INTERPERSONAL PROBLEMS AND THE OUTCOME OF INTERPERSONALLY ORIENTED PSYCHODYNAMIC TREATMENT OF GAD

The present study tested hypotheses concerning interpersonal problems and the course of brief psychodynamic treatment of generalized anxiety disorder (GAD). The authors found that the largest changes from preto posttherapy were evident for the Nonassertive, Exploitable, and Intrusive subscales of the Inventory of Interpersonal Problems. Relatively small changes were seen on the Overly Nurturant subscale, which was hypothesized to be most relevant to GAD. Changes in interpersonal problems were significantly associated with improvement in symptoms and worry. Brief dynamic therapy was not found to uniquely improve interpersonal problems compared with supportive therapy, although the psychodynamic approach was statistically and clinically superior to supportive therapy on symptomatic remission rates. Whereas an emphasis on interpersonal issues is the hallmark of psychodynamic and interpersonal therapies such as Klerman, Weissman, Rounsaville, and Chevron’s (1984) interpersonal psychotherapy and Luborsky’s (1984) supportive– expressive psychodynamic therapy, interpersonal issues and problems also play an important role in many other forms of psychotherapy, such as experiential therapy, variants of cognitive therapy (e.g., Safran & Segal, 1990), and family and marital therapies. Regardless of the form of therapy, improvement in social relationships and interpersonal problems is often one of the central goals of treatment. Several studies of various short-term psychotherapies have reported that interpersonal problems improve significantly from preto posttreatment (Cloitre, Koenen, Cohen, & Han, 2002; Muran et al., 1995; Rosenthal, Muran, Pinsker, Hellerstein, & Winston, 1999; Shapiro et al., 1994; Vittengl, Clark, & Jarrett, 2003), although recovery from interpersonal problems clearly takes longer than does symptomatic recovery (Barkham et al., 2002). The literature, however, is less consistent about the types of interpersonal changes that occur over the course of psychotherapy (Borkovec, Newman, Pincus, & Lytle, 2002; Horowitz, Rosenberg, Baer, Ureno, & Villasenor, 1988; Horowitz, Rosenberg, & Bartholomew, 1993; Maling, Gurtman, & Howard, 1995; Vittengl et al., 2003). Interpersonal problems are not only a focus of treatment outcome but also can serve to identify, at treatment onset, those patients who benefit relatively more or less from brief psychotherapy, in part because interpersonal problems are often a marker for personality disturbances (Pilkonis, Yookyung, Proietti, & Barkham, 1996; Stern, Yookyung, Trull, Scarpa, & Pilkonis, 2000). For example, Alden and Capreol (1993) reported betPaul Crits-Christoph, Mary Beth Connolly Gibbons, Julia Narducci, and Megan Schamberger, Department of Psychiatry, University of Pennsylvania; Robert Gallop, Department of Statistics and Applied Mathematics, West Chester University. Preparation of this manuscript was funded in part by National Institute of Mental Health Grants R21-MH56018 and P30-MH45178. Correspondence regarding this article should be addressed to Paul Crits-Christoph, PhD, University of Pennsylvania, 3535 Market Street, Room 650, Philadelphia, Pennsylvania 19104. E-mail: crits@mail.med.upenn.edu Psychotherapy: Theory, Research, Practice, Training Copyright 2005 by the Educational Publishing Foundation 2005, Vol. 42, No. 2, 211–224 0033-3204/05/$12.00 DOI: 10.1037/0033-3204.42.2.211