A naturalistic pilot study exploring the differences between fragile and resistant patients in ISTDP

Abstract

Introduction Intensive Short-Term Dynamic Psychotherapy (ISTDP) defines two spectra of patients based on the patients’ capacity to tolerate anxiety and complex emotions. Resistant patients have a better capacity to tolerate affective stimulus compared to fragile patients. There is, however, little empirical evidence that supports this categorization. This exploratory study seeks to identify reliable differences between 330 resistant and 88 fragile patients. Methods To assess which category patients belong to, therapists conducted a specific psychodiagnostic assessment of patients when entering psychotherapy. Patients selfreported on the Brief Symptom Inventory (BSI) and the Inventory of Interpersonal Problems (IIP). Independent samples t-tests estimated differences between psychodiagnostic categories on self-reported measurements. Results Fragile patients scored significantly higher on five IIP subscales and all BSI subscales, barring “Paranoid Ideation”. As symptom distress might mask underlying pathological processes, we used a matching procedure to compare resistant and fragile patients with the same level of symptom distress, before repeating estimation of differences between the categories. Fragile patients scored significantly higher only on the BSI somatization subscale as well as on three items from the BSI somatization subscale, and one item from each of three other BSI subscales (i.e., “Phobic anxiety”, “Anxiety”, “Psychoticism”). Limitations The study used generic psychometric instruments. A specific psychometric instrument developed according to ISTDP theory would likely be more suited to capture group differences. Conclusions The results provide support for the notion that fragile patients in general experience more psychological distress and specifically suffer from more somatization and additionally anxiety, phobic anxiety and psychoticism symptoms.