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Several approaches have been used to study the effectiveness of psychoanalysis. Here, in a cross-sectional study, we compare psychoanalysts' descriptions of patients beginning and ending psychoanalysis using a psychodyamically informed procedure, the Shedler-Westen Assessment Procedure 200, or SWAP-200 , which asks clinicians to describe patients using Q-sort methodology. Two hundred statements about a person are sorted into those that describe a patient from “very well” to “not at all well.” This approach yields reliable, valid, and clinically useful information .
Forty-six psychoanalysts, members of the American Psychoanalytic Association, each described one patient using the SWAP-200. Twenty-one described a patient at the beginning and 25 described a patient at the end of psychoanalysis with a mutually agreed-on termination. The clinicians also answered several questions about themselves, the patient, and the analysis.
The patients at the beginning of psychoanalysis had been in analysis for an average of 1.8 months (SD = .6). The patients at the end of psychoanalysis had been in analysis for an average of 66.9 months (SD = 33.2).
At the end of analysis, the personality disorder scores of patients were significantly lower on Paranoid, Schizoid, Schizotypal, Antisocial, Borderline, Histrionic, Avoidant, Dependent, and Obsessive scales, F (1, 24) > 4.45 and p < .05 in all instances, and scores were higher on the High Functioning scale, F (1, 44) = 32.03, p < .0001, and on the DSM-IV Global Assessment of Functioning scale, F (1, 44) = 53.38, p < .0001. The individual items most characteristic of patients at the beginning and end of psychoanalysis provide a meaningful picture of the two groups.
At both the beginning and the end of analysis, people were described as having important strengths: articulate, conscientious, and insightful, with a sense of humor. At the beginning of psychoanalysis, 8 of the 15 most descriptive items concerned internal struggles (e.g., anxious,