Psykodynamisk korttidsterapi. En intensivstudie av samspel, förändring och utfall

Sammanfattning: The overall aim of the thesis was to investigate the effects of psychodynamically oriented psychotherapy and gain an increased understanding of the curative factors in psychotherapy by thorough examination of the therapeutic alliance and of client change. The core of the thesis is a naturalistic study of 22 short-term dynamic psychotherapies and a follow-up 6-12 months later. Individual outcome measures based on the method Malan developed were employed. The thesis consists of five studies. The first study is a review of research on the effects of psychotherapy as seen in relation to various client and therapist variables. The research considered indicated psychotherapy to have a positive effect. Age, education and social group membership appeared to lack relevance for the outcome, and neither the experience nor the training of the therapist seemed to affect the outcome appreciably. The results of the second study, concerning outcome, were largely in line with the findings just cited, a significant positive correlation between the outcome and the therapist's skill as rated by supervisor also being obtained. In the third study, affective communication between the client and the therapist was studied in relation to client change. Two therapies were compared. The therapist in the one was adjudged to be highly skillful therapeutically and in the other to be much less skillful. The Core Conflictual Relationship Theme method (CCRT) and the Plan Diagnoses Method were employed. A positive change in the client´s relationship pattern and in the therapist´s ability to disconfirm the client´s “pathogenic beliefs” were found to be related, suggesting the therapist´s skill in identifying the client´s affective message and in responding to it with affective resonance to be curative factors in psychotherapy. The fourth study, based on a research review, examined the deeper meaning of the term alliance as seen in terms of an affect-theoretical approach. Alliance was suggested to basically represent an affective exchange between the client and the therapist, a theoretical view that was linked with Silvan Tomkins´ derivation of the human affect system. In the fifth paper, a case-study, hypotheses of how the client should behave at the beginning and the end of therapy and at follow-up in terms of two projective tests, PORT (Percept-genetic Object-relation Test) and DMT (Defense Mechanism Test), were formulated on the basis of earlier research. The hypotheses that the client should display signs of negative emotions, interpersonal conflicts and primitive defenses at the start of therapy and should show fewer signs of negative emotions and conflicts and display more thoroughly developed defenses at the close of therapy and at follow-up were supported. The fact that changes in the client were manifested at an unconscious or preconscious level was taken to suggest that such changes can be interpreted in structural terms. The results were seen to provide support for the usefulness of perceptgenetic methods in describing the effects of psychodynamic treatment and the developments that occur in the course of it. In the thesis as a whole it was found that psychodynamic therapy can clearly serve its purpose in an actual clinical context, that structural changes in clients can be achieved in short-term therapy, and that affective communication between the client and the therapist is of extreme importance for the outcome and for positive changes in the client occurring.