Cognitive-behavioral therapy in geriatric depression: Comment on Steuer et al.

Comments on and agrees with the findings of J. L. Steuer et al (see record 1987-21146-001) that both cognitive-behavioral and psychodynamic group therapies led to significant reductions in depression in geriatric patients, as measured by the short form of the Beck Depression Inventory (BDI) and by the Hamilton Psychiatric Rating Scale, but disagrees with their conclusion that the cognitive therapy did not produce a clinically meaningful treatment superiority. For the present study, a regression equation was used to predict equivalent short-form BDI values from full-scale scores in a clinical sample of 208 adult outpatients with affective disorders. It is suggested the significant treatment superiority obtained for cognitive therapy on the BDI is accurate and meaningful. (11 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using homework in psychodynamic psychotherapy.

Homework refers to an assignment given by the therapist to the patient that is to be fulfilled between sessions. It is a typical intervention in cognitive-behavioral therapy, but less common in psychodynamic therapy. This article describes an assimilative, integrative model of psychodynamic therapy that incorporates homework and describes its use in a series of clinical cases. Although the indications for and impact of homework vary from case to case, conclusions are drawn as to the most effective approaches to incorporating homework in a psychodynamic model. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The efficacy of psychodynamic psychotherapy.

Empirical evidence supports the efficacy of psychodynamic therapy. Effect sizes for psychodynamic therapy are as large as those reported for other therapies that have been actively promoted as “empirically supported” and “evidence based.” In addition, patients who receive psychodynamic therapy maintain therapeutic gains and appear to continue to improve after treatment ends. Finally, nonpsychodynamic therapies may be effective in part because the more skilled practitioners utilize techniques that have long been central to psychodynamic theory and practice. The perception that psychodynamic approaches lack empirical support does not accord with available scientific evidence and may reflect selective dissemination of research findings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The future of psychodynamic psychotherapy.

Discusses the current status and future outlook of psychodynamic psychotherapy. Important trends include (1) increasing attention to disturbances in infancy and early childhood; (2) focusing on more difficult patients; (3) focusing on the dyadic character of the therapeutic relationship; (4) recognition of the importance of the therapeutic alliance; (5) developments in neuroscience and pharmacotherapy; (6) more use of group, marital, and family therapy; (7) emphasis on brief therapy; (8) attempts to devise specific treatments for specific disorders; (9) the appearance of treatment manuals; and (10) the continued search for the mechanisms of change in personality and behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Couples psychotherapy: A psychodynamic model.

Psychoanalytic assumptions and goals need not be viewed or approached from a purely individual analytic perspective. Families and especially marriages offer a unique opportunity for systems-oriented intervention to add therapeutic depth by addressing psychodynamic interactions in vivo. Doing so requires integration in therapy, as well as in theory, of the manner in which individual psychodynamics manifest in primary interpersonal systems. A model is presented which aims at translating and instilling a useful degree of analytic insight in members of marital or family systems. Insight into transferential distortions and behavior is facilitated by introducing the metaphor of unconscious "hopes" and "expectations" in the interactive contexts of conjoint and individual sessions. It is suggested that such an expansion of systems-oriented approaches is a crucial step in adding depth and durability to change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Methods and mechanisms in the efficacy of psychodynamic psychotherapy.

Comments on the original article, "The efficacy of psychodynamic psychotherapy," by J. Shedler (see record 2010-02208-012). Shedler summarized a large body of research that shows psychodynamic therapy to have a substantial effect size, comparable to that for many empirically supported treatments. This is an important finding, in part refuting the concerns raised by Bornstein (2001, 2002) regarding the future of psychodynamic approaches had there been no substantial changes in how practitioners and researchers approached the science to demonstrate efficacy. Further, Shedler showed that the efficacy of psychoanalytic psychotherapy is due to therapeutic methods commonly employed in cognitive behavior therapy (CBT), one of the most frequently cited empirically supported approaches for a wide range of psychological conditions. From a methodological perspective, there are some important limitations to the claim of psychodynamic psychotherapy’s comparable efficacy to other empirically supported approaches. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The place of psychodynamic psychotherapy in the integrated treatment of posttraumatic stress disorder and trauma recovery.

