Published electronically on this site courtesy of the authors. © W. Keller 1997, Berlin, Germany. All rights reserved

A more detailed publication of the results is in preparation. A slightly longer version is
Keller W (1997) "Research and jungian psychotherapy - Outcome studies, part II." In: Mattoon MA (ed) Open Questions in Analytical Psychology. Proceedings of the Thirteenth International Congress for Analytical Psychology, Zurich 1995. Einsiedeln, Daimon, pp 641-645

Despite a number of studies on the effectiveness of psychotherapy, there are thus far no studies on the efficacy of long-term analyses with a naturalistic design that include psychoanalysts and psychotherapists in private practice. Responsible for this are the long duration of prospective outcome studies and the high costs involved as well as methodological difficulties in the treatment practice. For reasons of performing this study in an acceptable temporal and financial frame, a retrospective, naturalistic multi-level design was chosen. This study was financed by independent funding. ⁽²⁾

Study goal

1. Proving the effectivity of long-term analyses > 100 sessions in the field and examining the stability of outcome by a follow-up study 6 years after the end of therapy.

2. Evaluating aspects of cost-effectiveness.

3. Implementing research strategies in the area of outpatient care as a measure for quality assurance.

Methods and design

Central components of the study were, on the one hand, the follow-up of former patients via a questionnaire 6 years after the end of psychotherapy or psychoanalysis and, on the other hand, the recording of objective administrative data from health insurance claims (number of work disability days and hospitalization days) 5 years before and after therapy. All members of the German Society for Analytical Psychology, the umbrella organization of Jungian psychoanalysts (DGAP), were asked to participate in the study. 78% anwered our request, 24.6% participated. On the basis of their notes, the therapists in private practice participating in the study documented all cases (including dropouts) concluded between 1987 and 1988 with a basic questionnaire regarding clinical and sociodemographic data and setting characteristics at the start of therapy and gave a global assessment of their patients' state at the end of therapy. The selected sample of 111 cases obtained via a follow-up questionnaire was checked by comparing it with a total of 358 therapies concluded between 1987 and 1988 assessed by the basic questionnaire. The selection of therapists participing in the study was checked by a survey of all DGAP members with respect to central therapist and setting characteristics. Based on the applications of therapists for payment, a retrospective ICD-10 classification was carried out by two independent raters in a consensus rating using the Schepank method (BSS, 1987, 1994) to assess the severity of disease.

Results

The effectiveness of Jungian psychoanalysis and psychotherapy for the majority of the study population (70%-80% depending on the criterium) was evidenced on several assessment levels and on the basis of the success criteria. The effectivity of treatment was demonstrated on several levels:

1. 70-94% of the study participants report good to very good improvements in the subjective comparative self-assessment of patients with respect to physical or psychic symptoms, general satisfaction with life, job performance and partner and family relations as well as other socially relevant areas (including subjective attitude towards the disease).

2. The global assessment by the former therapists of the patients' state at the end of therapy shows relatively good agreement with the patients' own assessment at the time of follow-up 6 years after the end of therapy (therapist: 50.3% good, 29.7% moderate, 5.4% unchanged or deteriorated overall state, patients: 70.3% good, 22.5% moderate, 7.2% unchanged or deteriorated).

3. In the standardized psychometric test examinations of the actual state of health, the randome sample tested lies within the range of healthy standard samples compared to the other clinical disease groups with respect to the relevant alteration qualities of symptoms (SCL-90R) and personality traits (Gießen Test). Regarding a change in experience and behavior (VEV), the test subjects exhibited significant improvements in various areas of life (p < 01) compared to the calibrated random sample.

4. In the comparative pre- and post-expert rating of the actual state of the disease by clinical interviews during the follow-up, a partial random sample of n=33 patients (regional random sample Berlin) by independent raters showed a significant (p<0.01) decrease of the severity of disease (impairment severity according to Schepank).

5. A comparison of the work disability and days in hospital recorded by cost carriers 5 years and 1 year before and after treatment. An additional comparison to the mean values from a large health insurance company (Barmer Ersatzkasse) showed a reduction of objective work disability and hospitalization days (Fig. 1 and 2). A reduction of work disability and hospitalization days after treatment can be regarded as an indirect measure of the success of therapy. In order to assess the number of work disability days, the study participants had to be continuously employed. Part of the random sample is therefore not applicable. The random sample is thus reduced from 111 to 47 patients for work disability days and to 58 patients for hospitalization days.

Conclusion

The effectiveness of Jungian psychoanalysis and psychotherapy was determined on the basis of 5 different perspectives and different success criteria. More than 75% of the patients examined had had psychoanalysis so that empirical proof of the effectiveness of long-term analyses could be demonstrated even after an average of 6 years or more. Even after 5 years, the improvement in the patients' state of health and attitude toward the disease still resulted in a markedly constant reduction of health insurance claims (work disability days, hospitalization days, doctor's visits and drug intake) in a large number of the patients treated and thus in a reduction of costs. Cost effectiveness aspects increasingly play an important role as success criteria especially for health adminstrations. As we have demonstrated in this retrospective study, psychotherapy apparently also has a long-lasting effect on the patients' behavior toward claiming health insurance benefits. The complete recording of these data requires great care and a methodologically confirmed approach toward the interpretation of these data (Richter et al. 1994). However, when these prerequisites are provided, convincing arguments for the effectiveness of psychotherapy or psychoanalysis together with the clinical results can be found even for a retrospective design.

Literature

Schepank, H: Psychogene Erkrankungen der Stadtbevölkerung - eine epidemiologische Studie in Mannheim. Springer, Heidelberg, New York, London, Paris, Tokyo (1987).

Richter, R, Hartmann, A, Meyer AE, Rüger, U: Die Kränkesten gehen in eine psychoanalytische Behandlung? - Kritische Anmerkung zu einem Artikel in Report Psychologie. Zsch. psychosom. Med. 40, 41-51 (1994)

¹ D. Baldus, R. Väth-Szusdziara, C. Weitze, R. Huntzinger, G. Betzner, H. Krause, P. Affeld-Niemeyer, A. Göttke, S. Loesche [back]

² Foundation for Research on Education and the Handicapped: Robert Bosch
German Society for Analytical Psychology (DGAP) [back]

sample n=47, extrapolated to 100 patients