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)     

Individual psychodynamic psychotherapy of schizophrenia: Empirical evidence for the practicing clinician.

Practicing psychodynamically oriented clinicians need empirical evidence to support the use of individual psychodynamic psychotherapy for the treatment of individuals with schizophrenia. The purpose of this article is to provide psychodynamically oriented clinicians with that needed empirical evidence. A review of the meta-analytic research on the use of individual psychodynamic psychotherapy was conducted. It is concluded that strong empirical support exists for the use of individual psychodynamic psychotherapy in the treatment of schizophrenia. In addition, several suggestions are made to help clinicians apply the meta-analytic evidence to their daily clinical work. Limitations of the available evidence are discussed. (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)     

Core competencies in suicide risk assessment and management: Implications for supervision.

The recent publication of core competencies in suicide risk assessment and management (Suicide Prevention Resource Center, 2006) and the American Psychiatric Association's (2003) practice guidelines have raised concerns about how best to address these issues in clinical supervision of trainees. This article reviews the identified core competencies, addresses implications for supervision of trainees, and provides a general framework for applicable strategies for the supervision process to facilitate clinical skill development and refinement. (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)     

When it comes to evaluating psychodynamic therapy, the devil is in the details.

Comments on the original article, The efficacy of psychodynamic psychotherapy, by J. Shedler (see record 2010-02208-012). As Shedler noted, some researchers have reflexively and stridently dismissed psychodynamic therapy (PT) as ineffective without granting outcome studies on this modality a fair hearing. We applaud Shedler’s efforts to bring PT into the scientific mainstream and hope that his article encourages investigators to evaluate claims regarding PT’s efficacy with a more objective eye. Nevertheless, as Shedler also observed, one reason for the scientific community’s premature dismissal of PT is traceable to some psychodynamic practitioners’ historical antipathy toward controlled research and propensity to overstate PT’s efficacy. Regrettably, Shedler falls prey to the latter error by glossing over key methodological details, ignoring crucial findings that run counter to his position, and overstating the quality and quantity of the evidence base for PT. Because of space constraints, we focus only on a handful of the more serious shortcomings of Shedler’s analysis (a more complete review of these issues is available from the first author on request). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Is there consensus among predoctoral internship training directors regarding clinical supervision competencies? A descriptive analysis.

Although psychologists increasingly provide clinical supervision, the profession has only recently begun to establish standards for competently doing so. This study was aimed at conducting a broader exploration of predoctoral psychology internship training directors’ views (n = 184) on the importance of the supervision competencies initially suggested by C. A. Falender et al. (2004). Respondents generally agreed with the importance of the competencies but showed less agreement with the importance of different types of clinical supervision training. Results reflect the need for further discussion in defining what makes for competent clinical supervision before these competencies are adopted within the profession. Practical implications of these findings are addressed. (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)     

The supervisory encounter: A guide for teachers of psychodynamic psychotherapy and psychoanalysis.

Review of book: The Supervisory Encounter: A Guide for Teachers of Psychodynamic Psychotherapy and Psychoanalysis by Daniel Jacobs, Paul David and Donald J. Meyer, New Haven, CT: Yale University Press, 1985, 285 pp. Reviewed by Alan Z. Skolnikoff. (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)     

Review of Supervising the reflective practitioner: An essential guide to theory and practice.

Reviews the book, Supervising the reflective practitioner: An essential guide to theory and practice by Joyce Scaife (see record 2010-09732-000). This review begins with an elaboration on the two key terms in the title. First, the book is about supervising rather than being or becoming a reflective practitioner. As Scaife notes, much of supervision involves modeling, and therefore, a supervisor must be reflective in order to encourage the student to become more reflective. However, a psychodynamic practitioner would think of this as parallel process, so that the reflection in supervision might ultimately be translated into reflection in psychotherapy. The more important term in the title is reflective practitioner. This immediately draws to mind the concept of reflective practitioner introduced by Donald Sch?n (1983), and there are some very important parallels that the reviewer points out. In conclusion, the reader will be rewarded by multiple exercises that will be useful in supervising and in classroom teaching. Scaife very helpfully points out that assessment often is contrary to the spirit of reflection, because the student attempting to satisfy the instructor is not attending to his or her own needs, as is necessary for successful reflection. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Competency in integrative psychotherapy: Perspectives on training and supervision.

