[The efficacy of outpatient client-centered psychotherapy for bulimia nervosa: results of a randomised controlled trial]. / Wirksamkeit von ambulanter Gesprächspsychotherapie bei Bulimia nervosa: Ergebnisse einer randomisiert-kontrollierten Studie.

The efficacy of outpatient client-centered psychotherapy (CCP) for bulimia nervosa was investigated using guided self help (GSH) as comparison group. In the initial CCP-group ( N=29), 27,6% still met the diagnostic criteria at end of treatment and 34,5% at follow-up. In the completer sample ( N=25), 16% met the diagnostic criteria at end of treatment and 0% at follow-up; significant improvements in eating behaviour, comorbid and general psychopathology could be demonstrated which persisted over the follow-up period and which, in part, were significantly superior to the improvements in the GSH-group. As regards the diagnostic criteria, the CCP proved to be significantly more effective than the GSH for both the ITT and the completer samples. At follow-up, this group difference was present in the completer samples only. The results provide initial evidence for the efficacy of CCP in the outpatient treatment of women with bulimia nervosa.

Patterns of interpersonal problems and their improvement in depressive and anxious patients treated with psychoanalytic therapy.

Interpersonal problems were studied in 121 patients treated with psychoanalytic therapy using the Inventory of Interpersonal Problems. Four characteristic subtypes were identified, which differed in the quality and flexibility of their interpersonal behavior. Independent of the predominant type of interpersonal problems, the psychotherapy treatment led to strong decreases in interpersonal distress and increases in interpersonal differentiation. Psychoanalytic therapy was highly effective for all identified interpersonal subtypes and seems to help patients achieve more satisfactory relationships.

Associations among attachment characteristics, patients' assessment of therapeutic factors, and treatment outcome following inpatient psychodynamic group psychotherapy.

Within a multisite study, including 289 inpatients from six different hospitals who underwent interpersonal-psychodynamic group psychotherapy, associations among attachment characteristics, therapeutic factors, and treatment outcome were investigated. Attachment characteristics were assessed with an interview-based measure (Adult Attachment Prototype Rating [AAPR]) as well as an attachment self-report (Bielefeld Questionnaire of Client Expectations [BQCE]). Therapeutic factors were measured retrospectively with the Dusseldorf Therapeutic Factors Questionnaire and treated as an individual- as well as a hospital-specific characteristic. On an individual level, only the group climate factor independently predicted treatment outcome (i.e., Symptom Checklist-90-R Global Severity Index and Inventory of Interpersonal Problems mean). If simultaneously but separately included into a path model, analyses revealed independent significant effects of AAPR-Security and BQCE-Security on group climate. If modeled as a latent variable (common attachment security), a substantially higher proportion of group climate variance could be explained. Further analyses revealed interactions between particular therapeutic factors and attachment characteristics, indicating a particular importance of these therapeutic factors for different attachment categories.

[Psychotherapy of adjustment disorders]. / Psychotherapie von Anpassungsstörungen.

The purpose of the present study was to investigate the long-term effects of outpatient client-centered psychotherapy limited to 12 sessions on patients with adjustment disorder (ICD-10 F43.2). The patients in the follow-up study (n = 25) had been diagnosed to be suffering from an adjustment disorder in response to one of the following stressful events: the loss of an important person or a severe negative experience at work or university with lasting negative consequences. Two years after completion of treatment they were examined in regard to their levels of anxiety, depression and satisfaction with life by applying standardized measures. According to self-ratings lasting significant improvements in comparison to the initial symptom severity and no impairment in comparison to the results immediately after the end of the therapy could be observed. Subsequently the symptom decrease gained in the short-term therapy period is clearly maintained over the post-therapy period. Post-treatment gains after two years in the meaning of subsequent improvements - as often discovered in client-centered psychotherapies - could, however, not be demonstrated for patients with this type of disorder.

[Results of psychoanalytic long-term therapy in specific diagnostic groups: improvement in symptoms and interpersonal relationships]. / Ergebnisse analytischer Langzeitpsychotherapien bei spezifischen psychischen Störungen: Verbesserungen in der Symptomatik und in interpersonellen Beziehungen.

