Skip to main content

Process and Outcome in Psychoanalytic Psychotherapy Research: The Need for a (Relatively) New Paradigm

  • Chapter
  • First Online:
Psychodynamic Psychotherapy Research

Part of the book series: Current Clinical Psychiatry ((CCPSY))

Abstract

This chapter reviews key assumptions underlying contemporary research on process–outcome relationships in psychoanalytic treatments. This review shows that this body of research, with important exceptions, implicitly or explicitly, is based on a number of assumptions borrowed from pharmaceutical trials that do insufficient justice to the typical processes involved in psychodynamic treatments and in psychotherapy more generally [1].

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 199.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 279.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Stiles WB, Shapiro DA. Abuse of the drug metaphor in psychotherapy process–outcome research. Clin Psychol Rev. 1989;9(4):521–543.

    Article  Google Scholar 

  2. Luyten P, Blatt SJ, Van Houdenhove B, Corveleyn J. Depression research and treatment: are we skating to where the puck is going to be? Clin Psychol Rev. 2006;26(8):985–999.

    Article  PubMed  Google Scholar 

  3. Shahar G. Clinical action: introduction to the special section on the action perspective in clinical psychology. J Clin Psychol. 2006;62(9):1053–1064.

    Article  PubMed  Google Scholar 

  4. Shahar G, Priel B. Active vulnerability, adolescent distress, and the mediating/suppressing role of life events. Pers Indiv Differ. 2003;35(1):199–218.

    Article  Google Scholar 

  5. Blatt SJ. Polarities of experience: relatedness and self definition in personality development, psychopathology, and the therapeutic process. Washington, DC: American Psychological Association; 2008.

    Book  Google Scholar 

  6. Blatt SJ, Behrends RS. Internalization, separation-individuation, and the nature of therapeutic action. Int J Psychoanal. 1987;68:279–297.

    PubMed  Google Scholar 

  7. Fredrickson BL. The role of positive emotions in positive psychology. The broaden-and-build theory of positive emotions. Am Psychol. 2001;56(3):218–226.

    Article  PubMed  CAS  Google Scholar 

  8. Abbass AA, Hancock JT, Henderson J, Kisely SR. Short-term psychodynamic psychotherapies for common mental disorders. Cochrane Database Syst Rev. 2006;18(4):CD004687.

    Google Scholar 

  9. Driessen E, Cuijpers P, de Maat SCM, Abbass AA, de Jonghe F, Dekker JJM. The efficacy of short-term psychodynamic psychotherapy for depression: a meta-analysis. Clin Psychol Rev. 2010;30(1):25–36.

    Article  PubMed  Google Scholar 

  10. Fonagy P, Roth A, Higgitt A. Psychodynamic psychotherapies: evidence-based practice and clinical wisdom. Bull Menninger Clin. 2005;69(1):1–58.

    Article  PubMed  Google Scholar 

  11. Leichsenring F, Rabung S. Effectiveness of long-term psychodynamic psychotherapy: a meta-analysis. J Am Med Assoc. 2008;300(13):1551–1565.

    Article  CAS  Google Scholar 

  12. Shedler J. The efficacy of psychodynamic psychotherapy. Am Psychol. 2010;65(2):98–109.

    Article  PubMed  Google Scholar 

  13. de Maat S, De Jonghe F, de Kraker R, Leichsenring F, Abbass A, Luyten P, et al. The effectiveness of psychoanalysis: a comparison between psychoanalysis (PA) and long-term psychoanalytic psychotherapy (LTPP), ­submitted for publication.

    Google Scholar 

  14. Bhar SS, Thombs BD, Pignotti M, Bassel M, Jewett L, Coyne JC, et al. Is longer-term psychodynamic psychotherapy more effective than shorter-term therapies? Review and critique of the evidence. Psychother Psychosom. 2010;79(4):208–216.

    Article  PubMed  Google Scholar 

  15. Westen D, Novotny CM, Thompson-Brenner H. The empirical status of empirically supported psychotherapies: assumptions, findings, and reporting in controlled clinical trials. Psychol Bull. 2004;130(4):631–663.

    Article  PubMed  Google Scholar 

  16. Luyten P, Blatt SJ, Corveleyn J. Minding the gap between positivism and hermeneutics in psychoanalytic research. J Am Psychoanal Assoc. 2006;54(2):571–610.

