Short-term Inpatient Psychotherapy Research Articles

Effectiveness of Short-Term Inpatient Psychotherapy Based on Transactional Analysis With Patients With Personality Disorders: A Matched Control Study Using Propensity Score.

Controlled studies on the effectiveness of inpatient psychotherapy with patients with personality disorders (PD) are rare. This study aims to compare 3-month short-term inpatient psychotherapy based on transactional analysis (STIP-TA) with other psychotherapies (OP) up to 36-month follow-up. PD patients treated with STIP-TA were matched with OP patients using the propensity score. The primary outcome measure was general psychiatric symptomatology; secondary outcomes were psychosocial functioning and quality of life. In 67 pairs of patients, both STIP-TA and OP showed large symptomatic and functional improvements. However, STIP-TA patients showed more symptomatic improvement at all time points compared to OP patients. At 36 months, 68% of STIP-TA patients were symptomatically recovered compared to 48% of OP patients. STIP-TA outperformed OP in terms of improvements in general psychiatric symptomatology and quality of life. Superiority of STIP-TA was most pronounced at 12-month follow-up, but remained intact over the course of the 3-year follow-up.

Change in Identity Diffusion and Psychopathology in a Specialized Inpatient Treatment for Borderline Personality Disorder.

Patients with borderline personality disorder (BPD) show various psychopathological symptoms and suffer especially from disturbance in their identity. The purpose of the study was to investigate changes-particularly in affective BPD symptoms and identity diffusion-during a structured, disorder-specific inpatient treatment (DST) that combined a psychodynamic transference-focused psychotherapy approach with modules of dialectical behavioural skills training. In a prospective, two-group comparison trial, 44 patients with BPD were assessed with questionnaires addressing identity diffusion and state, as well as trait affective psychopathology, before and after 12 weeks of inpatient treatment. Thirty-two patients received DST, whereas 12 patients were given inpatient treatment-as-usual (TAU). The patients were allocated in a non-random procedure for two groups, in order of admission and availability of treatment options in the DST unit. In the pre-post-comparison, the DST group showed a significant decrease in identity diffusion (p < 0.001) and improvements in instability of the image of self and others (p < 0.008), as well as in pathological (trait and state) symptoms. However, there was no significant improvement in the TAU group. After a 12-week inpatient treatment, the findings indicate significant improvements in the DST group in typical affective borderline symptomatology and in the personality structure feature of identity diffusion. This highlights the significance of a short-term specific inpatient therapy for BPD. A structured, disorder-specific inpatient treatment of patients diagnosed with borderline personality disorder (BPD) combined a psychodynamic transference-focused psychotherapy treatment approach (focusing on pathological features in personality organization, particularly on non-integrated images of self and others) with modules of dialectical behavioural skills training. This treatment is associated with a decrease in identity diffusion of these patients after 12 weeks of treatment. The treatment is also related to a significant decrease in borderline typical psychopathological symptoms such as depressive symptoms, as well as an improvement in state anger. The outcomes of this structured, disorder-specific inpatient treatment of severely ill BPD patients indicated the relevance of intensive short-term inpatient psychotherapy in terms of psychopathological improvements as well as initial changes in structural personality organization.

Cost-Effectiveness of Psychotherapy for Cluster C Personality Disorders

To conduct a formal economic evaluation of various dosages of psychotherapy for patients with avoidant, dependent, and obsessive-compulsive (ie, cluster C) personality disorders (Structured Interview for DSM-IV Personality criteria). We developed a decision-analytic model to assess the cost-effectiveness of 5 dosages of psychotherapy (ie, long-term outpatient psychotherapy, short-term and long-term day hospital psychotherapy, and short-term and long-term inpatient psychotherapy) over a 5-year time horizon in terms of cost per recovered patient-year and cost per quality-adjusted life-year (QALY). Model parameters were estimated using data from 466 patients with cluster C personality disorders who were admitted to 6 specialist centers of psychotherapy in The Netherlands and assigned to 1 of the 5 treatment groups. Probabilistic analysis was conducted to explore the stability of results over uncertain data ranges. Analyses were conducted from both societal and payer perspectives. From the societal perspective and below a threshold of € 2,637 (US $3,351.92) per recovered patient-year, short-term day hospital psychotherapy resulted in the highest level of benefit for its cost; above the threshold, short-term inpatient psychotherapy was the most cost-effective choice. In terms of cost per QALY, this switch point was at a threshold value of € 16,570 (US $21,062.29) per QALY. From the payer perspective, the optimal strategy changed from short-term day hospital psychotherapy to short-term inpatient psychotherapy at threshold values of € 9,874 (US $12,550.94) per recovered patient-year and € 66,302 (US $84,277.13) per QALY. This study indicates that short-term day hospital psychotherapy and short-term inpatient psychotherapy are the most cost-effective treatment strategies for patients with cluster C personality disorders. The ultimate selection depends on what cost-effectiveness threshold is considered acceptable and what perspective is adopted.

