Psychodynamic psychotherapy

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Psychodynamic psychotherapy
MeSH D064889

Psychodynamic psychotherapy or psychoanalytic psychotherapy [1] [2] is a form of depth psychology, the primary focus of which is to reveal the unconscious content of a client's psyche in an effort to alleviate psychic tension. [3]

Contents

Psychodynamic psychotherapy relies on the interpersonal relationship between client and therapist more than other forms of depth psychology. In terms of approach, this form of therapy uses psychoanalysis adapted to a less intensive style of working, usually at a frequency of once or twice per week. Principal theorists drawn upon are Freud, Klein, and theorists of the object relations movement, e.g., Winnicott, Guntrip, and Bion. Some psychodynamic therapists also draw on Jung or Lacan or Langs. It is a focus that has been used in individual psychotherapy, group psychotherapy, family therapy, and to understand and work with institutional and organizational contexts. [4] In psychiatry, it is considered a treatment of choice for adjustment disorders, as well as posttraumatic stress disorder (PTSD) but more for personality-related disorders. [5] [6]

History

The principles of psychodynamics were introduced in the 1874 publication Lectures on Physiology by German physician and physiologist Ernst Wilhelm von Brücke. Von Brücke, taking a cue from thermodynamics, suggested all living organisms are energy systems, governed by the principle of energy conservation. During the same year, von Brücke was supervisor to first-year medical student Sigmund Freud at the University of Vienna. Freud later adopted this new construct of “dynamic” physiology to aid in his own conceptualization of the human psyche. Later, both the concept and application of psychodynamics were further developed by the likes of Carl Jung, Alfred Adler, Otto Rank, and Melanie Klein. [7]

Approaches

Most psychodynamic approaches are centered on the concept that some maladaptive functioning is in play, and that this maladaption is, at least in part, unconscious. [8] [9] The presumed maladaption develops early in life and eventually causes difficulties in day-to-day life. [10]

Psychodynamic therapies focus on revealing and resolving these unconscious conflicts that are driving their symptoms. [11] Major techniques used by psychodynamic therapists include free association, dream interpretation, recognizing resistance, transference, working through painful memories and difficult issues, and building a strong therapeutic alliance. [12] As in some psychoanalytic approaches, the therapeutic relationship is seen as a key means to understanding and working through the relational difficulties which the client has suffered in life. [12]

Core principles and characteristics

Although psychodynamic psychotherapy can take many forms, commonalities include: [12] [13]

Efficacy

Psychodynamic psychotherapy, both short-term and long-term, is an effective psychotherapy. Psychodynamic psychotherapy is an evidence-based therapy (Shedler 2010) and its more intensive form, psychoanalysis has also been proven to be evidence-based. Later meta-analyses showed psychoanalysis and psychodynamic therapy to be effective, with outcomes comparable or greater than other kinds of psychotherapy or antidepressant drugs, [14] [15] [16] but these arguments have also been subjected to various criticisms. [17] [18] [19] [20] For example, Meta-analyses in 2012 and 2013 came to the conclusion that there is little support or evidence for the efficacy of psychoanalytic therapy, thus further research is needed. [21] [22]

A systematic review of Long Term Psychodynamic Psychotherapy (LTPP) in 2009 found an overall effect size of .33. [23] Others have found effect sizes of .44–.68. [16]

Meta-analyses of Short Term Psychodynamic Psychotherapy (STPP) have found effect sizes ranging from .34–.71 compared to no treatment and was found to be slightly better than other therapies in follow up. [24] Other reviews have found an effect size of .78–.91 for somatic disorders compared to no treatment [25] and .69 for treating depression. [26] A 2012 meta-analysis by the Harvard Review of Psychiatry of Intensive Short-Term Dynamic Psychotherapy (ISTDP) found effect sizes ranging from .84 for interpersonal problems to 1.51 for depression. Overall ISTDP had an effect size of 1.18 compared to no treatment. [27]

In 2011, a study published in the American Journal of Psychiatry made 103 comparisons between psychodynamic treatment and a non-dynamic competitor and found that 6 were superior, 5 were inferior, 28 had no difference and 63 were adequate. The study found that this could be used as a basis "to make psychodynamic psychotherapy an "empirically validated" treatment." [28] In 2017, a meta-analysis of randomized controlled trials found psychodynamic therapy to be as efficacious as other therapies, including cognitive behavioral therapy. [29]

A 2011 meta study showed that long-term psychodynamic psychotherapy was superior to less intensive forms of psychotherapy in complex mental disorder. Depending upon severity of the underlying pathology, longer-term psychotherapy is required. For example, individuals functioning at Level 1 of the DSM Personality Functioning Scale would require less treatment than one functioning at Level 2 or above. Studies have also demonstrated that those who received psychodynamic psychotherapy continued to grow post-therapy whereas those who received cognitive Behavior therapy did not.

