Ulrich Jaeger

The effectiveness of psychoanalytic- interactional psychotherapy in borderline personality disorder

Different methods are available for the psychotherapeutic treatment of patients with severe personality disorders. In Germany, a special form of dynamically oriented therapy called psychoanalytic-interactional psychotherapy or method (PiM) has been clinically applied for many years. PiM was derived from psychoanalytic therapy and has been specifically adapted for the treatment of severely disordered patients, for example, patients with borderline personality disorders, prepsychotic disorders, addictions, and perversions. In a naturalistic study, the effectiveness of PiM was tested in a sample of patients with borderline personality disorders (N = 132). The patients were treated in the Clinic Tiefenbrunn near Göettingen. Standardized, reliable, and valid diagnostic instruments were used to study the treatment effects. According to the results, PiM achieved significant improvements in target symptoms, general symptoms, interpersonal problems, and contentedness with life. The results are discussed with regard to the treatment of severely disordered patients.

Patterns of interpersonal problems in borderline personality disorder.

Abstract Borderline personality disorder (BPD) is characterized by a wide variety of interpersonal problems. We examined whether there are different characteristic interpersonal patterns in BPD and how these patterns are related to symptom distress and therapeutic alliance. In 228 inpatients with diagnoses of BPD, interpersonal subtypes based on the Inventory of Interpersonal Problems (Horowitz et al., Inventar zur Erfassung Interpersonaler Probleme, 2000) were examined through cluster analyses. The global symptom severity and therapeutic alliance were also assessed. We identified five characteristic interpersonal patterns, which we labeled as follows: Cluster 1, “Vindictive”; Cluster 2, “Moderate Submissive”; Cluster 3, “Nonassertive”; Cluster 4, “Exploitable”; and Cluster 5, “Socially Avoidant.” The clusters differed significantly in terms of interpersonal distress, interpersonal differentiation, and severity of global symptoms. The ratings of the therapeutic alliance by therapists during treatment significantly differed between the interpersonal subtypes, and the lowest ratings for patients were in the “Socially Avoidant” cluster. Our results stress the impact of interpersonal style on the appearance and treatment of BPD.

Psychoanalytic-Interactional Therapy versus Psychodynamic Therapy by Experts for Personality Disorders: A Randomized Controlled Efficacy-Effectiveness Study in Cluster B Personality Disorders

Background: With regard to cluster B personality disorders, most psychotherapeutic treatments focus on borderline personality disorder. Evidence-based treatments for patients with other cluster B personality disorders are not yet available. Psychoanalytic-interactional therapy (PIT) represents a transdiagnostic treatment for severe personality disorders. PIT has been applied in clinical practice for many years and has proven effective in open studies. In a randomized controlled trial, we compared manual-guided PIT to nonmanualized pychodynamic therapy by experts in personality disorders (E-PDT) in patients with cluster B personality disorders. Methods: In an inpatient setting, patients with cluster B personality disorders were randomly assigned to manual-guided PIT (n = 64) or nonmanualized E-PDT (n = 58). In addition, a quasi-experimental control condition was used (n = 46) including both patients receiving treatment as usual and patients waiting for treatment. Primary outcomes were level of personality organization and overall psychological distress. As secondary outcomes, depression, anxiety and interpersonal problems were examined. Results: No significant improvements were found in the control patients. Both PIT and E-PDT achieved significant improvements in all outcome measures and were superior to the control condition. No differences were found between PIT and E-PDT in any outcome measure at the end of treatment. The type of cluster B personality disorder had no impact on the results. Conclusions: In an inpatient setting, both PIT and E-PDT proved to be superior to a control condition in cluster B personality disorders. In a head-to-head comparison, both treatments appeared to be equally effective. Further research on the treatment of cluster B personality disorders is required.

Der Zusammenhang zwischen Behandlungserleben und Behandlungserfolg bei der stationären Psychotherapie mit Kindern und Jugendlichen

Zusammenfassung: Fragestellung: Die Studie ging der Frage nach, inwiefern bestimmte Aspekte des Behandlungserlebens bei der stationaren Psychotherapie mit Kindern und Jugendlichen einen signifikanten Zusammenhang mit dem erzielten Behandlungserfolg aufweisen. Methodik: Analysiert wurden die Daten von 95 PatientInnen, die sich zwischen 2002 und 2006 in der Abteilung fur Klinische Psychotherapie von Kindern und Jugendlichen des NLKH Tiefenbrunn in stationarer Behandlung befanden. Zur Uberprufung der Zusammenhange wurden multiple Regressionsanalysen gerechnet, wobei als abhangige Variable im einen Fall die retrospektive Erfolgeinschatzung der Patienten anhand der Fragebogen zur Beurteilung der Behandlung (FBB) betrachtet wurde, im anderen Fall die Differenz im General-Severity-Index (GSI) der Symptomcheckliste 90-R (SCL-90-R) zwischen Aufnahme- und Entlasszeitpunkt. Das Behandlungserleben der Patienten wurde mit dem Stationserfahrungsbogen (SEB) von Sammet und Schauenburg (1999) erfasst. Ergebnisse: Die dire...

