Personality Disorders: Changes and Stability after Intensive Psychotherapy Focusing on Affect Consciousness

Abstract

Twenty-five patients participated in a prospective follow-up study at an outpatient psychotherapy unit specializing in treating patients with personality disorders and psychosis. The therapeutic approach was broadly based on object relations theory and psychodynamic self-psychology, and was focused in particular on affect consciousness, parental images, self-image and interpersonal relations. Mean duration of treatment was 25.4 months, and the mean follow-up period was 5.2 years. At termination of therapy, a statistically significant and substantial change was found in affect consciousness, characterological defenses, and symptoms. Moreover, 75% of the persons who had earlier fulfilled the DSM-III criteria for an axis I diagnosis no longer fulfilled these criteria. The reduction in axis II diagnoses was 72%. The patients who stayed in therapy for at least one year showed a change in rank ordering on the scales measuring affect consciousness and severity of personality disorder. At follow-up these patterns of change showed a high degree of stability. There was no significant change in mean levels of the tested variables, and the rank ordering of the individuals in the sample had remained highly stable over this period of time. The mean Health-Sickness Rating Scale (HSRS-global) was 72.

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