Affective Disorders and Cognitive Failures a Comparison of Seasonal and Nonseasonal Depression

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.

Results

The eight variables examined by the SCORS instrument are complexity of representation (COM), affective quality of representation (AFT), emotional investment in relationships (EIR), emotional investment in morals and moral standards (EIM), understanding of social causality (SC), experience and management of aggressive impulses (AGG), self-esteem (SE), and identity and coherence of self (ICS). The inter-rater (interviewers) reliability for these eight variables ranged from a high of 0.94 (EIR) to a low of 0.71 (ICS).

The only Rorschach variable able to predict the number of psychotherapy sessions attended was MOA PATH (r = 0.34, p = 0.003), which assesses the degree of disturbed object representation (Ackerman, Hilsenroth, Clemence, Weatherill, and Fowler, 2000, p. 397). By comparison, the two SCORS variables, AFF (r = 0.45, p = 0.02) and EIR (r = 0.42, p = 0.02), were predictive of the number of psychotherapy sessions attended.

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.