Dismantling the difference
Löffler-Stastka, H. (2009a). Von der empirisch psychoanalytischen Prozess- und Ergebnisforschung zur klinischen Praxis [From empirical psychoanalytic research and outcome studies to the clinical practice]. Psychotherapie Forum, 17(1), 21-28. DOI: 10.1007/s00729-009-0276-3.
Löffler-Stastka, H. (2009b). “Affektlose Zustände?" [“Affectless states?”]. Forum der Psychoanalyse, 25 (3), 237-254. DOI: 10.1007/s00451-009-0005-0.
Zimmermann, J., Löffler-Stastka, H., Huber, D., Klug, G., Alhabbo, S., Bock, A., & Benecke, C. (2015). Is it all about the higher dose? Why psychoanalytic psychotherapy is an effective treatment for major depression. Clinical Psychology & Psychotherapy 22, 469-487.
The empirical studies point at the necessity of interpreting affect-regulatory parameters, such as the hostile-externalizing-dysphoric parameter, from the very beginning of the treatment on. Acknowledgement and recognition of externalizing and projective mechanisms should be trained in the psychotherapeutic routine treatment in order to establish a stable working alliance with the patient. However, it is unclear whether the effectiveness of LTPP is due to distinctive features of psychodynamic/ psychoanalytic techniques or to a higher number of sessions.
We tested these rival hypotheses in a quasi-experimental study comparing psychoanalytic therapy (i.e., high-dose LTPP) with psychodynamic therapy (i.e., low-dose LTPP) an cognitive-behavioral therapy (CBT) for depression. Analyses were based on a subsample of 77 subjects, with 27 receiving psychoanalytic therapy, 26 receiving psychodynamic therapy, and 24 receiving CBT. Depressive symptoms, interpersonal problems, and introject affiliation were assessed prior to treatment, after treatment, and at the 1-, 2-, and 3-year follow-ups. Psychoanalytic techniques were assessed from three audiotaped middle sessions per treatment using the Psychotherapy Process Q-Set. Subjects receiving psychoanalytic therapy reported having fewer interpersonal problems, treated themselves in a more affiliative way directly after treatment, and tended to improve in depressive symptoms and interpersonal problems during follow-up as compared with patients receiving psychodynamic therapy and/or CBT.
Multilevel mediation analyses suggested that post-treatment differences in interpersonal problems and introject affiliation were mediated by the higher number of sessions, and follow-up differences in depressive symptoms were mediated by the more pronounced application of psychoanalytic techniques. We also found some evidence for indirect treatment effects via psychoanalytic techniques. These results provide support for the prediction that both a high dose and the application of psychoanalytic techniques facilitate therapeutic change in patients with major depression.
Henriette Löffler-Stastka, Assoc.Prof.in Priv.-Doz.in Dr.in
Medizinische Universität Wien, Universitätsklinik für Psychoanalyse und Psychotherapie, Währinger Gürtel 18-20, 1090 Wien