    Article  PubMed  Google Scholar 

  17. Ablon JS, Levy R, Katzenstein T. Beyond brand names of psychotherapy: identifying empirically supported change processes. Psychother Theor Res Pract. 2006;43(2):216–231.

    Article  Google Scholar 

  18. Roth A, Fonagy P. What works for whom? A critical review of psychotherapy research. 2nd ed. New York: Guilford Press; 2004.

    Google Scholar 

  19. Kazdin AE. Mediators and mechanisms of change in psychotherapy research. Annu Rev Clin Psychol. 2007;3: 1–27.

    Article  PubMed  Google Scholar 

  20. Kraemer HC, Stice E, Kazdin A, Offord D, Kupfer D. How do risk factors work together? Mediators, moderators, and independent, overlapping, and proxy risk factors. Am J Psychiatry. 2001;158(6):848–856.

    Article  PubMed  CAS  Google Scholar 

  21. Blatt SJ, Zuroff DC, Hawley LL, Auerbach JS. Predictors of sustained therapeutic change. Psychother Res. 2010;20:37–54.

    Article  PubMed  Google Scholar 

  22. Cronbach LJ. Correlation between persons as a research tool. In: Mowrer H, editor. Psychotherapy: theory and research. New York: Ronald Press; 1953. p. 376–389.

    Google Scholar 

  23. Freud S. The neuro-psychoses of defence. In: Strachey J, editor. The standard edition of the complete psychological works of Sigmund Freud, vol. 3. London: Hogarth Press; 1894. p. 43.

    Google Scholar 

  24. Lambert MJ, Barley DE. Research summary on the therapeutic relationship and psychotherapy outcome. In: Norcross JC, editor. Psychotherapy relationships that work. Oxford: Oxford University Press; 2002. p. 17–32.

    Google Scholar 

  25. Fonagy P. The changing shape of clinical practice: driven by science or by pragmatics? Psychoanal Psychother. 2010;24(1):22–43.

    Article  Google Scholar 

  26. Zuroff DC, Blatt SJ. The therapeutic relationship in the brief treatment of depression: contributions to clinical improvement and enhanced adaptive capacities. J Consult Clin Psychol. 2006;74(1):130–140.

    Article  PubMed  Google Scholar 

  27. Stiles WB, Leach C, Barkham M, Lucock M, Iveson S, Shapiro DA, et al. Early sudden gains in psychotherapy under routine clinic conditions: practice-based evidence. J Consult Clin Psychol. 2003;71(1):14–21.

    Article  PubMed  Google Scholar 

  28. Tang TZ, DeRubeis RJ, Hollon SD, Amsterdam J, Shelton R. Sudden gains in cognitive therapy of depression and depression relapse/recurrence. J Consult Clin Psychol. 2007;75(3):404–408.

    Article  PubMed  Google Scholar 

  29. Tang TZ, Luborsky L, Andrusyna T. Sudden gains in recovering from depression: are they also found in psychotherapies other than cognitive-behavioral therapy? J Consult Clin Psychol. 2002;70(2):444–447.

    Article  PubMed  Google Scholar 

  30. Lothane Z. Dramatology in life, disorder, and psychoanalytic therapy: a further contribution to interpersonal psychoanalysis. Int Forum Psychoanal. 2009;18:135–148.

    Article  Google Scholar 

  31. Freud S. The ego and the id. In: Strachey J, editor. The standard edition of the complete psychological works of Sigmund Freud, vol. 19. London: Hogarth Press; 1923. p. 1–59.

    Google Scholar 

  32. Levy KN, Clarkin JF, Yeomans FE, Scott LN, Wasserman RH, Kernberg OF. The mechanisms of change in the treatment of borderline personality disorder with transference focused psychotherapy. J Clin Psychol. 2006;62(4):481–501.

    Article  PubMed  Google Scholar 

  33. Fonagy P, Luyten P. A developmental, mentalization-based approach to the understanding and treatment of borderline personality disorder. Dev Psychopathol. 2009;21(4):1355–1381.

    Article  PubMed  Google Scholar 

  34. Bateman A, Fonagy P. 8-Year follow-up of patients treated for borderline personality disorder: mentalization-based treatment versus treatment as usual. Am J Psychiatry. 2008;165(5):631–638.

