Trends in Psychiatry and Psychotherapy
https://trends.org.br/article/doi/10.1590/2237-6089-2017-0151
Trends in Psychiatry and Psychotherapy
Original Article

What is the appropriate time to measure outcome and process factors in psychodynamic psychotherapy?

Qual o tempo apropriado pata medir fatores de resultado e processo em psicoterapia psicodinâmica?

Camila Piva Da Costa; Carolina Stopinski Padoan; Simone Hauck; Stefania Pigatto Teche; Cláudio Laks Eizirik

http://dx.doi.org/10.1590/2237-6089-2017-0151 Trends Psychiatry Psychother, vol.41, n2, p.112-120, 2019
PDF
SciELO
Downloads: 0
Views: 310

Abstract

Abstract Introduction Different instruments and methods for measuring factors related to the progress and effectiveness of psychodynamic psychotherapy (PDT) have been widely discussed in the literature. However, there are no established guidelines on the most appropriate time to perform these measurements. Objectives The aim of this study is to problematize what is the appropriate time to measure the initial outcomes (symptoms, interpersonal relationships, quality, and social role) and process factors (alliance) in the early stages of PDT. Methods A naturalistic cohort study was conducted, following 304 patients during the first six months of psychotherapy. The therapeutic alliance was evaluated after four sessions; symptoms, interpersonal relationships, and social role were evaluated at intake and after 12 and 24 sessions. Results Our results indicate that four sessions were sufficient to measure the bond dimension of the therapeutic alliance, while more time is probably needed to adequately measure other aspects of the therapeutic alliance, such as tasks and goals. However, 12 sessions of treatment proved sufficient to detect improvements in all dimensions of the outcome instruments with moderate effect sizes, and those gains were stable at the 24th session. Conclusion According to our findings, 12 sessions seem to be sufficient to assess initial gains in PDT, although more studies are needed to evaluate the appropriate time to assess all aspects of the therapeutic alliance. Further studies are also required to evaluate the appropriate time to assess intermediate and long-term progress with regard to symptoms, interpersonal relations, social role and personality reorganization.

Keywords

Psychodynamic psychotherapy, psychotherapy, cohort studies, interpersonal relations, treatment outcome

Resumo

Resumo Introdução Diferentes instrumentos e formas de medir fatores relacionados ao progresso e à efetividade da psicoterapia psicodinâmica (PDT) têm sido amplamente discutidos na literatura. No entanto, não há diretrizes estabelecidas sobre o tempo apropriado para que essas medidas sejam realizadas. Objetivos O objetivo deste estudo é problematizar qual o momento apropriado para medir resultados iniciais (sintomas, relações interpessoais e papel social) e fatores de processo (aliança) nos estágios iniciais da PDT. Métodos Realizou-se estudo de coorte naturalista que acompanhou 304 pacientes durante os primeiros seis meses de psicoterapia. A aliança terapêutica foi avaliada após quatro sessões; sintomas, relações interpessoais e papel social foram avaliados na entrevista de entrada e após 12 e 24 sessões. Resultados Nossos resultados indicam que quatro sessões foram suficientes para medir a dimensão do vínculo da aliança terapêutica, enquanto que é necessário mais tempo para medir adequadamente outros aspectos da aliança terapêutica, como tarefas e objetivos. No entanto, 12 sessões de tratamento revelaram-se suficientes para detectar melhora em todas as dimensões dos instrumentos de resultados com tamanhos de efeito moderados, e esses ganhos se mostraram estáveis na 24ª sessão. Conclusão De acordo com nossos achados, 12 sessões parecem ser suficientes para acessar os ganhos iniciais na PDT, porém mais estudos são necessários para avaliar o tempo apropriado de medir todos os aspectos da aliança terapêutica. São necessários mais estudos para avaliar o tempo apropriado para avaliar os ganhos intermediários e de longo prazo em relação a sintomas, função interpessoal e função social.

