Biomedical subjects

H Bachrach

Publications and source records attributed to H Bachrach.

11 recordsLinked to original sources

PubMed1981

Units of observation and perspectives on the psychoanalytic process.

Over the past quarter century, brief segments of tape-recorded psychotherapy have become the most widely employed unit for the empirical investigation of the psychotherapeutic process. Our aim was to see how judgements based upon brief segments of tape-recorded psychoanalysis corresponded with judgements based upon the hours from which they were taken. Seven experienced psychoanalysts independently made clinical and quantitative judgements about 29 treatment-related variables on 24 five-minute segments excerpted from psychoanalytic sessions and on the 12 whole sessions from which they were taken. It was found that judgements about the major dimensions of the therapeutic relationship, i.e. transference, based upon segments did not correlate with judgements based upon entire sessions. Judgements based upon segments were less reliable and tended to isolate one participant from another. Judgements based upon sessions were more reliable and captured the basic dimensions of the treatment process, particularly as related to the transference and therapeutic relationship. These findings confirm the results of the only other reported study (Mintz & Luborsky, 1971) in which such comparisons were made and suggest that brief segments cannot be naïvely substituted for entire sessions for the study of the psychotherapeutic process.

Adult↗

PubMed1980

Predicting the outcome of psychotherapy. findings of the Penn Psychotherapy Project.

Our study of predictability of outcomes of psychotherapy used predictions of two kinds: (1) direct predictions by patients, therapists, and clinical observers; and (2) predictive measures derived from the same sources. Seventy-three nonpsychotic patients were treated in psychoanalytically oriented psychotherapy (mean, 44 sessions). Two thirds of the therapists were residents in psychiatry; one third were more experienced. The two main composite outcome measures, measured at termination, were Raw Gain (residualized) and Rated Benefits, which intercorrelated at .76. Most patients improved and showed a considerable range of benefits. The clinical observers' direct predictions of Rated Benefits were highest (.27, P less than 905). The success of the predictive measures were generally insignificant, and the best of them were in the .2 to .3 range meaning that only 5% to 10% of the outcome variance was predicted. The Prognostic Index Interview variables did the best (eg, emotional freedom composite, .30; a crossvalidation for 30 patients was .39 (P less than .05). Neither the therapist measures nor the early psychotherapy session measures predicted significantly. Reanalysis of the similar Chicago Counseling Center study, in our terms, showed a similar low level of prediction success, eg, adequacy of functioning, marital status match, and length of treatment predicted significantly in both studies.

Adolescent↗

PubMed1979

Preconditions and consequences of transference interpretations. A clinical-quantitative investigation.

Our aim was to study the preconditions and consequences of transference interpretations by both quantitative and clinical methods. We selected the three specimen psychoanalytic treatments which had been studied most by clinical-quantitative research. For each patient the main data consisted of 16 interpretation contexts. The context of each interpretation included 250 patient words before and 250 patient words after the interpretation. Three judges independently rated these before and after segments for each of the 16 samples from each of the three patients. Judges tended to agree highly in rating these segments on nine variables. The before vs. after ratings showed that each patient had a different but individually typical response to the 16 interpretations, ranging from patient A who usually showed a negative response, to patient B who showed some positive response, to patient C who showed a very positive response. For each of these three patients there was a clear parallel between the positivity of the immediate response to interpretations and the outcome of treatment. Even though we have so far studied only three patients, the consistency of the results suggests that it would be worth testing in a larger group whether a sample of immediate responses to interpretations might predict the eventual outcome of the treatment. Patient factors seem central in explaining the bases for the different response of each of the three patients to transference interpretations. The Health-Sickness Rating Scale ratings showed that patient A and patient B were less healthy initially than patient C--healthier patients may be able to respond better to transference interpretations. Also, the analyses of the segments before the interpretation revealed that even before the interpretation there were differences in the three patients. These were consistent with their differing responses to interpretation; for example, patient A was rated as having less understanding than the other patients even before the interpretations. Another patient factor, the patient's readiness to experience a helping relationship, probably was significant also in explaining the differing response of the three patients to interpretations; they already differed in this experience by the third to fifth sessions, and these differences paralleled their response to interpretation.

Adult↗

PubMed1974