Measuring outcome in psychodynamic psychotherapy: Psychodynamic vs symptomatic assessment

Malan has argued forcefully that meaningful measurement of outcome in psychoanalytically oriented psychotherapy requires a complex clinical-judgment process by an expert clinician that is based on a psychodynamic hypothesis. Information pertaining only to symptom status before and after treatment was abstracted from each of 18 case summaries published by Malan. Each of these abstracted "cases" was related by a nonprofessional judge for global improvement and by me for symptomatic improvement. Correlations among these simple outcome ratings, "dynamic assessments" of treatment outcome made by the Tavistock group, and several theoretically important variables measuring transference manifestations during treatment were examined. Simple symptomatic improvement was an important component of the complex Tavistock outcome rating. The results raised questions as to the importance of the expert clinician and the psychodynamic hypothesis in the assessment of treatment outcome.