Who benefits from inpatient short-term psychotherapy in the long run? Patients' evaluations, outpatient after-care and determinants of outcome.
BACKGROUND
Little work has been published on short-term inpatient treatments combining the virtues of inpatient treatments and short-term psychotherapy. The purposes of this study are to (a) determine the outcomes of short-term psychodynamic inpatient psychotherapy from patients' and therapists' perspectives, (b) assess the stability of changes, and (c) identify predictors of long-term outcome.


METHODS
83 consecutive inpatients (76% of those eligible) were assessed at intake, discharge, and 1 year follow-up by standardized questionnaires regarding symptoms (SCL-90R), interpersonal problems (IIP), object relationships (IPO), and the therapeutic relationship (HAQ). Diagnoses and functioning (GAF) were assessed by the therapists.


RESULTS
Psychological distress (effect size S = 1.14) and physical complaints (ES = 1.03) decreased strongly from intake to discharge, the majority of patients moving from the pathological to the normal range of the global severity index GSI (SCL-90R). At follow-up, average distress remained at a low level, and the majority of patients, and their therapists and physicians, regarded their well-being as improved. In a multivariate approach, a substantial proportion of variance of the distress at follow-up (42%) was explained by an infantile object relationship pattern (IPO), social avoidance (IIP), negative vocational changes, and a lack of a confidant at follow-up. A delayed start of subsequent ambulatory psychotherapy was another negative outcome predictor.


CONCLUSIONS
Attention should be given to maladaptive interpersonal relationship patterns, to vocational reintegration, and a confiding relationship as potential predictors of long-term outcome. Also, patterns of ambulatory after-care following inpatient treatment need further scrutiny.
Beutel
M E
ME
Klinik für Psychosomatik und Psychotherapie, Justus-Liebig Universität Giessen, Germany. manfred.beutel@psycho.med.uni-giessen.de
Höflich
A
A
Kurth
R A
RA
Reimer
Ch
Ch
D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D004812:Epidemiologic Methods; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology / Q000628:therapy*; D008875:Middle Aged; D017060:Patient Satisfaction; D011614:Psychotherapy, Brief; D016896:Treatment Outcome