Review of Personality styles and brief psychotherapy.

Reviews the book, Personality styles and brief psychotherapy by Mardi Horowitz, Charles Marmar, Janice Krupnick, Nancy Wilner, Nancy Kaltreider, and Robert Wallerstein (1984). This book by Horowitz and his colleagues falls in the category of psychodynamic psychotherapy, and in fact lies very close to the heart of traditional, but updated, forms of psychoanalytic psychotherapy. Clinicians who have attempted to master ego-analytic psychotherapy will recognize key concepts in this book that are germane to traditional therapy. These include: stressful events that precipitate psychopathology in specific personality types; the concept of wish, defense, and the dynamic compromise behavior/attitude; patterns of defensive organization and cognitive style typical of personality types; therapeutic tactics related to those personality patterns; and the triad of insight-transference relationship, current relationships, and parental relationships. Horowitz's book has value for a number of overlapping purposes. It should be included in a course on short-term therapy, it is an up-to-date and sophisticated review of personality theory, it is important in the empirical refining of psychodynamic technique, short- or long-term, and it is essential for an understanding of how psychotherapy research is indeed beginning to have a significant impact on psychotherapy theory and technique. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A paradigm for single-case research: The time series study of a long-term psychotherapy for depression.

Articulates a paradigm for single-case research in psychotherapy. A patient diagnosed as having major depressive disorder was seen in an intensive, twice-weekly psychodynamic psychotherapy for 2.5 years. Each session was videotaped, and assessments of patient change were obtained at regular intervals. A time-series analysis was used to model fluctuations in the therapy process to take into account time and the effect of previous events on subsequent changes, thereby preserving the context-determined meaning for therapist and patient actions. A bidirectional analysis of causal effects shows that the influence processes between therapist and patient are mutual and reciprocal and suggests that the effect of the patient on the therapist and on the process has not been made sufficiently explicit in previous models of process and change. The potential of intensive single-case designs for uncovering causal effects in psychotherapy is demonstrated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Models of brief psychodynamic therapy.

Reviews the book, Models of brief psychodynamic therapy by Stanley B. Messer and C. Seth Warren. This book is suitable for supplementary reading in a graduate psychotherapy course, and is intended for graduate students in the field of clinical and counseling psychology. It is also intended as a concise reference work on brief psychodynamic therapies for clinicians who are or wish to practice in the newer mode of limited goals and limited sessions. The authors consider drive theory based psychotherapy treatment, as well as integrative and eclectic models of brief psychodynamic therapy. In consideration of each of the various approaches, Messer and Warren have primarily concerned themselves with four issues as a focal point of their analysis: (a) the theory of pathology involved; (b) the development of a clinical focus; (c) patient selection considerations, including indications and contraindications; and (d) typical techniques associated with the treatment involved. This text is an excellent addition to the literature, primarily for adjunct reading in graduate courses on psychotherapy. It also affords the opportunity for psychodynamically oriented clinicians to address a need for an overview and grounding in brief treatment models. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Handbook of evidence-based psychodynamic psychotherapy: Bridging the gap between science and practice.

Reviews the book, Handbook of evidence-based psychodynamic psychotherapy: Bridging the gap between science and practice by Raymond A. Levy and J. Stuart Ablon (see record 2008-14828-000). This book presents a lucid and timely review of research advances assessing the efficacy and effectiveness of psychodynamic psychotherapies in treating many psychological disorders. From research on broad-based meta-analyses of the effectiveness of psychodynamic psychotherapy to close process analysis of therapist and patient interactions, the invited contributors of this volume translate complex research findings into clinically relevant information for clinicians working in the field. The volume is organized to lead the reader from broad-based reviews of psychodynamic psychotherapy outcome studies to examining in-session processes of patient– therapist interactions that affect the patient’s well-being, improvement, and personality change. In all, it lives up to its title and should be added to any clinician’s library. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Tale of Two Visions: Can a New View of Personality Help Integrate Psychology?

Personality psychology studies how psychological systems work together. Consequently, the field can act as a unifying resource for the broader discipline of psychology. Yet personality's current fieldwide organization promotes a fragmented view of the person, seen through such competing theories as the psychodynamic, trait, and humanistic. There exists an alternative--a systems framework for personality--that focuses on 4 topics: identifying personality, personality's parts, its organization, and its development. This new framework and its view of personality are described. The framework is applied to such issues as personality measurement, psychotherapy outcome research, and education. The new framework may better organize the field of personality and help with its mission of addressing how major psychological systems interrelate. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavior therapy in retrospect: Patients' feelings about their behavior therapies.

Interviewed 14 behavior therapy patients to determine if phenomena regularly observed in psychodynamic psychotherapies had occurred in their behavior therapies as well. Interview data were analyzed both statistically and clinically. Ratings by patients, their therapists, and the es indicate that the prevalence of behavior modification techniques in the therapy was not significantly related to outcome, whereas a variety of the patients' personal feelings about their therapists were. Impressionistic analysis of the interviews also suggest that the important elements of these therapies were interpersonal ones, much as has been demonstrated in psychodynamic psychotherapy. The behavior modification techniques themselves seem to have added little to the therapies, and in some instances may even have facilitated continued defensive avoidance of problems. (37 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Techniques for strengthening clients' observing ego.