Client-therapist relationship

Because of the subjectivity of each patient's potential psychological ailments, there is rarely a clear-cut treatment approach. [12] Most often, therapists vary general approaches in order to best fit a patient's specific needs. [12] If a therapist does not understand the psychological ailments of their patient extremely well, then it is unlikely that they are able to decide upon a treatment structure that will help the patient. [12] Therefore, the patient-therapist relationship must be extremely strong. [12]

Therapists encourage their patients to be as open and honest as possible. [12] Patients must trust their therapist if this is to happen. [12] Because the effectiveness of treatment relies so heavily on the patient giving information to their therapist, the patient-therapist relationship is more vital to psychodynamic therapy than almost every other type of medical practice. [30]

See also

Related Research Articles

Cognitive behavioral therapy Therapy to improve mental health

Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to improve mental health. CBT focuses on challenging and changing cognitive distortions and behaviors, improving emotional regulation, and the development of personal coping strategies that target solving current problems. It was originally designed to treat depression, but its uses have been expanded to include treatment of a number of mental health conditions, including anxiety, alcohol and drug use problems, marital problems, and eating disorders. CBT includes a number of cognitive or behavior psychotherapies that treat defined psychopathologies using evidence-based techniques and strategies.

Psychoanalysis Psychological theory and therapy established by Sigmund Freud

Psychoanalysis is a set of theories and therapeutic techniques used to study the unconscious mind, which together form a method of treatment for mental disorders. The discipline was established in the early 1890s by Austrian neurologist Sigmund Freud, who retained the term psychoanalysis for his own school of thought. Freud's work stems partly from the clinical work of Josef Breuer and others. Psychoanalysis was later developed in different directions, mostly by students of Freud, such as Alfred Adler and his collaborator, Carl Gustav Jung, as well as by neo-Freudian thinkers, such as Erich Fromm, Karen Horney, and Harry Stack Sullivan.

Psychotherapy is the use of psychological methods, particularly when based on regular personal interaction with adults, to help a person change behavior and overcome problems in desired ways. Psychotherapy aims to improve an individual's well-being and mental health, to resolve or mitigate troublesome behaviors, beliefs, compulsions, thoughts, or emotions, and to improve relationships and social skills. There are also numerous types of psychotherapy designed for children and adolescents, such as play therapy. Certain psychotherapies are considered evidence-based for treating some diagnosed mental disorders. Others have been criticized as pseudoscience.

Group psychotherapy or group therapy is a form of psychotherapy in which one or more therapists treat a small group of clients together as a group. The term can legitimately refer to any form of psychotherapy when delivered in a group format, including Art therapy, cognitive behavioral therapy or interpersonal therapy, but it is usually applied to psychodynamic group therapy where the group context and group process is explicitly utilized as a mechanism of change by developing, exploring and examining interpersonal relationships within the group.

Clinical psychology is an integration of science, theory, and clinical knowledge for the purpose of understanding, preventing, and relieving psychologically-based distress or dysfunction and to promote subjective well-being and personal development. Central to its practice are psychological assessment, clinical formulation, and psychotherapy, although clinical psychologists also engage in research, teaching, consultation, forensic testimony, and program development and administration. In many countries, clinical psychology is a regulated mental health profession.

The Dodo bird verdict is a controversial topic in psychotherapy, referring to the claim that all empirically validated psychotherapies, regardless of their specific components, produce equivalent outcomes. It is named after the Dodo character in Alice in Wonderland. The conjecture was introduced by Saul Rosenzweig in 1936, drawing on imagery from Lewis Carroll's novel Alice's Adventures in Wonderland, but only came into prominence with the emergence of new research evidence in the 1970s.

Play therapy childrens mental health therapy method

Play therapy refers to a range of methods of capitalising on children's natural urge to explore and harnessing it to meet and respond to the developmental and later also their mental health needs. It is also used for forensic or psychological assessment purposes where the individual is too young or too traumatised to give a verbal account of adverse, abusive or potentially criminal circumstances in their life.

Intensive short-term dynamic psychotherapy (ISTDP) is a form of short-term psychotherapy developed through empirical, video-recorded research by Habib Davanloo.

The therapeuticalliance, or working alliance, as a concept has roots dating back to Sigmund Freud and traces psychotherapeutic thought up to the present day. Over the course of its evolution, the meaning of the therapeutic alliance has shifted both in form and implication. What started as an analytic construct has become over the years a transtheoretical formulation, an integrative variable, and a common factor.

