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One of the challenges of assessing psychoanalytic outcome is the problem of applying measures that are well established, meet conventional standards of reliability and validity, assess features that are truly meaningful, and meet pragmatic requirements. Shedler and Westen (1998) have developed the Shedler-Westen Assessment Procedure-200 (SWAP200), a dynamically informed Q-sort measure to which the clinician responds by rank ordering 200 statements, from those “very descriptive” of an individual patient to those “inapplicable or not descriptive.” Westen and Shedler have argued eloquently that clinicians are sophisticated observers of personality and have discussed the importance of longitudinal studies of the effectiveness of treatments as actually practiced in the community (Westen, Novotny, and Thompson-Brenner 2004).
In a preliminary cross-sectional study we compared psychoanalysts’ SWAP-200 descriptions of patients beginning and patients ending psychoanalysis (Cogan and Porcerelli 2005). We concluded that the SWAP-200 is a useful and practical way of studying longitudinal changes in people during psychoanalysis. We are now beginning a longitudinal study of psychoanalysis with the SWAP-200. This is a report of our early findings.
Twenty-two psychoanalyst volunteers have each provided a SWAP-200 description of one patient in psychoanalysis, and have each agreed to describe their patient, using the same method, every six months until the analysis reaches a natural conclusion. Here we report the changes in 14 of these patients during the first six months of their analysis. The SWAP-200 Q-sorts were scored for (1) personality disorders, (2) personality strengths, and (3) the most characteristic SWAP-200 items.
Six months into psychoanalysis, there were very modest changes in personality characteristics. Scores on a scale of narcissistic traits were lower (p =.06). Scores on two measures of personality strengths were unchanged.