Psychoanalytic-Interactional Therapy versus Psychodynamic Therapy by Experts for Personality Disorders: A Randomized Controlled Efficacy-Effectiveness Study in Cluster B Personality Disorders.

BACKGROUND: With regard to cluster B personality disorders, most psychotherapeutic treatments focus on borderline personality disorder. Evidence-based treatments for patients with other cluster B personality disorders are not yet available. Psychoanalytic-interactional therapy (PIT) represents a transdiagnostic treatment for severe personality disorders. PIT has been applied in clinical practice for many years and has proven effective in open studies. In a randomized controlled trial, we compared manual-guided PIT to nonmanualized pychodynamic therapy by experts in personality disorders (E-PDT) in patients with cluster B personality disorders. METHODS: In an inpatient setting, patients with cluster B personality disorders were randomly assigned to manual-guided PIT (n = 64) or nonmanualized E-PDT (n = 58). In addition, a quasi-experimental control condition was used (n = 46) including both patients receiving treatment as usual and patients waiting for treatment. Primary outcomes were level of personality organization and overall psychological distress. As secondary outcomes, depression, anxiety and interpersonal problems were examined. RESULTS: No significant improvements were found in the control patients. Both PIT and E-PDT achieved significant improvements in all outcome measures and were superior to the control condition. No differences were found between PIT and E-PDT in any outcome measure at the end of treatment. The type of cluster B personality disorder had no impact on the results. CONCLUSIONS: In an inpatient setting, both PIT and E-PDT proved to be superior to a control condition in cluster B personality disorders. In a head-to-head comparison, both treatments appeared to be equally effective. Further research on the treatment of cluster B personality disorders is required.

Patterns of interpersonal problems in borderline personality disorder.

Borderline personality disorder (BPD) is characterized by a wide variety of interpersonal problems. We examined whether there are different characteristic interpersonal patterns in BPD and how these patterns are related to symptom distress and therapeutic alliance. In 228 inpatients with diagnoses of BPD, interpersonal subtypes based on the Inventory of Interpersonal Problems (Horowitz et al., Inventar zur Erfassung Interpersonaler Probleme, 2000) were examined through cluster analyses. The global symptom severity and therapeutic alliance were also assessed. We identified five characteristic interpersonal patterns, which we labeled as follows: Cluster 1, "Vindictive"; Cluster 2, "Moderate Submissive"; Cluster 3, "Nonassertive"; Cluster 4, "Exploitable"; and Cluster 5, "Socially Avoidant." The clusters differed significantly in terms of interpersonal distress, interpersonal differentiation, and severity of global symptoms. The ratings of the therapeutic alliance by therapists during treatment significantly differed between the interpersonal subtypes, and the lowest ratings for patients were in the "Socially Avoidant" cluster. Our results stress the impact of interpersonal style on the appearance and treatment of BPD.

[The relationship between interpersonal subtypes and the modification of interpersonal problems in psychotherapy inpatients]. / Der Zusammenhang von interpersonalen Subtypen und der Veränderung interpersonaler Probleme am Beispiel stationärer Psychotherapiepatienten.

OBJECTIVES: Interpersonal problems are typically assessed with the Inventory of interpersonal Problems (IIP; Horowitz et al. 2000). Although patients show different interpersonal profiles, these have to date not been considered in outcome evaluation. We examined whether interpersonal subtypes can be found in inpatients, and whether they differ in the modification of interpersonal problems. Furthermore, we examined the impact of subtypes regarding overall outcome. METHODS: The Structural Summary Method for Circumplex Data was used to examine the interpersonal problems of N=2809 inpatients from the Asklepios Clinic Tiefenbrunn. Subtypes of interpersonal problems were determined by the centroid method of cluster analysis and were compared with regard to treatment effects. RESULTS: Patients were distributed in the interpersonal Circumplex and were assigned to eight IIP subtypes, which differed in improvement with regard to interpersonal problems and overall outcome. CONCLUSIONS: According to the circumplex structure of IIP data, for group level evaluation it is necessary to generate interpersonal subtypes so that clinically relevant results can be demonstrated.

[Psychoanalytic-interactional psychotherapy of severely disturbed adolescents]. / Psychoanalytisch-interaktionelle Psychotherapie von Jugendlichen mit strukturellen Störungen.

Due to specific developmental conditions of adolescence like deficient self reflective capacities or reduced potential to articulate, the psychotherapy of adolescents is faced with special problems. In adolescents with severe Ego-structural disorders like Borderline (Development) Disorders these problems are increased exponentially. Patients replicate their negative and often traumatic relational experiences in everyday life as well as in therapy. The therapeutic treatment of relational entanglements often results in malignant repetitions. Here the Psychoanalytic-interactional Method (PiM) is suitable as intervention where the therapist approaches the patient as a person who influences the development positively and strives for Ego-structural advancement within the therapeutic relation. The Psychoanalytic-interactional Method allows for the adolescence-specific conditions of limited mentalization and particulary for the problem of Ego-structural disorders in adolescence. The method is demonstrated by treatment sequences of the therapy of a juvenile female patient with Borderline (Development) Disorder.

