ABSTRACT
OBJECTIVE: To review empirical studies on outpatients' pretherapy suitability for psychoanalytic psychotherapy. METHOD: A literature search for studies in English was made in the databases MEDLINE, PsychInfo and EM-base. Forty-one studies spanning 20 years were selected for a thorough evaluation. RESULTS: Seventy-five per cent of the studies concerned brief dynamic psychotherapy. In general, application of single measures of suitability had a modest predictive value with correlations in the range of 0.17-0.73. There was no consistent difference between various formats of therapies. Most promising variables with the highest correlations with good outcome were: 'good quality of object relations', 'psychological mindedness' and 'motivation for change'. Some clinical guidelines can be drawn from quantitative research to provide the therapist with best method and format. CONCLUSION: The importance of psychological variables known from the development of the brief dynamic therapies and earlier research was confirmed. Most correlations were modest and single factors could not be identified. Multivariate designs that combine different methods and formats with patient characteristics seem most promising in future predictor-outcome research.
Subject(s)
Patient Selection , Practice Guidelines as Topic , Psychoanalytic Therapy , Clinical Trials as Topic , Female , Forecasting , Humans , Male , Medical FutilityABSTRACT
OBJECTIVE: To examine the predictive validity of a particular interview and rating scale of patient suitability for psychoanalytic psychotherapy: The Dynamic Assessment Interview (DAI) scale. METHOD: Seventy-four psychiatric out-patients were interviewed with the DAI and the associations between DAI-scores and measures of outcome and of therapeutic alliance were investigated. RESULTS: Small to moderate correlations were found between the DAI suitability score and outcome (0.06-0.46) and between DAI suitability score and early rated alliance (0.14-0.45). The predictive value of the DAI-score was limited although on a par with the alliance measures used in the study. No other pretherapy predictor variable investigated was found significantly to predict outcome. CONCLUSION: The predictive power of the DAI measure was limited, a result, which is in agreement with results from former studies on suitability.
Subject(s)
Interview, Psychological , Patient Selection , Personality Disorders/psychology , Psychoanalytic Therapy , Adolescent , Adult , Factor Analysis, Statistical , Female , Forecasting , Humans , Interpersonal Relations , Male , Middle Aged , Outcome and Process Assessment, Health Care , Personality Disorders/therapy , Psychometrics , Reproducibility of ResultsABSTRACT
In this study we investigated the interrelationships between the Dynamic Assessment Interview (DAI), the interpersonal process of the assessment interview analyzed with Structural analysis of Social Behavior (SASB), and treatment outcome. The DAI is a semistructured interview and rating procedure designed to evaluate patient suitability for psychodynamic psychotherapy based on the patient's immediate interaction with the assessment interviewer. In the selected sample (n = 20) the DAI ratings showed no significant correlations with the SASB-coded interpersonal process of the assessment interview nor with treatment outcome. The SASB-coded interpersonal process in the assessment interview correlated significantly with interpersonal process early in therapy and was able to predict treatment outcome. It is concluded that the abstract ''inner'' patient characteristics assumed to be of major prognostic importance for psychodynamic psychotherapy might be of limited validity, whereas the patient offered interpersonal process is worth further consideration as a predictor of treatment outcome. Finally, the relatively stressful structure of the DAI interview might have facilitated the prediction of treatment outcome from the interpersonal process in the assessment interview.
ABSTRACT
The Dynamic Assessment Interview (DAI) is a semi-structured interview with anchored scales to rate patients; suitability for psychodynamic psychotherapy. The DAI was inspired by the Personality Assessment Interview developed by Selzer et al. in 1987 and it introduces from the beginning of the assessment interview an explicit focus on the patient's immediate interactions with the interviewer. Seven theoretical derived variables are assessed, namely psychological mindedness, capacity for self-observation, capacity for empathy, tolerance of frustration, motivation, response to confrontation, and ability to contain and work with affect. In addition, the patient's attractiveness as a psychotherapy patient and his or her assumed confidence in the forthcoming treatment are assessed. The patient's personality organization ad modum Kernberg is measured from a global assessment of the interview. The present paper describes the DAI and presents its psychometric properties. An acceptable level of inter-rater agreement was found for the theoretically derived variables and for the personality organization diagnosis, with intra-class correlations or kappa coefficients ranging from 0.68 to 0.80.
