In recent years more attention has been paid to non-responders, i.e. patients who do not benefit from therapy, do not engage in treatment or terminate therapy prematurely.

It was to identify personality factors predicting psychotherapy utilization on the basis of personality pathology, affect regulation and interpersonal functioning.

Affectivity (AREQ), the interpersonal context (QORS) and character pathology (SWAP-200) were assessed.

Combination of instruments showed one stable factor predictive for non-engagement in psychotherapy, revealing an externalizing personality dimension, dominated by externalizing defenses, acting out, deficient super-ego functions, impairment in reflective functioning and in relating to others (n sample 1 = 129). Stability of the predictive power of this personality factor for therapy engagement could be shown and a replication in two other samples (n sample 2 = 95, n sample 3 = 94) confirmed the findings.

Further we examined the question if the externalizing mode of functioning is relevant for the course of psychoanalytic treatments.

In 38 psychoanalytic treatments, severity of symptoms (SCL-90-R), interpersonal problems (IIP), character traits and psychostructural functioning (SWAP-200) were investigated half-yearly.

For the first year denial of needs for closeness, and fears of an impulsive breakthrough of negative affects predicted dropout of therapy. During the second year externalizing defence, projection/projective identification, somatisation, hypochondria and dismissive interpersonal behaviour predicted break-ups.

The studies point at the necessity of interpreting affect-regulatory parameters, such as the externalizing parameter, from the very beginning and during the course of the treatment.