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Therapists’ professional and personal characteristics as predictors of outcome in long-term psychodynamic psychotherapy and psychoanalysis

Published online by Cambridge University Press:  15 April 2020

E. Heinonen ,
P. Knekt ,
T. Jääskeläinen  and
O. Lindfors
E. Heinonen
Affiliation:
National Institute for Health and Welfare, Finland
P. Knekt*
Affiliation:
National Institute for Health and Welfare, Finland Social Insurance Institution, Finland
T. Jääskeläinen
Affiliation:
National Institute for Health and Welfare, Finland
O. Lindfors
Affiliation:
National Institute for Health and Welfare, Finland
*
*Correspondence at: National Institute for Health and Welfare, Mannerheimintie 166, P.O. Box 30, FIN-00271 Helsinki, Finland. Tel.: +358 29 524 8774; fax: +358 29 524 8760. E-mail address:[email protected] (P. Knekt).
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Abstract

Background:

Whether long-term psychodynamic therapy (LPP) and psychoanalysis (PA) differ from each other and require different therapist qualities has been debated extensively, but rarely investigated empirically.

Methods:

In a quasi-experimental design, LPP was provided for 128 and PA for 41 outpatients, aged 20–46 years and suffering from mood or anxiety disorder, with a 5-year follow-up from start of treatment. Therapies were provided by 58 experienced therapists. Therapist characteristics, measured pre-treatment, were assessed with the Development of Psychotherapists Common Core Questionnaire (DPCCQ). General psychiatric symptoms were assessed as the main outcome measure at baseline and yearly after start of treatment with the Symptom Check List, Global Severity Index (SCL-90-GSI).

Results:

Professionally less affirming and personally more forceful and less aloof therapists predicted less symptoms in PA than in LPP at the end of the follow-up. A faster symptom reduction in LPP was predicted by a more moderate relational style and work experiences of both skillfulness and difficulties, indicating differences between PA and LPP in the therapy process.

Conclusions:

Results challenge the benefit of a classically “neutral” psychoanalyst in PA. They also indicate closer examinations of therapy processes within and between the two treatments, which may benefit training and supervision of therapists.

Keywords

Unipolar depressionAnxiety disordersPsychodynamic therapyOther psychotherapyEducation in psychiatry
Type
Original articles
Information
European Psychiatry , Volume 29 , Issue 5 , June 2014 , pp. 265 - 274
Copyright
Copyright © Elsevier Masson SAS 2014