Subject(s)
Interview, Psychological/standards , Mental Disorders/therapy , Patient Selection , Psychiatric Status Rating Scales/standards , Psychometrics/methods , Psychotherapy/methods , Adult , Attitude to Health , Factor Analysis, Statistical , Female , Humans , Interview, Psychological/methods , Male , Mental Disorders/classification , Mental Disorders/diagnosis , Middle Aged , Motivation , Observer Variation , Personality , Professional-Patient Relations , Sampling StudiesABSTRACT
This study demonstrates a simple epidemiological method to evaluate the changes in service pattern for a defined catchment area after the establishment of a hospital-based community psychiatry service in Denmark. It measures the number of patients in contact with the service on 2 census days, before the new service was introduced and 3 years later, and deals with quantitative measures of sex, age, diagnosis and type of service contact. The services for 2 other areas are used as controls. A new community psychiatry service with an office situated outside the hospital is described and is shown to be superior to both the psychiatry service from the hospital and the rest of the hospital service: the number of inpatients and day patients were reduced by 42% vs 12% and 16% respectively. The number of outpatients increased by 104% in the new service compared with 23% for the service located at the hospital. The increase in outpatient care for the service outside the hospital was mainly caused by contact with middle-aged women with personality disorders.
Subject(s)
Community Mental Health Services/statistics & numerical data , Deinstitutionalization/trends , Mental Disorders/epidemiology , Adult , Ambulatory Care/statistics & numerical data , Cross-Sectional Studies , Day Care, Medical/statistics & numerical data , Denmark/epidemiology , Female , Hospitals, Psychiatric/statistics & numerical data , Humans , Incidence , Male , Mental Disorders/psychology , Mental Disorders/therapy , Patient Admission/trends , Schizophrenia/epidemiology , Schizophrenia/therapy , Schizophrenic PsychologyABSTRACT
For a number of years consumer satisfaction evaluation has been used as documentary evidence of the effect of treatment in psychiatric service systems. Especially in the USA consumer evaluations have been used in connection with the closure of the large central mental hospitals and the changeover to a community based psychiatric service system. The present investigation was conducted in a large psychiatric hospital and confirmed other such investigations that the patients are satisfied with the psychiatric treatment system. This result is in sharp contrast with society's general attitude to the same treatment system. In the present study we found a significant positive correlation between a positive assessment of hospitalisation and the relatives' contact with the staff on the ward. This is an important result in a period when spending cuts and reductions in staff might reduce time for contacts with relatives. Consumer evaluations such as the present one are necessary as a basis of future adjustments in the psychiatric treatment system.
Subject(s)
Consumer Behavior , Hospitalization , Mental Disorders/therapy , Psychoanalytic Therapy , Adolescent , Adult , Denmark , Female , Follow-Up Studies , Hospitals, Psychiatric , Humans , Male , Mental Disorders/psychology , Middle Aged , Social EnvironmentABSTRACT
Only few research studies on psychotherapy in Denmark have been published. Our investigation summarizes the results of the psychotherapeutic treatment given 1982-1987 at the Outpatient Clinic for the treatment of Neuroses, Psychiatric Hospital in Aarhus. 45% of the 803 patients who were referred to the clinic commenced psychotherapy. 30% of the patients were students aged 20-39 years. Diagnostically, 60% of the patients had neurotic disturbances, 20% were borderline personality organised and the remainder included patients with higher level personality disturbances and psychotic patients. 85% of the patients were on the waiting list for less than six months. 42% of the men and 52% of the women had more than 25 psychotherapy sessions. 80% had individual psychotherapy. According to the opinions of the psychotherapists, 48% of the male patients and 44% of the female patients gained considerably from the treatment. Those who were helped by the treatment received treatment significantly longer than those in whom the condition did not change or deteriorated. The results of the investigation indicate the need for a prospective qualitative study of the therapeutic alliance, and this investigation is in preparation.
