Assessing Reenactment in Inpatient Psychodynamic Therapy

Abstract

Research material from a study relating to a central concept of inpatient psychotherapy is presented. The purpose of the research program was to investigate the extent to which patients reenact their experience and behavior from relationships outside of psychotherapy during inpatient treatment. Toward this end, the concordance of patients' relationship and behavior experiences was measured at 2 separate stages of treatment. Patients' subjective relationship structures, as diagnosed at the beginning of treatment, were compared with the consensus rating of the team of therapists, who then assessed patients' interpersonal experience and behavior during the first 3 weeks of treatment. Axis II (relationships) of the Operationalized Psychodynamic Diagnostics System was used as a measuring instrument. The similarity of the assessments was illustrated and checked for chance hits by means of the weighted kappa coefficient, κw (J. Cohen, 1968). All similarity comparisons showed clear kappa concordance (κw = 0.55, variance-κw < 0.001; and κw = 0.57, variance-κw < 0.001, respectively). Therefore, we believe that interpersonal relationship patterns from a patient's past, as related in the Relationship Anecdotes Paradigm Interview, largely correspond with his or her behavior observed by the hospital team. We thus conclude that the reenactment of relationship-behavior forms does occur.