The overall aim of the present proposal is to test the validity of a new method for assessing psychodynamic change resulting from psychotherapy. An initial psychodynamic interview is rated in a two stage procedure that yields an idiographic conflict formulation (ICF), and scores on the 14 Psychodynamic Conflict Rating Scales (PCRS). Dynamic change will be assessed at one and two years of follow-up. This method will be tested in a naturalistic study of 150 neurotic, depressive, or personality disordered outpatients entering psychotherapy with 25 participating therapists at three sites. The effect on patient outcome of giving the treating therapist the patient's ICF and PCRS will also be assessed. Symptom and dynamic status will be independently measured over a two year follow-up period. Assessment procedures will include the course of any DSM-III axis I disorder, problems with impulse control, and psychosocial role functioning. Dynamic assessments will compare the new methods with change in defenses and coping with prospectively gathered life events. The methodological aims include testing the reliability and stability of both initial and outcome psychodynamic assessment procedures, as well as comparing them with Luborsky's CCRT method. The clinical aims include determining 1) the association between select diagnoses and dynamic conflicts at intake, 2) the effect on patient outcome of giving the ICF to the therapist, and 3) the relationship between symptomatic and dynamic improvement. Dynamic status at one year will be used to predict lasting recovery at two years, over and above what symptom status at one year predicts, helping to answer the question of whether clinicians should attend to issues of dynamic recovery beyond attending to symptomatic improvement. The relative clinical usefulness of the ICF will be tested against the CCRT by comparing interpretations compatible with each formulation in relationship to patient outcome. This study should advance the study of psychodynamic assessment and facilitate subsequent studies of the efficacy of specific types of psychotherapy for specific psychodynamic conflicts and diagnoses.
| Perry, J C (2001) A pilot study of defenses in adults with personality disorders entering psychotherapy. J Nerv Ment Dis 189:651-60 |
| Perry, J C; Augusto, F; Cooper, S H (1989) Assessing psychodynamic conflicts: I. Reliability of the idiographic conflict formulation method. Psychiatry 52:289-301 |
