Ideas of cure related to psychotherapy outcome : young adults in psychoanalytic psychotherapy

Abstract

Background: Ideas of cure within the psychoanalytical movement have mainly focused on 'insight' or 'interpersonal relationship'. Patients' ideas of curative factors during and after therapy have been studied previously, as well as their expectancies and preferences prior to treatment.

Aims: This project aimed at studying psychoanalytic psychotherapy with young adults from the viewpoints of ideas of cure among patients, and outcome, and how these two aspects are related to each other.

Method: Patients (n=134) between 18 and 25 years were included. The mean time in therapy was 15 months. The therapists were highly trained and had long professional experience. Two included studies concern a subgroup of 46 patients in individual psychoanalytic psychotherapy. Ideas of cure were explored using the Private Theories Interview (PTI). Therapeutic alliance was assessed using the Revised Helping Alliance Questionnaire (HAQ-II). Outcome was measured using the Symptom Checklist -90 (SCL90-R), Self-Rated Health (SRH), Global Assessment of Functioning (GAF), Inventory of Interpersonal Problems (IIP), Structural Analysis of Social Behavior Intrex Questionnaire (SASB), and Differentiation-Relatedness Scale (DRS). Patients were typologised based on their ideas of cure using 'ideal type analysis'.

Results: Twenty separate categories of ideas of cure were found. The typologisation of individuals resulted in seven types, conceptualized as being positioned along the dimension 'approaching-distancing'. The patients showed improvement on all outcome measures in terms of pre- versus post-therapy effect sizes. Patients who terminated therapy prematurely were significantly closer to the 'distancing' pole regarding ideas of cure, while the therapy completers were more often found near the ,approaching' pole. No associations were found between ideas of cure and early alliance or outcome at termination. An explorative study of four cases showed that the therapists in the more successful cases early in therapy made interpretative interventions directed at obstacles to the therapeutic work.

Conclusions: A majority of the patients had ideas of cure that were in line with psychoanalytic psychotherapy. However, these ideas emphasized the 'insight' aspect of psychotherapy and seldom touched upon the 'interpersonal relationship' aspect. The patients' improvements during therapy were larger than would have been expected from spontaneous remission. The introductory sessions seem to be of vital importance in helping patients to engage in a potentially beneficial therapy. Hypotheses were generated that it is beneficial with a therapist listening to the patient's ideas and making interpretative interventions focusing on obstacles to the therapeutic work.