Categorical or dimensional? Differentiation of treatment techniques in short and long-term psychodynamic and psychoanalytic therapies [Elektronische Ressource] / Carolina Seybert

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• Publié par: universitat_ulm
• Publié le: 01 janvier 2011
• Nombre de lectures: 14
• Langue: English
• Poids de l'ouvrage: 6 Mo

Extrait

Department for Psychosomatic Medicine & Psychotherapy
Ulm University

Director: Prof. Dr. Harald Gündel









CATEGORICAL OR DIMENSIONAL? DIFFERENTIATION OF TREATMENT
TECHNIQUES IN SHORT AND LONG-TERM PSYCHODYNAMIC AND
PSYCHOANALYTIC THERAPIES







Dissertation
to obtain the Doctoral Degree of Human Biology (Dr. biol. hum.)
at the Faculty of Medicine, University of Ulm












Carolina Seybert
Porto
2011









































Present Dean: Prof. Dr. Thomas Wirth



1. Reviewer: Prof. Dr. Dr. Horst Kächele


2. Reviewer: Prof. Dr. Anna Buchheim


Graduation Day: 08.07.2011
TABLE OF CONTENTS

1. Introduction.…..………………………………………………………..............1
1.1 Psychoanalytic therapy research……………………………………………... 1
1.1.1 The six stages of treatment research…………………………………........... 4
1.2 Methods of psychoanalytic process research………………………….……. 6
1.2.1 The use of audio- or video-recordings.…….. 7
1.2.2 Triadic Methods: Patient-Therapist-Process…………………………….…... 7
1.3 The ‘Psychotherapy Process Q-set’ (PQS).…....13
1.3.1 Past research with the PQS method………………………………………....16
1.4 Therapeutic techniques………………………………………………………. 27
1.4.1 Introduction to therapeutic techniques…………………………………….... 27
1.4.2 Operationalization of therapeutic techniques by the PQS………………... 29
1.5 Hypothesis and research questions……………………………………….… 48
1.5.1 Hypotheses…………………………………………………………………….. 48
1.5.2 Research questions…………………………………………………………... 48

2. Method and Material……………………………………………………….... 50
2.1 Study framework………………………………………………………………. 50
2.2 Description of the sample………………………………………………….…. 51
2.2.1 Psychoanalysis (PA)………………………………………………………….. 51
2.2.2 Long-term psychodynamic psychotherapies (LTDP)………………….…... 53
2.2.3 Short-term psychodynamic psychotherapies (STDP).….. 55
2.3 Study procedures………………………………………………………….…... 57
2.3.1 Selection criteria for analyzed sessions………………………………….…. 57
2.3.2 Learning experience and rating with the PQS……………………………... 59 2.3.3 Protocol for rating therapy session with the PQS………………………….. 65
2.4 Description of data analysis………………………………………………….. 71
2.4.1 The PQS methodology……………………………………………………….. 71
2.4.2 Different statistical approaches…………………………………………….... 71

3. Results…………………………………………………………………………. 74
3.1 Comparison of most and least characteristic items of the samples……… 74
3.1.1 Description of PA sample in comparison with LTDP and STDP…………. 77
3.1.2 Description of LTDP sample in comparison with STDP and PA…………. 79
3.1.3 Description of STDP sample in comparison with LTDP and PA…………. 81
3.2 Comparison of techniques items…………………………………………….. 83
3.3 Variable items during therapeutic process of STDP, LTDP and PA…….. 86
3.4 Variable technique items during therapeutic process……………………... 91
3.5 Explorative Procedure: ‘Discriminant analysis’……………………………. 95
3.6 Comparison of the samples with the psychoanalytic PQS prototype….. 102

4. Discussion…………………………………………………………………... 103
4.1 Similarities among STDP, LTDP and PA………………………………......103
4.2 Differentiating aspects of each sample……………………………………. 104
4.3 Similarities in the usage of therapy techniques…………………………....106
4.4 Differences in the usage of therapy technique…………………………….107
4.5 Variance of therapeutic factors throughout therapeutic process……….. 109
4.6 Surprising amount of psychoanalytic features in STDP…………………. 112
4.7 The PA sample is not prototypical but what is prototypical?................... 113
4.8 Limitations of the study…………………………………………………….... 116
4.9 Recommendations for further research………………………………….... 119

