Progressive changes in patients' lives after psychotherapy: which treatment effects support them?

The endurance of psychotherapeutic effects after conclusion of inpatient treatment is examined in a follow-up study of 49 patients with psychosomatic, neurotic, and personality disorders. The perspective is not symptomatological but rather relates to the concrete changes occurring in the lives of the patients after treatment. The investigators hypothesized that the probability of progressively coping with life demands depends on the extent to which patients have gained insight into their central psychological problems. Using the Heidelberg Structural Change Scale (HSCS) to gauge the extent to which patients succeed in gaining cognitively and emotionally definitive insight into their intrapsychic conflicts and the structural vulnerabilities determining their condition, the authors were able to confirm their hypothesis. The HSCS, compared with other measures, offered the only possibility of predicting progressive (i.e., symptomatic) changes. The authors concluded that the demands of external life present opportunities for therapy success to be realized as progressive changes and that these changes can form a basis for further positive development.

[Therapeutic changes beyond the symptoms - effects of inpatient treatment according to the Heidelberg Structural Change Scale]. / Therapeutische Veränderungen jenseits der Symptomatik - Wirkungen stationärer Psychotherapie im Licht der Heidelberger Umstrukturierungsskala.

The question is discussed how changes concerning the patient's ability to recognize and obtain insight into dysfunctional relationship patterns, life-determining conflicts, and structural vulnerability as well as the readiness to take on the responsibility for the negative effects caused by these may be conceptualized. A model has been developed based on Operationalized Psychodynamic Diagnosis (OPD) in which individual problem areas for each patient may be chosen from a list of foci. Changes in these foci are evaluated using the Heidelberg Structural Change Scale which is presented and discussed in detail. This concept is applied to a sample of patients who had been treated in an in-patient setting. It is demonstrated that this method of measuring changes can be used reliably. Furthermore, the changes registered with the structural change scale correlate on an absolute level quite high to the global assessment of outcome through the therapeutic team; this correlation is even higher than the correlation between symptomatic changes and the global assessments. How this concept may be applied in planning, evaluating, and ensuring the quality of psychotherapy is presented in conclusion.