Corresponding Author Information: Jaakko Stenius

Session Abstract: BACKROUND AND PURPOSE: Interview-based pre-treatment evaluation of patient characteristics may help selecting optimal type or length of psychotherapeutic treatment. The Rorschach-based Ego Impairment Index (EII-2) provides a yet uninvestigated performance-based approach for evaluating these kinds of qualities that are not gauged by the interview methodology. We hypothesized lower ego impairment to predict faster gain in short-term as compared to long-term psychotherapy. SUBJECTS: The sample included 326 outpatients. The patients were suffering from depressive or anxiety disorders. The patients were randomized into solution-focused (n = 97), short-term psychodynamic (n = 101) or long-term psychodynamic psychotherapy (n = 128), while the mean duration of therapies was 7.5, 5.7, and 31.3 months, respectively. METHODS AND MATERIALS:  A cohort study design with repeated measurements was used. The predictive ability of the EII-2 on psychotherapy outcome was evaluated at the baseline and after 3, 7, 12, 24, 36, 48, and 60 months time points during the five-year follow-up. Psychotherapy outcome assessments covered psychiatric symptoms (SCL-90-GSI), social functioning (SAS-SR) and work ability (WAI). ANALYSES: The 'intention-to-treat' (ITT) design was followed, in which all the patients who had been randomized were included. The analyses were based on the assumption of ignorable dropouts. The statistical analyses were performed using linear mixed models. Model-adjusted differences in outcomes between patients with "low" and "high" ego impairment at different measurement points were calculated and the confidence intervals were computed using the delta method. RESULTS:  Lower EII-2 values, indicating less problematic ego functioning, were found to predict faster improvement in both short-term therapies as compared to long-term psychotherapy. CONCLUSIONS: The results provide preliminary support for the utility of EII-2 as a complement to interview-based methods for identifying patients with good capacity to benefit from brief treatment. The limitations of the study include that all outcome measures were based on self-reports. As this was the first study on the predictive ability of the EII-2 on psychotherapy outcome, more research is needed to confirm and extend the presented findings.


Jaakko Stenius | Niuvanniemi Hospital, Kuopio, Finland

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