Relational and Classical Elements in Psychoanalyses: An Empirical Study with Case Illustrations

The first aim of this article is to report a newly developed measure of therapeutic process, the Dynamic Interaction Scales. When combined with the Analytic Process Scales (Waldron, Scharf, Crouse, et al., 2004; Waldron, Scharf, Hurst, et al., 2004), the two instruments permit a reliable and fine-grained assessment of technical and relational aspects of psychoanalytic and psychodynamic psychotherapeutic process. The Shedler-Westen Assessment Procedure and Psychological Health Index (Westen & Shedler, 1999a, 1999b; Waldron et al., 2011) permit a reliable and fine-grained assessment of the changes during treatment. The second aim is to demonstrate how combining results from these instruments permits exploring the relationships between processes and outcomes of treatment. We illustrate the utility of this approach by a demonstration project, applying the instruments to two treatments started 21 years apart. The results show different relational and classical approaches of the analysts and different outcomes. Both patients had a similar level of psychological functioning at the outset of treatment, but one made a much more extensive recovery than the other. The difference in outcomes may reflect different patient pathology, in spite of their initial level of functioning, but it may also reflect the impact in the better outcome case of a more relational approach, combined with a more extensive use of classical analytic interventions judged to be of higher quality. We then present quantitative results applying the same instruments to 11 additional patients. Technical and relational differences are found between good and poor outcome cases in this group, similar to those found in our two demonstration cases. Ongoing evaluation of an additional 18 cases will permit further study of these differences.