An empirical exploration of psychoanalytic processes and outcomes in 27 long-term psychoanalytic treatments

Despite the vast clinical and theoretical literature on what the analytic process should look like, we know very little empirically about the actual analytic process in long-term psychoanalytic treatments. In this study, we explored how much the therapeutic work in psychoanalytic treatments in naturalistic practice resembles an “ideal” psychoanalytic process. Using the Process Q-set expert prototype of an “ideal” psychoanalytic session (PQS-PA), we examined the course of treatment for 27 patients, and its relationship with treatment outcome using multilevel growth models. The treatments resembled the “ideal” analytic process to a moderate degree, regardless of treatment length and frequency of sessions per week. The level of “ideal” analytic process varied significantly between patients but not between analysts and was not affected by total number of sessions, or frequency of sessions. However, the session date might also have influenced the analytic process in that the resemblance to an “ideal” analytic session decreased over the 44 years of analytic practice. The extent to which the treatment resembled an “ideal” analytic process was not related to treatment outcome. The results may potentially speak to the patients’ role in the therapeutic process and the changing emphases in analytic techniques over time.