The construct of the observing ego has received little attention in the psychotherapy literature since it was first introduced by Freud, yet its attainment is considered one of the hallmarks of mental health. Despite the importance of increasing clients' observing ego functions, little has been written about how to accomplish this goal in psychotherapy. This article describes an integrative psychodynamic approach to treatment that selectively uses modified techniques from other theoretical approaches. The relationship between the therapeutic alliance and the observing ego is discussed, and 4 techniques for increasing observing ego functions are suggested: (1) the use of clarification following catharsis; (2) increasing reality testing; (3) serving as an auxiliary ego; and (4) the use of distancing techniques such as the conscious projection of a problem, use of metaphors, humor, journals, and the gestalt empty chair technique. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trainee theoretical orientation: Profiles and potential predictors.

The goal of this study was to provide data on the theoretical orientations of a sample of therapists in-training, as well as to investigate constructs that may help to predict identification with a particular theoretical orientation(s). Data on therapist theoretical orientation and personality were gathered from 46 graduate student therapists in 4 APA accredited clinical and counseling psychology programs. Although psychodynamic therapy was the most strongly endorsed single theoretical framework across the sample, the orientation with the highest mean rating was an eclectic/integrative approach. A 2-step cluster analysis was used to create orientation profiles to further explore psychotherapy integration, which produced a 3-cluster solution: (a) humanistic/systems/psychodynamic, (b) psychodynamic, and (c) cognitive–behavioral. A significant main effect for cluster membership and personality factors was found, and a chi-square analysis indicated differential representation across the three “integration clusters” as a function of training program. Implications for psychotherapy integration and training are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Short-term psychotherapy for perinatal loss.

Suggests that psychotherapy with victims of perinatal loss provides an opportunity to facilitate the mourning process as well as further resolution of long-standing conflicts in pregnancy and its tragic aftermath. Two cases illustrate psychotherapy for recent perinatal loss and for unresolved grief. While a psychodynamic orientation is used, it is argued that interpersonal resources and family styles of coping are important factors in the outcome of perinatal bereavement. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preliminary relationships between adherence and outcome in dynamic deconstructive psychotherapy.

This study examined adherence to specific psychotherapeutic techniques as a predictor of outcome in dynamic deconstructive psychotherapy (DDP), a new psychodynamic therapy for treatment-resistant clients with borderline personality disorder (BPD). Ten clients dually diagnosed with BPD and alcohol use disorders underwent 12 months of DDP. Outcome indexes included measures of borderline symptoms, depression, dissociation, social support, alcohol misuse, parasuicide, and institutional care. Independent raters coded videorecorded sessions on adherence to DDP techniques, using a scale developed for this study, as well as therapeutic alliance and standard cognitive–behavioral and psychodynamic techniques. The adherence instrument demonstrated excellent interrater and test–retest reliability. Adherence to DDP techniques was positively related to improvement in BPD symptoms (ρ = .64) and most secondary outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapy and Alcoholics Anonymous: An integrated approach.

This article provides a rationale for, and a method of, combining a nonprofessional self-help addiction recovery program, Alcoholics Anonymous (AA), and a professional treatment approach, psychotherapy. The two approaches share a common goal, target similar issues, and work toward similar outcomes. A psychotherapy approach that integrates the two approaches can be quite powerful. Treating a patient in psychotherapy who is also working in the AA program without a good understanding of AA can result in the two approaches working at cross-purposes, diminishing the effectiveness of both interventions. After a brief discussion of psychotherapy integration, the AA program is examined in detail, focusing on the philosophy and change strategies that are compatible with psychodynamic and cognitive–behavioral models of psychotherapy. A method for integrating these techniques into a psychotherapy directed at treating addiction is presented. Guidelines are provided to manage the implementation of this integrated approach throughout the process of recovery. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An analysis of professed psychotherapeutic techniques.

Psychotherapeutic technique is commonly assumed to be an important source of variance in the process and outcome of psychotherapy. It was postulated that at least 3 dimensions are essential to adequately characterize therapeutic technique. The hypothesized dimensions were psychoanalytic, impersonal vs. personal, and directive techniques. An inventory to assess therapeutic technique preferences was constructed and administered to 265 psychotherapists. 3 independent hypothesized factors were confirmed. Pattern scores of therapists on the factors related to their profession, sex, and amount of personal psychotherapy, but not to experience. The results provide a basis for classifying psychotherapists according to their characteristic techniques and for studying the effects of technique on treatment process and outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Correction to Larsson, Kaldo, and Broberg (2009).

