Who benefits from inpatient short‐term psychotherapy in the long run? Patients' evaluations,outpatient after‐care and determinants of outcome

Background. Little work has been published on short‐term inpatient treatments combining the virtues of inpatient treatments and short‐term psychotherapy. The purposes of this study are to (a) determine the outcomes of short‐term psychodynamic inpatient psychotherapy from patients' and therapists' perspectives, (b) assess the stability of changes, and (c) identify predictors of long‐term outcome. Methods. 83 consecutive inpatients (76% of those eligible) were assessed at intake, discharge, and 1 year follow‐up by standardized questionnaires regarding symptoms (SCL‐90R), interpersonal problems (IIP), object relationships (IPO), and the therapeutic relationship (HAQ). Diagnoses and functioning (GAF) were assessed by the therapists. Results. Psychological distress (effect size S=1.14) and physical complaints (ES=1.03) decreased strongly from intake to discharge, the majority of patients moving from the pathological to the normal range of the global severity index GSI (SCL‐90R). At follow‐up, average distress remained at a low level, and the majority of patients, and their therapists and physicians, regarded their well‐being as improved. In a multivariate approach, a substantial proportion of variance of the distress at follow‐up (42%) was explained by an infantile object relationship pattern (IPO), social avoidance (IIP), negative vocational changes, and a lack of a confidant at follow‐up. A delayed start of subsequent ambulatory psychotherapy was another negative outcome predictor. Conclusions. Attention should be given to maladaptive interpersonal relationship patterns, to vocational reintegration, and a confiding relationship as potential predictors of long‐term outcome. Also, patterns of ambulatory after‐care following inpatient treatment need further scrutiny.