Identity Structure Analysis: a potential framework for process and outcome evaluation in psychotherapy

Purpose This paper aims to explore the potential utility of Identity Structure Analysis (ISA) in single-case and group-level outcome and process evaluations. Design/methodology/approach A study was conducted to evaluate mentalization-based therapy by using ISA and its linked framework software, Ipseus. Ten patients with borderline personality disorder and substance use disorder were involved in the study. ISA/Ipseus was administered prior to and at the completion of the treatment. Five-year follow-up data, comprising behavioural indicators, were also collected and compared to ISA/Ipseus results. Findings Improvements occurred in the evaluation of stressful, demanding and emotionally burdening situations. Evaluations on concerned others also improved, together with progress in self-reflection. Changes in the evaluation of recovery-related themes were less salient. On a case level, changes in the self-states and role models were consistent with the results of the five-year-follow up data. An initial crisis state seems suggestive of progress, while initial defensive positions with high positive self-regard, of stagnation. Originality/value ISA/Ipseus, integrating the benefits of qualitative and quantitative approaches in evaluation, is a potential method to explore the complexity of identity changes during therapy.