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Rothchild, E. (1973). Bulletin of the Menninger Clinic. XXXVI, 1972, Nos. 1/2: Psychotherapy and Psychoanalysis. Final Report of the Menninger Foundation's Psychotherapy Research Project. O. Kernberg, E. Burstein, L. Coyne, A. Appelbaum, L. Horwitz, H. Voth.. Psychoanal Q., 42:313-314.
Psychoanalytic Electronic Publishing: Bulletin of the Menninger Clinic. XXXVI, 1972, Nos. 1/2: Psychotherapy and Psychoanalysis. Final Report of the Menninger Foundation's Psychotherapy Research Project. O. Kernberg, E. Burstein, L. Coyne, A. Appelbaum, L. Horwitz, H. Voth.

(1973). Psychoanalytic Quarterly, 42:313-314

Bulletin of the Menninger Clinic. XXXVI, 1972, Nos. 1/2: Psychotherapy and Psychoanalysis. Final Report of the Menninger Foundation's Psychotherapy Research Project. O. Kernberg, E. Burstein, L. Coyne, A. Appelbaum, L. Horwitz, H. Voth.

Ellen Rothchild

This double issue of the Bulletin, which has also been published in book form, is the final report of the Menninger Foundation's Psychotherapy Research Project that began in 1954 to study the process and outcome of psychotherapy and psychoanalysis.

The study was based on forth-two adult patients, half of whom were in psychoanalysis; the remainder received psychoanalytically-oriented psychotherapy. Only patients diagnosed as having neuroses, character pathology including borderline conditions, and latent psychosis were included. Until treatment ended neither patients nor therapists were informed that they were being studied. Data on each subject were obtained and organized for three points in time—pretreatment, termination, and follow-up, within three general categories of variables—patients, therapy, and environment. One major quantitative approach to handling these variables was the method of 'paired comparisons': patients were ranked as having 'more than' or 'less than' one another in terms of key variables. Within the limitations imposed by small sample size and a large number of variables, hypotheses concerning the outcome of treatment were then statistically tested. Later in the project another method of analyzing the same quantitative data was found in a technique termed Multi-Dimensional Scalogram Analysis, a computerized geometric means of representing groups or categories of data. Based on 'facet theory', a system by which complex concepts or variables are broken down into simple sets of elements or 'facets', this technique allows the most relevant variables to be singled out from a large number, although conclusions cannot be stated in probability terms.

Some major findings and conclusions derived from both these approaches to the data pertinent to the diagnostic entities studied include the following: 1, high initial ego strength (defined in terms of patterning of defenses, anxiety tolerance, quality of interpersonal relationships, and severity of symptoms) implies a good prognosis regardless of treatment modality, though psychoanalysis may bring about the highest degree of improvement in such patients; 2, patients with low ego strength (borderline patients in this study) improve with psychotherapy if that therapy is supportive-interpretive and focuses especially on transference phenomena; 3, psychotherapy that is exclusively supportive is not helpful to patients with low ego strength, nor for long-term treatment of patients with high ego strength; 4, a highly skilled therapist contributes significantly to the improvement of patients regardless of whether treatment is interpretive or supportive, while a less skilled therapist contributes more effectively to improvement if the treatment modality is interpretive; 5, as a corollary, the skill of the therapist is especially important to improvement of very sick patients while it is not greatly influential in improvement of 'stronger' patients; 6, a high level of manifest anxiety prognosticates well for treatment; 7, initial motivation for change is not prognostically significant; and

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8, the pretreatment characteristics of the environment (including its stress and conflict-triggering aspects) are not significant as predictors of treatment outcome.

Much of this long and detailed report of a complex and monumental research effort, complete with nine appendices, deals with problems of research design and interpretation that arose along the way. The reward to the reader rests as much in following the unfolding of an intriguing and important methodologic approach to problems of prediction in psychotherapy and psychoanalysis as in the clinical applicability of the findings.

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Article Citation

Rothchild, E. (1973). Bulletin of the Menninger Clinic. XXXVI, 1972, Nos. 1/2. Psychoanal. Q., 42:313-314

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