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References

Ablon, J.S., Jones, E.E.On analytic process. J Am Psychoanal Assoc 2005;53:541–568.Google ScholarPubMed
Alexander, F.Psychoanalysis and psychotherapy. J Am Psychoanal Assoc 1954;2:722–733.CrossRefGoogle Scholar
Alexander, F.Psychoanalysis and psychotherapy: developments in theory, technique, and training. New York, NY: Norton; 1956.Google Scholar
A.P.A., Diagnostic and statistical manual of mental disorders. Washington, DC: American Psychiatric Association; 1994.Google Scholar
Blatt, S.J., Shahar, G.Psychoanalysis–with whom, for what, and how? Comparisons with psychotherapy. J Am Psychoanal Assoc 2004;52:393–447.CrossRefGoogle ScholarPubMed
Blomberg, J., Lazar, A., Sandell, R.Long-term outcome of long-term psychoanalytically oriented therapies: first findings of the Stockholm Outcome of Psychotherapy and Psychoanalysis Study. Psychother Res 2001;11:361–382.CrossRefGoogle Scholar
Breslow, N.E., Day, N.E.Statistical methods in cancer research. The analysis of case-control studies. IARC Scientific Publications no 32 Vol. 1. Lyon: International Association for Research on Cancer; 1980.Google Scholar
Busch, F.Distinguishing psychoanalysis from psychotherapy. Int J Psychoanal 2010;91:23–34.CrossRefGoogle ScholarPubMed
de Maat, S., Dekker, J., Schoevers, R., de Jonghe, F.The effectiveness of long-term psychotherapy: methodological research issues. Psychother Res 2007;17:59–65.CrossRefGoogle Scholar
de Maat, S., de Jonghe, F., Schoevers, R., Dekker, J.The effectiveness of long-term psychoanalytic therapy: a systematic review of empirical studies. Harv Rev Psychiatry 2009;17:1–23.CrossRefGoogle ScholarPubMed
de Maat, S., de Jonghe, F., de Kraker, R., Leichsenring, F., Abbass, A., Luyten, P.et al.The current state of the empirical evidence for psychoanalysis: a meta-analytic approach. Harv Rev Psychiatry 2013;21:107–137.Google ScholarPubMed
Derogatis, L.R., Lipman, R.S., Covi, L.SCL-90: an outpatient psychiatric rating scale–preliminary report. Psychopharmacol Bull 1973;9:13–28.Google ScholarPubMed
Dozier, M., Cue, K.L., Barnett, L.Clinicians as caregivers: role of attachment organization in treatment. J Consult Clin Psychol 1994;62:793–800.CrossRefGoogle ScholarPubMed
Eagle, M.N., Wolitzky, D.L.Systematic empirical research versus clinical case studies: a valid antagonism?. J Am Psychoanal Assoc 2011;59:791–818.CrossRefGoogle ScholarPubMed
Eagle, M.N., Wolitzky, D.L.Response to commentaries. J Am Psychoanal Assoc 2012;60:153–168.CrossRefGoogle ScholarPubMed
Gabbard, G.O.Long-term psychodynamic psychotherapy: a basic text. Arlington, VA: American Psychiatric Publishing, Inc; 2004.Google Scholar
Gill, M.M.Ego psychology and psychotherapy. Psychoanal Q 1951;20:62–71.CrossRefGoogle ScholarPubMed
Gill, M.M.Psychoanalysis and exploratory psychotherapy. J Am Psychoanal Assoc 1954;2:771–797.CrossRefGoogle ScholarPubMed
Gill, M.M.Psychoanalysis and psychotherapy. A revision. Int J Psychoanal 1984;11:161–179.Google Scholar
Grant, J., Sandell, R.Close family or mere neighbours? Some empirical data on the differences between psychoanalysis and psychotherapy. In: Richardson, P.Renlund, C.Kächele, H.Research on psychoanalytic psychotherapy with adults London: Karnac Books; 2004. p. 81–107.Google Scholar
Greenson, R.R.The technique and practice of psychoanalysis. London: Hogarth Press and the Institute of Psycho-analysis; 1985.Google Scholar
Hartmann, A., Zeeck, A., Orlinsky, D. Accuracy of therapist's perception of patient's alliance: explaining the error. Paper presented at the 42nd International meeting of the Society for Psychotherapy Research 2011 June 29–July 2.Google Scholar
Heinonen, E., Lindfors, O., Härkänen, T., Virtala, E., Jääskeläinen, T., Knekt, P.Therapists’ professional and personal characteristics as predictors of working alliance in short-term and long-term psychotherapies. Clin Psychol Psychother 2013. http://dx.doi.org/10.1002/cpp.1852.CrossRefGoogle ScholarPubMed
Heinonen, E., Lindfors, O., Laaksonen, M.A., Knekt, P.Therapists’ professional and personal characteristics as predictors of outcome in short- and long-term psychotherapy. J Affect Disord 2012;138:2011 June 29–July 2. p. 301–312.CrossRefGoogle Scholar
Heinonen, E., Orlinsky, D.E.Psychotherapists’ personal identities, theoretical orientations, and professional relationships: elective affinity and role adjustment as modes of congruence. Psychother Res 201310.1080/10503307.2013.814926.CrossRefGoogle ScholarPubMed
