title: [Structural change as an outcome paradigm in psychodynamic psychotherapy - results of the PAL-Study (long-term psychoanalytic psychotherapy study].
abstract: OBJECTIVE
  Psychodynamic psychotherapies have proved to lead to relevant symptomatic improvement. An unresolved question, however, is what amount of psychodynamic change can be expected beyond symptom relief. For theoretical and methodological reasons rooted in the psychodynamic approach, this question has been difficult to answer until now.
  
  
  METHODS
  In the German study PAL (long-term psychoanalytic psychotherapy), 32 patients in psychoanalytic therapy and 27 patients in psychodynamic psychotherapy were studied from the perspective of therapists, patients and researchers through three years post-treatment. In this paper we study the aspect of psychodynamic change of dysfunctional relations, unconscious conflicts and structural aspects as diagnosed by the Operationalized Psychodynamic Diagnostic method. Structural change is rated by the Heidelberg Structural Change Scale.
  
  
  RESULTS
  A comparison of the two forms of therapy shows more structural change in long-term psychoanalytic psychotherapy compared to the shorter psychodynamic psychotherapy. A comparison of patients with a high level and a low level of structural change revealed that the highly changed patients showed greater symptom relief and greater satisfaction with therapy, and that their therapists perceived a better overall result of treatment.
  
  
  CONCLUSIONS
  For psychodynamic psychotherapies structural change seems to be a relevant paradigm of outcome in addition to symptom relief. In longer and more frequent psychoanalytic therapies more structural change occurs compared to shorter psychodynamic psychotherapies. Beside the amount and length of treatment, the different therapy targets - working through vs. supportive - seem to be important.
authors.affiliation: Psychosomatische Universitätsklinik, Thibautstr.2, Heidelberg. gerd.rudolf@gmx.net
authors.forename: Gerd
authors.initials: G
authors.lastname: Rudolf
authors.forename: Thorsten
authors.initials: T
authors.lastname: Jakobsen
authors.forename: Wolfram
authors.initials: W
authors.lastname: Keller
authors.forename: Bärbel
authors.initials: B
authors.lastname: Krawietz
authors.forename: Monika
authors.initials: M
authors.lastname: Langer
authors.forename: Claudia
authors.initials: C
authors.lastname: Oberbracht
authors.forename: Sabine
authors.initials: S
authors.lastname: Stehle
authors.forename: Margret
authors.initials: M
authors.lastname: Stennes
authors.forename: Tilman
authors.initials: T
authors.lastname: Grande
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D003220:Conflict, Psychological; D006801:Humans; D007389:Internal-External Control; D007398:Interpersonal Relations; D008134:Long-Term Care / Q000379:methods* / Q000523:psychology; D008137:Longitudinal Studies; D017063:Outcome Assessment, Health Care / Q000379:methods*; D017060:Patient Satisfaction; D010554:Personality Disorders / Q000523:psychology / Q000628:therapy*; D011575:Psychoanalytic Therapy / Q000379:methods*