    Article  PubMed  Google Scholar 

  35. Vermote R, Lowyck B, Luyten P, Vertommen H, Corveleyn J, Verhaes Y, et al. Process and outcome in psychodynamic hospitalization-based treatment for patients with a personality disorder. J Nerv Ment Dis. 2010;198(2): 110–115.

    Article  PubMed  Google Scholar 

  36. Koelen J, Luyten P, Eurelings-Bontekoe EH, Diguer L, Vermote R, Lowyck B, et al. The impact of personality organisation on treatment response and the therapeutic process, submitted for publication.

    Google Scholar 

  37. Kächele H, Schachter J, Thomä H. From psychoanalytic narrative to empirical single case research: implications for psychoanalytic practice. New York/London: Routledge; 2009.

    Google Scholar 

  38. Luyten P, Lowyck B, Vermote R. The Relationship Between Interpersonal Problems and Outcome in Psychodynamic Hospitalization-Based Treatment for Personality Disorders: A 12-month Follow-Up Study. Psychoanalytic Psychotherapy. 2010;24(4):417–436.

    Google Scholar 

  39. Vermote R, Lowyck B, Luyten P, Verhaest Y, Vertommen H, Vandeneede, B. et al. Patterns of Inner Change and Their Relation with Patient Characteristics and Outcome in a Psychoanalytic Hospitalization-Based Treatment for Personality Disordered Patients. Clinical Psychology & Psychotherapy. 2011;18(4):303–313.

    Google Scholar 

  40. Blatt SJ. Experiences of depression: theoretical, clinical and research perspectives. Washington, DC: American Psychological Association; 2004.

    Book  Google Scholar 

  41. Falkenstrom F, Grant J, Broberg J, Sandell R. Self-analysis and post-termination improvement after psychoanalysis and long-term psychotherapy. J Am Psychoanal Assoc. 2007;55(2):629–674.

    Article  PubMed  Google Scholar 

  42. Luyten P, Fonagy P, Lemma A, Target M. Depression. In A. Bateman P. Fonagy (Eds.), Handbook of Mentalizing in mental health practice (pp. 385–417). Washington, DC: American Psychiatric Association; 2012.

    Google Scholar 

  43. Roisman GI, Padron E, Sroufe LA, Egeland B. Earned secure attachment in retrospect and prospect. Child Dev. 2002;73:1204–1219.

    Article  PubMed  Google Scholar 

  44. Luyten P, Fonagy P, Mayes LC, Vermote R, Lowyck B, Bateman A, et al. Broadening the scope of the mentalization-based approach to psychopathologyk, submitted for publication.

    Google Scholar 

  45. Luyten P, Vliegen N, Van Houdenhove B, Blatt SJ. Equifinality, multifinality, and the rediscovery of the importance of early experiences: pathways from early adversity to psychiatric and (functional) somatic disorders. Psychoanal Study Child. 2008;63:27–60.

    PubMed  Google Scholar 

  46. Luyten P, Mayes LC, Fonagy P, van Houdenhove B. The interpersonal regulation of stress: a developmental framework, submitted for publication.

    Google Scholar 

  47. Zuroff DC, Blatt SJ. When brief treatment is over: enhanced adaptive capacities and stress reactivity after termination. Psychother Res. 2003;13:99–115.

    Article  PubMed  CAS  Google Scholar 

  48. Hawley LL, Ho M-HR, Zuroff DC, Blatt SJ. The relationship of perfectionism, depression, and therapeutic alliance during treatment for depression: latent difference score analysis. J Consult Clin Psychol. 2006;74(5): 930–942.

    Article  PubMed  Google Scholar 

  49. Grant J, Sandell R. Close family or mere neighbors? Some empirical data on the differences between psychoanalysis and psychotherapy. In: Richardson P, Kächele H, Renlund C, editors. Research on psychoanalytic psychotherapy with adults. London: Karnac; 2004. p. 81–108.

    Google Scholar 

  50. Kächele H. Distinguishing psychoanalysis from psychotherapy. Int J Psychoanal. 2010;91(1):35–43.

    Article  PubMed  Google Scholar 

  51. Blatt SJ, Luyten P. A structural-developmental psychodynamic approach to psychopathology: two polarities of experience across the life span. Dev Psychopathol. 2009;21(3):793–814.

