Objectives: Are there predictive factors which impair the progress in psychoanalytic treatments of patients with severe personality disorders?
Methods: In 38 psychoanalytic treatments, severity of symptoms (SCL-90-R), interpersonal problems (IIP), character traits and psychostructural functioning (SWAP-200) were investigated half-yearly. Predictors for drop-out were identified using stepwise binary logistic regression models and repeated ANOVA models. The statistical stability was controlled using a jackknife algorithm.
Results: For the first year denial of needs for closeness, conflicts around engagement and abandonment, as well as fears of an impulsive breakthrough of negative affects predicted dropout of therapy. During the second year externalizing defence, projection/projective identification, somatisation, hypochondria and dismissive interpersonal behaviour predicted break-ups.
Conclusions: For psychoanalytic technique, it is necessary to perceive and catch paranoid anxieties, negative affects, externalizing mechanisms and projective identification from the very beginning as well as to interpret and work through these elements in transference thoroughly in order to prevent treatment dropout.