Dramatic storytelling and naming subjective experiences in psychodynamic treatments of depressed women-An exploratory study of assimilative functions of narrating.

Objective: The present study aims to demonstrate how assimilation processes indicated by formal aspects of in-session narratives change in the course of psychodynamic therapy and how this differs by therapy outcome. Method: Two sessions each from the initial, the middle, and the termination phase of six successful and six unsuccessful psychodynamic treatments were compared. All narratives were identified and coded for dramatic narrating and naming of emotions and mental verbs. Results: Good outcome cases peaked in the use of direct speech and naming negative emotions in the middle phase of treatment. Poorer treatment outcome was associated with a high amount of narrating and a tendency to more dramatic narrating in the termination phase and with a use of more narrative clauses throughout treatment. Conclusions: Emotional remembering and naming of emotional states in the middle phase could provide partial support for the role of assimilation processes in good outcome cases. Narrative characteristics of less successful treatments are discussed.

Efficacy of high-intensity versus low-intensity psychoanalytically oriented long-term treatments and determinants of outcome: individual participant data Meta-analysis of Long-term Analytic treatment Studies (MeLAS).

INTRODUCTION: Long-term psychodynamic/psychoanalytic psychotherapy (LTPP) is a prevalent treatment option for complex mental disorders. Yet, little is known about the role of treatment intensity in LTPP. We present a study protocol for a systematic review and individual participant data (IPD) meta-analysis aggregating and analysing individual data from randomised and quasi-experimental trials by meta-analysis. The purpose is to (1) determine the treatment effectiveness of LTPP with low versus high intensity (up to 2 weekly sessions vs three or more), (2) compare their joint effectiveness to shorter therapies and treatments as usual, (3) identify predictors and moderators of treatment outcomes and (4) determine reciprocal relationships between different outcome domains (symptomatic and structural/personality change) over the courses of LTPP. METHODS AND ANALYSIS: We include studies from (randomised controlled trial, RCT) and quasi-experimental trials, where at least one condition was LTPP of high or low frequency. Long-term treatment is defined as ≥1 year or ≥50 sessions. To be eligible studies must include a standardised outcome measure of symptoms (global or disorder specific) with at least one proof of reliability. The primary outcome is symptom reduction (global or specific), secondary outcome criteria are reliable change, remission, functional capacities, personality, personality functioning and interpersonal pathology. Relevant studies will mainly be identified by searching relevant databases: PubMed, PsycINFO (via EBSCO), Web of Science (via Elsevier), Chochrane's Central Register of Controlled Trials (via Wiley). Risk of bias will be evaluated in line with the Cochrane assessments tools for quasi-experimental trials and RCTs, respectively. ETHICS AND DISSEMINATION: Aggregation of data from primary trials collected based on ethics votes. Dissemination into clinical practice via open access publications of findings. PROSPERO REGISTRATION NUMBER: CRD42022304982; Pre-results.

Insight and Outcome in Long-Term Psychotherapies of Depression.

Objectives: In different therapeutic approaches, insight is acknowledged as an important part of patient's therapeutic change process. We examined whether the level of insight (1) differs between psychoanalytic (PA), psychodynamic (PD) and cognitive-behavioral therapy (CBT), and (2) predicts long-term symptomatic outcome. Methods: A completer sample of 67 depressed patients from the Munich Psychotherapy Study was analyzed. Symptoms were assessed with Beck Depression Inventory (BDI) and Symptom Checklist-Revised (SCL-90-R) at pre-treatment and three-year follow-up. Insight was assessed from 242 sessions of mid-therapy phase with the Experiencing Scale. Results: The general level of insight was higher in PA as compared to CBT, and associated with lower depressive symptoms (BDI) across all three therapeutic modalities at three-year follow-up. Insight was unrelated to general distress (SCL-90-R). Exploratory analyses suggested that patients treated with PA showed higher levels of insight especially in high quality sessions (assessed by therapist). Patients for whom the extent of insight was positively linked to session quality, suffered from more depressive symptoms at three-year follow-up than patients gaining insight when session quality was low. Conclusion: Insight differs between PA and CBT and may be a common change mechanism in long-term psychotherapies.

Is countertransference a valid source of clinical information? Investigating emotional responses to audiotaped psychotherapy sessions.

The study aimed to test whether countertransference reactions contain valid information about the patient. The authors examined whether a significant part of the variance in emotional, cognitive, and motivational responses to recorded therapy sessions is attributable to the patient. Six student raters listened to 605 audiotaped sessions of 81 patients with major depression treated by 19 therapists and indicated their reactions using a modified version of the Countertransference Questionnaire. The relative amount of variance in countertransference reactions due to differences between patients, ranging from 2% to 16%, was significant for most of the countertransference dimensions. Reactions were influenced by type of treatment and severity of depression but not by comorbid personality disorder or interpersonal problems. The relative amount of variance due to differences between raters was large, averaging at 23%. The authors conclude that-albeit having a relatively low "signal-to-noise ratio"in raters without psychotherapy training-countertransference reactions contain valid clinical information.

