Quality of object relations versus interpersonal functioning as predictors of therapeutic alliance and psychotherapy outcome

The purpose of the study was to compare an interview measure of quality of object relations to questionnaire and interview measures of recent interpersonal functioning with respect to the prediction of therapeutic alliance and psychotherapy outcome. The sample consisted of 64 patients who had received approximately 20 sessions of short-term individual psychotherapy within a controlled, clinical-trial investigation. Ratings of therapeutic alliance were provided independently by the patient and the therapist after each session. Outcome measures, which were provided by three sources (patient, therapist, and independent assessor), covered the areas of interpersonal functioning, psychiatric symptomatology, self-esteem, and life satisfaction. Quality of object relations, which characterizes the patient's lifelong pattern of relationships, was the best predictor. It was significantly related to patient-rated and therapist-rated therapeutic alliance and to patient improvement of both general symptomatology and specific target problems. The study also replicated previous studies that have reported significant relationships between therapeutic alliance and therapy outcome. The advantages of pretherapy predictors of therapy outcome, such as quality of object relations, are discussed.     

COSTING ACUTE MYOCARDIAL INFARCTION IN NEW SOUTH WALES,AUSTRALIA, BASED ON INCIDENCE RATHER THAN PREVALENCE METHODS

Estimating the economic costs of a disease is an important prerequisite to determining the costs and benefits of various preventive programs. For preventive programs, incidence-based costing is a more appropriate means of estimation than is prevalence-based costing. In this study the cost of acute myocardial infarction (AMI) in New South Wales has been estimated using an incidence-based approach. The calculated cost of AMI in 1979 was $301.0 million, made up of $32.3 million as direct costs and $268.7 million as indirect costs. In a sensitivity analysis, the cost was shown to be most sensitive to the incidence of AMI, the discount rate, and the assumption of a wage for housework. Both the direct costs and indirect costs per case are substantially higher in the United States than in Australia, and this reflects higher physician charges, higher hospital costs, and in the case of indirect costs, higher average weekly earnings.