Dissertations, Theses, and Capstone Projects

Date of Degree

2001

Document Type

Dissertation

Degree Name

Ph.D.

Program

Psychology

Advisor

Vera S. Paster

Committee Members

Peter Fraenkel

Barbara Milrod

Kenneth Levy (Reader)

Charles Raps (Reader)

Subject Categories

Psychology

Abstract

This study identified psychotherapeutic processes that relate meaningfully to psychotherapeutic outcome for patients with panic disorder undergoing Panic-Focused Psychodynamic Psychotherapy ([PFPP]; Milrod, Busch, Cooper, & Shapiro, 1997). Subjects were 21 patients who participated in an open clinical trial of PFPP (Milrod et al., in press; Milrod et al., 2000). Patients received 24 sessions over approximately 12 weeks. Each patient was diagnostically screened by an independent evaluator and completed a battery of outcome assessments at baseline, termination and 6-month follow up.

The present study utilized two process measures: the Interactive Process Assessment ([IPA]; Klein, Milrod, Busch, 1999), developed specifically to identify the process of PFPP; and the Vanderbilt Psychotherapy Process Scale ([VPPS]; Strupp, Hartley, & Blackwood, 1974), designed to capture nonspecific psychotherapy processes such as therapist warmth and friendliness and patient participation. Outcome measures represented a subset of those used in the open clinical trial: Panic Disorder Severity Scale ([PDSS]; Shear, Brown, Barlow, et al., 1997); Sheehan Disability Scale ([SDS]; Sheehan, 1983); and Hamilton Anxiety Rating Scale ([HARS]; Hamilton, 1969; 1959). To evaluate process-outcome relationships, partial correlation coefficients that controlled for initial symptomatology were calculated between process factors at early, middle, and late treatment and outcome measures at termination.

The data provided mixed support for the predictions of this investigation. Results showed that the therapist's focus on the transference was associated with more positive therapy outcome when the focus occurred towards the end of these time-limited treatments. Conversely, results indicated that the therapist's focus on the transference early in treatment correlated with increased levels of non-panic specific anxiety and more impairment in quality of life functioning. In contrast to previous research, the present study suggested that therapists might wish to be cautious in adopting a warm and friendly stance too early in treatment. These findings suggest that the timing of psychotherapeutic interventions and therapist stance needs to be carefully considered. It was unclear from the present study how focusing on panic symptomatology affected the treatment. This process might be better investigated by comparing this aspect of PFPP with alternative psychotherapies.

Comments

Digital reproduction from the UMI microform.

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