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Panel Title: Treatment outcome, client attachment, and therapy process in a randomized controlledtrialofpsychoanalyticpsychotherapyandcognitivebehaviortherapyforbulimianervosa Presenters:StigPoulsen(Moderator),SusanneLunn,&SarahDaniel–UniversityofCopenhagen, Denmark Discussant:KennethLevy–PennStateUniversity,USA Abstract Severalrandomizedcontrolledstudiesofvariouspsychotherapeutictreatmentsforbulimianervosa(BN)documenttheefficacyofcognitivebehaviortherapy(CBT)forBN(Fairburn,2008)aswell aslongertermeffectsofinterpersonaltherapy(c.f.Hay,Bacaltchuk,&Stefano,2004;Shapiroet al.,2007).Still,only30to50%ofclientswithBNarefullyrecoveredfollowingCBT(Wilson,Grilo,& Vitousek,2007).Thus,thedevelopmentandtestingofothertreatmentmodalitiesaswellasidentificationofmoderatorsofoutcomeinCBTseemindicated. PsychoanalyticpsychotherapyislargelyuntestedasatreatmentmodalityforBN.Onlyonerandomizedcontrolledtrialofshort-termpsychodynamicpsychotherapyforBNhasbeenconducted (Garneretal.,1993),andnotrialsoflonger-termpsychoanalyticpsychotherapyforBNhavebeen performed. TheCopenhagenBulimiaTrialisarandomizedcontrolledtrialcomparingmanualizedtwoyear weeklyindividualpsychoanalyticpsychotherapytostandardCBTforBN.Thefirstpaperpresents themainoutcomedataofthetrial.Besidestheoverallaimoftestingtheefficacyofthetwo treatmentmodalities,aparticularresearchfocushasbeentoidentifyclientcharacteristicsthat mightserveascriteriafordifferentialassignmentofclientstodifferenttypesoftreatment.Accordingly,thesecondpaperfocusesonclientattachmentasapotentialmoderatoroftreatment outcomewithinthetwotreatmentmodalities.Finally,thethirdpaperpresentsaqualitativemultiplecaseanalysisofsuccessfulandunsuccessfulpsychoanalyticpsychotherapiesbasedonclient interviewsconductedafterthetreatments. Keywords:Evidence-basedpsychotherapies,Attachment&development,Quantitative&qualitativemethod. PaperinaPanel Title:Arandomizedcontrolledtrialofpsychoanalyticpsychotherapyandcognitivebehaviortherapyforbulimianervosa Authors:StigPoulsen(presenter),SusanneLunn,SarahDaniel–UniversityofCopenhagen,Denmark Abstract Aim:Whereascognitivebehaviortherapy(CBT)isestablishedasanefficacioustreatmentforbulimianervosa(BN),theefficacyoflonger-termpsychoanalyticpsychotherapy(PPT)hasnotpreviouslybeeninvestigated.ThispaperpresentsthemainoutcomedataoftheCopenhagenBulimia Trial,arandomizedcontrolledtrialcomparingCBTwithPPTastreatmentsforBN. Methods:70adultclients,fulfillingtheDSM-IVcriteriaforbulimianervosawererandomlyassignedtoeitherindividualCBTfor20weeksorweeklyindividualPPTfortwoyears.TheEating DisorderExamination(EDE)wasconductedwithallclientsbeforetreatment,5monthsafterthe beginningoftreatment(endofCBT),and24monthsafterthebeginningoftreatment(endofPPT). Primaryoutcomevariableswerea)fullrecoveryfrombulimianervosaandb)remissionofthebulimicsymptomsdefinedasbingingandpurginglessthantwiceperweekoverthelast28days. Results:Anintention-to-treatanalysisshowedthatastatisticallysignificantproportionofclientsin CBTwereremittedat5and24months,whileforPPTtheproportionofclientsremittedwassignificantat24months.CBTwassignificantlysuperiortoPPTinbothintention-to-treatandcompleter analysesatboth5monthsand24monthsandinboththepercentagesofclientsrecoveredand remitted.GlobalEDEscoresweresignificantlylowerinCBTclientsthaninPPTat5months,but