Aging without depression: a cross-sectional study.

OBJECTIVES: The aim of the study was to analyze the association between secure attachment style, loneliness, and social network as risk factors for late-life depression. METHODS: This cross-sectional study examined 969 subjects of the KORA-Age study. We applied the Relationship-Specific Attachment Scales for Adults (Beziehungsspezifische Bindungsskalen für Erwachsene, BBE), the UCLA Loneliness Scale, and the Social Network Index (SNI). Depression was operationalized through the Geriatric Depression Scale (GDS-15) and/or use of antidepressants. Logistic-regression models were calculated, sex-stratified, and controlled for age and living status. RESULTS: For men, lower depression scores were associated with higher attachment security scores (OR = 0.26, 95% CI = 0.15-0.44) and not reporting feelings of loneliness (OR = 0.27, 95% CI = 0.14-0.53). For women, independent determinants of not having late life depression consist of not feeling lonely (OR = 0.22, 95% CI = 0.13-0.38). DISCUSSION: Loneliness is a risk factor for late life depression in women and men, attachment style is a risk factor more for men, while social network size is not a risk factor.

Psychoanalytic versus psychodynamic therapy for depression: a three-year follow-up study.

The aim of this study was to investigate the effectiveness of long-term psychoanalytic and psychodynamic psychotherapies. In a prospective, randomized outcome study, psychoanalytic (mean duration: 39 months, mean dose: 234 sessions) and psychodynamic (mean duration: 34 months, mean dose: 88 sessions) therapy were compared at post-treatment and at one-, two-, and three-year follow-up in the treatment of patients with a primary diagnosis of unipolar depression. All treatments were carried out by experienced psychotherapists. Primary outcome measures were the Beck Depression Inventory and the Scales of Psychological Capacities, and secondary outcome measures were the Global Severity Index of the Symptom Checklist 90-R, the Inventory of Interpersonal Problems, the Social Support Questionnaire, and the INTREX Introject Questionnaire. Interviewers at pre- and post-treatment and at one-year follow-up were blinded; at two- and three-year follow-up, all self-report instruments were mailed to the patients. Analyses of covariance, effect sizes, and clinical significances were calculated to contrast the groups. We found significant outcome differences between treatments in terms of depressive and global psychiatric symptoms, personality functioning, and social relations at three-year follow-up, with psychoanalytic therapy being more effective. No outcome differences were found in terms of interpersonal problems. We concluded that psychoanalytic therapy associated with its higher treatment dose shows longer-lasting effects.

Comparison of cognitive-behaviour therapy with psychoanalytic and psychodynamic therapy for depressed patients - a three-year follow-up study.

OBJECTIVE: The study investigates the effectiveness of long-term psychotherapies. Cognitive-behaviour therapy was compared with psychoanalytic and psychodynamic therapy in the treatment of patients with a primary diagnosis of unipolar depression. METHOD: In a prospective, quasi-experimental design 100 patients were compared at pre- and post-treatment and three-year follow-up. Outcome measures were the Beck Depression Inventory and Global Severity Index for measuring symptoms, the Inventory of Interpersonal Problems and the Social Support Questionnaire for measurement of social-interpersonal functioning, and the INTREX Introject Questionnaire for measuring personality structure. Comparative effectiveness of the experimental groups was analyzed using mixed models. RESULTS: We found significant outcome differences between psychoanalytic therapy and cognitive-behaviour therapy in depressive and global psychiatric symptoms, partly social-interpersonal and personality structure at three-year follow-up. Psychodynamic therapy was superior to cognitive-behaviour therapy in the reduction of interpersonal problems. CONCLUSION: Psychoanalytic therapy shows significantly longer-lasting effects compared to cognitive-behaviour therapy three years after termination of treatment, which is discussed as a dose-effect.

The scales of psychological capacities: Measuring beyond symptoms.

The Scales of Psychological Capacities (SPC) are introduced as a new measure of structural change as the mode-specific effect of psychoanalytic psychotherapy. The design and results of an interrater reliability study, a convergent and discriminant validity study with well-established construct-near and construct-distant measures, and a discriminant validity study with different diagnostic groups are presented. The results indicate substantial evidence that the SPC are a reliable and valid measure of psychic structure and, if their sensitivity to change is proven, are a suitable instrument for psychoanalytic process-outcome research.