Hoffman, I.Z.Doublethinking our way to scientific legitimacy: the desiccation of human experience. J Am Psychoanal Assoc 2009;57:1043–1069.CrossRefGoogle ScholarPubMed
Hoffman, I.Z.Response to Eagle and Wolitzky. J Am Psychoanal Assoc 2012;60:105–120.CrossRefGoogle ScholarPubMed
Holi, M., Sammallahti, P., Aalberg, V.A Finnish validation study of the SCL-90. Acta Psychiatr Scand 1998;97:42–46.CrossRefGoogle ScholarPubMed
Härkänen, T., Knekt, P., Virtala, E., Lindfors, O.A case study in comparing therapies involving informative drop-out, non-ignorable non-compliance and repeated measurements. Stat Med 2005;24:3773–3787.CrossRefGoogle ScholarPubMed
Kazdin, A.E.Mediators and mechanisms of change in psychotherapy research. Annu Rev Clin Psychol 2007;3:1–27.CrossRefGoogle ScholarPubMed
Kernberg, O.F.Psychoanalysis, psychoanalytic psychotherapy and supportive psychotherapy: contemporary controversies. Int J Psychoanal 1999;80:1075–1091.CrossRefGoogle ScholarPubMed
Knekt, P., Lindfors, O. editors. A randomized trial of the effect of four forms of psychotherapy on depressive and anxiety disorders. Design, methods, and results on the effectiveness of short-term psychodynamic psychotherapy and solution-focused therapy during a one-year follow-up. Helsinki: The Social Insurance Institution; 2004 [http://www.thl.fi./hps, Accessed March 12, 2013].Google Scholar
Knekt, P., Lindfors, O., Härkänen, T., Välikoski, M., Virtala, E., Laaksonen, M.A.et al.Randomized trial on the effectiveness of long- and short-term psychodynamic psychotherapy and solution-focused therapy on psychiatric symptoms during a 3-year follow-up. Psychol Med 2008;38:689–703.CrossRefGoogle ScholarPubMed
Knekt, P., Lindfors, O., Laaksonen, M.A., Renlund, C., Haaramo, P., Härkänen, T.et al.Quasi-experimental study on the effectiveness of psychoanalysis, long-term and short-term psychotherapy on psychiatric symptoms, work ability and functional capacity during a 5-year follow-up. J Affect Disord 2011;132:37–47.CrossRefGoogle ScholarPubMed
Kächele, H.Distinguishing psychoanalysis from psychotherapy. Int J Psychoanal 2010;91:35–43.CrossRefGoogle ScholarPubMed
Lee, J.Covariance adjustment of rates based on the multiple logistic regression model. J Chronic Dis 1981;34:415–426.CrossRefGoogle ScholarPubMed
Leichsenring, F., Rabung, S.Long-term psychodynamic psychotherapy in complex mental disorders: update of a meta-analysis. Br J Psychiatry 2011;199:15–22.CrossRefGoogle ScholarPubMed
Lipton, S.D.Later developments in Freud's technique (1920–1939). In: Wolman, B.B.Psychoanalytic technique: a handbook for the practicing psychoanalyst. New York, NY: Basic Books; 1967. p. 51–92.Google Scholar
Lutz, W., Leon, S.C., Martinovich, Z., Lyons, J.S., Stiles, W.B.Therapist effects in outpatient psychotherapy: a three-level growth curve approach. J Couns Psychol 2007;54:32–39.CrossRefGoogle Scholar
Migon, H.S., Gamerman, D.Statistical inference: an integrated approach. London: Arnold; 1999.Google Scholar
Nissen-Lie, H., Monsen, J.T., Rønnestad, M.H.Therapist predictors of early patient-rated working alliance: a multilevel approach. Psychother Res 2010;20:627–646.CrossRefGoogle ScholarPubMed
Nissen-Lie, H., Monsen, J.T., Ulleberg, P., Rønnestad, M.H.Psychotherapists’ self-reports of their interpersonal functioning and difficulties in practice as predictors of patient outcome. Psychother Res 2013;23:86–104.CrossRefGoogle ScholarPubMed
Øiesvold, T., Bakkejord, T., Sexton, J.A.Concurrent validity of the Health of the Nation Outcome Scales compared with a patient-derived measure, the Symptom Checklist-90-Revised in out-patient clinics. Psychiatry Res 2011;187:297–300.CrossRefGoogle ScholarPubMed
Orlinsky, D.E., Ronnestad, M.H.How psychotherapists develop: a study of therapeutic work and professional growth. Washington, DC: American Psychological Association; 2005.CrossRefGoogle Scholar
Rangell, L.Similarities and differences between psychoanalysis and dynamic psychotherapy. J Am Psychoanal Assoc 1954;2:734–744.CrossRefGoogle ScholarPubMed
Rothman, K., Greenland, S., Lash, T.Modern epidemiology. 3rd ed.Philadelphia, PA: Lippincott Williams & Wilkins; 2008.Google Scholar
Rubin, D.B.Multiple imputation for nonresponse in surveys. New York, NY: Wiley; 1987.CrossRefGoogle Scholar
Rubino, G., Barker, C., Roth, T., Fearon, P.Therapist empathy and depth of interpretation in response to potential alliance ruptures: the role of therapist and patient attachment styles. Psychother Res 2000;10:408–420.CrossRefGoogle ScholarPubMed
