Ideas of cure as a predictor of premature termination, early alliance and outcome in psychoanalytic psychotherapy.

OBJECTIVES

This study examines how young adult patients' ideas of cure prior to psychoanalytic psychotherapy are associated with premature termination, early alliance and therapy outcome. The hypotheses were that ideas about approaching one's problems would be related to fewer premature terminations, higher early alliance and better outcome, than would ideas about distancing oneself from one's problems.

DESIGN

Young adult patients (N=46) were interviewed prior to therapy regarding their ideas of cure. Outcome measures were administered pre- and post-therapy. Alliance measures were administered early in treatment.

METHODS

A typology of the patients based on their ideas of cure was performed using ideal type analysis. Clusters of patients were then rank ordered in accordance to the theoretical dimension 'approaching-distancing'. The relation between rank ordered ideas of cure and premature termination was analysed using Mann-Whitney's U-test. These ideas' associations with early alliance and therapy outcome were analysed using Spearman's rho.

RESULTS

Patients who terminated therapy prematurely were significantly closer to the 'distancing' pole regarding ideas of cure, while the therapy completers were more often found near the 'approaching' pole. No associations were found between ideas of cure and early alliance or therapy outcome. In addition, patients with attrition due to failure to participate in interviews and complete interviews were significantly closer to the 'distancing' pole than those who had completed their research commitments.

CONCLUSIONS

The positive finding regarding premature termination indicates the importance of negotiating ideas of cure as a part of the initial assessment process. Possible explanations for the negative findings are discussed.