Mechanisms of change in focused psychodynamic therapy: A systematized single-case time-series analysis

This study explored therapeutic foci's structural change and its interaction with clinical severity in a young adult patient receiving psychodynamic therapy. We conducted a systematized single-case time-series analysis for a complete focused psychodynamic treatment (54 sessions). To assess clinical severity, the patient completed the Outcome Questionnaire 45.2 every session. Two external raters established a psychodynamic profile with five therapeutic foci for the case, using Operationalized Psychodynamic Diagnosis. These foci included one relational focus, two conflict foci and two structure foci. Raters estimated patient's structural change by means of Heidelberg Structural Change Scale, assessing the evolution of such foci. Raters used this measure to code every session. We conducted a vector autoregressive analysis to explore therapeutic foci's structural change and its interaction with clinical severity. Time-series analysis showed predictive effects of foci's structural change throughout the entire treatment. Greater structural change in the relational focus predicted greater clinical severity and less structural change in conflict foci. Also, greater structural change in conflict foci predicted greater structural change in structure foci. Results support the hypothesis of structural modifications as a mechanism of change for psychodynamic therapy. We discuss results to better understand how patients may benefit from psychodynamic therapy.