Predicting psychotherapy persistence in patients with personality disorders

Predicting Patient Investment Into Psychotherapy

Psychotherapy Investment

Prediction Patient Investment in Psychotherapy

Predicting Patient Investment into Psychotherapy

The factors that cause an individual to terminate psychotherapy have been of interest since this form of therapy was developed. Some researchers and theorists have argued that the need to relieve personal isolation and habits of dependency may motivate patients to remain in psychotherapy (reviewed by Ackerman, Hilsenroth, Clemence, Weatherill, and Fowler, 2000, p. 387). This does not imply that patients who remain in psychotherapy are docile though. Quite the contrary, studies have shown that these patients are often aggressive, contrary, have turbulent negative emotions, and high levels of interpersonal distress.

The research data that produced the above findings were based primarily on Rorschach examinations. Whether these findings would be validated by non-Rorschach instruments is unknown. Towards this goal, Ackerman and colleagues (2000) examined the utility of the Westen's Social Cognition and Object Relations Scale in predicting the number of sessions attended by patients with DSM-IV Axis II personality disorders.

Methods

The Rorschach instruments, Mutuality of Autonomy Scale (MOA) and Holt primary (A1) and secondary (A2) process Aggression variables Scale (HAS) were used to assess personality traits. These results were compared to the Westen's Social Cognition and Object Relations Scale (SCORS).

The sample (N = 76) was drawn from case files archived at a university outpatient community clinic. Only those with Rorschach data in their records and a DSM-IV personality disorder were included in the study.

Discussion

These findings revealed that a higher MOA PATH score predicted persistence in psychotherapy (Ackerman, Hilsenroth, Clemence, Weatherill, and Fowler, 2000, p. 398). By comparison, a lower score on the AFF variable and a higher score on EIR were correlated with attending more therapy sessions. In other words, patients with personality disorders and severe disturbances in object representations and interpersonal relationships are more likely to invest in psychotherapy. This is consistent with the theory that patients with the severest disturbances gain the most benefit from psychotherapy, and from interacting with another person (therapist) in a controlled and well-defined setting.

Validation of these results is conferred by similar findings from earlier studies and independently by the results of the non-Rorschach SCORS instrument. These results are also limited in scope, since they are applicable only to patients with DSM-IV Axis II personality disorders. Since this is an essentially retrospective study, it cannot provide guidance for what could be changed to encourage other patients to invest in psychotherapy, therefore its utility for psychotherapy patients as a whole is minimal.