Dynamic conflicts in recurrent major depression: Does combined short-term psychotherapy and antidepressive medication lead to healthy dynamic functioning?

Abstract

After Malan, Heath, Bacal, and Balfour's (1975) pioneering empirical work, there has been a growing interest in studying whether psychotherapy improves dynamic conflicts. We examined whether dynamic conflicts and adaptation to conflicts improve following short-term psychotherapy. Twelve patients with acute recurrent major depression were randomized to receive antidepressive medications plus 20 sessions of either cognitive-behavioral or dynamic psychotherapy. The Psychodynamic Conflict Rating Scales (PCRS) assessed conflicts and adaptation to conflicts at intake and 1-year follow-up. The Hamilton and Beck Depression Scales assessed depression, and defenses were rated at intake and at 1 year. Significant change was found on measures of depression. Dynamic conflicts showed significant improvement in levels of adaptation (median/mean effect size ϭ 1.41/.92, 95% confidence interval [CI] [.03, 1.81]). However, change in Overall Pathological Conflict scores was not significant (median/mean effect size ϭ 1.23/.85, 95% CI [Ϫ.28, 1.99]), principally because 1/3 of subjects failed to progress in this time frame. At 1 year, change in Overall Pathological Conflict scores correlated with self-report (r s ϭ Ϫ.72, 95% CI [Ϫ94, .01]) but not observer-rated depression. At 1 year, PCRS Conflict scores were correlated with defensive functioning (r s ϭ .77, 95% CI [Ϫ.95, Ϫ.10]). Short-term psychotherapy was associated with improvement in depression and adaptation to conflict, but there was more heterogeneity in improvement in conflict pathology. The PCRS showed convergent validity with defensive functioning. Longer term therapies and follow-up may be required to develop dynamic recovery and resistance to recurrences of major depression.

A Naturalistic Study of Time to Recovery in Adults with Treatment-refractory Disorders

“…The Psychodynamic Conflict Rating Scales (PCRS) assess 14 conflicts, while companion scales assess healthy adaptation to each conflict (J.D. Perry & Perry, 2004;Perry, 1987;Perry et al, 2017;Perry & Cooper, 1986;Perry & Simon, 1988). Each conflict is represented by 8 to 15 items, constituting lowinferential statements of affective, behavioral, or cognitive facets of the conflict.…”