Sandell, R., Blomberg, J., Lazar, A., Carlsson, J., Broberg, J., Schubert, J.Varieties of long-term outcome among patients in psychoanalysis and long-term psychotherapy: a review of findings in the Stockholm Outcome of Psychoanalysis and Psychotherapy Project (STOPP). Int J Psychoanal 2000;81:921–942.CrossRefGoogle Scholar
Sandell, R., Lazar, A., Grant, J., Carlsson, J., Schubert, J., Broberg, J.Therapist attitudes and patient outcomes. III. A latent class analysis of therapists. Psychol Psychother 2006;79:629–647.CrossRefGoogle ScholarPubMed
Sandell, R., Lazar, A., Grant, J., Carlsson, J., Schubert, J., Broberg, J.Therapist attitudes and patient outcomes: II. Therapist attitudes influence change during treatment. Psychother Res 2007;17:196–204.CrossRefGoogle Scholar
Sandell, R.Research on outcomes of psychoanalysis and psychoanalysis-derived psychotherapies. In: Gabbard, G.O.Litowitz, B.E.Williams, P.Textbook of psychoanalysis Arlington, VA: American Psychiatric Press; 2012. p. 385–403.Google Scholar
SAS Institute Inc. SAS Online Doc. SAS/STAT User's Guide, Version 9.2. Cary, NC: SAS Institute Inc.; 2008.Google Scholar
Schachter, J., Kächele, H.The analyst's role in healing: psychoanalysis-plus. Psychoanal Psychol 2007;24:429–444.CrossRefGoogle Scholar
Schmitz, N., Kruse, J., Heckrath, C., Alberti, L., Tress, W.Diagnosing mental disorders in primary care: the General Health Questionnaire (GHQ) and the Symptom Check List (SCL-90-R) as screening instruments. Soc Psychiatry Psychiatr Epidemiol 1999;34:360–366.CrossRefGoogle ScholarPubMed
Schofield, M., Orlinsky, D., Wiseman, H., Grant, J. Therapists attachment styles, experience of self in close personal relationships and relational manner in therapy. Paper presented at the 42nd International meeting of the Society for Psychotherapy Research 2011 June 29–July 2.Google Scholar
Seybert, C., Desmet, M., Erhardt, I., Hörz, S., Mertens, W., Ablon, J.S.et al.Therapists’ techniques in psychoanalysis and short-term and long-term psychoanalytic psychotherapy: are they different?. J Am Psychoanal Assoc 2011;59:2011 June 29–July 2. p. 592–602.Google Scholar
Stolorow, R.D.Converting psychotherapy to psychoanalysis: a critique of the underlying assumptions. Psychoanal Inq 1990;10:119–130.CrossRefGoogle Scholar
Tyrrell, C.L., Dozier, M., Teague, G.B., Fallot, R.D.Effective treatment relationships for persons with serious psychiatric disorders: the importance of attachment states of mind. J Consult Clin Psychol 1999;67:725–733.CrossRefGoogle ScholarPubMed
Verbeke, G., Molenberghs, G.Linear mixed models in practice: a SAS-oriented approach. New York, NY: Springer; 1997.CrossRefGoogle Scholar
Vivona, J.M.Between a rock and hard science: how should psychoanalysis respond to pressures for quantitative evidence of effectiveness?. J Am Psychoanal Assoc 2012;60:121–129.CrossRefGoogle ScholarPubMed
Wachtel, P.L.Beyond ESTs: problematic assumptions in the pursuit of evidence-based practice. Psychoanal Psychol 2010;27:251–272.CrossRefGoogle Scholar
Waldron, S., Scharf, R.D., Hurst, D., Firestein, S.K., Burton, A.What happens in a psychoanalysis? A view through the lens of the analytic process scales (APS). Int J Psychoanal 2004;85:443–466.CrossRefGoogle Scholar
Wallerstein, R.S.Introduction to panel on psychoanalysis and psychotherapy: the relationship of psychoanalysis to psychotherapy: current issues. Int J Psychoanal 1969;50:117–126.Google ScholarPubMed
Wallerstein, R.S.42 lives in treatment. A study of psychoanalysis and psychotherapy. New York, NY: Guilford; 1986.Google Scholar
Wallerstein, R.S.The psychotherapy research project of the Menninger Foundation: an overview. J Consult Clin Psychol 1989;57:195–205.CrossRefGoogle ScholarPubMed
Wallerstein, R.S.The talking cures: the psychoanalyses and the psychotherapies. New Haven, CT: Yale University Press; 1995.Google Scholar
Walls, G.Is systematic quantitative research scientifically rigorous? Methodological and statistical considerations. J Am Psychoanal Assoc 2012;60:145–152.CrossRefGoogle ScholarPubMed
Wampold, B.E.The great psychotherapy debate: models, methods, and findings. Mahwah, NJ: Lawrence Erlbaum Associates Publishers; 2001.Google Scholar
Warren, C.S.Faustian science and the future of psychoanalysis. J Am Psychoanal Assoc 2012;60:131–144.CrossRefGoogle ScholarPubMed
Widlöcher, D.Distinguishing psychoanalysis from psychotherapy. Int J Psychoanal 2010;91:45–50.CrossRefGoogle ScholarPubMed
Zeeck, A., Orlinsky, D.E., Hermann, S., Joos, A., Wirsching, M., Weidmann, W.et al.Stressful involvement in psychotherapeutic work: therapist, client and process correlates. Psychother Res 2012;22:543–555.CrossRefGoogle ScholarPubMed
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