[The effectiveness of psychoanalytic-interactional therapy in borderline personality disorder: a study of clinical data]. / Zur Wirksamkeit psychoanalytisch-interaktioneller Therapie am Beispiel der Borderline-Persönlichkeitsstörung: Daten aus der klinischen Praxis.

OBJECTIVES: Different methods are available for the psychotherapeutic treatment of patients with severe structural mental disorders. Psychoanalytic-interactional therapy is among those methods which have been clinically proven to be effective for many years. Psychoanalytic-interactional therapy was derived from analytic psychotherapy specifically to allow for the treatment of severely disturbed patients, e.g. patients with borderline personality disorders, prepsychotic disorders, addictions and perversions. METHODS: In a naturalistic study, the effectiveness of psychoanalytic-interactional therapy was tested in a sample of patients with borderline personality disorders (N = 132). The patients were treated at the Clinic Tiefenbrunn near Goettingen, Germany. Standardized, reliable and valid diagnostic instruments were used to study the treatment effects. RESULTS: Psychoanalytic-interactional therapy was found to significantly improve target symptoms, general symptoms, interpersonal problems and life satisfaction. DISCUSSION: The results are discussed with regard to the treatment of severely disturbed patients.

[Qualitative psychotherapy research in German speaking countries]. / Qualitative Psychotherapieforschung im deutschsprachigen Raum--Ein Blick auf die Ergebnisse.

OBJECTIVES: The subject of this paper is a review of qualitative research in psychotherapy and psychosomatic medicine in German speaking countries. METHODS: A short systematic survey of the relevant topics is given. RESULTS: The methodology and methods are reviewed as well as subjects and results, e.g. first interview and diagnostics, psychosomatic disorders, research into the course of psychotherapy, patient-therapist-interaction, and follow-up investigations. DISCUSSION: We briefly examine the historical and sociological backgrounds most relevant for the development of qualitative psychotherapy research.

The effectiveness of psychoanalytic-interactional psychotherapy in borderline personality disorder.

Different methods are available for the psychotherapeutic treatment of patients with severe personality disorders. In Germany, a special form of dynamically oriented therapy called psychoanalytic-interactional psychotherapy or method (PiM) has been clinically applied for many years. PiM was derived from psychoanalytic therapy and has been specifically adapted for the treatment of severely disordered patients, for example, patients with borderline personality disorders, prepsychotic disorders, addictions, and perversions. In a naturalistic study, the effectiveness of PiM was tested in a sample of patients with borderline personality disorders (N = 132). The patients were treated in the Clinic Tiefenbrunn near Göettingen. Standardized, reliable, and valid diagnostic instruments were used to study the treatment effects. According to the results, PiM achieved significant improvements in target symptoms, general symptoms, interpersonal problems, and contentedness with life. The results are discussed with regard to the treatment of severely disordered patients.

[Social anxieties in a clinical sample]. / Soziale Angste in einer klinischen Population.

Under the label of social phobia a complex of ailments was introduced into the syndromal diagnostic classification system of ICD-10 and DSM-IV, which is characterized by fear of embarrassing and humiliating experiences in relation to other persons. According to our experiences, however, social phobias and other problems in interpersonal relations are not yet paid the clinical attention that these problems deserve, when the severity of impairments subjects affected by social phobias suffer from is taken into account. There is a considerable lack of research of the psychodynamic aspects of social phobia as well. For this reason, we studied the frequency and extent of social anxieties in a sample of patients requiring psychiatric-psychotherapeutic inpatient treatment suffering from social anxieties (N = 930). This sample was compared to another sample of patients without social anxieties. We applied standardized diagnostic and psychometric instruments in order to collect information about anamnestic and social data as well as data about symptom severity, interpersonal impairments and comorbid disorders. The results do not only show the high frequency of social anxieties (45 %), but also the severe impairments in various domains of personal functioning of patients suffering from social anxieties compared to the patients without severe social anxieties. According to our clinical experiences and to the results presented here, the construct of social phobia as it is currently used in the psychiatric classification systems is an syndromal additive description that falls short of a form of suffering that is characterized by the facts that it is interwoven with the complete social existence of an affected person. For this reason, the term social phobia should be replaced by the more appropriate term of social anxiety.

Qualitative psychotherapy research in German-speaking countries.

The authors present an overview of qualitative psychotherapy research in German-speaking countries. Special attention is paid to specific characteristics of methods, topics, and results, about which little is known in English-speaking countries. The authors describe historical and sociological developments in psychiatry, psychosomatic medicine, clinical psychology, and the social sciences relevant to the advancement of qualitative psychotherapy research. They then focus on the development of methods of analyzing and generalizing data obtained from qualitative observations. Finally, they outline the most important topics and results of these methods: first interviews with patients/diagnostics, psychosomatic syndromes, patient's experience of the therapy process, interaction between patient and therapist, therapist's experience of the therapy process, and follow-up research.