5. Summary…………………………………………………………………….. 121
6. References…………………………………………………………………... 123

Appendix
Acknowledgements
Curriculum Vitae
LIST OF ABBREVIATIONS
APsaA American Psychoanalytic Association
CALPAS California Psychotherapy Alliance Scale
CCRT Core Conflictual Relationship Theme
CAPS Columbia Analytic Process Scale
CBT Cognitive Behavioral Therapy
DFG Deutsche Forschungsgemeinschaft (German Research Association)
DSM-IV Diagnostic and Statistical Manual of Mental Disorder IV
DSM-V Diagnostic and Statistical Manual of Mental Disorder V
HCVRCS Hill Counselor Verbal Response Category System
ICD-10 International Statistical Classification of Diseases and Related Health
Problems, 10th Revision
IPT Interpersonal Psychotherapy
IPTAR Institute for Psychoanalytic Training and Research
LTDP Long-term psychodynamic psychotherapy
m Mean
N Number
NIMH National Institute of Mental Health
SCL-90 The Symptom Checklist -90
SD Standard deviation
SPSS 17 Statistical Package for Social Science 17.0
STDP Short-term psychodynamic psychotherapy
T Therapist
TDCRP Treatment of Depression Collaborative Research Program
TfP Transference-Focused Psychotherapy
TPI Therapeutic Procedures Inventory
TVII Therapist Verbal Intervention Inventory
P Patient
PA Psychoanalysis
PIRS Psychodynamic Intervention Rating Scale
PQS Psychotherapy Process Q-set
PTSD Post-traumatic stress disorder
q.v. quod vide (see also)
I RF Reflective Functioning
RCT Randomized Controlled Trial
USA United States of America
VPPS Vanderbilt Psychotherapy Process Scales
vs. Versus
# Number



II 1 Introduction

In the field of psychoanalysis prevails a preference for categorical differentiation
between and psychodynamic psychotherapy in terms of technique,
which has not been scientifically determined on the basis of the empirical analysis
of the practiced technique (Kächele 2010). The present study will utilize the
‘Psychotherapy Process Q-set (PQS)’ (Jones 2000) method to differentiate and
acquire a dimensional perspective on this issue. In this way, one will be able to
look into what actually happens in clinical practice and not rely on what
professionals say they do. The PQS ratings of actual therapies will be compared
with the psychoanalytic prototype (according to Ablon & Jones 1998) to assess the
degree of congruence between the therapeutic process (in psychoanalytic and
psychodynamic therapies) and that of the psychoanalytic prototype. This study will
gather an exceptionally large database of material for this field, leading to
heightened scientific discussion surrounding the delimitation of psychoanalysis
and psychodynamic psychotherapy.

1.1 Psychoanalytic Therapy Research
Scientific research on psychoanalysis often revolves around the notion of ‘analytic
process’, although the multiplicity of meanings of this concept (Compton 1990) is
confusing. It is like an image, an appearance without a uniform silhouette, that
everyone among the field recognizes its existence but not many agree on what
form it takes. It might be wise not looking for one sole analytic process but to try
identifying various processes that are located at its different levels. Or pick
definable ingredients, like therapist interventions or techniques, which are less
ambiguous for observation and for comparison (among cases or sessions).
The search for the ‘real’ analytic process started long ago with Alexander & French
(1946) by softening and deviating from canonized principles of psychoanalytic
therapy. Rapidly the critics towards the technical modifications emerged and were
highlighted by the ‘invention of the psychoanalytic ideal technique’ (Eissler 1953).
Historically these disagreements marked the start of the long lasting attempt to
distinguish psychoanalysis from psychodynamic psychotherapy. Gill (1954)
1 strongly advocated the distinction between ‘psychoanalysis proper’ and ‘dynamic
psychotherapy’ (not real psychoanalysis), though he himself later abandoned this
distinction (Gill 1982).
The lively discussion about the proper way to define psychoanalysis persists.
Nevertheless, in 1993, the members of a committee of the ‘International
Psychoanalytic Association’ (IPA), overcoming their theoretical divergences, could
agree about the specific nature and consequences of analytic process (Freedman
et al. 2003). For them, a psychoanalytical process includes transference,
regression transference, interpretation, recognition of symbolic meanings and
expert use of countertransference. Although psychoanalysts seem to agree in
opinion, how does it look in their practice? Some critics and skepticism can still be
heard towards psychoanalytic research being based on therapy recordings,
because in their perspective the process needs to include the subjective
understanding of the participating psychoanalyst. The observing third can never
understand completely while standing outside the dyad. Still, conceptions
concerning