A Randomized Clinical Trial on the Effectiveness of a Reintegration Training Program Versus Booster Sessions After Short-Term Inpatient Psychotherapy

Although several studies show symptomatic improvements in patients with personality disorders after short-term inpatient psychotherapy, reintegration remains difficult. In this study the effectiveness of a specifically designed reintegration training program is investigated. One hundred twenty-eight patients were randomized to either a reintegration training program aimed at improving general functioning and work resumption, or booster sessions. Outcome measures used were symptom level, work status, absence from and impediments at work. The results showed that compliance in the booster session group was significantly better than in the reintegration training program. The percentage of persons with a paid job increased during the booster sessions from 64 to 87%, but not during the reintegration training (76%). There were no differences in the other outcome measures. We concluded that reintegration training was not more (cost)-effective than booster sessions. Our hypothesis is that continuity of care (same therapists and program) explains the favorable results of the booster sessions.

Dyadic affective interactive patterns in the intake interview as a predictor of outcome

Facial affective behavior of patients and therapists is assumed to be closely related to patients’ interpersonal patterns and therapists’ involvement in these patterns. In this study, facial affect displays of patients and therapists during intake interviews were analyzed to determine their impact on the outcome of the subsequent short-term inpatient psychotherapy. Interviews of ten successful and ten unsuccessful patients (15 female, five male) with two therapists were analyzed with Friesen and Ekman's EMFACS procedure. Feeling states of patients and therapists were registered using the Differential Affect Scale. Reciprocal dyadic patterns of facial affect were determined based on the same lead affect of patient and therapist. As expected, reciprocal patterns predicted an unsuccessful treatment outcome and showed a correlation to positive feeling states in the therapist during the interview. Our data suggest that, in unsuccessful cases, therapists became overly involved in patients’ interpersonal patterns.

Experiences of Patients after Short-Term Inpatient Transactional Analysis Psychotherapy

This article presents the results of interviews with 14 ex-patients four years after a short-term inpatient psychotherapy in which transactional analysis was used as one of the methods. These interviews show that for some patients the positive results of the psychotherapy did not hold; their symptoms recurred and they sought help again. For them the transition from the hospital to society was difficult, especially since they did not participate in aftercare. The results of the interviews has stimulated additional research, which is already underway, to compare the effects of different forms of aftercare on complaints and seeking help again.

Time-limited inpatient group therapy: a developmental model.

ABSTRACTA developmental model of conducting a time-limited, short-term inpatient psychotherapy group is described. The therapist's primary goal in this model is to promote members' awareness of their dysfunctional interpersonal behaviors and the conflicts underlying these behaviors. The therapist pursues this goal by facilitating the group in resolving the conflicts of the four phases through which the group passes. In Phase I, the group addresses conflicts related to the establishment of trust. In Phase II, issues related to dependency wishes focused upon authority figures occupy the group's attention. In Phase III, conflicts within peer relation-ships become focal. In Phase IV as the group approaches termination, group members explore feelings related to the acceptance of loss. For each phase, optimal therapist interventions are described.

Effect of a pregroup collective project on the cohesiveness of inpatient therapy groups.

An attempt was made to increase the cohesion of inpatient therapy groups by having the group members work collectively on a creative art project immediately prior to their second therapy session. Ten short-term inpatient psychotherapy groups, having 6 to 8 members each, were randomly assigned either to this collective project or to an individual project on which group members worked individually on a similar art project. In the therapy session which followed, groups on the collective project showed a significant decrease in physical distance between group members relative to a baseline therapy session and relative to groups on the individual project. Groups on the collective project also scored significantly higher on a cohesion questionnaire than those in the individual project. The questionnaire and intermember-distance measures of group cohesion correlated highly (0.72). Intermember distance returned to baseline during a follow-up therapy session. No differences in the frequency of three types of verbal behavior were found during therapy. Collective art projects may be used to increase cohesion in short-term groups. Further exploration of intermember distance as a measure of group cohesion was suggested.