Direct and indirect effects of adverse and protective childhood experiences on symptom improvement in psychotherapy

Abstract

Objective:

To investigate the effects of adverse and protective childhood experiences on symptom improvement in outpatient psychotherapy.

Method:

We evaluated n = 648 completed outpatient psychodynamic psychotherapies. First, we estimated the rate of symptom improvement for each patient using a two-stage hierarchical linear model. We then calculated the direct and indirect influences of childhood experiences on the improvement rate using a structural equation model. Personality functioning, according to the Operationalized Psychodynamic Diagnosis system, was examined as being a possible mediating factor.

Results:

The presence of adverse childhood experiences was directly associated with a slower improvement rate in psychotherapy. Moreover, a higher number of adverse childhood experiences was associated with greater impairments in the ability to communicate as one dimension of personality functioning, which in turn was associated with a slower improvement of symptoms. Protective childhood experiences were associated with fewer impairments in specific dimensions of personality functioning, but had no direct effect on the improvement rate.

Conclusions:

Adverse childhood experiences can directly influence the course of psychotherapy. In addition, the communication dimension of personality functioning appears to be a central mediator on which adverse and protective childhood experiences act antagonistically and can thus indirectly affect the improvement rate in psychotherapy.

Keywords:

• adverse childhood experiences
• protective childhood experiences
• personality functioning
• psychotherapy
• improvement rate
• communication

Acknowledgements

We thank Molly Sutcliffe for English language editing.

Disclosure Statement

No potential conflict of interest was reported by the author(s).

Availability of Data

The analysis code is available at DOI https://doi.org/10.11588/data/MYFILV. The datasets used and analyzed during the present study cannot be shared due to restrictions by the ethical review board.