From Impression to Inquiry

A Tribute to the Work of Robert Wallerstein

Wilma Bucci

• Publisher: Routledge
• Year: 2018
• Topic: Psychology
• eBook ISBN:
  9780429914140
• Subtopic: History & Theory in Psychology
• Index: Psychology

From Impression to Inquiry is a tribute to the work of Robert Wallerstein and is a homage to his exceptional attitude regarding the problem of agreements, divergences, and uncertainties in psychoanalysis.

III
Outcome measures for structural change

8
The development of the Scales of Psychological Capacities: a work in progress

Kathryn N. DeWitt

For over twenty years, it has been my privilege to be part of a research group formed by Robert Wallerstein to follow up on the pioneering efforts of the Psychotherapy Research Project of the Menninger Foundation (Wallerstein, 1986). As is the case with most researchers of psychoanalytic therapies, our group had companion interests in both the process and outcome of the therapeutic enterprise. This chapter provides a summary of the results of our research collaboration. Our work is one of many testimonies to the unique contribution of Dr Wallerstein to the field of Psychoanalytic Research. As a researcher, he is unflaggingly enthusiastic and determined in his mission of discovering verifiable evidence of the processes that can be brought to bear to foster changes in human beings that will relieve their suffering and maximize their chances for positive participation in life's opportunities. We are all grateful for his leadership.

The research group formed by Robert Wallerstein at the University of California, San Francisco, followed up on the pioneering efforts of the Psychotherapy Research Project of the Menninger Foundation (Wallerstein, 1986). As is the case with most researchers of psychoanalytic therapies, our group had companion interests in both the process and outcome of the therapeutic enterprise, and in this chapter I summarize the results of our research collaboration.

Selecting a research focus

The general goal of our research group was to continue and update the work of the Menninger Psychotherapy Project by conducting research that would help to determine what attributes of patient and therapist, before and during the process of psychoanalytic therapy, would be associated with the various changes that could be detected in the patients during and after treatment. We placed special emphasis on the kinds of pervasive, enduring changes that are the objective of intensive analytic therapy and had a continuing interest in examining the relative contributions of the so-called Expressive and Supportive techniques.

Feasibility considerations played a significant role in the group's selection of a specific research focus. For the members of the group— Robert Wallerstein as leader, with a workgroup that included Nate Zilberg, Dianna Hartley, Saul Rosenberg, and me—the work was a voluntary commitment, added to already busy professional lives. Our financial resources, during an era of scarce funding, consisted of a patchwork of small grants from private individuals, psychoanalytic organizations, and public institutions that Bob located and helped us to secure.¹ After much discussion, we decided that a viable initial task for the group was the development of a well-constructed and appropriate outcome measure.

From the beginning, we, as others, had been struck by the lack of available standardized measures of clinically meaningful change in patients who had undergone long-term psychotherapy or psychoanalysis. Although the field of psychotherapy research had settled on relatively standard measures of symptoms (reviewed by Strupp, Horowitz, & Lambert, 1997), there were no similarly accepted measures of change in the more enduring aspects of personal function ing—the so-called "structure" of the patient's personality. Without such measures, it was not possible to assess the outcome of treatments designed to have an impact on the character disorders or to address the currently pressing practical demand for evidence of the "added value" of the more intensive treatment approaches over the briefer (and cheaper) time-limited treatments.

Our measurement strategy

Our initial search of relevant literature located three types of measures, all of which had some drawbacks for our purposes:

1. Global measures, such as the Health-Sickness Rating Scale (Lubor-sky, 1962), did not provide the level of detail needed to pinpoint process-outcome associations.
2. Idiographic measures, such as the Core Conflictual Relationship Theme (Luborsky, 1977), work well for within-patient studies but are not as well suited to between-patient or between-group studies.
3. Nomothetic scales were developed for use with one particular patient population (e.g. Kern berg, 1981) or seemed to us to employ concepts that were too abstract or too wedded to one theoretical orientation (e.g. Bellak, Hurvich, & Gediman, 1973; Karush, Easser, Cooper, & Swerdloff, 1964).

In the absence, at that time, of a satisfactory measurement approach, we set about the task of designing a set of scales that we hoped would provide a relatively comprehensive assessment of character functioning.

The conceptual background for our measurement strategy was first described in detail at the Thirty-Sixth Congress of the IPA, in Rome, in July 1989, and reported in full in 1991 (Zilberg, Wallerstein, DeWitt, Hartley, & Rosenberg, 1991). We began by noting that there is a general lack of theoretical consensus as to the meaning of psychological "structure" as a construct. (Wallerstein, 1995, pp. 459-479, provides an updated summary of issues and discussion in this area.) This lack of a theoretical consensus, in combination with difficulties due to varying levels of abstraction and to unclear relationships between constructs and observable behaviour, had impeded the development of any generally accepted measurement approach. Meanwhile, psychoanalytic research could not proceed without some relatively acceptable and meaningful measure of patient change.

In response to this dilemma, our research group adopted the practical strategy of proposing the use of a set of theor...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Contents
• PSYCHOANALYTIC IDEAS AND APPLICATIONS SERIES
• ACKNOWLEDGEMENTS
• EDITORS AND CONTRIBUTORS
• FOREWORD
• Introduction Robert Wallerstein's vision and the evolution of psychoanalytic research—the one and the many
• I Robert Wallerstein's career and the development of research in the psychoanalytic establishment
• II From Topeka onward
• III Outcome measures for structural change
• IV The CAMP initiative and looking ahead
• EPILOGUE The Wallerstein summary
• REFERENCES AND BIBLIOGRAPHY
• INDEX