INTERPERSONAL PROBLEMS IN PSYCHODYNAMIC PSYCHOTHERAPY

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Previous studies of psychodynamic psychotherapy have focused on changes in symptoms, though the treatment itself primarily concerns interpersonal problems and conflicts. This project will develop two new methods for studying the interpersonal aspects of psychotherapy--(1) an Inventory of Interpersonal Problems, a self-report instrument for describing a patient's distress arising from interpersonal problems, and (2) a group-derived dynamic formulation, an objective and systematic method of combining clinicians' independent judgment into a dynamic formulation that describes a patients's interpersonal problems. The patients in this study will be men and women who are about to receive brief psychodynamic psychotherapy through the Kaiser-Permanente Medical Center. While they are on the waiting list, they will complete a battery of questionnaires twice over a 2-month period. Then each patient will be interviewed in a psychodynamic intake interview which will be videotaped and presented to a group of experienced clinical formulators whose judgments will be combined into a group-derived dynamic formulation. The patients will then be measured after the tenth session, after the last session, and a 6-month follow-up interview. The design includes repeated assessments of the patient's interpersonal and symptomatic complaints. Also, to increase the reliability of the data, every measurement will involve multiple assessments. The two methods will be used (1) to trace interpersonal and noninterpersonal changes that occur throughout treatment; (2) to compare changes in interpersonal distress to changes in symptomatic distress; (3) to study whether the patient and therapist become more congruent across sessions in identifying salient interpersonal problems; and (4) to study whether a patient's report of interpersonal problems increasingly comes to match that suggested by the dynamic formulation. It will also be possible to classify patients according to their interpersonal problems and to examine the therapeutic progress of different subgroups.