Although it has proven possible to verify the effectiveness of a range of psychotherapeutic methods, there are few pertinent and robust research findings comparatively speaking of the underlying effectively which could explain the success (or failure) of psychotherapies.
On the basis of the data from the Munich Psychotherapy Study (MPS), a comparative process-outcome study with depressive patients of analytical, depth psychology-based and cognitive-behavioural psychotherapies (Huber et al., 2012, 2013), a pan-regional psychotherapy group was formed in January 2012 to survey the process-outcome correlations.
This group consists of the following centres: International Psychoanalytic University (IPU) Berlin (Huber, Ratzek, Seybert), Institut für Psychologie/Institute for Psychology, Kassel University (Benecke, Alhabbo, Zimmermann), Klinikum München-Harlaching Clinic and Klinikum rechts der Isar Clinic Munich (Huber, Klug), Psychoanalytische Klinik des Universitätsklinikums/Psychoanalytic Clinic of the University Clinic, Vienna (Döring, Löffler-Stastka). This pan-regional research group brings a broadly based range of knowledge and experience to the application of various process instruments.
Digitalisation and transcriptions to some extent of more than 600 therapy sessions recorded on audio, with 3 hours each at the beginning, the middle and the end of the therapy being evaluated.
Analysis of these audio recordings with the Psychotherapy Q-Sort (PQS; Ablon, 2000), a process measurement instrument that draws on the reactions of the patients, the interventions by the therapist as well as the interactions between both of them. These analyses of the audio recordings were conducted in their entirety in Vienna in the Clinic for Psychoanalysis by certified PQS raters. This also provided guaranteed anonymity for the Munich-based therapists.
Results: Psychodynamic and cognitive-behavioural prototype scores are stable over three hours (Cronbach's alpha > 7). Psychodynamic (PD) and cognitive-behavioural (CBT) prototype scores differentiate as expected between depth psychology/psychoanalytic and behavioural therapy treatment, but not between depth psychology and psychoanalytic treatments. A replication of the results from Ablon and Jones illustrates that in the behavioural therapy treatment, the PD technique correlates positively and the CBT technique negatively with the outcome. After these initial findings, the predominance in the reduction in the depressive symptoms with psychoanalytic treatments compared to behavioural therapy treatments with respect to the outcome is more likely to be explained as a result of the psychodynamic technique and not through the number of sessions (dosage rate). The results of these comparative process assessments as well as of psychometric investigations of the PQS (factor analysis, validity studies) were presented in talks and on posters at various congresses; a manuscript was submitted (Zimmermann et al.). Research funding was provided by the German Psychoanalysis Society (DPG) and the International Psychoanalytical Association (IPA).
The development of a micro-process instrument, the computer supported Kassel-based Micro-process Instrument (KAMPI) in order to assess transcript, audio and video material of psychotherapeutic treatments: The KAMPI consists of 12 modules which should permit a language content and interactions analytical perspective of current relevant psychotherapeutic factors (e.g. emotion, relation, conflict, countertransference, experience(s) of illness, etc. based on operationalised psychodynamic diagnostics (OPD). The evaluation can occur qualitatively and/or quantitatively. An initial validation of the KAMPI has occurred within the Munich Psychotherapy Study (MPS) on the basis of individual utterances from a total of 20 to 25 analytical, depth psychology-based and behavioural therapy sessions.
Development of an adherence measurement instrument in order to be able to differentiate between analytical psychotherapy and depth psychology-based psychotherapy. Funded by the German Psychoanalysis Society (DPG); see also "Investigation of Adherence Measurement" project description by M. Ratzek.
On a macro-process level, trajectories and mediators are being determined during the treatment. There are different trajectories of the change for depressive symptoms and for interpersonal problems in analytical, depth psychology-based and cognitive-behavioural therapies which provide an indication that analytical and depth psychology-based therapies profit from their specific technique and their longer treatment periods. The data indicates that cognitive-behavioural therapy has almost no influence on interpersonal problems. The positive introject is a mediator for depressive symptoms in all three forms of therapy; there is only a mediator in depth psychology-based therapy for the successful treatment of interpersonal problems, which apparently focuses more on it. The working alliance is not a mediator in all three therapies. Funded by the Steger-Stiftung Foundation, Munich.
Most recently, a process-outcome study on emotional processing and therapy outcomes in long-term psychotherapies was planned that has been approved by the Heidehofstiftung Foundation in the meantime and has just commenced; see also the "Emotional Processing and Therapy Outcome in Long-term Psychotherapies: A Process-Outcome Study" project description.
Four meetings have been held to date (since January 2012) in Munich, Berlin or Vienna to coordinate the activities of the groups.
International Psychonalytic University, IPU Berlin
Stromstraße 3b, 10555 Berlin
Prof. Dr. Dr. Dorothea Huber, dorothea.huber(at)ipu-berlin.de
Dr. Dipl. Psych. Melanie Ratzek, melanie.ratzek(at)ipu-berlin.de
Dr. Dipl. Psych. Carolina Seybert, carolina.seybert(at)ipu-berlin.de
Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie / Clinic and Polyclinic for Psychosomatic Medicine and Psychotherapy
TU Munich University
Langerstrasse 3, 81675 München
Dr. Günther Klug
Institut für Psychologie / Institute for Psychology, Kassel University
Holländische Strasse 36-38, 43127 Kassel
Prof. Dr. Cord Benecke
Dipl. Psych. Sarah Alhabbo
Klinik für Psychoanalyse und Psychotherapie / Clinic for Psychoanalysis and Psychotherapy
Medical University Vienna
Währinger Gürtel 18-20
Prof. Dr. Stephan Doering
Priv. Doz. Dr.med. Henriette Löffler-Stastka