On October 29-30, 1984, a Special Review Committee of the National Institute of Mental Health (NIMH) considered 23 applications for grant support under a special announcement for research on psychodynamic treatment of nonpsychotic disorders. The Committee approved ten of the 23 proposals as scientifically meritorious, practicable, and likely to yield useful findings. They gave each approved application a priority score, reflecting their judgment about the importance of the study, to allow for the likelihood that funds might not be sufficient for all approved grants. Indeed, in recent years NIMH has had funds sufficient to support only about half of approved grants. The priority scores may range between 100, a perfect score, to 500, implying lowest priority. In recent years the “payline,” or cut-off score of funding, has dropped steadily as budget allocations have decreased.
This year, the funding cut-off for all applications to NIMH is a priority score of 170. The ten approved applications won priority scores from 130 to 265, and the five scoring better than 170 were funded. In all but one instance support was considerably less than the budget or time requested. Thus, of the $500,000 originally allocated for this special program, only $300,000 was awarded in grants. The recommendations of the review committee were subsequently reviewed and approved by the Advisory Council of NIMH in February 1985.
The procedure followed in reviewing these applications was the same peer review system employed throughout the Institute with the exception that rather than being reviewed by a standing Initial Review Group (IRG), a special review committee was appointed of members knowledgable about research on psychodynamic psychotherapy and psychoanalysis. The Committee included four psychoanalysts who are members of the Association, Morton Reiser, M.D., Leopold Bellak, M.D., Allen Frances, M.D. and Merton Gill, M.D. The other members of the Committee included Hal S. Arkowitz, Ph.D., Department of Psychology, University of Arizona; Leslie Greenberg, Ph.D., Department of Counseling Psychology, University of British Columbia; John Gunderson, M.D., McLean Hospital; James Mintz, Department of Psychology, University of California at Los Angeles; and George Silberschatz, Ph.D., Mt. Zion Hospital and Medical Center.
The standing review committees of NIMH have occasionally been criticized by psychoanalytic researchers for not being expert in or appreciative of the phenomena, processes, and values of psychodynamic psychotherapy or psychoanalysis. This Special Review group could not be faulted on these grounds.
The principal investigators of the funded projects are Paul Crits-Christoph of the University of Pennsylvania, for a project entitled What are the Benefits of Interpretive Techniques?; Leonard Horowitz, Ph.D., of Stanford University, for a project entitled Interpersonal Problems in Psychodynamic Psychotherapy; Elsa Marziali, Ph.D., Clark Institute of Psychiatry in Toronto, for a project entitled Brief Psychotherapy of Severe Character Disorders; Peter Maxim, Ph.D., M.D., University of Washington, for a project entitled Measuring Key Psychodynamic Constructs; and John Perry, M.D., North Charles Mental Health Center, Boston, for a project entitled Validating a Method to Assess Psychodynamic Change. Each of the five requested three or four years of support, in amounts ranging from $44,000 to nearly $120,000 per year.
One of the five was approved for the three years requested while four of the five were approved for only two years, in amounts ranging from $20,000 to $71,000 per year. Only one of the grants was funded in the full amount and time requested, while three were funded for less time and for one-fifth to one-third of the amount requested. Funding in reduced time and amount is a frequent way of indicating that the review group believes that the aims of a study are important but that some further development of methods or pilot work is needed before the full study proposed can be accomplished. Thus, just the methods development portions of these studies were supported.
One of the projects will involve clinical testing of a self-report inventory of interpersonal problems and will permit measurement of the convergence of patient and therapist judgments during the course of treatment. This project will also examine the reliability of dynamic formulations as well as the relationship between the patients' experience of distress from their symptoms and from interpersonal difficulties.
Another funded project will investigate the accuracy of therapists' interpretations using Luborsky's Core Conflictual Relationship Theme method. The intent is to develop this case-specific process measure as an approach to the measurement of quality of intervention.
One of the other studies proposes to develop an observational coding system to measure affect, interpersonal messages, and coping abilities through language analysis of therapist-patient verbal interchanges. This study too will link its findings to Luborsky's Core Conflictual Relationship Theme method and will study the match between therapist and patient in their views of significant relationships. This project is intended to further the measurement of differentiated outcomes in psychotherapy research.
Another study proposes to study the usefulness of combined individual and group therapy for patients with severe character disorders. An important aspect will be to extend the investigator's work in the development of instruments for measuring character pathology, in particular self-other differentiation. A manual will be developed for training and guiding time-limited therapeutic strategies with such severely ill patients.
The remaining project is designed to develop a psychodynamic conflict rating scale in order to examine the psychodynamic factors specific to various psychiatric diagnoses. The aim is to develop and test the ability of new methods of assessing psychodynamic changes resulting from psychotherapy.
The five approved and funded applications all promised advances in methods of observation, measurement, and analysis of the data of psychotherapy. The review committee apparently agreed with the Request for Applications of this special grants program that a major problem impeding research on psychodynamic psychotherapy and psychoanalysis has been the lack of appropriate methods for investigating treatment process and outcome. Applications focusing on methods development, or that had sections devoted to methods development, would be most likely to advance the field and were viewed therefore as most deserving of support.
Editor's Note—Dr. Schlesinger wrote this report at our request so that the membership might have a follow up to the report on the NIMH funding which had been made available last year to support a special program of research on dynamic psychotherapy. As he notes, the initial funding was somewhat more restrained than had been anticipated, but he hoped his report might supply information and guidelines for those who had research proposals in mind and might wish to apply for such grants in the future.
Since the recent reorganization at NIMH, we have had no information as to what we can expect for the future of this program. We will continue to keep you appraised of further developments.