notat24months. Discussion:Theresultswillbediscussedwithaparticularfocusonpossibleexplanationsforthe relativelackofsuccessofPPT. Keywords:Evidence-basedpsychotherapies. PaperinaPanel Title: Client attachment and treatment outcome in psychoanalytic psychotherapy and cognitive behaviortherapyforbulimianervosa Authors:SarahDaniel(presenter),StigPoulsen,SusanneLunn–UniversityofCopenhagen,Denmark Abstract Aim: Theoretically as well as empirically, eating disorders have been related to insecure attachment.Furthermore,agrowingpsychotherapyresearchliteraturehasaddressedthelinkbetween clientattachmentandkeyaspectsoftreatmentprocessandoutcome.Clientattachmenthasbeen posited as a potential moderator of treatment outcome that might be relevant to the choice of intervention type and strategy. This paper explores the relation between client attachment and treatment outcome in psychoanalytic psychotherapy (PPT) and cognitive behavior therapy (CBT) forbulimianervosa. Method:IntheCopenhagenBulimiaTrial,clientswereassessedwiththeAdultAttachmentInterview(AAI)atintake,after5monthsoftreatment,andafter24months.Treatmentoutcomewas evaluatedusingtheEatingDisorderExamination(EDE)atthesameintervals. Results:Althoughthemajorityofclientshadinsecureattachmentstatesofmind,32%weresecure ontheirintakeAAIs.Contrarytoexpectations,secureattachmentwasnotrelatedtobettertreat- mentoutcomes.Whileoverall,CBTwassuperiortoPPTinalleviatingeatingdisordersymptoms, CBTtreatmentresultswithpreoccupiedclientswerepoorcomparedtosecureanddismissingclients. There was a significant interaction between type of attachment insecurity and treatment typeinpredictingthefrequencyofpurgingatoutcome.CBTwaslessefficientinreducingpurging withmorepreoccupiedclients,whereasoutcomeinPPTwasnotrelatedtoattachment. Discussion:Thediscussionwillfocusonthesurprisinglackofeffectofclientattachmentsecurity andonhowtomakesenseoftheapparentmismatchbetweenpreoccupiedclientsandCBT. Keywords:Evidence-basedpsychotherapies,Attachment&development. PaperinaPanel Title: A multiple case study of psychoanalytic therapies with good and poor outcome in clients withbulimianervosa Authors:SusanneLunn(presenter),StigPoulsen,SarahDaniel–UniversityofCopenhagen,Denmark Abstract Aim:Inpsychotherapyresearch,arecurrentquestioniswhatworksforwhom.IntheCopenhagen BulimiaTrial,CBTwassuperiortoPPTinrelievingsymptomsinbulimicclients.However,withclients with preoccupied attachment states of mind the two therapy types had results that were more comparable. This paper provides a qualitative exploration of PPT cases with good or poor outcomeinpreoccupiedclientswithbulimianervosa(BN). Method:Fourpreoccupiedclients,tworecoveredandtwounchanged,wereselectedfromatotal of34PPTcases.Afterendingtheirtherapies,allclientswereinterviewedabouttheirexperience of the therapy using an adapted version of the Client Change Interview Schedule (Elliott, 1996). Salientcharacteristicsoftheclientexperiencesingoodandpooroutcometherapieswereidentifiedthroughqualitativecaseanalysisandcomparedtothetherapists’journalnotes. ResultsandDiscussion:Inthepresentation,wewillreportthestrengthsandchallengesofPPTin relationtopreoccupiedclientswithparticularregardtothetherapeuticallianceandthepsychotherapyprocess.FindingswillbediscussedwithregardtochoiceoftreatmentforclientswithBN. Keywords:Evidence-basedpsychotherapies,Quantitativeandqualitativemethod.