study of therapeutic results was delivered by the Berlin Psychoanalytic Institute and reported by Fenichel [1]. This study set a precedent that many psychoanalysts were to follow in subsequent years [2–4] (for a review see [5]). At times, the work of these analysts had far-reaching social impacts; the studies Duhrssen [6] performed at the Berlin Central Institute for Psychogenic Illnesses led to the inclusion of psychodynamic (PD) and psychoanalytic (PA) treatments among the forms of therapy covered by health insurance in Germany. From the available literature, it is clear that the PA community has cared about the issue of the long-term effects of treatment from early on.

Correction to: Self-Report and Observer Ratings of Personality Functioning: A Study of the OPD System

On page 222, right column, line 49: “Pearson r = .66” should be “Pearson r = .62” On page 222, right column, line 53: “ranged between .39 and .63” should be “ranged between .35 and .59” On page 223, left column, lines 7–8: “MPat = 2.20, SD = 0.60; t = 9.10” should be “MPat = 2.15, SD = 0.54; t = 9.51” On page 223, left column, lines 26–27: “correlations of OPD scales were higher with borderline PDs than with avoidant PD” should be “correlations of OPD–LSIA scales on perception, regulation, and communication with others were higher with borderline PD than with avoidant PD, whereas correlations of OPD–SQ scales did not differ significantly between the two disorders” On page 223, footnote 1, line 5: “56.2% of the variance” should be “57.5% of the variance.” On page 223, right column, line 4: “F(1, 98) = 29.66” should be “F(1,98) = 13.60” On page 223, right column, line 8: “(p = .17)” should be “(p = .57)” On page 224, left column, lines 40–45: “OPD–LSIA expert ratings as well as participant self-report (OPD–SQ) scales correlate higher with the borderline PD diagnosis as compared to avoidant PD. This might indicate that the deficiencies in personality functioning underlying borderline PD are more pronounced or more easily recognizable for both patients and observers” should be “OPD–LSIA expert ratings of perception, regulation, and communications with others correlated higher with BPD compared to APD, whereas participant self-report (OPD–SQ) scales show no difference in magnitude between the two disorders. This might indicate that some aspects of personality dysfunction are less recognizable for individuals with BPD than for observers” On page 223, left column, the reported numbers in Table 3 should be: