Workshop 1 Title: Using Code-a-text to Analyse Psychotherapy Texts Authors



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Participants: Gary Diamond, Eric McCollum, and Ana Estrada
Moderator: Jay Lebow
Address for Correspondence:
Jay Lebow

#651


Chicago Center for Family Health

445 East Illinois Street

Chicago, IL 60611

USA
ABSTRACT


The state of the field of family and marital therapy research will be considered. During the first hour, panelists will address key questions posed by the moderator. During the final half hour, members of the audience will be invited to respond with questions and comments. The format is intended to stimulate an examination of issues related to the past performance, current status, and future direction of family and marital therapy research.
Panel Session 16 - Overall Summary
Title: Symbolic and Verbal Processing in Psychotherapy : A Single Case Study
Participants: Dan Pokorny, Michael Stigler
Moderator: Clara E. Hill
Discussant: Clara E. Hill
Address for Correspondence :
Michael Stigler

University of Lausanne

Dept. of Adult Psychiatry

1, rue du Tunnel

CH-1005 Lausanne (Switzerland)

e-mail : Michael.Stigler@inst.hospvd.ch


ABSTRACT
The basic question in this panel is: how does imagery contribute to the psychotherapy

process ?

When imagery becomes a subject in psychotherapeutic work, it mostly stems from recalled material from nightdreams. In this study, we use material from actively stimulated and directly recorded imagery in a state of altered consciousness, as it is realized by Leuner’s method of Guided Affective Imagery. The advantage of this direct access to dreamlike imagery is to obtain protocols that are more complete and more precise, and more authentic for the affective ambience.

For the analysis of the completely transcribed texts, rating methods (CCRT, DMRS) and computerized instruments (RID, ADU, EAP, RA) are applied to compare sessions with and without guided affective imagery. The patient, a 34 year-old woman suffering from panic disorder having started one year before, had 19 sessions of brief dynamic psychotherapy including 6 sessions with imagery followed by elaboration. At the end of therapy she was consistently improved, a result confirmed by follow-up through 3 years.

The presentations of Dan Pokorny on relationship themes and mechanisms of defense, and of Michael Stigler on computerized analysis of the session texts will be commented and discussed by Clara E. Hill who has done much clinical and research work in the domain of the interpretation of nightdreams (Hill 1996).


Paper in Panel - Panel Session 16


Title: Computerized Text Analysis in Psychotherapy Using Imagery
Authors:  Michael Stigler, Dan Pokorny
Address for Correspondence:
Michael Stigler

University of Lausanne

Dept. of Adult Psychiatry

1, rue du Tunnel

CH-1005 Lausanne (Switzerland)

e-mail : Michael.Stigler@inst.hospvd.ch



ABSTRACT
The computerized text analysis methods applied in this study come from different theoretical backgrounds and are based on specific constructs each, but their common territory of interest is the processing from subsymbolic perceptual and emotional expression to symbolic expression by images and narratives (as predominant in imagery sessions), to abstract reflection and elaboration (as predominant in exclusively verbal sessions).
The therapist is interested in the referential process (Bucci), e.g. the operation that connects the multiple representational formats of the nonverbal system to one another and to words.
The place of an actively applied imagery method in fostering this process is investigated by comparing the proportions of regressive imagery words (RID, Martindale 1975), emotion words (ADU, Hölzer et al. 1992), emotion-abstraction patterns (EAP, Mergenthaler 1996) , and words supposed to be characteristic of referential activity (CRA, Bucci 1997).
Our hypothesis is that the specific contribution of imagery is a high degree of mobilisation in the domain of emotions and intuitive actions that are made accessible to abstract verbal work by the medium of images and concrete, action centered words.

Paper in Panel - Panel Session 16
Title: CCRT and DMRS in Verbal and Imagery Sessions: Differences and

Analogies


Authors : Dan Pokorny, Michael Stigler, Reinhard Denzinger
Address for Correspondence:
Dan Pokorny

University of Ulm

Dept. of Psychotherapy and Psychosomatics

Am Hochsträss 8

D-89081 Ulm, Germany

e-mail : pokorny@sip.medizin.uni-ulm.de



ABSTRACT
The hypothesis for applying the methods of CCRT and DMRS in this study is that therapeutic daydream imagery is effective by reducing anxiety so that objects otherwise too dangerous can be approached and treated sooner and easier.
Both CCRT and DMRS have been rated for all 19 sessions (13 verbal, 6 imagery plus elaboration) of this brief dynamic psychotherapy integrating Leuner’s method of Guided Affective Imagery.
By the CCRT method, we aim at specific differences in the expression of central relationship themes in the imagery as compared to the verbal condition. Differences may show up in the issue of the relationship episodes (positive or negative responses from others and self) as well as in the choice of wishes and responses relating to daydream versus real life objects. Furthermore, we are interested in a possible evolution of CCRT components from session 1 to 19.
The DMRS will allow us to test the hypothesis of a lower level of censorship in imagery, facilitating the access to conflicts that otherwise would need much more and longer work. The issue is open : we do not know if the mechanisms of dream-work like displacement and symbolization let the objects appear less terrifying so that more mature defenses can be mobilized, or if they lower the threshold for more archaic conflicts which then possibly lead to more primitive defenses. As with CCRT, we are also interested in a possible evolution in the level of defenses from session 1 to 19.
Panel Session 17 - Overall Summary
Title: Aspects of Abstraction, Emotion, and Referential Activity Along with Attach­ment Concepts and a Session Inventory
Participants: Anna Buchheim, Stefanie Cornehl, Erhard Mergenthaler, Friedemann Pfäfflin, Sylvia Gril, Marina Altman de Litvan, Montevideo
Moderator: Sylvia Gril
Discussant: Erhard Mergenthaler
Address for Correspondence:
Sylvia Gril

Departamento de Psicología Médica

Hospital de Clínicas Piso 15 Avenida Italia S/N

Montevideo - Uruguay

Fax: ++598 2 2044707,

Email: sgril@chasque.apc.org


ABSTRACT
The presentations in this panel have the computer assisted approach of measuring Abstraction, Emotion Tone, and Referential Activity in common. Additionally all of them utilize a third measure to evaluate the clinical material.
In the first presentation Anna Buchheim reports about a study where the Adult Attach­ment Interview (Main) is analysed and the results are related to the attachment representation.
In the second presentation Stefanie Cornehl reports a cross-sectional study comparing sex offenders and neurotic patients.
The third presentation by Sylvia Gril reports from a project that integrates the attachment concept and the language measures to a praxis oriented approach for consulting mothers with their psycho functional disordered babies.
Paper in Panel- Panel Session 17
Title: The Relationship Between Adult Attachment Representation, Emotion/Abstraction Patterns and Referential Activity: The Problem of "Pseudo-In­sight" in Insecure Preoccupied Attachment
Authors: Anna Buchheim, Erhard Mergenthaler
Address for Correspondence:

Anna Buchheim

Department of Psychotherapy and Psychosomatic Medicine

University of Ulm - Medical Faculty

Am Hochsträß 8

89081 Ulm, Germany

anna@sip.medizin.uni-ulm.de
ABSTRACT
In this study we examine the relationship between adult attachment representa­tion, coded with the Adult Attachment Interview of Main (AAI, George et al. 1985) and its lin­guistic components, assessed by the computer assisted language measures for Emotion-Abstraction Patterns (EAP, Mergenthaler 1996) and Computer Referential Activity (CRA, Mergenthaler & Bucci in press). Both of them have been successfully applied in psychothe­rapy research. In a recent extension of the Therapeutic Cycle Model, Mergenthaler (in prep.) Additionally introduces a qualitative dimension of Emotion Tone. The presence of positive emotion tone is seen as a promising condition for crea­tivity and problem solving (Izen et al. 1987), both essential aspects of insight, whereas negative emotion tone rather will be seen in context with pseudo-insight. With regard to narrative style the three major attachment categories are classi­fied as: 1) Secure-autonomous; narratives are coherent and open, responses are clear and rele­vant; statements about childhood integrate and reflect emotional aspects. 2) Insecure-Dis­missing; narratives are incoherent and emotionally distant on a general, abstract level. 3) Insecure-preoccupied; emotional conflicts in childhood are addressed li­vely but incoherent; use of pseudo-psychological language without adequate distance to conflicts. Compared to the insecure classified subjects the secure ones are expected to show a higher proportion of insight, measured as "Connecting", a pattern where emo­tion tone and abstraction occur si­multaneously, and also a higher level of CRA, which represents a vivid narrative style. For the purpose of the study presented here from a larger sample comprising mothers and fa­thers of premature infants, we randomly se­lec­ted 20 subjects classified as secure, 10 as dismissing, and 10 as being preoccupied. First results support that EAP and CRA can identify dismissing subjects. It was unexpected, however, that EAP and CRA did not differentiate between the secure and preoccupied subjects. With regard to the distinction between positive and negative emotion tone we will consider the rich, but incoherent narrative style of preoccupied subjects as being "pseudo-insight". This will be discussed in more detail along with two single cases (secure versus preoccupied).

Paper in Panel
Title: The Interactional Dimensions of Key Moments or What Triggers Insight in Therapies with Sexual Offenders Compared to Neurotic Patients?
Authors: Stephanie Cornehl, Friedemann Pfäfflin, Erhard Mergenthaler
Address for Correspondence:
Stephanie Cornehl

Sektion Forensische Psychotherapie

Universität Ulm - Medizinische Fakultät

89081 Ulm, Germany

Fax: +49 731 502 5672

cornehl@sip.medizin.uni-ulm.de


ABSTRACT
The present study investigates insight as the central phenomena of change in psychotherapies. Especially we will focus on related dyadic aspects in the therapeutic relationship and on the interactional repertories used by patients. The study will use a cross-sectional design.
Subjects are eight forensic patients who were sentenced of sexual child abuse and treated under court order in a high security hospital, opposed to eight clinical pati­ents (Major Depression, Dysthymia) in psychotherapy. Three hours of each therapy were evaluated using both, a qualitative and a quantitative approach on a micro-analytic level. The computer assisted method of measuring Emotion-Abstraction patterns in transcripts identifies Therapeutic Cycles and key moments often understood as insight (Mergenthaler, 1996). Additionally we applied the Stuttgarter-Kategorien-Inventar (SKI-II, Czogalik et al., 1987) as a qualitative tool to describe the interactional patterns of patients and therapists.
In an exploratory approach we expect to find differences in the frequency of key moments such as insight due to the different motivational disposition of the forensic vs. clinical patients. We also assume that different interactional structures can be identi­fied and in a meaningful way related to the phases of the Therapeutic Cycle.
Paper in Panel- Panel Session 17
Title: Attachment and Narratives: The Relationship Between the Verbal Exchange of Mother and Analyst and the Non-Verbal Interaction of Mother and Baby
Authors: Sylvia Gril, Marina Altmann de Litvan, Erhard Mergenthaler
Address for Correspondence:
Sylvia Gril

Departamento de Psicología Médica

Hospital de Clínicas Piso 15 Avenida Italia S/N

Montevideo - Uruguay

Fax: ++598 2 2044707,

Email: sgril@chasque.apc.org


ABSTRACT
In our study we were investigating implicit and explicit factors contributing to clini­cally observed effects in psychoanalytic oriented consultations with mothers and their ba­bies with psychofunctional disorders. Of special interest is the relationship between the verbal exchange between mother and analyst and the non-verbal interactions between mo­ther and baby. Emphasis is put on emotional and reflective processes and the integration of narrative structures in the therapeutic discourse. The mother-baby relationship is assessed with an attachment oriented instrument (Massie-Campbell Scale, 1983).
Based on the positive findings in a pilot study we expect that encouraging the mo­ther to recall narratives that integrate the baby's behavior during the consultations promotes more intimacy with the baby. The improvement in the quality of the therapeutic cycles that took place studying the psychotherapeutic discourse of the mother and the analyst was po­sitively correlated with the improvement in the attachment scores of the mother and the baby. The related emotional and cognitive processes can be measured by means of the Cy­cles Model (Bucci 1997; Mergenthaler 1996).
We will present the findings with an extended sample of ten mother-baby dyads each having two to three consultation sessions. The sessions were videotaped and transcri­bed following the transcription standards for the Spanish language (Mergenthaler & Gril 1996). An important goal of the project is to find relevant implications for clinical practice along with narrative production. The sample of this study belongs to a group with high psychosocial risk which would significantly benefit from brief and focused therapeutic in­terventions. Guidelines for an effective intervention program with mother and babies are being developed along with this project and shortly will be presented.
Panel Session 18 - Overall Summary
Title: Karolinska Psychodynamic Profile (KAPP) as Predictor of Outcome
Participants: Robert M. Weinryb, Barbro Thormählen, Sabrina Fossella
Moderator: Robert M. Weinryb
Discussant: Bernhard Strauss
Address for Correspondence:

Robert M. Weinryb, MD, PhD

Department of Psychotherapy

Karolinska Institute

Björngårdsgatan 25

S-118 52 Stockholm, Sweden

E-mail: robert.weinryb@knv.ki.se
ABSTRACT
The Karolinska Psychodynamic Profile (KAPP) is an instrument for making psychodynamic assessment from clinical interviews. The purpose of the panel is to present data about KAPP as a predictor of outcome both among somatic patients undergoing surgery and patients in psychotherapy.

Weinryb will present a longitudinal study of patients with ulcerative colitis describing the relationship between psychodynamically assessed personality traits before surgery and psychosocial adjustment 7 years later.


Thormählen will report the results from a study predicting dropout from Supportive-Expressive psychotherapy for personality disorders. Eighty patients who had not primarily applied for psychotherapy were offered once a week time-limited Supportive-Expressive psychotherapy for 40 sessions. The study compared the patients who did not did not begin treatment, those that dropped out and those who completed treatment on the KAPP, Inventory of Interpersonal Problems, and a measure of alexithymia.
Fossella will present results from a study of personality change after 2 years of psychodynamic psychotherapy or pharmacotherapy. After 2 years, patients in psychotherapy reached a statistically significant improvement of 30%, when compared to patients treated with psychotropic drugs alone (improvement of 2%). Moreover, the results indicated that psychotherapy affects different areas of personality organization as measured by the KAPP depending on whether the patients were initially neurotic, psychotic or personality disordered.
Paper in Panel - Panel Session 18
Title: Personality Change After Psychodynamic Psychotherapy: A Long-Term Case-Control Study
Authors: Sabrina Fossella, Roberta Siani, Orazio Siciliani

Address for Correspondence:

Sabrina Fossella

Servizio di Psicoterapia (Psychotherapy Service)

Clinica psichiatrica (Psychiatric Clinic)

University of Verona

via delle Menegone 10

37134 VERONA (Italy)

E-mail: sabfos@borgoroma.univr.it


ABSTRACT
The aim of the present study was to examine personality change, assessed by Karolinska Psychodynamic Profile (KAPP), after a 2-year psychotherapeutic treatment in a group of psychiatric patients. 50 outpatients, with various ICD-10 psychiatric diagnosis, were randomly assigned to two types of treatment: every third case was enrolled in the "control group", who received only psychotropic drugs; the remaining 34 patients were admitted to an individual psychodynamic psychotherapy - one session a week - according to Kohut's Self Psychology. Among the psychotherapy group (10 psychotics, 14 neurotics, 10 personality disorders) pharmacotherapy was combined in 90% of psychotics and in 30% of the neurotics and the PDs. KAPP was used to provide a psychodynamic assessment of personality. KAPP interviews were conducted by two blind raters at three different occasions: at the beginning of treatment, after two months and after 2 years.
The analysis of variance for repeated measures, carried out on KAPP total score taken as a global index of personality change, indicated a significant interaction between treatments and times. After 2 years, patients in psychotherapy reached a statistically significant improvement (Sheffe test) of 30%, when compared to patients treated with psychotropic drugs alone (improvement of 2%).
Moreover, a non-parametric analysis performed on every single KAPP subscale (Wilcoxon and Median tests) showed that psychotherapy affects different areas of personality, depending on the diagnostic categories.

Paper in Panel - Panel Session 18
Title: Personality Traits Predicting Adjustment 7 Years After Major Abdominal Surgery
Authors: Robert M. Weinryb, J. Petter Gustavsson, Jacques P. Barber

Address for Correspondence:
Robert M. Weinryb, M.D., Ph.D.

Department of Psychotherapy, Karolinska Institute

Björngårdsgatan 25

S-118 52 Stockholm, Sweden

E-mail: robert.weinryb@knv.ki.se
ABSTRACT
Very few studies have examined the relationship between preoperative personality traits and long-term postoperative psychosocial adjustment. In a sample of 48 patients, we examined the relationship between psychodynamically assessed personality traits before pelvic pouch surgery for ulcerative colitis and psychosocial adjustment 7 years postoperatively, controlling for the effects of surgical functional outcome and initial level of psychosocial adjustment. Personality traits were assessed with the interview based Karolinska Psychodynamic Profile (KAPP). Surgical functional outcome scales and the Psychosocial Adjustment to Illness Scale (PAIS) were used.
Poor preoperative frustration tolerance, lack of alexithymia, high degree of conformism, problems with sexual functioning and satisfaction, and excessive emphasis on bodily appearance and function as sources of self-esteem were all found to predict poorer psychosocial adjustment seven years after surgery, even after the effects of initial level of psychosocial adjustment and functional surgical outcome were controlled for.
The findings further support the predictive validity of the KAPP. They also strongly suggest that preoperative personality traits are important predictors for long-term postoperative psychosocial adjustment. Preoperative assessment can benefit by also taking personality factors into account and, thus, alerting clinicians as to which patients are potentially at risk for poor postoperative psychosocial adjustment.

Paper in Panel- Panel Session 18
Title: Predicting Dropout From Supportive-Expressive Psychotherapy for Personality Disorders
Authors: Barbro Thormählen, Kristina Norén, Bo E. Vinnars, Jacques P. Barber, Robert M. Weinryb
Address for Correspondence:
Barbro Thormählen

Department of Psychiatry, M57

Huddinge University Hospital

S-141 86 Huddinge, Sweden

E-mail: Barbro.Thormahlen@cnsf.ki.se
ABSTRACT
This study examined patient factors related to not starting in or dropping out from psychotherapy. Eighty (55 women and 25 men, mean age 35 years) psychiatric outpatients with personality disorders (Axis II, DSM IV), who had not primarily applied for psychotherapy were offered once a week time-limited Supportive-Expressive psychotherapy for 40 sessions. Eight patients (10%) did not begin treatment, 52 patients completed psychotherapy and 20 patients (28%) dropped out.
First, the non-starters were compared to the starters in psychotherapy. Then, the dropouts were compared to the patients who completed their psychotherapy. Patients were compared on age, sex, sociodemographics, psychiatric symptoms (SCL 90, Well-Being Profile), alexithymia measures (Toronto Alexithymia Scale - TAS, Schalling-Sifneos Personality Scale) and DSM IV axis II pathology. In addition, personality as assessed by the Karolinska Psychodynamic Profile (KAPP), and interpersonal problems (IIP) were evaluated.
The 8 non-starters were all women. Their main interpersonal problem on the IIP was in being assertive with others, and they had significantly more problems than the starters in this respect. In addition they were significantly more alexithymic (as measured with the TAS) than the starters.
The dropouts were significantly younger than the completers. They had significantly more problems in handling aggressive affects with tendencies to act out, and they experienced fewer problems with assertiveness than the completers did. In addition, they were more alexithymic (as measured with the KAPP). There was also a tendency for patients with more serious personality disorders (cluster A and B) to be dropouts.

Panel Session 19 - Overall Summary
Title: Factors of Effectiveness and Outcome in In-Patient Psychotherapy
Participants: Udo Porsch, Annegret Eckhardt-Henn, Sven Olaf Hoffmann, Isa Sammet, Henning Schauenburg, Wolfgang Wöller, Norbert Hartkamp, Veronika Bergstein, Ute Schnierda, Johannes Kruse
Moderator: Wolfgang Wöller
Discussant: H. Kordy
Address for Correspondence:
Dr. W. Wöller, Department of Psychosomatics and Psychotherapy

University of Duesseldorf,

Bergische Landstr. 2, D-40629 Duesseldorf

FAX: 0049-211-922-4709, e-mail: woeller@uni-duesseldorf.de


ABSTRACT
Psychodynamic inpatient psychotherapy is a multimodal type of therapy which includes individual psychotherapy, group psychotherapy, sociotherapy, art therapy, music therapy, body-oriented therapy and contacts with nurses. Moreover, the relationships with the fellow patients are supposed to have therapeutic effects. The approach has been shown to be effective in a variety of severely disturbed patients. However, little research has been done as to how treatment effects come about and which are the most relevant factors of effectiveness. Likewise, little is known about patient factors which determine a favorable outcome. Given this background, the studies presented in this panel address these topics from different viewpoints.

The first study presented by U. Porsch and coworkers investigates changes in self- and object representations in the course of inpatient psychotherapy using Repertory-Grid technique. Changes in self- and object representations were related to therapy outcome at a 1 year follow-up.

The study by I. Sammet and H. Schauenburg focuses on the development of therapeutic relationships during the course of inpatient therapy: the patients´ relationship to their individual therapist, to the therapeutic team and to their fellow patients. The authors test the hypothesis that changes in patients´ perceived relationships are of substantial relevance for their improvement.

A similar approach is used by W. Wöller and coworkers who also developed an instrument for weekly evaluating aspects of therapeutic alliance in the different settings of inpatient psychotherapy. The research question addressed here was whether patients´ introject structure (as measured by SASB-INTREX) exerts an influence on the development of the therapeutic relationships.



Paper in Panel - Panel Session 19

Title: Introject Structure and Therapeutic Alliances in a Multiprofessional Inpatient Treatment Approach
Authors: Wolfgang Wöller, Norbert Hartkamp, Veronika Bergstein, Ute Schnierda, Johannes Kruse
Address for Correspondence:
Dr. W. Wöller

Department of Psychosomatics and Psychotherapy

University of Duesseldorf

Bergische Landstr. 2, D-40629 Duesseldorf

FAX: 0049-211-922-4709, e-mail: woeller@uni-duesseldorf.de
ABSTRACT
During treatment in a multimodal psychodynamic in-patient psychotherapy unit, the patients are faced with a variety of therapeutic relationships which include individual psychotherapy, group psychotherapy, sociotherapy, art therapy, music therapy, body-oriented therapy, etc. As a consequence, they are expected to establish a variety of therapeutic alliances with the persons contributing to the therapy.
The aims of the study were


  1. to investigate the influence of multiple therapeutic alliances on therapy outcome;

  2. to examine the influence of the patients´ introject structure on the development of therapeutic alliances.

An instrument was developed for weekly evaluating aspects of therapeutic alliance in the different settings of inpatient psychotherapy. Introject structure was measured using SASB-INTREX questionnaire, outcome was evaluated in terms of symptomatic change as measured by SCL-90-R.


Data of 81 completed in-patient psychotherapies show (1) that perceived helping alliance in individual therapy was the best predictor of therapy outcome and (2) that patients exhibiting a self-supporting introject structure were more likely to develop a positive therapeutic alliance in several relationships.


Paper in Panel- Panel Session 19
Title: The Development of Multiple Relationships During Inpatient Psychotherapy and Their Impact on Symptom Courses: A Process Study
Authors: Isa Sammet & Henning Schauenburg
Address for Correspondence:
Department of Psychosomatics and Psychotherapy

University of Göttingen

Von-Siebold-Str. 5, 37075 Göttingen, Germany

e-mail: isammer@gwdg.de, hschaue@gwdg.de


ABSTRACT
Psychodynamic inpatient psychotherapy, as commonly practiced in Germany, is an intensive treatment for patients with severe neurotic and personality disorders. It is characterized by a therapeutic format integrating a variety of treatment methods (individual and group therapy, art and body therapy). Thus, patients experience multiple relationships to different therapists and to other patients, with whom they are living close together. The quality of the therapeutic alliance is widely accepted to be associated with therapy outcome in individual therapy. By analogy, it can be assumed for inpatient treatment, that the different therapeutic or nontherapeutic relationships have important effects on the course of symptom reduction and therapy success.

In this context, the purpose of the present study was to investigate how those different relationships contribute to symptom courses, self-efficacy and therapy outcome. On the basis of understanding the therapeutic process dynamically, it was our hypothesis, that mainly the change in experiencing the therapeutic alliances or the relationship to other patients is relevant for the patient´s improvement (in the sense of correcting experiences).

Design of study: 80 patients with heterogeneous neurotic or personality disorders, treated in our Department of Psychosomatics and Psychotherapy for 8 to 20 weeks, were given the “Stationserfahrungsbogen SEB” (Sammet und Schauenburg, 1998) weekly to report the quality of their relationships to their individual therapist, to the therapeutic team and to their fellow patients together with their feeling of self-efficacy. Symptom development was simultaneously assessed by the Brief Symptom Inventory BSI (Derogatis, 1993). We selected three groups, that had either extremely positive, negative or neutral developments of their different relationships (according to the slopes of their weekly relationship ratings). Then, we analyzed the correlations over time between those courses of relationship ratings and the courses of symptoms and self-efficacy and tested the three groups for differences in pre-post symptom measures (SCL90R, Derogatis 1977).

The results point out the necessity of process research for better understanding the-rapeutic change, especially in this field of inpatient psychotherapy with its multiple transferences. They will be discussed with a critical view on methodological issues.



Paper in Panel - Panel Session 19
Title: Changes of the Self- and Object Representations in the Course of an In-Patient Psychotherapeutic Treatment
Authors: Udo Porsch, Annegret Eckhardt-Hen, Sven-Olaf Hoffmann
Address for Correspondence:
Dr. U. Porsch

Department of Psychosomatics and Psychotherapy

University of Mainz

Untere Zahlbacher Str. 8, D-55131 Mainz




ABSTRACT
The study examines the changes of the self- and object representations in the course of an inpatient psychotherapeutic treatment. The successful and less successful treated patients were identified and examined in regard to the specific effective changes within their self- and object representations. These results were put into relation with the psychopathological findings and the quality of the therapeutic relationship.
In addition to a symptom check-list (SCL-90-R), the patients were given an inventory of interpersonal conflicts (IIP), a questionnaire in respect to helping alliance (TAB) and a modified Repertory Grid.
The catamnestic therapy evaluation occurred by means of the goal attainment scale (GAS).
Panel Session 20 - Overall Summary
Title: Signs and Voices in the Assimilation Process: Distinguishing Problematic Voices in the First Session and Tracing the Growth of Meaning Bridges
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