University of Jyväskylä

Dissertation: 17.12 Patient suitability for short-term and long-term psychotherapy (Laaksonen)

Start date: Dec 17, 2014 12:00 AM

End date: Dec 17, 2014 03:00 PM

Location: Mattilanniemi, MaA 211

Maarit Laaksonen. Kuvaaja: Alister CordinerPhD, M.Soc.Sc. Maarit Laaksonen defends her doctoral dissertation in Psychology ”Patient suitability for short-term and long-term psychotherapy”. Opponent  Professor Emeritus Johannes Lehtonen and custos Professor Jarl Wahlstrom (University of Jyväskylä). The event is in Finnish.


A clinically-informed, evidence-based choice of optimal psychotherapy is considered of the utmost importance to patients’ recovery from mental disorders. Nevertheless, no generally accepted, systematic method of referring psychiatric patients to psychotherapy currently exists. Patients’ psychological, intrapsychic and interpersonal, capacities are among the core psychotherapy suitability selection criteria suggested for differentiating those treatable with short-term psychotherapy from those in need of long-term psychotherapy. Research into both the assessment of psychotherapy suitability and its prediction of psychotherapy outcomes remains scarce, however. Only a few psychotherapy suitability assessment scales have been studied for their reliability and validity. Psychotherapy outcome prediction by patient suitability has been almost exclusively studied based on short-term therapies. No study has compared outcome prediction by patient suitability in short-term versus long-term psychotherapy. In this study, a new interview-based 7-item Suitability for Psychotherapy Scale (SPS) was presented and its reliability, validity, and prediction of outcomes of short-term and long-term psychotherapy were thoroughly evaluated based on data from the Helsinki Psychotherapy Study (HPS).

In the HPS, 326 outpatients aged 20-46 years and suffering from mood and anxiety disorders were randomized between individual short-term, psychodynamic (N = 101) or solution-focused (N = 97), psychotherapy or long-term psychodynamic psychotherapy (N = 128). Prior to randomization, the patients’ psychological capacities (i.e., modulation of affects, flexibility of interaction with the interviewer, self-concept in relation to ego ideal, reflective ability, response to trial interpretation, motivation, and the focality of the problems) were assessed using the SPS. A cumulative SPS score, varying between 0-7, was formed by summing up the values of the seven suitability measures, classified as good (0) or poor (1). Psychiatric symptoms were self-reported using the Symptom Checklist-90, Global Severity Index (SCL-90-GSI) at baseline and seven times during a 3-year follow-up. The reliability of the SPS was evaluated based on a non-random sample of 39 videotaped interviews by measuring the agreement between the seven individual interviewers’ assessments and the repeatability of the interviewers’ assessments over three years using kappa coefficients. The validity of the SPS was evaluated based on the total sample of 326 patients by measuring its association with a criterion measure, Quality of Object Relations Scale (QORS), and a discriminating measure, SCL-90-GSI, at baseline using linear models. Prediction by the seven SPS measures and the SPS score of the development of psychiatric symptoms in the two short-term therapies and the long-term therapy during the 3-year follow-up was measured using linear mixed models, adjusting for baseline symptoms.

The findings supported both the agreement between individual interviewers’ assessments and the repeatability of the interviewers’ assessments over time. An association of the SPS with the personality functions but not with psychiatric symptoms supported the criterion and discriminating validity of the SPS. The SPS predicted changes in psychiatric symptoms during follow-up for all three therapy groups irrespective of the baseline symptom level. The SPS did not notably differentiate the outcome of the two short-term therapies, but strongly differentiated the outcome of short-term and long-term psychotherapy. Patients with good values in the individual SPS measures experienced a faster symptom reduction in short-term therapy, whereas patients with poor values in these measures experienced a greater symptom reduction in long-term therapy. Three patient groups with different prognosis were identified when the cumulative SPS score was used to predict symptom development: 1) patients with mainly good values in the seven suitability measures (score values 0-3) seemed to benefit more from short-term therapy, 2) patients with mainly poor values in the seven suitability measures (score values 4-6) seemed to benefit more from long-term therapy, and 3) patients for whom all seven values were poor (score value 7) seemed to fail to benefit from either short-term or long-term therapy.

The SPS appeared to be a reliable and valid pre-treatment psychotherapy suitability assessment method, with the ability to predict and differentiate the outcome of short-term and long-term psychotherapy. The SPS may thus be utilized in matching patients to treatments and optimizing both treatment outcomes and health care resources. However, more research is needed to confirm these findings and to demonstrate their usefulness in practice.

Keywords: anxiety disorder, long-term psychotherapy, mood disorder, prediction, psychological capacity, psychotherapy suitability assessment, reliability, short-term psychotherapy, validity

The dissertation is published in the series Tutkimus, THL - National Institute for health and welfare, 144, ISBN 978-952-302-332-1 (printed); ISBN 978-952-302-333-8 (pdf).

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