Inpatient analytical psychotherapy and its effectiveness

Prof. Dorothea Huber

As psychoanalytic treatment methods are coming under increasing pressure to prove their effectiveness empirically, the measurement of psychoanalytically based constructs is receiving particular attention. The constructs of structural impairment and mentalization capacity provide important insights into the understanding and treatment of structurally impaired patients. While lasting changes in symptoms and interpersonal problems have been repeatedly demonstrated (Huber et al. 2009; Hermann & Huber, 2013; Fizke, 2017), there are hardly any studies on improvements in mentalization and structure. This study investigated the influence of inpatient analytically oriented psychotherapy on changes in symptoms, mentalization ability, and structural impairment, taking into account the diagnostic groups.

The data for the current study were based on 898 patients. The predominant diagnoses were depressive disorders, anxiety disorders, trauma-related disorders, eating disorders, somatoform disorders, and personality disorders. The PHQ-D health questionnaire (Löwe et al., 2002) was used to measure symptom severity, and the MZQ mentalization questionnaire (Hausberg et al., 2012) was used to measure impairment of basic mentalization abilities. The degree of structural impairment according to Kernberg was assessed using the IPO-16 questionnaire (Zimmermann et al., 2013).

Results: In terms of symptoms, highly significant therapeutic success with large effect sizes (Cohen, 1988) was observed. According to Gignac and Szodorai (2016), the effect size of the improvement in mentalization ability is high, while the improvement in structural impairment is classified as medium to high. Before treatment, patients with emotionally unstable personality disorder had significantly higher scores on structural impairment than other patients, especially on the primitive defense subscale. These patients also had more impaired mentalization ability; the difference was particularly large on the affect regulation subscale.

Factors influencing the measured therapeutic success included comorbidity and motivation for treatment. The therapeutic outcome deteriorated with an increasing number of diagnoses or comorbidities. Patients who were assessed by therapists as having little motivation benefited less from treatment.

Original language: German

Joachim Frank (Research Fellow)

Cooperation partners:
Dr. Matthias Noertemann (Chief Physician at the Clinic for Psychosomatic Medicine and Psychotherapy Munich Clinic, Munich)

Project Start: 01/2016
Project End: 12/2022

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