Reports an error in "Similarities and differences between practitioners of psychotherapy in Sweden: A comparison of attitudes between psychodynamic, cognitive, cognitive–behavioral, and integrative therapists" by Billy P. M. Larsson, Viktor Kaldo and Anders G. Broberg (Journal of Psychotherapy Integration, 2009[Mar], Vol 19[1], 34-66). The results of the post hoc tests were printed illegibly. In order to make it possible for the reader to understand which of the effect sizes belong to which of the comparisons, the tables are clarified in this erratum. (The following abstract of the original article appeared in record 2009-03150-003.) This study focuses on similarities and differences between Swedish psychotherapists of four orientations: psychodynamic, cognitive, cognitive–behavioral, and integrative therapy. The aim is to describe similarities and differences regarding (a) background factors, (b) focus in psychotherapy, (c) attitudes toward psychotherapy as art/craftsmanship, (d) scientific outlook, (e) what characterizes a good psychotherapist, and (f) how psychotherapy ought to be pursued. The therapists had very similar attitudes about the therapeutic relationship and rather similar attitudes about which effects psychotherapy ought to obtain. The greatest differences were related to psychotherapeutic techniques and science. The results are discussed with emphasis on the distance or proximity between the orientations. The conclusion is that there are differences between psychodynamic psychotherapy compared with cognitive and cognitive–behavioral therapies, which imply difficulties in integrating these orientations. However, the differences between the cognitive and cognitive–behavioral therapists are not of such a magnitude that they necessarily present an obstacle to integration. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Beyond brand names of psychotherapy: Identifying empirically supported change processes.

There is considerable debate about which empirical research methods best advance clinical outcomes in psychotherapy. The prevailing tendency has been to test treatment packages using randomized, controlled clinical trials. Recently, focus has shifted to considering how studying the process of change in naturalistic treatments can be a useful complement to controlled trials. Clinicians self-identifying as psychodynamic treated 17 panic disorder patients in naturalistic psychotherapy for an average of 21 sessions. Patients achieved statistically significant reductions in symptoms across all domains. Rates of remission and clinically significant change as well as effect sizes were commensurate with those of empirically supported therapies for panic disorder. Treatment gains were maintained at 6-month follow-up. Intensive analysis of the process of the treatments revealed that integrative elements characterized the treatments: Adherence to cognitive-behavioral process was most characteristic, adherence to interpersonal and psychodynamic process, however, was most predictive of positive outcome. Specific process predictors of outcome were identified using the Psychotherapy Process Q-Set. These findings demonstrate how process research can be used to empirically validate change processes in naturalistic treatments as opposed to treatment packages in controlled trials. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Theory-based research for understanding the process of dynamic psychotherapy.

Research is reviewed on 6 theoretical propositions central to psychodynamic psychotherapy: (1) The establishment of an alliance is important to successful outcome; (2) the patient displays a central relationship theme (transference); (3) transference interpretations are helpful; (4) the therapist aims at accurate interpretations of the transference; (5) the patient gains understanding of self and the relationship pattern; and (6) the patient's improvement is reflected in changes in the relationship pattern, although the pattern is still evident. We suggest concepts that are in need of research development: internalization, resistance, working through, self-understanding and insight, and the therapist's adherence to recommended techniques. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Addressing Relationship Concerns in Individual Psychotherapy.

Many clients in individual psychotherapy present with relationship concerns but are not joined in psychotherapy by the partner in the problematic relationship. To increase clients' motivation for and satisfaction with individual psychotherapy, therapists must offer interventions that meet the clients' specific needs. This article presents an assimilative integration that uses L. Luborsky's (1984) core conflictual relationship theme approach to psychodynamic psychotherapy as its dominant theoretical orientation. Ideas and techniques from J. M. Gottman's (1998, 1999) sound marital house theory were integrated into the treatment to facilitate working through the client's core relationship conflicts. The integration proved useful in actively addressing relationship concerns within individual psychotherapy and in matching the client's readiness for 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)     

Similarities and differences between practitioners of psychotherapy in Sweden: A comparison of attitudes between psychodynamic, cognitive, cognitive–behavioral, and integrative therapists.

[Correction Notice: An erratum for this article was reported in Vol 19(3) of Journal of Psychotherapy Integration (see record 2009-16521-006). The results of the post hoc tests were printed illegibly. In order to make it possible for the reader to understand which of the effect sizes belong to which of the comparisons, the tables are clarified in this erratum.] This study focuses on similarities and differences between Swedish psychotherapists of four orientations: psychodynamic, cognitive, cognitive–behavioral, and integrative therapy. The aim is to describe similarities and differences regarding (a) background factors, (b) focus in psychotherapy, (c) attitudes toward psychotherapy as art/craftsmanship, (d) scientific outlook, (e) what characterizes a good psychotherapist, and (f) how psychotherapy ought to be pursued. The therapists had very similar attitudes about the therapeutic relationship and rather similar attitudes about which effects psychotherapy ought to obtain. The greatest differences were related to psychotherapeutic techniques and science. The results are discussed with emphasis on the distance or proximity between the orientations. The conclusion is that there are differences between psychodynamic psychotherapy compared with cognitive and cognitive–behavioral therapies, which imply difficulties in integrating these orientations. However, the differences between the cognitive and cognitive–behavioral therapists are not of such a magnitude that they necessarily present an obstacle to integration. (PsycINFO Database Record (c) 2010 APA, all rights reserved)