Palavras-chave

Psicoterapia psicodinâmica, psicoterapia, estudos de coorte, relações interpessoais, resultado de tratamento

References

Steinert C, Muder T, Rabung S, Hoyer J, Leichsenring F. Psychodynamic therapy: as efficacious as other empirically supported treatments? A meta-analysis testing equivalence of outcomes. Am J Psychiatry. 2017;15:1-11.

Fonagy P. The effectiveness of psychodynamic psychotherapies: an update. World Psychiatry. 2015;14:137-50.

De Maat S, Jonghe F, Kraker R, Leichsenring F, Abbass A, Luyten P. The current state of the empirical evidence for psychoanalysis: a meta-analytic approach. Harv Rev Psychiatry. 2013;21:107-37.

Luyten P, Blatt S, Mayes L. Process and outcome in psychoanalytic psychotherapy research: the need for a (relatively) new paradigm. Psychodynamic psychotherapy research: evidence-based practice and practice-based evidence. 2012:145-60.

Roth A, Fonagy P. What works for whom: A critical review of psychotherapy research. 2005.

Shedler J. The efficacy of psychodynamic psychotherapy. Am Psychol. 2010;65:98-109.

Leuzinger-Bohleber M, Kächele H. An open door review of outcome and process studies in psychoanalysis. 2015.

Goldfried M. Consensus in psychotherapy research and practice: Where have all the findings gone?. Psychother Res. 2000;10:1-16.

Werbart A, Andersson H, Sandell R. Dropout revisited: Patient and therapist initiated discontinuation of psychotherapy as a function. Psychother Res. 2014;24:724-37.

Brown J, Scholle SH, Azur M. Strategies for measuring the quality of psychotherapy: A white paper to inform measure development and implementation. Report submitted to the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services. (Contract No.: HHSP23320095642WC and task order number HHSP 23320100019WI). 2014.

Lambert MJ, Harmon C, Slade K, Whipple JL, Hawkins EJ. Providing feedback to psychotherapists on their patient’s progress: clinical results and practice suggestions. J Clin Psychol. 2005;61:165-74.

Hansen NB, Lambert MJ, Forman EM. The psychotherapy dose-response effect and its implications for treatment delivery services. Clin Psychol. 2002;9:329-43.

Lambert MJ. Presidential address: What we have learned from a decade of research aimed at improving psychotherapy outcome in routine care. Psychother Res. 2007;17:1-14.

Howard KI, Kopta I, Krause SM, Orlinsky DE. The dose-response relationship in psychotherapy. Am Psychol. 1986;41:159-64.

Schiepek G, Aichhorn W, Gruber M, Strunk G, Bachler E, Aas B. Real-time monitoring of psychotherapeutic processes: Concept and compliance. Front Psychol. 2016;7.

Barrett MS, Chua WJ, Crits-Christoph P, Gibbons MB, Thompson D. Early withdrawal from mental health treatment: Implications for psychotherapy practice. Psychother Theor Res Pract Train. 2008;45:247-67.

Gelso CJ. The real relationship in psychotherapy. The hidden foundation of change. 2011.

Grande T, Wolfram K, Rudolf G. What happens after treatment: Can structural change be a predictor of long-term outcome?. Psychodynamic psychotherapy research: Evidence-based practice and practice-based evidence. 2012:169-83.

Hill CE. Therapist techniques, client involvement, and the therapeutic relationship: Inextricably intertwined in the therapy process. Psychother Theor Res Pract Train. 2005;42:431-42.

Howard KI, Lueger RJ, Kolden GG. Measuring progress and outcome in the treatment of affective disorders. Measuring patient change after treatment for mood, anxiety, and personality disorders: Toward a core battery. 1997:263-81.

Norcross JC, Lambert MJ. Psychotherapy relationships that work II. Psychotherapy. 2011;48:4-8.

