Resumen

Se ha realizado la traducción y adaptación al español del KAPP estudiando su validez concuirrente y su fiabilidad entre examinadores. Los resultados muestran una fiabilidad aceptable en muchos de los items aunque menor que la que obtuvieron los autores del instrumento.

Abstract

The Spanish version of the KAPP has been made in conformity with presently accepted methodology: The fact that we have obtained a translation which is semantically close to the original as possible has to a great extent eliminated the possible transcultural differences inherent in differences in idiom, and this has allowed us to apply the same concurrent validity criteria to the Spanish version which we applied to the original version. Reliability between examiners was also analyzed.

The results obtained in our study, although acceptable, show lower correlation coefficients than those obtained by the Swedish authors in their original publication. Later studies carried out by persons who were not directly involved in the creation of the method of measurement have obtained figures similar to ours Further studies with different groups of subjects and researchers will be required to provide information about the applicability of KAPP in research and in clinical practice.

INTRODUCTION

The construction of psychodynamic evaluation systems which are valid, reliable and inexpensive in their application is a real challenge within the field of research in psychotherapy. The tools presently available display varying degrees of reliability, require intensive training beforehand and take a great deal of time to administer.

The Karolinska Psychodynamic Profile - KAPP - is a method of measurement based upon the psychoanalytical theory which includes recent thinking about objectal relationships and permits us to evaluate relatively steady, gradual types of change in mental function, as well as character traits.

Unlike other scales, the KAPP avoids metapsychological formulations and includes descriptions which are closely related to clinically observed phenomena.

According to its authors, it is a reliable tool when used by professionals who have psychotherapeutic experience and are trained in its application.

Following its translation into Spanish, we now present the results of the reliability study of this version.

MATERIALS AND METHODS

Assessors

6 researchers were involved. Two were interviewers: one was a psychiatrist (PQ1) and the other a psychologist (PS1), both with extensive dynamic and clinical training. Three were assessors: one was a psychiatrist (PQ2) - highly trained, like the two interviewers - and two psychologists. One of these (PS3) had a lower level of training and psychodynamic experience and the other (PS2) was of an intermediate level. PQ1 and PS2 were involved with the translation of the Spanish version.
Subjects
We worked with a sample of 24 subjects. Of these, half were undergoing psychiatric treatment and were diagnosed as DSM-IV on Axis I. The other half had no previous history.

The distribution of diagnoses in the group of patients was as follows: four cases of schizophrenia, four dysthymic disorders, one major depressive disorder, one generalised anxiety disorder, one alcohol dependency and one opiate dependency.

The patients came from the acute unit of the Hospital Civil in Basurto. They were informed of the aims of the study and included in it after giving their consent. All of them were interviewed one or two days before being discharged. Six patients declined to take part, and two more did not appear after having agreed to participate. The average age was 31.9 years (range from 19-42) and distribution by sex was equal (6/6), the majority being single (9/3) and unemployed (9/3).

The other twelve subjects, who had no previous history, were working mostly in a social work centre, and attended voluntarily. They were informed about the study and included in it after an interview with another researcher with responsibility for selection of the sample. One candidate, who showed clear signs of a serious personality disorder, was rejected. The average age of this group was 33.6 (range 26-43) and distribution by sex was equal (6/6), the majority being single (8/4) and employed (8/4).

Procedure

Before beginning the interviews and their assessments, there were several group sessions of familiarisation and training with the method of measurement. An interview was carried out and recorded on video - this was not included in the reliability analysis - and was subsequently viewed, discussed and evaluated in a group session by most of the researchers. Assessor PQ2 was not present at any of these sessions.

The two interviewers (PQ1 and PS1) carried out between them a total of 24 interviews, 12 each, which were recorded on video. The theoretical formulations and suggestions described by Kernberg (1984) then followed, in order to form a "structured" procedure for psychodynamic interview. The average length was one hour twenty-five minutes, all recorded in one session. The two interviewers did not know any of the subjects, nor did they have any information about them. Each interviewer saw six patients and six controls. After the interview they filled in the various KAPP sub-scales. In addition, each interviewer had to view and assess the other interviewer's videos. These assessments were not discussed, so that the learning situation was personal to each interviewer.

The rest of the researchers each assessed twelve videos, six by each interviewer, and in equal numbers of subjects with diagnosis/subjects without diagnosis, and of men/women.

With this procedure we are attempting to:

A) Analyse reliability between examiners by studying the correlation existing between the scores awarded independently by the researchers to the subjects in the sample.

B) Evaluate the influence of the two different levels of training by analysis of the correlation between assessors with a different degree of experience and dynamic training.

C) Estimate the impact of pre-training in the use of the method of measurement by comparing the results of the interviewers with an assessor of a similar level (PQ2) who did not attend the group training sessions before the interviewers' assessment.

Statistical Analysis

An independent researcher who was not one of the assessors selected the sample and carried out the statistical analysis. In view of the features of the measurement system, it was decided to use non-parametric methods. The Spearman coefficient was used to study the correlation between the different administrations, and the Wilcoxon method of mean comparison to analyse the differences.

Results

Table 1 shows the correlations between the evaluations made by the different assessors. The means vary between 0.662 and 0.360. Researcher PQ2, who did not attend the group sessions of training and video viewing, obtained the lowest coefficients.

Pictures one and two show in graphic form the mean correlations per item (1) and the means of the correlations of the different assessors (2).