A Study of the Evaluation of Ego Capacity in Short-Term Psychodynamic Psychotherapy

Short-Term Psychodynamic Psychotherapy (STPP) has developed as a form of intensive, focal psychodynamic psychotherapy with treatment applications across a range of mental health disorders. The concept of ‘ego capacity’ has a central place in STPP, based upon a core principle that accelerated treatment is enabled through working at an optimum level of a patient’s ego capacity. Precise evaluation of ego capacity is required to determine choice and application of treatment interventions. Theoretical underpinnings suggest change and improvement in ego capacity are expected during and at the end of treatment. Although core to theory and practice of STPP the evaluation of ego capacity has attracted limited research and remains difficult to undertake clinically. The study aimed to derive knowledge and understanding of the evaluation of ego capacity in the clinical practice of STPP. A five-stage ethnographic method was undertaken with an expert practitioner group. Interviews and analysis included video-based adapted Interpersonal Process Recall procedures. Informants were enlisted in reflexive analysis of their own data to uncover explicit and implicit practices and understandings used in routine evaluations of ego capacity. Ego and ego capacity were differentiated and described as units of knowledge. A framework for the evaluation of ego capacity was developed that comprises levels, dimensions and indictors used in the evaluation of ego capacity. Dimensions and indicators within the framework contained an observational focus used to differentiate between levels of evaluation of ego capacity. This development has implications for practice, theory and research.