Aims. To investigate the effectiveness of psychodynamic-interpersonaltherapy (PIT)
in a routine clinical practice setting.
Methods. Full pre-post data were available on 62 out of a total of 67 patients aged
between 19 and 60 years. Patients were seen over a 52-month period (2001@2005)
receiving a course of PIT therapy (mean number of sessions = 16.9. median number of
sessions = 16). The outcomes were assessed using a range of outcome measures:the
32-item version ofthe Inventory ofInterpersonal Problems (HP-32),the Clinical
Outcomes in Routine Evaluation Outcome Measure (CORE-OM), and the Beck
Depression Inventory – Second Edition (BDI-Ⅱ). Study data_were benchmarked against
comparative national and local data.
Results. There were significant pre-postreductions on all measures: HP-32 effect size
(ES)- 0.56; CORE-OM ES = 0.76; BDI-11 ES = 0.76. Reliable and clinically significant
change was achieved by 34% of clients on the BDI-11 and by 40% of clients on the CORE-OM.
Clients with high pre-therapy levels of interpersonal problems had poorer outcomes.
Conclusion. Benchmarking ourresults against both national and local comparative
data showed that ourresults were less favourable than those obtained where PIT had
been used in efficacy trials, but were comparable with reports of other therapies
(including cognitive behaviouraltherapy (CBT))in routine practice settings. The results
show that PIT can yield acceptable clinical outcomes, comparable to CBT in a routine care
setting, within the context of current limitations of the practice-based evidence paradigm.
Cognitive behavioural therapy (CBT) currently sets the benchmark for EBP in the
field of psychological interventions. However,it could be argued that the dominance of
CBT is primarily due to the quantity of published evidence for this approach rather than
any inherent superiority (see Stiles et al., 2006.in press). The challenge,therefore,is for
non-CBT interventions to produce a similar level of evidence in order to be considered
as viable alternatives to the CBT
Psychodynamic-interpersonal psychotherapy の解説
One such intervention model is that of the psychodynamic-interpersonaltherapy (PIT),
which derives from Hobson’s Conversational Model of psychotherapy (Hobson,1985).
The PIT is an integrative model that combines psychodynamic, humanistic, and
interpersonal theory and techniques. This integration enables the model to be clearly
identified as a distinct model of therapy (Guthrie.1999).Importantly,this interpersonal
model contrasts with other evidence-based psychotherapies that carry the label
‘interpersonal’, primarily interpersonal psychotherapy (IPT; Markovitz & Weissman,
1995) and is quite separate in its origins and therapeutic approach.In contrast to CBT
and IPT, PIT, although maintaining a similar focus to IPT on the interpersonal context of
depression and other mental health problems,is less structured. The underpinning
‘style’ or ‘fundamental stance’ of the model is of equal,if not greater,importance than
the technical interventions that are used in the model. This stance bases the heart of the
model very firmly on the developing relationship that emerges between the therapist
and the client.
The skill set of the model is based around negotiation, emphasizing the mutuality
between the therapist and the client, picking up on material that is offered by the client
within the therapy,together with all therapist interventions being offered in a tentative
and non-dogmatic way. There is no assumption within the model that the therapist
somehow ‘already knows’ what the client means. The task of the therapistis to
constantly try to understand how the patient may be feeling and the meaning of
problems for them as an individual. The mutual, shared task of the therapist and the
client is to engage in a therapeutic ‘conversation’ in which interpersonal problems are
not only ‘talked about’ as past events but also are actively relived in the present, and thus
resolved,in the here-and-now as they unfold within the therapeutic relationship.
The model is thus highly ‘user-friendly’ and consistent, with much research showing
that the quality of the relationship between the therapist and the client is a central
determinant of clinical outcomes of psychotherapy (e.g. Horvath, & Bedi, 2002; Norcoss,
2002). The PIT places a primary focus on the therapeutic relationship as a vehicle for the
therapist to deliver skills or psychoeducation to the client. Moorey and Guthrie (2003.
p. 548) state that in PIT,the focus of the therapy is the developing personal relationship
between the patient and therapist.It can almost be said that the “therapy” is the
“relationship”;i.e.that new learning or change arises within this relationship or
In terms of research,the PIT is one of the small numbers of non-cognitive behavioural
therapies for which there is an evidence base drawing on trials methodology. The model
has been the subject of a programme of research which has demonstrated the following:(1)
efficacy for people who self-harm (Guthrie et al., 2001);(2)reduction in healthcare costs
for people with chronic non-psychotic psychiatric problems (Guthrie, Moorey, Barker,
Margison, & McGrath.1998; Guthrie et al.,1999);(3) palliative effect for people with
irritable bowel syndrome and chronic dyspepsia (Guthrie, Creed, Dawson. & Tomenson,
1991; Hamilton et al., 2000); and (4) broadly equivalent outcomes with cognitive
behavioural therapy for people presenting with depression (Shapiro et al.,1994).
However, While there is a body of evidence from research trials as to the efficacy of
PIT,there has been a paucity of evidence reporting on the effectiveness of this approach
in routine practice settings and what evidence there is has mainly been carried out with
counsellors in primary care. Stiles et al.(2006.in press) have provided initial evidence
for the broad equivalence of the CBT, person-centred therapy, and psychodynamic
approaches as practised in the NHS routine primary care settings, but advise caution in
the interpretation of these findings due to common limitations of the practice-based
research. Guthrie et al.(2004) have reported on the training of primary care counsellors
in the PIT. However,there have been no reports drawing from secondary or specialist
care routine practice in which outcomes have been benchmarked against,for example,
published reports of the CBT as delivered in routine secondary/specialist settings.
Accordingly, we adopted the practice-based evidence paradigm to provide an
opportunity to compare the implementation of PIT in routine settings with results from
trial settings as well as non-PIT therapies in routine settings (including cognitive
behavioural therapies)through the application of benchmarking techniques. Utilizing
published outcome data as a comparator or benchmark has been employed to evaluate
the new service delivery models (e.g. Gilbert et al., 2005) and is proving to be a
developing strategy for understanding the effectiveness of routine outcome data
(e.g. Minami, Wampold, Serlin, Kircher, & Brown, 2007). We used published UK data on
the outcomes of non-PIT (including CBT)in routine settings as the benchmark against
which to compare the outcomes of the PIT in routine secondary services. To facilitate
such comparisons with other services as part of continual service improvement and also
to enable a focus on more interpersonal issues,the service had adopted as routine
practice the use of a small battery of outcome measures comprising a combination of
widely adopted generic and interpersonal measures.