Treatment duration and premature termination of psychotherapy in personality disorders: predictive performance of psychodynamic personality functioning

Objective. Little is known about predictors of treatment duration and premature termination of psychotherapy. Method. Sociodemographic variables, descriptive DSM-IV psychiatric diagnoses, general symptom severity, and psychodynamic personality functioning were assessed in 148 inpatients with personality disorders who were receiving psychotherapy. Psychodynamic personality functioning was assessed using the Developmental Profile (DP). Predictive performance and incremental value over and beyond demographics and descriptive diagnoses were determined. Results. In contrast to DSM-IV diagnoses and symptom severity, psychodynamic variables and the level of personality functioning significantly predicted treatment duration and premature treatment termination. Longer treatment duration was predicted by adaptive DP levels of personality functioning, whereas shorter treatment duration was associated with maladaptive personality functioning (primitive DP levels, including fragmentation and self-centeredness). DP variables independently explained 6% of the variance. Conclusion. In contrast to DSM-IV diagnoses and general symptom severity, psychodynamic personality variables significantly predicted treatment duration and premature discharge. These findings support the relevance of psychodynamic assessments in clinical practice, the DSM-5 proposals for the definition of personality functioning, and the predictive validity of the DP. (Journal of Psychiatric Practice 2012;18:172-186)