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Obsessive-compulsive disorder (OCD) is a chronic disabling disorder characterized by recurrent obsessions and uncontrolled compulsions. Recent research on anxiety disorders suggests that manual-guided short-term psychodynamic therapy (STPP) may be a promising approach. Building on this, a model of STPP for OCD was developed based on Luborsky's supportive-expressive (SE) therapy. Treatment consists of 12 modules, which include the characteristic elements of SE therapy, that is, a focus on the Core Conflictual Relationship Theme (CCRT) associated with OCD symptoms and on establishing a secure alliance. Disorder-specific treatment elements were integrated, including addressing ambivalence, differentiating between thinking and acting, mitigating the superego, addressing existential issues, and, last but not least, implementing Freud's original recommendation to induce OCD patients to face the feared situation and to use the aroused experiences to work on the underlying conflict (i.e., CCRT). There are reasons to assume that the empirically derived model of STPP described here may be beneficial in OCD.

Interpersonal problems were studied in 121 patients treated with psychoanalytic therapy using the Inventory of Interpersonal Problems. Four characteristic subtypes were identified, which differed in the quality and flexibility of their interpersonal behavior. Independent of the predominant type of interpersonal problems, the psychotherapy treatment led to strong decreases in interpersonal distress and increases in interpersonal differentiation. Psychoanalytic therapy was highly effective for all identified interpersonal subtypes and seems to help patients achieve more satisfactory relationships.

Clinical observations suggest that depressive experiences in patients with borderline personality disorder have a specific quality. These experiences are characterized by emptiness and anger ("angry depression") and are associated with primitive forms of object relations. In this study, this observation was tested empirically. A sample of borderline inpatients (N=30) was compared with a sample of inpatients with higher levels of personality organization suffering from neurotic disorders (N=30). Depression and other affects were assessed by the Affective Dictionary Ulm (Dahl, Hölzer,Berry, 1992). The quality of object relations was assessed by a scale developed by Urist (1977), which was applied to responses in the Holtzman Inkblot Technique (Holtzman, Thorpe, Swartz,Herron, 1961). Correlations were assessed between depression, on the one hand, and anger, anxiety, and the quality of object relations, on the other hand. The clinical observations were confirmed: In the patients with borderline personality disorder, depression showed significant correlations with the affects of anger, anxiety, and fear, and with primitive forms of object relations. In the patients with higher levels of personality organization, no such correlations were found. The results are discussed with regard to the understanding of borderline disorders, diagnosis, and therapy.

Although theoretical assumptions and empirical evidence suggest an association between borderline personality disorder (BPD) and antisocial behavior or even antisocial personality disorder (APD), there is no study relating the psychodynamic aspects of BPD to antisocial behavior. In this study, the authors tested the correlation between the structural criteria of borderline personality organization (BPO)--that is, identity diffusion, primitive defense mechanisms, and reality testing--and antisocial features, neuroticism, and interpersonal problems. A sample of imprisoned violent offenders (N = 91) was studied using the Antisocial Personality Questionnaire (APQ), the Borderline Personality Inventory (BPI), the Neo-Five-Factor-Inventory (Neo-FFI), and the Inventory of Interpersonal Problems (IIP). Significant correlations were predicted and found between the BPI scales of identity diffusion, primitive defense mechanisms, impaired reality testing, and fear of closeness and antisocial features, neuroticism, agreeableness, and interpersonal problems. The results are consistent with both object relations theory and attachment theory.

In this article, the authors present a psychodynamically oriented psychotherapy approach for posttraumatic stress disorder (PTSD) related to childhood abuse. This neurobiologically informed, phase-oriented treatment approach, which has been developed in Germany during the past 20 years, takes into account the broad comorbidity and the large degree of ego-function impairment typically found in these patients. Based on a psychodynamic relationship orientation, this treatment integrates a variety of trauma-specific imaginative and resource-oriented techniques. The approach places major emphasis on the prevention of vicarious traumatization. The authors are presently planning to test the approach in a randomized controlled trial aimed at strengthening the evidence base for psychodynamic psychotherapy in PTSD.

The aim of the authors' study was to explore a model of suicidal ideation among adolescents in which environmental risk factors were mediated by both depression and defensive psychopathology. Suicidal ideation, depression, defensive psychopathology (substance use, borderline traits or symptoms, dissociative symptoms), parental attachment, and stressful life events were assessed among 615 adolescents (62% male). Despite gender differences, the proposed model received support. Findings suggest a psychodynamic relationship linking suicidal ideation to defensive mechanisms, aiming to alleviate depressive affects.

Different methods are available for the psychotherapeutic treatment of patients with severe personality disorders. In Germany, a special form of dynamically oriented therapy called psychoanalytic-interactional psychotherapy or method (PiM) has been clinically applied for many years. PiM was derived from psychoanalytic therapy and has been specifically adapted for the treatment of severely disordered patients, for example, patients with borderline personality disorders, prepsychotic disorders, addictions, and perversions. In a naturalistic study, the effectiveness of PiM was tested in a sample of patients with borderline personality disorders (N = 132). The patients were treated in the Clinic Tiefenbrunn near Goettingen. Standardized, reliable, and valid diagnostic instruments were used to study the treatment effects. According to the results, PiM achieved significant improvements in target symptoms, general symptoms, interpersonal problems, and contentedness with life. The results are discussed with regard to the treatment of severely disordered patients.

Social phobia is a very frequent mental disorder characterized by an early onset, a chronic unremitting course, severe psychosocial impairments and high socioeconomic costs. To date, no manual for the psychodynamic treatment of social phobia exists. After a brief description of the disorder, a manual for a short-term psychodynamic treatment of social phobia is presented. The treatment is based on Luborsky s supportive-expressive (SE) therapy, which is complemented by treatment elements specific to social phobia. The treatment includes the characteristic elements of SE therapy, that is, setting goals, focus on the Core Conflictual Relationship Theme (CCRT) associated with the patient s symptoms, interpretive interventions to enhance insight into the CCRT, and supportive interventions, in particular fostering a helping alliance. In order to tailor the treatment more specifically to social phobia, treatment elements have been added, for example informing the patient about the disorder and the treatment, a specific focus on shame and on unrealistic demands, and encouraging the patient to confront anxiety-producing situations. More directive interventions are included as well, such as specific prescriptions to stop persisting self-devaluations. The treatment manual is presently being used in a large-scale randomized controlled multicenter study comparing short-term psychodynamic psychotherapy and cognitive-behavioral therapy in the treatment of social phobia.

In a naturalistic outcome study, the authors evaluated the results of a specific psychodynamically oriented trauma-focused inpatient treatment for women with complex posttraumatic stress disorder and concomitant borderline personality disorder, self-mutilating behavior, and depression. At admission, the frequency of self-mutilating behavior and the amount of inpatient treatment (an average of 68 days annually) of the sample was high, characterizing this patient group as "previously therapy resistant." Treatment outcome was assessed both at the end of treatment and in a 1-year follow-up. In comparison with a treatment-as-usual control group, the treatment program brought about significant and stable improvements both in trauma-specific symptoms (e.g. dissociation, intrusion, avoidance) and in general psychiatric symptoms (e.g., general symptom distress, frequency of self-mutilating behavior, number of hospitalizations). The frequency of inpatient treatments (hospitalizations) decreased dramatically (< 10 days annually; effect size: d = 2.88).

Although psychotherapeutic observation and empirical data suggest a link between borderline and antisocial personality disorder or traits in adolescents, there is no study on the relationships of borderline personality organization (BPO) and psychopathic traits in adolescents. The aim of this study was to explore the relationship of structural criteria of (BPO) as assessed by the French version of the Borderline Personality Inventory (BPI), with psychopathic traits, as assessed by the French version of the Levenson Self-Report Psychopathy Scale (LSRP), in a nonclinical sample of 243 adolescents. Significant correlations were found between the BPI scales of identity diffusion, primitive defense mechanisms, impaired reality testing, and psychopathic traits of callousness and impulsivity, suggesting that BPO may contribute to psychopathic traits in nonforensic, nonclinical adolescents.

The present article addresses the question of what kind of evidence is required to demonstrate that a method of psychotherapy works. Referring to recent conceptualizations of the logical structure of scientific theories, that is, the structuralistic view of theories, the author shows that randomized controlled studies (RCTs) and naturalistic studies (effectiveness studies) refer to different domains of intended applications (laboratory vs. field). This view has several important implications: (1) RCTs and naturalistic studies do not differ concerning their internal and external validity; (2) naturalistic studies do not necessarily provide lower-level evidence than RCTs; (3) evidence from RCTs cannot be transferred to psychotherapeutic practice in the field; (4) naturalistic studies are required to demonstrate that a form of therapy works in the field; (5) The proposed catalogues for levels of evidence focus on RCTs; thus, they cannot be applied to the question if a therapy works in the field; (6) It is necessary to define separate criteria for levels of evidence of naturalistic studies; and (7) a new research agenda for naturalistic studies can be derived, which is analogous to that of efficacy studies. In this article, a proposal is made to define levels of evidence of naturalistic studies. A gold standard for naturalistic studies is proposed.