The Heidelberg Berlin Study: Psychodynamic change in two forms of long term psychoanalytic therapy

Grande, T., Dilg, R., Jakobsen, Th., Keller, W., Krawietz, B., Langer, M., Oberbracht, C., Stehle, S., Stennes, M., & Rudolf, G. (2006): Differential effects of two forms of psychoanalytic therapy: Results of the Heidelberg-Berlin Study. Psychotherapy Research 16, 470-485
Grande, T., Dilg, R., Jakobsen, Th., Keller, W., Krawietz, B., Langer, M., Oberbracht, C., Stehle, S., Stennes, M., & Rudolf, G. (2009): Structural change as a predictor of long-term follow-up outcome. Psychotherapy Research, 19, 344-357.
Leising, D., Rudolf, G., Stadler, K., Jakobsen, Th., Oberbracht, C., & Grande, T. (2003): Do interpersonal behavior and emotional experience change in the course of successful longterm psychoanalytic therapies? Psychotherapy Research 13, 461-474.
Rudolf, G., Grande, T., & Oberbracht, C. (2000). Die Heidelberger Umstrukturierungsskala. Ein Modell der Veränderung in psychoanalytischen Therapien und seine Operationalisierung in einer Schätzskala {The Heidelberg Structural Change Scale. A model of change in psychoanalytic therapies and its operationalisation in a rating scale}. Psychotherapeut, 45, 237-246.

Purpose

In this multicenter study process and outcome of two forms of long-term therapies (psychoanalytic and psychodynamic) have been studied. There were three main points of interest: to describe the clinical outcome of psychoanalytic long term therapies; studying psychodynamic nature of change in longer and shorter therapies; identifying predictors for follow-up developments.

Patients have been assigned and treated by experienced psychoanalytic practitioners and have been interviewed and videotaped by members of the study group. Clinical, social and psychodynamic data (rated in the OPD system) were collected by therapists, the study group and patients self reports every three months, respectively six months during the long term therapy and follow-up one and three years after. Those groups were matched in social demographic data and clinical severity.

Results

No difference in global outcome rates between longer psychoanalytic and shorter psychodynamic therapies was found, but the level of structural psychodynamic change (as measured by the Heidelberg Structural Change Scale Scale (HSC) (see Rudolf, 2000) was higher in longer therapies. Structural change at the end of therapy was the best predictor for longterm follow-up development of the patients. The HSC was found to be especially useful for psychodynamic training and quality assessment.

Evaluation

The main interest was to evaluate longer and shorter psychoanalytic therapies under naturalistic conditions. In the videotaped interviews the change of focal psycho­dynamic aspects (“structural change”) were rated by blind raters. Thus the perspective of patients self reports, therapist ratings and the ratings of the independent study group could be compared. For some questions data of this study have been put together with other German studies run in this time (see Jacobsen et al. 2007).

 In consequence of the fact that initial level of patients structural integration (due to OPD) correlated with therapy outcome in the following years we developed a modified psychodynamic therapy for patients with low structural level (Rudolf 2004, 2006, 2013).

Contact

Prof. G. Rudolf, former director of the Heidelberg psychosomatic university clinic.

E-Mail: gerd.rudolf@med.uni-heidelberg.de

PD. Dr. T. Grande

E-mail: tilman.grande@t-online.de