OBJECTIVES: In the present paper, data from four German studies on the efficacy of outpatient psychoanalytic long-term psychotherapy were examined for symptom reduction (SCL-90-R) and reduction of interpersonal problems (IIP-D). Specifically, the research question addressed the efficacy of long-term therapy in specific diagnostic groups and was was compared with that of a parallel group who underwent shorter-term psychodynamic therapy. METHODS: Data from four German studies addressing the efficacy of outpatient psychoanalytic long-term therapy were collected. Evaluation of these data was carried for specific diagnostic groups allowing for comorbid diagnoses. The effects of psychoanalytic therapy were assessed by pre-post and pre-follow-up comparisons using paired t-tests. Additionally, effect sizes were calculated. Psychoanalytic long-term psychotherapy and shorter-term psychodynamic therapy were compared by using a repeated measure ANOVA: Pretreatment vs. posttreatment/follow-up (two-levels) with the between subject factor "therapy conditions" (two levels). RESULTS: The results showed that in terms of improvement of symptoms and interpersonal problems, psychoanalytic long-term therapy was at least as effective as shorter term psychodynamic therapy with regard to the following ICD-10 diagnostic groups: affective disorders (F3), anxiety disorders (F40; F41; F42), personality disorders (F60; F61; F62), and a group of mixed neurotic disorders (F43; F50; F51; F1; F55). Effect sizes were large and remained stable at follow-up. CONCLUSIONS: The authors emphasize the clinical relevance of the examined diagnostic groups and relatively large effects achieved by the psychoanalytic treatment. Furthermore, the occurrence of comorbid diagnoses and their consequences are discussed. The authors stress that the specific effects of psychoanalytic therapy can only be very insufficiently tapped by the outcome measures referring to symptoms and interpersonal problems.

Attachment and substance use disorders: a review of the literature and a study in drug dependent adolescents.

Earlier studies on attachment and substance use disorders using the Hazan and Shaver (1987) self-report mainly indicate a link with "avoidant" attachment styles. Studies working with the Adult Attachment Interview (Main & Goldwyn, 1998) have produced inconsistent results. The present study used the Bartholomew (1990) interview coding system to assess attachment in a sample of 71 German opiate using, drug dependent adolescents (DDAs, age 14 - 25) and 39 non-clinical controls. Fearful attachment was predominant in DDAs, while controls were predominantly secure. Severity of drug use, as assessed with the European Addiction Severity Index (Gsellhofer, Fahrner, & Platt, 1994) and urinalyses, was positively correlated with fearful attachment, but negatively correlated with dismissing attachment. The presence of comorbid psychiatric disorders was associated with fearful attachment but not with addiction severity.

[Therapy goals, change of goals and goal attainment in the process of psychoanalytically oriented and behavior long-term therapy--a comparative study from the private practices of insurance-registered psychotherapists]. / Therapieziele, Zieländerungen und Zielerreichung im Verlauf psychoanalytisch orientierter und verhaltenstherapeutischer Langzeittherapie--Eine vergleichende Untersuchung aus der Praxis niedergelassener Psychotherapeuten.

In a prospective naturalistic design 31 patients with long-term behavior therapy (average 63 treatment hours) and 31 patients with psychoanalytically-oriented long-term therapy (average 185 treatment hours) were compared. All patients were examined by extern interviewers with the Structured Clinical Interview for Diagnosis (SCID) before they were included in the study. Only patients that showed DSM-III-R criteria of a depressive or anxiety disorder were included. At four times the patient goals in therapy and the actual state was examined: At the beginning of treatment, after 1, after 2,5 and after 3,5 years. At all times the patients could formulate new goals and release old ones. The symptoms were registered by SCL-90-R and the interpersonal problems were recorded by IIP-D. After 3,5 years a follow-up interview was conducted. Although all patients were comparable in their diagnoses the patients in behavior therapy and those in psychoanalytically-oriented therapy differed in a number of characteristics, for example by the way they gained access to therapy (doctors' subscription versus personal initiative for an appointment), the education, the consuming of psychotropic medication and the strain of symptoms. The patients did not differ remarkably in their goals in therapy. The symptoms as a goal did not have the highest priority in both groups, but the category "self-worth-problems" was found in both groups with a high priority. About one third of therapy goals were redefined by the patients in both groups within one year. After 2,5 years the number of goals in the category "interpersonal conflicts" increases remarkably in both treatment groups. For both groups we found the extent of reaching aimed goals in therapy (recorded by GAS) was significant over time. The results seem to prove that psychotherapy under naturalistic conditions aims more at improving the general level of functioning than at reducing the symptoms.