Psychodynamic psychotherapists treating posttraumatic stress disorder (PTSD) sufferers can draw on an accumulated body of trauma studies from their own field to guide their work. However, these reports, often based on case studies or conceptual reviews, do not have the same empirical conclusiveness as more recent evidence-based research demonstrating the efficacy of cognitive–behavioral and body-oriented therapies. In this article, a psychodynamic psychotherapist reflects on his treatment of an Israeli man who developed PTSD after enduring 4 terrorist attacks. The author shows how assimilative integration offered him a theory- and research-based model that helped him comfortably combine separate treatment interventions. He also shows how this model helped him locate with some precision the specific contribution of psychodynamic psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personal constructs and psychodynamic psychotherapy: A case study.

[Correction Notice: An erratum for this article was reported in Vol 24(1) of Psychoanalytic Psychology (see record 2007-00135-015). An error was made in the reproduction of figures 5 and 6. The corrected versions are provided with the erratum.] During a short term, psychoanalytically informed psychotherapy, a college student's salient constructs regarding her self and her object representations were elicited via the Role Construct Repertory Test. The course of this psychotherapy is traced and is examined with regard to the information provided by component analyses of these repertory grids. The aims of this article are to demonstrate the utility of an independent measure such as repertory grids for 1) additional understanding of the patient's modes of construing self and others; 2) establishing meaningful foci for a short-term treatment; 3) providing information for a more considered set of interpretive interventions regarding key conflicts; and 4) considering changes and outcome in light of the foci of the treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

What changes in short-term psychodynamic psychotherapy?

Reviews theories of the change process in short-term therapy and presents case material from 15 therapy sessions of a male seeking treatment for intermittent depression. A reconceptualization of the change process is offered, using examples from the case to illustrate theoretical principles. A taxonomy of loci of neurotic disturbance is proposed, and a corresponding taxonomy of avenues for therapeutic change is described. The 5 loci identified for therapeutic change in short-term therapy include the uncovering and reworking of (1) dysfunctional set-goals, (2) inaccurate or maladaptive cognitions and expectancies, (3) anachronistic affects, (4) maladaptive compromises between multiple cognitive–affective schemas, and (5) routinized and dysfunctional mental and/or behavioral control mechansims. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cohesion in group psychotherapy.

Insight into the therapeutic relationship in group psychotherapy requires an understanding of the treatment context. Cohesion is defined as the therapeutic relationship in group psychotherapy emerging from the aggregate of member leader, member-member, and member-group relationships. Using this definition, evidence for the relationship between cohesion, patient outcome, an treatment processes is reviewed. Six empirically supported principles that undergird the development and maintenance of cohesion are presented touching on pregroup preparation, ear group structure, leader interaction, feedback, leader modeling, and member emotional expression. The limitations the present research are discussed; leading to opportunities for future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting depressive symptomatology: Cognitive-behavioral models and postpartum depression.

170 women (mean age 26.6 yrs), seen in their 2nd trimester of pregnancy, were followed-up about 3 mo postpartum. Level of depression (Beck Depression Inventory) was just as high during pregnancy as during the postpartum period. Several variables assessed during pregnancy and during the postpartum period were significant predictors of postpartum depression level, including measures of prepartum depression, attributional style, delivery stress, and stressful life events. The predictor variables accounted for about 40% of the variance in level of postpartum depression. Predictor variables from earlier research such as history of menstrual problems, parity, education, and income did not account for significant variance in postpartum depression level. These findings provide some evidence for the role of cognitive-behavioral factors and stressful life events in depression. (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The therapeutic alliance in psychodynamic psychotherapy: Theoretical conceptualizations and research findings.

The construct of the therapeutic alliance is approached from the psychoanalytic tradition by reference to the ideas of Freud, R. Sterba, E. R. Zetzel, R. R. Greenson, and L. Luborsky. The transtheoretical approaches posited by E. S. Bordin and L. Gaston are also presented and the relation of alliance to the transference is discussed. The empirical evidence as to the role of the alliance in psychodynamically oriented psychotherapy is presented, and the construct is operationally defined by means of the major psychometric instruments. Factors that foster the development of strong alliances (patient and therapist factors), as well as those that hinder or result in its rupture are discussed in detail. The differential association of alliance to outcome depending on who measures the alliance (patient, therapist, or independent observer) and the timing of the measurement of the alliance (first, third, fifth, or later session) are considered. Last, there is a discussion of the criticisms of how research in this area is conducted, and suggestions for future researchers are made. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist session intentions in cognitive–behavioral and psychodynamic–interpersonal psychotherapy.