Misserfolge in der stationären Therapie von Patienten mit Persönlichkeitsstörungen

ZusammenfassungWährend Wirksamkeit und Effektivität von Psychotherapie in der Behandlung von Persönlichkeitsstörungen vielfach untersucht und erwiesen worden sind, stehen Untersuchungen zu Misserfolgen im Sinne einer ungenügenden Symptombesserung aus. In einem naturalistischen Ansatz wurden die Misserfolge von 1239 stationär behandelten Patienten mit Persönlichkeitsstörungen mithilfe der direkten und indirekten Verlaufsmessung aus Sicht der Patienten sowie der behandelnden Therapeuten untersucht. Zur indirekten Verlaufsmessung wurden die Werte bei Aufnahme und Entlassung des Gesamtschwereindex der Symptom Check List-90-R (SCL-90-R, Patientenurteil) und des Beeinträchtigungsschwere-Score (BSS, Therapeutenurteil) genutzt. Abhängig von der Art der Messung zeigten zwischen 11 und 31% der persönlichkeitsgestörten Patienten keine relevante Symptombesserung. Die Übereinstimmungsgüte der Messarten war mit κ-Werten zwischen 0,1 und 0,3 unbefriedigend. Weder soziodemografische noch klinische Merkmale erlaubten eine Differenzierung zwischen „erfolgreichen“ und „erfolglosen“ Patienten. Im vorliegenden Beitrag werden die Befunde bezüglich methodischer Einschränkungen sowie mit Blick auf klinisch-therapeutische Implikationen und zukünftige Forschungsansätze diskutiert.AbstractWhile psychotherapy has proven its efficacy and effectiveness in the treatment of personality disorders (PD) there is a lack of studies on treatment failure, i.e. non-response or deterioration of psychopathology. In a naturalistic approach the failed treatment of1,239 inpatients with PD was studied by means of direct and indirect assessment of change from patient and therapist perspectives. For indirect assessment the global severity index of the symptom checklist SCL-90-R (self-report by patients) and the impairment severity score (judgement by therapists) were used. Depending on the method between 11% and 31% of inpatients did not show any relevant improvement in symptoms but concordance between the methods was poor (Cohen’s kappa between 0.10 and 0.30). Patients with treatment failure did not differ from those with successful treatment with respect to sociodemographic and clinical features. The findings are discussed with respect to methodological limitations but also reflect possible clinical and therapeutic implications as well as future research approaches.

Psychometrische Überprüfung der Social Phobia Scale (SPS) und der Social Interaction Anxiety Scale (SIAS) im stationären Setting

Zusammenfassung. Da soziale Angste bei stationar behandlungsbedurftigen Psychotherapiepatienten allgemein weit verbreitet sind, bestand das Ziel der vorliegenden Untersuchung in der psychometrischen Uberprufung der Social Phobia Scale (SPS) und der Social Interaction Anxiety Scale (SIAS) im stationaren Setting. Untersucht wurde eine Stichprobe von 823 stationaren Psychotherapiepatienten (190 mit sozialer Phobie, 129 mit sonstigen Angststorungen, 504 mit anderen klinischen Storungen). Die beiden Skalen erweisen sich angesichts hoher interner Konsistenz und Stabilitat als reliabel. Korrelationen mit anderen Beschwerde-Fragebogen belegen eine gute konvergente, aber mangelnde diskriminante Validitat. SPS und SIAS unterscheiden zwar zwischen den untersuchten Storungsgruppen, ihre Klassifikationsleistung im Einzelfall ist jedoch unbefriedigend und sinkt zudem mit zunehmender Komorbiditat. Der Nutzen der beiden Skalen zur Bearbeitung differenzieller diagnostischer Fragestellungen im stationaren Kontext erscheint...

Forms of attunement during the initial stages of music therapy for patients with acute psychosis - A multicentre clinical study

ABSTRACT The aim of this non-experimental follow-up study was to specify and quantify rhythmic attunement processes within free improvisations in the early phase of psychodynamic music therapy in order to investigate its predictive value for therapeutic change. Twenty-one in-patients diagnosed with psychosis (ICD-10F20, 23, 25) were included in the study. Participants received five sessions of individual music therapy as per usual. Improvisations were audio recorded. The initial and final improvisations were analysed with the Rhythmic Attunement Scale for Psychosis (RAS-P), which was specifically developed for the project. Clinical measures included external and self-report assessments (BPRS, Dührsen and Happach, TAS 20). Analysis of the audio recordings revealed early occurrence of rhythmic attunement on a stable and qualitatively high level. BPRS scores showed a post-treatment decline of 20%. There was no significant difference for the Dührsen and Happach and TAS 20 scores. Statistical analysis revealed that when initial rhythmic attunement occurred further into the first session, it was a predictor for the decline of psychotic symptoms. Evidence of carefully organised rhythmic attunement suggests beneficial effects on patients with psychosis through improvisational music therapy. Results are limited due to a small sample size and lack of a control comparison.