Criteria for judging results. A study about conceptualization of goals in psychoanalysis

Westenberger-Breuer, H. (2003). Kriterien des Erfolgs. Eine Untersuchung zum Konzept des Behandlungsziels in der Psychoanalyse {Criteria of success. An investigation on the concept of treatment goals in psychoanalysis}. Tübingen: edition diskord.
Westenberger-Breuer, H. (2007). The goals of psychoanalytic treatment: conceptual considerations and follow-up interview evaluation with a former analysand, International Journal of Psychoanalysis, 88, 1-13.

There has been an increasing number of studies of the effects of psychoanalytic treatment over the past 20 years which many psychoanalysts approach rather sceptically. One of the criticisms concerns the criteria by which treatment results are judged. The sought-after changes unique to psychoanalytic treatment are seen as impossible to operationalize, i.e. according to this view, they simply cannot, or not sufficiently, be grasped within the confines of empirical research. Studying this argument reveals that the opinions of psychoanalysts concerning the goals to which psychoanalysis aspires in treating patients vary extensively, even including the position that psychoanalytic treatment ought to be utterly goalless. Without a common understanding of the results that can generally be expected from a psychoanalytic treatment conducted lege artis, it is impossible to reflect on and judge our own methods. Even if as a psychoanalyst one believes that the changes resulting from psychoanalytic treatment simply cannot be measured psychometrically, in some way or other these changes ought to be conceived of as treatment effects so that potentially necessary corrections can be developed in our understanding and technique.

There already exist a plethora of goal definitions by psychoanalysts from the various theoretical schools, so many that many authors even lament their confusing and contradictory diversity.  The wealth of goal descriptions that can be found in the literature was reduced by differentiating the definitions according to their content and their level of abstraction at which they are formulated. They were grouped in four categories. The proposal for a conceptualization was, that the goal of psychoanalytic treatment encompasses these four components: (1) Changes in symptoms and complaints, (2) Changes in life adjustment, (3) Changes in personality structure and (4) Realization of procedural goals.

Method/Design

This definiton of the goal in psychoanalysis was tested by presenting a transcript of two follow-up interviews with a former analysand to 19 psychoanalysts. The case comes from the follow-up study of the German Psychoanalytic Society (DPV), reported by Leuzinger-Bohleber, M. et al. in 2002. There were audio-taped discussions in the local and in the nationwide research group, in which the statements of the former analysand were evaluated. Additionally two other colleagues commented the interviews. The group included psychoanalysts of various ages, with differing interests and theoretical orientations.

Moreover the transcripts of the follow-up interviews were presented to a philosopher, a behavioural therapist, a sociologist, an educational researcher, a psychiatrist, a Gestalt therapist, a systems therapist and a manager of the Association of Statutory Health Insurance Physicians.

Those formulations which refer to goal criteria have been placed into the categories defined above. The statements have been taken from the protocols verbatim and from authorized protocols of the interviews with the experts. The selection of statements taken from the protocols and their classification in the form given here were reviewed by another person, who agreed in large part with that of the author.

In Westenberger-Breuer (2003) all the protocols can be found, as well as a complete report of the follow-up interviews with the former patient.

Results

The judgments of the analysts who co-operated in this follow-up project can be meaningfully assigned to the defined categories. Psychoanalysts use the criteria defined above implicitly in forming their opinions about treatment outcome. None of the aspects remains unmentioned, no aspect is singled out in its importance and no special weight is accorded to specific theoretical orientations by individual psychoanalysts in their concrete overall appraisal to treatment outcome. Moreover the psychoanalysts not only employed similar criteria in their assessments, but also showed wide agreement in judging the content.

The outside experts came to similar results. There was wide agreement with the criteria used by the psychoanalysts, as well as with judging the content of the treatment outcome.

Contact

Heike Westenberger-Breuer  

Email: westenberger-breuer@t-online.de