Character, symptoms and relationship patterns before and after psychoanalytic psychotherapy

Abstract: Background. In psychoanalytic theory, character is conceived as a regulating structure intended for life-long adaptation between inner needs and outer reality. If this adaptation fails, symptoms and dysfunctional relationship patterns might emerge, thus, implying a close association between symptoms, relationship patterns and underlying character. Furthermore, according to psychoanalytic theory decreased symptomatic suffering and more adaptive relations are regarded to be consequences of change in character structure. Aims. This project was designed to empirically investigate psychoanalytic theory regarding the association between character, symptoms and relationship pattems. The specific aims were to study: 1) the psychiatric and demographic characteristics of patients selected for long-term psychoanalytic therapy in a naturalistic clinical setting; 2) the relationship between character, symptoms and relationship pattems in these patients; 3) the change in character, symptoms and relationship patterns after long-term psychoanalytic therapy; 4) whether change in one of the aforementioned three aspects was interrelated with change in any other aspect; 5) the relationship between change of character or change in symptoms and duration of treatment or frequency of sessions. Method. The sample at intake comprised 55 patients selected for long-term psychoanalytic therapy. Character was assessed with the Karolinska Psychodynamic Profile (KAPP), and relationship patterns with the Core Conflictual Relationship Theme (CCRT). The DSM-III-R was used for psychiatric diagnosis. Self-report questionnaires assessing symptoms (the Comprehensive Psychopathological Rating Scale-Self-Affective, CPRS-S-A) and personality (the Karolinska Scales of Personality, KSP) were filled out after the interview. Thirty-six patients who underwent long-term psychotherapy completed follow-up assessments 6 months after treatment termination, and 10 patients, who for various reasons did not enter treatment, completed follow-up assessments 3 years after intake. The psychotherapists who conducted the treatment were well trained and had long professional experience. Results. After long-term psychotherapy, patients reported a significantly decreased level of character pathology and symptomatic suffering, as well as significantly improved relationship patterns. There were, however, very few significant associations between change in character and change in symptoms or maladaptive relationships. Duration of treatment and frequency of sessions were not related to change. In the 10 patients who did not undergo treatment, almost no change was found after 3 years. Conclusions. The patients, who were selected in a traditional clinical fashion for longterm psychoanalytic therapy, suffered from various symptoms but displayed a low level of character pathology. Neither the psychoanalytic theory regarding a close association between character, symptoms and relationship patterns, nor the psychoanalytic theory of structural change received support from our results.