    Article  PubMed  Google Scholar 

  52. Allen J, Fonagy P, Bateman A. Mentalizing in clinical practice. Washington: American Psychiatric Press; 2008.

    Google Scholar 

  53. Alexander F, French TM. Psychoanalytic therapy: principles and application. New York: Ronald Press; 1946.

    Google Scholar 

  54. Kohut H. The restoration of the self. New York: International Universities Press; 1977.

    Google Scholar 

  55. Blatt SJ, Luyten P. Reactivating the psychodynamic approach to classify psychopathology. In: Millon T, Krueger RF, Simonsen E, editors. Contemporary directions in psychopathology: scientific foundations of the DSM-V and ICD-11. New York: Guilford Press; 2010. p. 483–514.

    Google Scholar 

  56. Fonagy P, Target M. Attachment, trauma, and psychoanalysis: where psychoanalysis meets neuroscience. In: Jurist EJ, Slade A, Bergner S, editors. Mind to mind: infant research, neuroscience, and psychoanalysis. New York: Other Press; 2008. p. 15–49.

    Google Scholar 

  57. Connolly Gibbons MB, Crits-Christoph P, Barber JP, Stirman SW, Gallop R, Goldstein LA, et al. Unique and common mechanisms of change across cognitive and dynamic psychotherapies. J Consult Clin Psychol. 2009;77(5):801–813.

    Article  Google Scholar 

  58. Kanninen K, Salo J, Punamäki RL. Attachment patterns and working alliance in trauma therapy for victims of political violence. Psychother Res. 2000;10(4):435–449.

    Article  PubMed  CAS  Google Scholar 

  59. Eames V, Roth A. Patient attachment orientation and the early working alliance – a study of patient and therapist reports of alliance quality and ruptures. Psychother Res. 2000;10(4):421–434.

    Article  PubMed  CAS  Google Scholar 

  60. The Boston Change Process Study Group. The “something more” than interpretation revisited: sloppiness and co-creativity in the psychoanalytic encounter. J Am Psychoanal Assoc. 2005;53(3):693–729.

    Article  Google Scholar 

  61. Safran JD, Muran JC, Samstag LW, Steven C. Repairing alliance ruptures. In: Norcross JC, editor. Psychotherapy relationships that work. Oxford: Oxford University Press; 2002. p. 235–254.

    Google Scholar 

  62. Hoglend P. Analys of transference in psychodynamic psychotherapy. Can J Psychoanal. 2004;12:279–300.

    Google Scholar 

  63. Crits-Christoph P, Connolly Gibbons MB. Relational interpretations. In: Norcross JC, editor. Psychotherapy relationships that work. Oxford: Oxford University Press; 2002. p. 285–300.

    Google Scholar 

  64. Hoglend P, Amlo S, Marble A, Bogwald KP, Sorbye O, Sjaastad MC, et al. Analysis of the patient–therapist relationship in dynamic psychotherapy: an experimental study of transference interpretations. Am J Psychiatry. 2006;163(10):1739–1746.

    Article  PubMed  Google Scholar 

  65. Hoglend P, Bogwald K-P, Amlo S, Marble A, Ulberg R, Sjaastad MC, et al. Transference interpretations in dynamic psychotherapy: do they really yield sustained effects? Am J Psychiatry. 2008;165(6):763–771.

    Article  PubMed  Google Scholar 

  66. Johansson P, Hoglend P, Ulberg R, Bogwald KP, Amlo S, Marble A, et al. The mediating role of insight for ­long-term improvements in psychodynamic therapy. Journal of Consulting & Clinical Psychology. 2010;78(3):438–448.

    Google Scholar 

  67. McCullough L, Winston A, Farber BA, Porter F, Pollack J, Laikin M, et al. The relationship of patient-therapist interaction to outcome in brief psychotherapy. Psychotherapy. 1991;28:525–533.

    Article  Google Scholar 

  68. Henry WP, Strupp HH, Schach TE, Gaston L. Psychodynamic approaches. In: Bergin AE, Garfield L, editors. Handbook of psychotherapy and behavior change. 4th ed. New York: Wiley; 1994. p. 467–508.

    Google Scholar 

  69. Ablon JS, Jones E. On analytic process. J Am Psychoanal Assoc. 2005;53(2):541–568.

    Article  PubMed  Google Scholar 

  70. Horowitz LM, Wilson KR, Turan B, Zolotsev P, Constantino MJ, Henderson L. How interpersonal motives clarify the meaning of interpersonal behavior: a revised circumplex model. Pers Soc Psychol Rev. 2006;10(1):67–86.