Increasingly, many psychotherapists identify with an integrative approach to psychotherapy. In recent years, more attention has been directed toward the operationalization and evaluation of competence in professional psychology and health care service delivery. Aspects of integrative psychotherapy competency may differ from competency in other psychotherapy orientations, although convergence is more often the case. Despite the potential differences, there exist very few formal training programs or guidelines to systematically guide clinicians in developing a competent integrative practice. This paper attempts to distill the essential elements of competent integrative psychotherapy practice and focuses on how these might be developed in training and supervision. We address most of these complex issues from a specific integrative perspective: principle-based assimilative integration. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Middle-class waifs. The psychodynamic treatment of affectively disturbed children.

Reviews the book, Middle-class waifs. The psychodynamic treatment of affectively disturbed children by Elaine V. Siegel (see record 1991-98014-000). Most of this book is devoted to case histories of children and their parents who have relatively severe emotional problems yet can be sufficiently responsive to psychotherapy so that positive changes occur. Particularly impressive are the ways in which the author, in her therapeutic role, overcomes the resistances presented by both children and parents. She is clearly an excellent therapist, who would probably be effective regardless of orientation, and her manner of working with people has applicability for all psychotherapists. Her appreciation of the necessary balance in understanding the needs of children and their parents is an exemplary model of what it really means to respect the personhood of patients. One of the intriguing possibilities in this book is the case that is made for the broad applicability of psychoanalytic theory and treatment. During a time in which psychodynamic work is being criticized as taking too long, costing too much, and producing too little, the author offers quite a convincing demonstration of its value. The negative consequences of increased disparagement of this approach are also made apparent, so that a definite step is taken to restore the worth of treatment options. Any limitations of this book are minor, relative to the excellent portrayal of the process of psychotherapy with difficult patients that too often frighten or overwhelm people who could help them if the helpers would let themselves discover how. This work by a master clinician definitely points the way. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A competency-based approach to couple and family therapy supervision.

The competency-based movement continues to guide professional psychology. This has been highlighted through the establishment of essential foundational and functional competencies. The current paper focuses on the intervention competency domain and delineates its relevance within the field of couple and family therapy (CFT). We begin by providing an overview of 8 essential components of CFT: developing a systemic formulation, forging a systemic therapeutic alliance, understanding family-of-origin issues, reframing, managing negative interactions, building cohesion/intimacy/communication, restructuring/parenting, and understanding and applying evidence-based CFT models. We then provide a brief illustration of foundational and functional competencies essential to CFT. We conclude by addressing the CFT competency within an integrative approach to supervision and provide a case illustration that depicts this process. The relevance of establishing unique, evidence-based, theory-specific competency components is highlighted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Commentaries on the ethical and effective practice of clinical supervision.

Every psychologist participates in clinical supervision during various aspects of his or her training. Many psychologists also provide supervision to less experienced colleagues and to those in training. But what makes for an effective and competent supervisor? Psychologists need to know because substandard or ineffective clinical supervision may have far-reaching consequences for the developing professional and for those he or she treats. This contribution provides key information on clinical supervision and related competence issues. A number of questions are raised that must be addressed by individual psychologists and the profession alike. Then, 3 invited expert commentaries are offered to address these issues, further this important discussion, and attempt to answer the challenging questions raised. Attention to the issues raised and recommendations made will hopefully lead to enhanced clinical competence and effectiveness by clinical supervisors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Advances in psychotherapy supervision: Introduction.

Psychologists tend to take psychotherapy supervision for granted. This is especially puzzling when they discover that 55% of academic clinicians spent between 10% and 29% of their time in supervision and another 7% claim to spend over 30% of their time so engaged. As recently as 10 years ago, few and scattered materials existed in the literature to guide the conscientious supervisor, but more materials have recently become available, including books, a journal devoted to supervision, and workshops offered at regional and national conventions. Given these developments, it is fitting that psychologists take stock of the field of psychotherapy supervision. Toward this end, several people who have worked in a particular area were asked to prepare either a review of the area or a seminal treatment of a topic in the area. The articles that follow are the result. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Brief psychodynamic and cognitive therapy regarding acute treatment.

Cognitive–behavioral therapy (CBT) and psychodynamic psychotherapy either in their pure forms or possibly synthesized as a form of eclectic therapy appear to be the 2 most commonly utilized forms of psychotherapy, both having levels of empirical support. As the majority of outpatient therapy in America appears to be very brief, 1 reasonable assumption is that treatment is often sought for resolution of acute episodes. A relevant question for practice and clinical training is what are the potential implications with brief psychodynamic and cognitive therapy for this type of treatment? This brief commentary will address the following: (a) the current general differential empirical status of each approach; (b) distinctions between acute treatment and traditional brief therapy and current common treatment patterns; and (c) the general clinical mechanisms for change for each approach and their potential implications regarding acute treatment and clinical supervision. (PsycINFO Database Record (c) 2010 APA, all rights reserved)