Success and Failure in Time-Limited Psychotherapy

Abstract

Why do some patients succeed in psychotherapy whereas others fail? Moreover, what can be learned from a comparison of two comparable patients treated by the same therapist under very similar conditions? Two cases drawn from the Vanderbilt Psychotherapy Project, a controlled study of process and outcome, were studied with a view toward deepening scientific and clinical understanding of time-limited psychoanalytic psychotherapy. Analyses of this kind are also important because the typical psychotherapy outcome study largely ignores individual cases entering into data of "average improvement." Based on systematic outcome and process measures, combined with a detailed study of complete process recordings, the case histories presented herein were those of two young men suffering from anxiety, depression, and social withdrawal who were treated by the same psychotherapist. The results of this analysis, the first of a series, suggest that therapy outcomes are importantly determined by the patient's ability to take advantage of the particular relationship the therapist has to offer; conversely, therapy fails if there is a poor match on these dimensions. Pertinent variables are further specified.

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