Faculty Bibliography

Recently published methods are reviewed to assess dynamic formulations derived from psychodynamic case material, especially those methods that emphasize central maladaptive interpersonal patterns. These methods are divided into those that yield psychometric data based on samples that are at least of moderate size and those in which the measures are derived from case studies. The psychometric properties of the first group of measures are reviewed, including interjudge reliability, internal consistency, and content, predictive, and concurrent validity. This article then examines how the measures have addressed and could address the question of construct validity. Also discussed are issues involving the comparison of the methods, particularly their importance for examining specific hypotheses in psychodynamic psychotherapy. Concrete suggestions are made for future research.

In a group of 25 patients with major depression, the authors investigated the relationships among having a comorbid personality disorder, the severity of psychiatric disorder, and the outcome of dynamic psychotherapy. They found that 1) depressed patients with a comorbid diagnosis of personality disorder had more severe psychiatric disturbance at intake and at termination of therapy as well as at follow-up and 2) although all patients improved and maintained their gains at follow-up, those with a comorbid personality disorder diagnosis did not improve as much as those without a personality disorder.

Forty-four outpatients were given the opportunity to have two sessions each with two different therapists and then choose one for ongoing treatment. Patients chose the therapist whom they viewed as more helpful and liked better, but not on the basis of demographic similarity or pretreatment expectations about the therapist's qualities. Patients reported liking the opportunity to choose and stated definite reasons for their choices. However, 75% of the patients chose the second therapist. Possible explanations for the preponderant choice of the second therapist are discussed.

The extent to which the accuracy of therapists' interpretations predicts changes in the therapeutic alliance from early-in-treatment to later-in-treatment was investigated using a sample of 33 patients (25 females, 8 males, aged 15-48 yrs) in psychodynamic treatment of moderate length (21 to 149 wks). Accuracy of interpretation was assessed by judges' ratings of whether the contents of therapists' interpretations were congruent with patients' core conflictual relationship themes (CCRT). Results indicated that accuracy on the wish, plus response from other dimension of the CCRT, strongly predicted changes in the therapeutic alliance, but accuracy on the response of self dimension did not. Findings support the hypothesis that therapist actions are important in maintaining good alliances and repairing problematic ones.