Horvath AO, Del Re AC, Flückiger C, Symonds D. Alliance in individual psychotherapy. Psychotherapy. 2011;48:9-16.

Horvath AO. The therapeutic relationship: from transference to alliance. J Clin Psychol. 2000;56:163-73.

Philips B, Wennberg P, Wezbart A. Ideas of cure as a predictor of premature termination, early alliance and outcome in psychoanalytic psychotherapy. Psychol Psychother. 2007;80:229-45.

Gastaud MB, Costa CP, Padoan CS, Berger D, D’Incao DB, Krieger DV. Aderência à técnica na psicoterapia psicanalítica: estudo preliminar. J Bras Psiquiatr. 2012;61:189-90.

Derogatis LR, Savitz KL. The SCL-90-R and the Brief Symptom Inventory (BSI) in primary care. Handbook of psychological assessment in primary care settings. 2000:297-334.

Laloni D. Escala de Avaliação de Sintomas 90-R (SCL-90-R): Adaptação, precisão e validade. 2001.

Lambert M, Burlingame G, Umphress V, Hansen N, Vermeersch D, Clouse G. The Reliability and Validity of the Outcome Questionnaire. Clin Psychol Psychother. 1996;3:249-58.

Carvalho LF, Rocha GMA. Tradução e adaptação cultural do Outcome Questionnaire (OQ-45) para o Brasil. Psico-USF. 2009;14:309-16.

Horvath AO, Greenberg LS. Development and validation of the Working Alliance Inventory. J Couns Psychol. 1989;3:223-33.

Bordin E. The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy. 1979;16:252-60.

Horvath AO. Empirical validation of Bordin’s pantheoretical model of alliance: The Working Alliance Inventory perspective. The working alliance: theory, research and practice. 1994:109-28.

Cohen J. Statistical power analysis for the behavioral sciences. 1988.

Tryon GS, Winograd G. Goal consensus and collaboration. Psychotherapy. 2011;48:50-7.

Daniels J, Wearden AJ. Socialization to the model: The active component in the therapeutic alliance? A preliminary study. Behav Cogn Psychother. 2011;39:221-7.

Heinonen E, Lindfors O, Laaksonen MA, Knekt P. Therapists’ professional and personal characteristics as predictors of outcome in short- and long-term psychotherapy. J Affect Disord. 2012;138:301-12.

Garcia JA, Weisz JR. When youth mental health care stops: Therapeutic relationship problems and other reasons for ending youth outpatient treatment. J Consult Clin Psychol. 2002;70:439-43.

Borgeat F, O’Connor K, Amado D, St-Pierre-Delorme MÈ. Psychotherapy augmentation through preconscious priming. Front Psychiatry. 2013;4:1-8.

Michalak J, Klappheck MA, Kosfelder J. Personal goals of psychotherapy patients: The intensity and the “why” of goal-motivated behavior and their implications for the therapeutic process. Psychother Res. 2004;14:193-209.

Schöttke H, Trame L, Sembill A. Relevance of therapy goals in outpatient cognitive-behavioral and psychodynamic psychotherapy. Psychother Res. 2014;24:711-23.

Gabbard GO. Long-term psychodynamic psychotherapy: a basic text. 2017.

Fonagy P, Rost F, Carlyle JA, McPherson S, Thomas R, Pasco Fearon RM. Pragmatic randomized controlled trial of long-term psychoanalytic psychotherapy for treatment-resistant depression: the Tavistock Adult Depression Study (TADS). World Psychiatry. 2015;14:312-21.

Lingiardi V, Colli A, Gentile D, Tanzilli A. Exploration of session process: Relationship to depth and alliance. Psychotherapy. 2011;48:391-400.

6165fc40a95395164d1444a2 trends Articles
Links & Downloads
2238-0019 (Electronic)
Trends Psychiatry Psychother ©2024 All rights reserved.

Trends Psychiatry Psychother

Share this page
Page Sections