Table 2 shows the correlations of the assessors who were present at the training sessions. The average values per item vary between 0.80 - feeling of belonging - and 0.32 - sexual function. In general, the items show acceptable correlation coefficients, except for sexual function (0.32), bodily function (0.35), alexithymia (0.44) and bodily appearance (0.55), which are the sub-scales with the lowest correlation coefficient and are not significant.

Pictures three and four show in graphic form the mean correlations per item (3) and the means of the correlations of the different assessors (4).

Table three shows the Wilcoxon coefficients of the assessors who were present at the training sessions.

Discussion

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. Thus Haver et al (1), using an assessor from the original study with a sample of 21 women who were alcohol abusers or alcohol-dependent, obtained a mean correlation of 0.56. In this study the control sub-scales, tolerance of frustration, alexithymia and body image did not reach statistical significance.

The correlation coefficients obtained in our study correspond to those published in other studies which use different methods of psychoanalytical evaluation. Thus Bellak (2) in a study with the EFA scale of evaluation obtained values of reliability between assessors of between 0.61 and 0.88. Dahl (3), using the same scale with trained assessors, encountered lower correlations of between 0.13 and 0.81 (mean 0.47); 9 of the 12 scales had correlations lower than 0.50. Another group of researchers obtained a mean correlation of 0.77, with intensive pre-training of assessors and interviewers (4,5).

We ourselves did not find that there was such a clear tendency for reliability to increase in relation to years of experience and psychotherapeutic training as in relation to group training in the use of the measurement method. We consider that the scores obtained by PQ2 may be interpreted in this way. The question of the amount of training and psychodynamic experience involved is not easy to quantify.

There are several factors which might explain the differences in results from those of the original study. Our data were based upon blind and independent evaluations of the interviews recorded on video, using two interviewers and a sample where half of the subjects fulfilled different DSM-IV (Axis I) diagnostic criteria. The Swedish authors listened to the tapes together, awarded scores independently and subsequently discussed the evaluations made. This procedure, without doubt, made the assessors' criteria more similar. The lack of experience and specific training may also contribute, since our assessors' reliability has not been demonstrated. Until now there has been no information about the amount of training required to produce a competent KAPP assessor.

On the other hand, the fact that a higher percentage of subjects fulfilling DSM-IV criteria were used may also have contributed to the fact that lower correlations were obtained.

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.

Bibliografic

1- B.Haver, P.Svanborg, S. Lindberg . Improving the usefulness of the Karolinska Psychodinamic Profile in research: proposals from a reliability study. Acta Psychiatr Scand 1995:92: 132-137

2- Bellak L, Hurvich M, Gediman HK. Ego functions in schizofrenics, neurotics and normals. A systematic study of conceptual, diagnostic, and therapeutic aspect. New York: John Wiley & Sons,1984: 160-166.

3- Dahl AA. A study of agreement among raters of Bellak#s Ego Function Assessment Test. In: Bellak L, Goldsmith La ed. The broad scope of ego function assessment. New York: John Wiley & Sons, 1984: 160-166.

4- Sohlberg S, Norrig C. Presentation av diagnosmetod: Bed`mning av jag-fungerande. Psykolog Tidningen 1988: 15: 9-12.

5- Norring 11c, Sohlberg S, Rosmark B, Humble K, Holmgren S, Nordquist C. Ego functioning in eating disorders: Description and relation to diagnostic classification. Int J Eating Disord 1989: 8: 607-621.