In dieser Studie werden die Behandlungsergebnisse einer psychosomatisch-psychotherapeutischen Abteilung an einem Allgemeinkrankenhaus untersucht.

Abstract To evaluate long-term psychotherapy with mode-specific measures, the Scales of Psychological Capacities (SPC) have been applied to measure psychic structure and, by repeated measurements, the psychoanalytic construct structural change. This study focuses on stability and sensitivity to change as crucial psychometric qualities of an outcome measure. Stability was studied using the test–retest reliability method with a sample of 20 depressed patients. Sensitivity to change was investigated with a sample of 42 depressive patients by means of a pre–post comparison of the effects of psychoanalytic long-term psychotherapy, an intervention known to bring about structural change. The test–retest study showed no significant change, thus demonstrating stability of the test. The sensitivity to change of the SPC was very satisfactory, yielding an effect size of 1.84 for the SPC total score; this result was also clinically significant (using the Reliable Change Index) when the sample was compared with 60 healthy controls.

This prospective, comparative study evaluates process and outcome of psycho-analysis and psychodynamic psychotherapies. Diagnostically homogenous samples of depressed patients, diagnosed by two psychiatrists/psychotherapists by means of an ICD-10 and DSM-IV checklist, are compared in a randomised controlled design. All treatments were performed by experienced psychoanalytic psychotherapists (at least five years of professional experience) in private practice in a crossed design. The outcome measure battery is up to commonly agreed upon standards of psychotherapy research and special attention is paid to the measurement of psychoanalytic mode-specific effects, namely structural change with the Scales of Psychological Capacities (SPC). The data come from three different sources: self-rating by patients; assessment by therapists; assessment by researchers (=external investigator). Measurement points are pre-treatment, post-treatment, and follow-up measurement one, two and three years after termination of treatment. Different external investigators carried out pre- and post-treatment interviews to control for memory- and expectancy-effects. Therapeutic process is measured every six months; therapists and patients filled out questionnaires sent by mail.

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.

Zusammenfassung Eine zentrale differentielle Indikationsentscheidung im Rahmen eines psychosomatisch-psychotherapeutischen Beratungsgesprächs betrifft die Frage, ob eine ambulante oder stationäre Psychotherapie angemessen ist. In einer prospektiven Feldstudie einer psychosomatischen Poliklinik wurden 129 Patienten mit ambulanter Therapieempfehlung mit 112 Patienten mit stationärer Therapieempfehlung im Hinblick auf soziodemographische und klinische Daten verglichen. Außerdem wurde untersucht, wie gut die Einschätzung der initialen therapeutischen Arbeitsbeziehung zwischen dem zuweisenden und dem nachbehandelnden Therapeuten übereinstimmt. Die zentralen Ergebnisse: Die differentielle Therapieindikation wird überwiegend aufgrund der Schwere und Art der Störung, einschließlich des Funktions- und Strukturniveaus der Persönlichkeit gestellt. In der Einschätzung der therapeutischen Beziehung durch die zuweisenden Therapeuten besteht kein Unterschied zwischen den Patientengruppen, dagegen wird die Beziehung zu stationären Patienten durch die nachbehandelnden Therapeuten signifikant ungünstiger eingeschätzt. Die Bedeutung der unterschiedlichen Behandlungssettings in Interaktion mit der Schwere der Störung wird diskutiert. Die therapeutische Beziehung im Beratungsgespräch erlaubt keine Prognose auf die therapeutische Beziehung während der Therapie.