"Psyche and Research:
Effectiveness and Process Evolution in Long-Term Psychotherapies
Based on C.G. Jung's Method"
PAL Study: Psyche & Research
On September 27, 2003, a conference was held at the Burgholzli Psychiatric Clinic of the University of Zurich, Switzerland where the results of an empirical research study on the effectiveness and process evolution of Jungian psychotherapy was presented to the public. The therapies have been evaluated in the context of free practice, thus in a naturalistic study design.
The study clearly shows that long-term Jungian psychotherapies are necessary and effective for the achievement of long-lasting changes in the psychic structure.
During the years 1900 to 1909 Carl Gustav Jung worked at the Burgholzli Hospital, the Psychiatric Clinic of the University of Zurich. It was there that he developed the fundamentals of his later method of psychotherapy. Today about 260 Jungian psychoanalysts are active in Switzerland; they are affiliated of the Swiss Society for Analytical Psychology (SGAP). Around the world about 2500 psychoanalysts are practicing on the basis of Jung’s findings. The C.G. Jung Institute of Zurich located in Küsnacht on Lake Zurich was founded in 1948. Since that time 1050 candidates from all over the world have finished its post-graduate training and received their diploma.
Practical experience gained over several decades has shown Jungian psychotherapy to be a possible and effective treatment for a broad range of psychic disturbances and diseases. Due to the increasing financial pressure on public health care systems the requirements for acceptance of therapeutic methods have become more specific during the last years. Laws on public health care thus now request all therapeutic methods to provide a scientific proof of their effectiveness, expediency and efficiency (WZW) if their practitioners want their patients to receive third party payment for their treatment.
To answer this request and to secure the further existence of Jungian psychotherapy in future – e.g. recognition and granting of a license to its professionals within the federal law on public health care that will soon be applicable and possible third party payment granted by the health insurances – the SGAP (Swiss Association of Analytical Psychology) and the Jung Institute began initiating measures to that end many years ago. In 1994 they recorded a basic documentation for the whole of Switzerland, including 3000 cases treated by 200 therapists making it possible to get a first overview of the real contribution of Jungian psychotherapy to basic psychotherapeutic care.
Later, the possibility arose to participate in a psychotherapy research project that was to examine analytical psychotherapies – and other psychotherapies based on depth psychology – in the naturalistic framework of free practice. Most research studies are carried out under artificially restricted conditions, e.g. with regard to only one symptom of a disease. As this research design rarely corresponds to the reality of those who suffer as in most cases several symptoms and disturbances can occur simultaneously.
The Naturalistic Study of Long-Term Analytical Psychotherapies (PAL), supervised under the authority of Prof. Dr. med. Gerd Rudolf (University of Heidelberg), is a naturalistic process-outcome study examining the effectiveness of psychotherapies that has created a model of cooperation between several groups of researchers: Prof. Dr. med. G. Rudolf, Dr. phil. T. Grande (Heidelberg) Dr. med. W. Keller (Berlin) and Dr. med. G. Mattanza (Zurich). The Swiss PAL-Study was financed by private funds provided by SGAP and the C.G. Jung Institute of Zurich.
The study empirically and systematically examined the effectiveness of Jungian psychotherapies based on the observation of treatment in private practice. The study was set up to cause a minimum of intrusion and disturbance to the treatment. In contrast to the so-called experimental study designs considered the “gold standard”, the professional ethics of private practice make it impossible to leave a group of patients without treatment in order to provide a control group.
The process of treatment was examined throughout time: at the very beginning; every six months: at the end; on three different levels: self-evaluation of the patient, the professional evaluation by the psychotherapist, the evaluation of a member of the research team. These examinations was executed through questionnaires, freely written texts and video interviews. The core piece of research consisted in an analysis of psychodynamics using the criteria of Operationalized Psychodynamic Diagnostics (OPD) and the continuous measurement of certain patterns of disturbances by the research team.
The study of these newly begun psychotherapies started in the autumn of 1997. The recruiting of cases met with more difficulties than expected thus the recruiting phase had to be extended to two and a half years. Ultimately, 37 patients treated by 26 psychotherapists were included in the final study. After the exclusion of dropouts, 28 cases were evaluated. The survey was closed for a first evaluation in February 2003. Each catamnesis was completed on the anniversaries of the 1st year and the 3rd year and then after the end of treatment
Results of the study: Jungian psychotherapy is effective in the treatment of patients with a large range of disturbances and different degrees of suffering. The methods, the setting (e.g. frequency) and duration of therapy can be adapted to the needs of the patients and thus are variable. – The average number of hours of treatment is 100 for women and 74 for men. Evaluation of the outcome of treatment was positive (90 % in the opinion of the patients, 75 % in the opinion of the therapists); these results have been completed by the core piece of the PAL-Study, the evaluation of the outcome of treatment given by the external researchers on the basis of the Heidelberg Scale of Change of Structure.
The inquiry into psychodynamic aspects was excuted according to Axis II (patterns of relationships), Axis III (coping with conflicts) and Axis IV (evaluation of psychic structure) of OPD; the measurement of changes observed by the research team gives an average change of structure of 2.7 points for all patients and all foci (on a scale of 7 points). This means that a process has taken place towards raised consciousness, better coping strategies and resolving core difficulties of the patients. (Foci are, e.g. the dimension of dependence vs. autonomy; for some foci there has been seen a degree of 6 in change of structure, for other foci less than 4).
To get a better understanding of the therapeutic processes, patients have been classified into three types of course of development according to the highest degree of change of structure they have reached. For Group I the medium degree of change of structure attained during psychotherapy is 2.5, for Group II, 2.7, and for Group III, 3.0 points, on the Heidelberg Scale of Change of Structure. Group I achieved its result in 57 sessions over 25 months; Group II in 87 sessions over 38 months and Group III in 120 sessions over 42 months. The results show clearly that a longer duration of the psychotherapy leads to a higher degree of change of structure. Long-lasting changes in the quality of relationships, of coping strategies and of the patients’ psychic structure can only be achieved with long-term therapies and corresponding effort by both the patient and the therapist.
During the last years the financial pressure within the public health care system has tended to favor pharmaceutical treatment, short-term psychotherapies and following therapeutic manuals granting more credence to economics. This tendency does not give account of the fact that as social beings, humans need exchange and confrontation within a relationship, both in psychotherapy and in the context of coping with every day life. Long-term psychotherapy is thus indispensable for correcting emotional experiences of relationship. Disturbed patterns of relationship cannot be modified sustainably with medication or short-term therapies that may only help coping with an acute crisis or a single symptom.
The results of the study were presented by the members of the Zurich research team including Guido Mattanza, Jacqueline Hurt and Sigrid Schwandt. Furthermore, Prof. Daniel Hell (Zurich) presented a paper on “The Lost Soul in Psychiatry and Psychotherapy”; Prof. Gerd Rudolf (Heidelberg) spoke on the “Empirical Approach to an Impossible Object: The Naturalistic Study of Long-Term Analytical Psychotherapies (PAL)”; Prof. Joachim Küchenhoff (Basel) on “Analytical Psychology and its Empirical Exploration – a Critical Assessment”, and Prof. Verena Kast (Zurich) on, “Why Does Psychotherapy Need the Jungian Approach?”.
The report can be ordered from:
C.G. Jung Institute-Zurich,