In what follows, I cite significance levels as calculated by Mann–Whitney tests, but the group contrasts are self-evident from the ranges of scores reported. On BP adherence scales, there was a highly significant group difference (p < .001). On this measure of BP adherence, the range of the BP transcript scores was between 37 and 58 (mean 48.7, where the maximum possible score for both BP and IP scales is 68), and the range of IP transcript scores was between 10 and 23 (mean 15.0). Terefore every single one of the BP tran- scripts scored more highly than every one of the IP transcripts.
On IP adherence scales, there was again a highly significant group dif- ference (p <.001). Te range of the IP transcript scores was between 27 and 51 (mean 37.4), and the range of BP transcript scores was between 8 and 21 (mean 15.4). In this case, then, every single one of the IP transcripts scored more highly than every one of the BP transcripts.
Te profile of results on these two measures is depicted in Figure 9.1.
Results on the two sub-scales of the ISS again yielded a distinctive profile for each mode of treatment. Compared with IP transcripts, BP transcripts were rated as significantly more interpretive (p < .01) and significantly less support-
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one of the BP transcripts were scored more highly than the highest-scoring IP transcript. On the supportive sub-scale, by contrast, every one of the IP transcripts scored more highly than the highest-scoring BP transcript.
Finally, on the “specific psychodynamic strategies” sub-scale of the VSS, there was again a highly significant group difference (p < .001), with a com- plete split in scores from the two forms of treatment. All the BP transcripts scored highly (range 17–26, mean 21.1), whereas all the IP transcripts were given low scores (range 3–9, mean 6.7).
Discussion
Te results from this study were clear-cut. For the BP and IP adherence scales, there was very substantial agreement in the ratings of independent raters. Moreover, the three BP sub-scale scores correlated highly with each other. It was clear from visual inspection of the BP sub-scales that each was making a substantial contribution to the overall rating. Inter-rater reliability for scores on the ISS sub-scales and the “specific psychodynamic strategy” sub-scale of the VSS were also good.
Secondly, all seven transcripts of BP sessions were given higher BP scores than the seven transcripts of IP sessions. Here it should be recalled that, for the purposes of the analyses, any given transcript received a BP rating from a single rater, randomly selected from the two individuals who had made ratings, and IP ratings on that particular transcript were made by the other rater.
Tis latter consideration is also relevant for the next finding, namely that all seven transcripts of IP sessions were given higher IP scores than the seven transcripts of BP sessions. Terefore it was not just that one of the two treatments scored highly on everything, a result that might have reflected, for example, how active and interventionist one group of therapists had been.
0 10 20 30 40 50 60
BPT Adherence Scale IPT Adherence Scale
M e a n S c o r e
BPT Transcripts IPT Transcripts
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On the contrary, there was specificity to the profile of results. BP transcripts were scored high on BP adherenceand low on IP adherence, and IP tran-
scripts were scored high on IP adherence and low on BP adherence.
Te nature and magnitude of these differences between the two forms of treatment attest to the degree of homogeneity within each group. Different therapists were conducting BP in a similar way, and different therapists were conducting IP in a similar way. Te contrasts were not specific to particular therapists. Given that potential interference effects across different adherence measures is likely to have been modest, the major methodological limitation of the study concerned the small number of transcripts being rated. As it turned out, marked consistency in the results, with high within-group homogeneity and very substantial between-group differences, provides unexpectedly strong indication that the BP and IP adherence measures would have yielded simi- lar profiles of scores if substantially more treatments had been rated.
Te distinctiveness of BP was also apparent in the ratings from the remaining two adherence scales. Te ISS scores revealed substantial group differences on the “supportive” sub-scale, where BP transcripts were scored very low and IP transcripts high. Tis provides evidence that BP therapists were withholding forms of supportive or reassuring intervention that IP therapists provided. Yet again, this was not because BP therapists were less active overall, because they scored highly on the interpretive scale. Rather, they were more occupied with commenting on what was happening in the transference. Tis is also reflected in the final result, where they were rated highly for employing strategies specific to psychodynamic therapy with its focus on the interpersonal, patient–therapist relationship.
In the light of these results, it becomes difficult to sustain t he view that all therapies are much the same. rue, IP is not the closest relative of BP, so the contrasts are unlikely to be quite so stark if, say, BP is compared with DI or the Conversational Model. Here it is relevant that the BP adherence scale seems to be reasonably successful in capturing essential features of the therapy. If this is so, how far does it look as if other treatments such as those
described in Chapter 2 would be given high scores on the BP adherence scale? Of course it remains to be studied whether, if different forms of brief psy- choanalytic psychotherapy have distinctive characteristics, they have distinc- tive effects (for some patients, when administered by some therapists). Here it may be worth adding that in the experience of raters of the transcripts, IP and BP could be very different from a patient’s point of view, but the con-
trasts became less striking when experienced and sensitive clinicians were therapists. Tere is much that remains to be understood about t he interaction between different therapists and different treatments.
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Conclusions
Te empirical study I have described provides evidence that in all likelihood, BP is distinctive. Te BP Adherence Manual comprises items that can be rated reliably, and on the face of it, many of these appear to characterize BP more than they apply to other psychodynamically informed treatments. Te quantitative comparison demonstrated that there are certainly contrasts between BP and IP. More than this, the results indicated an impressive degree of consistency among BP therapists in conducting psychoanalytic psychotherapy in a style that conforms with BP principles. From a com- plementary viewpoint, the consistency in scores on the BP adherence scale suggests that the items succeeded in capturing something essential to BP. Other investigators’ adherence measures yielded additional evidence for the claim that prominent among the characteristic features of BP is a focus on the transference.
At the end of the day, we have achieved some clarity over what BP involves. Tis has been made explicit, both in outline as a reatment Manual, and in fine-grained detail as an Adherence Manual. Critics may be skeptical of BP, and supporters enthusiastic—but neither of these groups can be in doubt over the nature of the treatment about which they disagree. From here on, anyone with the necessary resources, commitment, and skill is in a position to con- duct research to uncover what the evidence has to say about BP and its value.