The therapeutic relationship refers to the relationship between a healthcare professional and a client or patient. It is the means by which a therapist and a client hope to engage with each other and effect beneficial change in the client.

Child psychotherapy, or mental health interventions for children have developed varied approaches over the last century. Two distinct historic pathways can be identified for present-day provision in Western Europe and in the United States: one through the Child Guidance Movement, the other stemming from Adult psychiatry or Psychological Medicine, which evolved a separate Child psychiatry specialism.

Interpersonal psychotherapy (IPT) is a brief, attachment-focused psychotherapy that centers on resolving interpersonal problems and symptomatic recovery. It is an empirically supported treatment (EST) that follows a highly structured and time-limited approach and is intended to be completed within 12–16 weeks. IPT is based on the principle that relationships and life events impact mood and that the reverse is also true. It was developed by Gerald Klerman and Myrna Weissman for major depression in the 1970s and has since been adapted for other mental disorders. IPT is an empirically validated intervention for depressive disorders, and is more effective when used in combination with psychiatric medications. Along with cognitive behavioral therapy (CBT), IPT is recommended in treatment guidelines as a psychosocial treatment of choice for depression.

Forensic psychotherapy

Forensic psychotherapy is the application of psychological knowledge to the treatment of offender-patients who commit violent acts against themselves or others. This form of treatment allows for a therapist to potentially understand the offender and their mental state. It gives the individual providing treatment the opportunity to examine further whether the offender’s criminal behavior was a conscious act or not, what exactly their association with violent behavior is, and what possible motives could have driven them. The discipline of forensic psychotherapy is one that requires the involvement of individuals other than simply the therapist and patient. A therapist may collaborate with other professionals, such as physicians, social workers, and other psychologists in order to best serve the offenders’ needs. Whether the treatment is successful or not relies on a multitude of things, but typically ensuring that a systemic approach is taken and that all involved in the treatment process are well informed and supportive has proven to be the most effective. In addition to group work, forensic psychotherapy may also involve therapeutic communities, individual interaction with victims as well as offenders, and family work. In order for this specialized therapy to be as effective as possible, it demands the compliance of not only the patient and therapist, but of the rest of society as well. The main focus of forensic psychotherapy is to obtain a psychodynamic understanding of the offender in order to attempt to provide them with an effective form of treatment. Guidelines have been set to ensure proficiency in the field of Forensic Psychology.

Psychoanalytic dream interpretation

Psychoanalytic dream interpretation is a subdivision of dream interpretation as well as a subdivision of psychoanalysis pioneered by Sigmund Freud in the early twentieth century. Psychoanalytic dream interpretation is the process of explaining the meaning of the way the unconscious thoughts and emotions are processed in the mind during sleep.

History of psychotherapy

Although modern, scientific psychology is often dated from the 1879 opening of the first psychological clinic by Wilhelm Wundt, attempts to create methods for assessing and treating mental distress existed long before. The earliest recorded approaches were a combination of religious, magical and/or medical perspectives. Early examples of such psychological thinkers included Patañjali, Padmasambhava, Rhazes, Avicenna and Rumi.

Peter Fonagy

Peter Fonagy, is a Hungarian-born British psychoanalyst and clinical psychologist. He studied clinical psychology at University College London. He is Professor of Contemporary Psychoanalysis and Developmental Science and Head of the Division of Psychology and Language Sciences at University College London, Chief Executive of the Anna Freud Centre, a training and supervising analyst in the British Psycho-Analytical Society in child and adult analysis, a Fellow of the British Academy, the Faculty of Medical Sciences, the Academy of Social Sciences and a registrant of the BPC. His clinical interests centre on issues of borderline psychopathology, violence and early attachment relationships. His work attempts to integrate empirical research with psychoanalytic theory. He has published over 500 papers, 270 chapters and has authored 19 and edited 17 books.

Supportive psychotherapy is a psychotherapeutic approach that integrates various therapeutic schools such as psychodynamic and cognitive-behavioral, as well as interpersonal conceptual models and techniques.

The mainstay of management of borderline personality disorder is various forms of psychotherapy with medications being found to be of little use.

Dr. Allan Abbass is professor, psychiatrist, and founding Director of the Centre for Emotions and Health at Dalhousie University in Halifax, Nova Scotia, Canada.

Diana Fosha is a Romanian-American psychologist, known for developing accelerated experiential dynamic psychotherapy (AEDP) and for her work on the psychotherapy of adults suffering the effects of childhood attachment trauma and abuse.

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