Theories of psychotherapy are implemented by therapists' intentional actions within sessions. This study examined the structure and construct validity of the Therapist Session Intentions (TSI) form. Ten therapists rated their therapeutic intentions following each of 2,305 therapy sessions of cognitive–behavioral or psychodynamic–interpersonal therapy in the Second Sheffield Psychotherapy Project. Seven conceptually coherent clusters of intentions, or therapeutic foci, were identified: treatment context, session structure, affect, obstacles, encouraging change, behavior, and cognition-insight. Contrasting patterns of therapeutic focus across treatments and changes in focus across sessions within treatments appeared conceptually coherent. Correlations across a subsample of sessions confirmed correspondences of the TSI foci with dimensions found previously in observers' ratings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The missed session: A neglected aspect of psychodynamic psychotherapy.

Missed sessions, whether initiated by the patient, therapist, or nature, are events in psychotherapy, not non-events. When appropriately handled, missed sessions provide valuable opportunities for therapeutic exploration. A clear cancellation policy, discussed early in therapy, offers a frame within which therapist and patient may understand the meanings of the missed session. An awareness of transference and countertransference contributes to therapeutic implementation of the cancellation policy and resulting maintenance of exploratory space. Therapists whose cancellation policies are unclear, too rigid, or too lenient render the therapy unsafe. Addressing the financial implications of a missed session before attending to motivations and feelings surrounding it is a clinical mistake. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive-behavioral treatment of panic disorder.

Cognitive-behavioral therapy can be effective for many clients with panic disorder. Therapy can be conceptualized in terms of four central components. First, the initial preparation for therapy involves establishing a working alliance, educating the client about panic symptoms and treatments, and conducting a diagnostic assessment. Second, skills training is used to cultivate active coping skills that the client can use to tolerate symptoms of emotional distress. Third, exposure is used to encourage clients to test and refine their newly developed coping skills. Fourth, relapse prevention is used to help clients discontinue psychological and biological treatments without suffering lasting setbacks. Through the use of cognitive-behavioral therapy, most clients can learn to control their symptoms of panic and reduce their anticipatory anxiety. Treatment gains can be maintained after therapy is discontinued. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparative outcomes for individual cognitive-behavior therapy, supportive-expressive group psychotherapy, and sertraline for the treatment of depression in multiple sclerosis.

This study compared the efficacy of 3 16-week treatments for depression in 63 patients with multiple sclerosis (MS) and major depressive disorder (MDD): individual cognitive- behavioral therapy (CBT), supportive expressive group therapy (SEG), and the antidepressant sertraline. Significant reductions were seen from pre- to posttreatment in all measures of depression. Intent-to-treat and completers analyses using the Beck Depression Inventory (BDI; A. T. Beck, C. H. Ward, M. Medelson, J. Mock, & J. Erbaugh, 1961) and MDD diagnosis found that CBT and sertraline were more effective than SEG at reducing depression. These results were largely supported by the BDI-18, which eliminates BDI items confounded with MS. However, the Hamilton Rating Scale for Depression (M. Hamilton, 1960) did not show consistent differences between treatments. Reasons for this inconsistency are discussed. These findings suggest that CBT or sertraline is more likely to be effective in treating MDD in MS compared with supportive group treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Short-term psychodynamic psychotherapy: Reflections on the past and current practice.

Reviews the literature on short-term psychodynamic psychotherapy (STDP) and contends that its roots began with the active therapy of S. Ferenczi. O. Rank laid the foundation for recognition of the importance of personality development in infancy. F. Alexander and T. French challenged analytic concepts but maintained dynamic design. D. Malan systematically studied the process of therapy. P. Sifneos proposed that psychodynamic change involved substituting more adaptive and useful defense mechanisms for maladaptive ones. H. Davanloo felt that persistent challenging of defense made STDP effective even with resistant patients suffering from chronic symptomatic and characterological problems. It is suggested that the aim of STDP is to uncover, reexperience, and work through repressed emotional conflict by means of analysis of defense, resistance, and transference using an active approach. (27 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Late-life depression and functional disability: the role of goal-focused group psychotherapy

This study compares the efficacy of two time-limited group psychotherapies for depression and functional disability in late life. Goal-focused group psychotherapy (GFGP) utilized focused psychoeducation and skills training to assist each patient in the achievement of individualized goals. Reminiscence therapy (RT) emphasized individual life review to facilitate discussion. Subjects (N = 13), ages 55 and above, with major depression were randomly assigned to one of the two groups. Most were receiving antidepressant treatment. All had failed to achieve full remission. Whereas both treatment groups improved in depressed mood and disability, GFGP subjects had a far greater change in depressive symptomatology and also improved in the areas of hope, hopelessness, anxiety and social functioning.