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During the course of drafting position papers for the American Psychoanalytic Association, questions frequently arose about factors that affect the duration and outcome of psychoanalysis. In the 1996 Survey of Analytic Practice, all members of the American Psychoanalytic Association were asked to submit information about their three most recently terminated analytic cases. We were able to identify demographic information and DSM-III-R diagnoses for 972 terminated cases submitted by 355 analysts. Outcome was measured by whether the case failed, was interrupted, or was completed and by changes in the GAF (DSM-III-R Axis V) components scored according to a protocol of demonstrated reliability that was provided to all study participants.
Ninety-six percent of the cases submitted for this study had at least one reported Axis I or Axis II diagnosis. Eighty-two percent had an Axis I diagnosis. Seventy-three percent of patients who had any Axis I disorder also had a comorbid Axis II (Personality) Disorder. Thirteen percent of the study cases had only an Axis II Disorder. Distribution of cases with a reported Axis II diagnosis: Cluster A = 1%; Cluster B = 39%; Cluster C = 30%; Personality Disorder N.O.S. = 30%.
Completion rates varied significantly within Axis I. The average completion rate was 60%, but it was only 30% for Social Phobia and 39% for Major Affective Disorder, Recurrent.
Patients with an Axis II disorder seem to have lower completion rates than those without any Axis II disorder (F = 4.87; p < .03), but post hoc test (Tukey) indicates this is not significant. Patients with an Axis II disorder who complete treatment have significantly more sessions than patients without an Axis II disorder, 1147 vs. 945 sessions (Wilcoxon matched pairs test 26.09; p < .002).
Patients with lower initial psychological functioning scores tend to have lower completion rates and tend to take longer to complete treatment. If they complete treatment