    Article  PubMed  Google Scholar 

  71. Moskowitz DS, Zuroff DC. Flux, pulse, and spin: dynamic additions to the personality lexicon. J Pers Soc Psychol. 2004;86(6):880–893.

    Article  PubMed  CAS  Google Scholar 

  72. Coady N. The association between complex types of therapist interventions and outcomes in psychodynamic psychotherapy. Res Social Work Prac. 1991;1:257–277.

    Article  Google Scholar 

  73. Bateman A, Fonagy P. Randomized controlled trial of outpatient mentalization-based treatment versus structured clinical management for borderline personality disorder. Am J Psychiatry. 2009;166(12):1355–1364.

    Article  PubMed  Google Scholar 

  74. Lingiardi V, Shedler J, Gazzillo F. Assessing personality change in psychotherapy with the SWAP-200: a case study. J Pers Assess. 2006;86:23–32.

    Article  PubMed  Google Scholar 

  75. Gelso CJ, Hayes JA. The management of counter transference. In: Norcross JC, editor. Psychotherapy relationships that work. Oxford: Oxford University Press; 2002. p. 267–283.

    Google Scholar 

  76. Fonagy P, Gergely G, Target M. The parent–infant dyad and the construction of the subjective self. J Child Psychol Psychiatry. 2007;48(3/4):288–328.

    Article  PubMed  Google Scholar 

  77. Shahar G, Blatt SJ, Zuroff DC, Krupnick J, Sotsky SM. Perfectionism impedes social relations and response to brief treatment for depression. J Soc Clin Psychol. 2004;23:140–154.

    Article  Google Scholar 

  78. Auerbach JS, Blatt SJ. Self-reflexivity, intersubjectivity, and therapeutic change. Psychoanal Psychol. 2001;18:427–450.

    Article  Google Scholar 

  79. Harpaz-Rotem I, Blatt SJ. A pathway to therapeutic change: changes in self-representation in the treatment of adolescents and young adults. Psychiatr Interpers Biol Process. 2009;72:32–49.

    Article  Google Scholar 

  80. Risch N, Herrell R, Lehner T, Liang K-Y, Eaves L, Hoh J, et al. Interaction between the serotonin transporter gene (5-HTTLPR), stressful life events, and risk of depression: a meta-analysis. JAMA. 2009;301(23):2462–2471.

    Article  PubMed  CAS  Google Scholar 

  81. Kaufman J, Yang B-Z, Douglas-Palumberi H, Houshyar S, Lipschitz D, Krystal JH. Social support and serotonin transporter gene moderate depression in maltreated children. Proc Natl Acad Sci USA. 2004;101:17316–17321.

    Article  PubMed  CAS  Google Scholar 

  82. Bakermans-Kranenburg MJ, Van Ijzendoorn MH, Mesman J, Alink LRA, Juffer F. Effects of an attachment-based intervention on daily cortisol moderated by dopamine receptor D4: a randomized control trial on 1- to 3-year-olds screened for externalizing behavior. Dev Psychopathol. 2008;20:805–820.

    Article  PubMed  Google Scholar 

  83. Polanczyk G, Caspi A, Williams B, Price TS, Danese A, Sugden K, et al. Protective effect of CRHR1 gene variants on the development of adult depression following childhood maltreatment: replication and extension. Arch Gen Psychiatry. 2009;66(9):978–985.

    Article  PubMed  CAS  Google Scholar 

  84. Luyten P, Blatt SJ. Integrating theory-driven and empirically-derived models of personality development and psychopathology: A proposal for DSM-V. Clinical Psychology Review. 2011;31:52–68.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Patrick Luyten PhD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Luyten, P., Blatt, S.J., Mayes, L.C. (2012). Process and Outcome in Psychoanalytic Psychotherapy Research: The Need for a (Relatively) New Paradigm. In: Levy, R., Ablon, J., Kächele, H. (eds) Psychodynamic Psychotherapy Research. Current Clinical Psychiatry. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60761-792-1_21

Download citation

  • DOI: https://doi.org/10.1007/978-1-60761-792-1_21

  • Published:

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-60761-791-4

  • Online ISBN: 978-1-60761-792-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics