Search

Introduction: In recent years more attention has been paid to non-responders, i.e. patients who do not benefit from therapy, do not engage in treatment or terminate therapy prematurely. Study 1/objectives: It was to identify personality factors predicting psychotherapy utilization on the basis of personality pathology, affect regulation and interpersonal functioning. Methods: Affectivity (AREQ), the interpersonal context (QORS) and character pathology (SWAP-200) were assessed. Results: Combination of instruments showed one stable factor predictive for non-engagement in psychotherapy, revealing an externalizing personality dimension, dominated by externalizing defenses, acting out, deficient super-ego functions, impairment in reflective functioning and in relating to others (n sample 1 = 129). Stability of the predictive power of this personality factor for therapy engagement could be shown and a replication in two other samples (n sample 2 = 95, n sample 3 = 94) confirmed the findings. Study 2/objectives: Further we examined the question if the externalizing mode of functioning is relevant for the course of psychoanalytic treatments. Methods: In 38 psychoanalytic treatments, severity of symptoms (SCL-90-R), interpersonal problems (IIP), character traits and psychostructural functioning (SWAP-200) were investigated half-yearly. Results: For the first year denial of needs for closeness, and fears of an impulsive breakthrough of negative affects predicted dropout of therapy. During the second year externalizing defence, projection/projective identification, somatisation, hypochondria and dismissive interpersonal behaviour predicted break-ups. Conclusion: The studies point at the necessity of interpreting affect-regulatory parameters, such as the externalizing parameter, from the very beginning and during the course of the treatment. [ABSTRACT FROM AUTHOR]

Introduction: On the road to DSM-V, instruments are demanded which provide clinically meaningful information, e.g. predictions about psychotherapy utilization. One interesting and promising personality assessment method is the Shedler-Westen-Assessment Procedure-200 (SWAP-200) providing dimensional and prototypical assessment possibilities for personalty disorders. Objectives: The study compares the predictive power of the Shedler-Westen-Assessment Procedure-200 with the Structured Clinical Interview for DSM-IV on engagement in (psychoanalytic) psychotherapy. Methods: 297 patients with personality disorders were assessed with both instruments in a 4-year-follow-up study. Multinomial logistic regression showed small differences between the prediction rates in the cross-validated data. Results: Both instruments showed clinically useful prediction rates for treatment rejecters: SWAP scales led to correct predictions with dysphoric traits as semi-stable predictors for rejecters, while SCID scales led to correct predictions with Negativistic, Depressive and Schizotypal PD as stable predictors. Conclusions: Results are discussed under the aspect of advantages and disadvantages of the SWAP-200 diagnostic procedure, which includes the assessment of affect-experience, defence-organisation, and object-relation-style. [Copyright &y& Elsevier]