Therapies
Forms of therapy
Four forms of therapy were studied: solution-focused therapy, short-term psychodynamic psychotherapy, long-term psychodynamic psychotherapy, and psychoanalysis.
External specifications of therapy
- In solution-focused therapy the frequency of sessions was flexible, usually one every second or third week, with up to a maximum of 12 sessions over an average of 7.5 months.
- In short-term psychodynamic psychotherapy the therapy was scheduled for 20 treatment sessions (one a week) over an average of 5.7 months.
- In long-term psychodynamic psychotherapy the frequency of sessions was 2-3 a week, and the duration of therapy was up to 3 years.
- In psychoanalysis the frequency of sessions was 4 a week, and the duration was up to 5 years.
The goals of the therapies and the therapy process
Solution-focused therapy is a brief therapy approach which emphasizes the identification of a problem and collaborative efforts to maintain a focus on finding a solution to the problem (Johnson and Miller 1994; Lambert et al. 1998). No single, accepted theory of solution-focused therapy exists, but the approach is closely related to postmodernism, narrative theory, and language theory (Miller et al. 1995). In this study, the main components were the search for pre-session change (i.e. questions on changes that occurred before the treatment began), goal-setting, the use of miracle and scaling questions, exploration of exceptions, the use of one-way mirror and a consulting break, and the use of positive feedback and home assignments.
Short-term psychodynamic psychotherapy is characterized by the exploration of a focus, which can be identified by both the therapist and the patient. This consists of material from current and past interpersonal and intrapsychic conflicts. The therapist's role in this approach is active in creating the alliance and ensuring a time-limited focus (Malan 1976). The main therapeutic interventions used were confrontation, clarification, and interpretation.
Long-term psychodynamic psychotherapy is characterized by a framework in which the central elements are the exploration of unconscious conflicts, deficits, and distortions of intrapsychic structures. Confrontation, clarification, and interpretation were major elements, as well as the therapist's actions in ensuring the alliance and working through in the therapeutic relationship (Gabbard 1994). The therapy process was oriented towards conflict resolution and greater self-awareness.
In psychoanalysis, current and past interpersonal and intrapsychic conflicts, transference phenomena, and developmental arrests are explored. The central aim of psychoanalysis is the enhancement of the self-awareness of unconscious motives, impulses, fears, and conflicts, and thereby a thorough restructuring of personality (Greenson 1985) as well as a new developmental growth process within the therapeutic relationship (Tähkä 1993).
Performance of the therapies
- A total of 71 therapists participated in the study. 6 therapists provided solution-focused therapy, 12 short-term psychodynamic psychotherapy, 41 long-term psychodynamic psychotherapy, and 30 psychoanalysis.
- The therapists were mainly psychologists (78%).
- The therapists had practiced for at least 2 years after training in the specific form of psychotherapy. The mean years of experience was 9 for both short-term psychodynamic psychotherapy and the solution-focused groups of therapists, and at least 15 years for the therapists giving long-term psychotherapy and psychoanalysis.
- The therapies were conducted in conformance with clinical practice. No therapy manuals were used and no training was arranged by the HPS.
- No video or audio taping was carried out during the sessions. Patients and therapists answered questions on the quality of the co-operation. The extent to which the treatment satisfied criteria based on treatment characteristics was also evaluated. The characteristics considered were the waiting time until the beginning of the therapy, frequency of sessions, length of therapy, number of sessions, unusual breaks in treatment, change of therapist, and discontinuation of therapy.