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)     

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)     

Structural family versus psychodynamic child therapy for problematic Hispanic boys.

Structural family therapy, psychodynamic child therapy, and a recreational control condition were compared for 69 six-to-twelve-year-old Hispanic boys who presented with behavioral and emotional problems. The results suggest that the control condition was significantly less effective in retaining cases than the two treatment conditions, which were apparently equivalent in reducing behavioral and emotional problems as well as in improving psychodynamic ratings of child functioning. Structural family therapy was more effective than psychodynamic child therapy in protecting the integrity of the family at 1-year follow-up. Finally, the results did not support basic assumptions of structural family systems therapy regarding the mechanisms mediating symptom reduction. (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)     

Symptom management of bulimia.

This article describes a treatment approach for the symptom management of bulimia that is a synthesis of various techniques, including cognitive-behavioral therapy, response prevention, relapse training, and psychodynamic therapy. The model has been a useful teaching tool for both staff and patients in both group and individual formats. In addition to describing the treatment model, this article briefly addresses some of the challenges of integrating behavioral and psychodynamic interventions in the treatment of this patient population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interpersonal Problems and the Outcome of Interpersonally Oriented Psychodynamic Treatment of GAD.

The present study tested hypotheses concerning interpersonal problems and the course of brief psychodynamic treatment of generalized anxiety disorder (GAD). The authors found that the largest changes from pre- to post-therapy were evident for the Nonassertive, Exploitable, and Intrusive subscales of the Inventory of Interpersonal Problems. Relatively small changes were seen on the Overly Nurturant subscale, which was hypothesized to be most relevant to GAD. Changes in interpersonal problems were significantly associated with improvement in symptoms and worry. Brief dynamic therapy was not found to uniquely improve interpersonal problems compared with supportive therapy, although the psychodynamic approach was statistically and clinically superior to supportive therapy on symptomatic remission rates. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Effects of clinician theoretical orientation and patient explanatory bias on initial clinical judgments.

18 behavioral (mean age 27.89 yrs), 18 cognitive (mean age 25.78 yrs), and 18 psychodynamic (mean age 29.22 yrs) clinical trainees viewed a videotaped intake interview with a female actress who explained her fear of going on elevators according to 1 of 3 explanatory biases: learned reactions, faulty thoughts, or underlying conflicts. After viewing the tape, Ss made judgments about the patient's responsiveness to therapy. Across all 3 experimental conditions, psychodynamic Ss expressed more "pessimistic" prognoses than both behavioral and cognitive Ss, who did not differ. However, among psychodynamic Ss, those who viewed the patient whose explanatory bias was consistent with a psychodynamic orientation were less pessimistic than were their colleagues exposed to patient explanatory biases inconsistent with a psychodynamic orientation. Implications for client–therapist matching, clinical training, and rapprochement between orientations are discussed. (37 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapy integration as practiced by experts.

Twenty-four psychotherapists who were experts in psychotherapy integration and had a mean of 32 years of clinical experience completed a questionnaire assessing their practice history and fidelity to various psychodynamic, cognitive–behavioral, humanistic, and family systems theories. They then completed the 100-item Psychotherapy Process Q set (Jones, Hall, & Parke, 1991) modified to be a self-report questionnaire, based on a client they had treated using integrative therapy. Most therapists reported some influence of all 4 orientations, but almost three-quarters indicated that only 1 was a salient influence. Principal components factor analysis revealed 4 factors representing 4 integrative practice styles, which were then correlated with prior prototypes of cognitive–behavioral, psychodynamic, and interpersonal therapies. The first factor, accounting for just over half the variance, most resembled cognitive–behavioral therapy. The second factor shared elements of several orientations, whereas the third factor most resembled psychodynamic therapy. The responses of more than half the therapists loaded on more than 1 factor. Findings demonstrate a diversity of theoretical influences and practices among these experts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Client experience of psychodynamic psychotherapy for bulimia nervosa: An interview study.

We examined 14 bulimic clients' experiences of individual psychodynamic psychotherapy through semistructured interviews, which were analyzed using qualitative methods. The results showed that the psychodynamic approach was a challenge to most of the clients. Yet, most clients profited from therapy both symptomatically and with regard to interpersonal relations and affect regulation. There were, however, marked differences in the clients' experiences. One subgroup rather quickly felt that the therapy met their needs, another initially felt challenged by the approach and the therapeutic attitude but ultimately succeeded in using this particular kind of therapy. A third group remained predominantly critical of their therapies. The clinical implications and possible explanations of the results are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Negative factors in brief psychotherapy: An empirical assessment.

18 male undergraduates with symptoms of depression, anxiety, and unsatisfying interpersonal relationships were seen in brief therapy by professional psychodynamic and experiential therapists. Judges rated audiotapes of early therapy sessions using the Vanderbilt Negative Indicators Scale (VNIS), which consists of 5 subscales representing factors believed to deter therapeutic progress. The hypothesis that negative factors in therapy, as assessed by the VNIS, would be inversely related to outcome was confirmed. The Errors in Technique subscale was the most consistent predictor of outcome. Subscales tapping deficiencies in Patient Qualities and the Patient–Therapist Interaction as well as Global Session Ratings were also related to outcome, although ratings of Therapist Personal Qualities were not. VNIS ratings were more strongly related to the outcome of psychodynamic therapy than experiential therapy and were more often associated with the therapist's and independent clinician's assessments of outcome than the patient's assessment of outcome. (23 ref) (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)     

Is there room for criticism of studies of psychodynamic psychotherapy?

Comments on the original article, "The efficacy of psychodynamic psychotherapy," by J. Shedler (see record 2010-02208-012). Shedler declared unequivocally that “empirical evidence supports the efficacy of psychodynamic therapy” (p. 98). He did not mention any specific criticisms that have been made of evidence on psychodynamic psychotherapies or address possible distinctions between evidence for short-term versus long-term psychodynamic psychotherapies. Instead, he attributed dissenting views to biases in evidence dissemination and review, which he suggested are rooted in a “lingering distaste in the mental health professions professions for past psychoanalytic arrogance and authority” related to a “hierarchical medical establishment that denied training to non-MDs and adopted a dismissive stance toward research” (Shedler, 2010, p. 98). Shedler (2010) justified his blanket dismissal of criticisms of evidence supporting psychodynamic psychotherapy on the basis of several published meta-analyses. The validity of conclusions from metaanalyses depends on the quality of the evidence synthesized, the nature of the studies included, and the rigor of the statistical analyses employed. Many meta-analyses, however, are not performed rigorously, which can result in treatment efficacy estimates that obscure important intertrial differences and that are unlikely to be replicated in clinical practice. (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 Models of brief psychodynamic therapy.

Reviews the book, Models of brief psychodynamic therapy by Stanley B. Messer and C. Seth Warren (see record 1995-98730-000), stating that the book organizes the prevailing models of brief psychodynamic therapy (BPT) into a clear and easily comprehended framework. The opening chapter sets the stage for the remainder of the book through a general overview of the current and historical contexts in which brief psychodynamic therapies have been performed and developed. Current views of brief psychotherapy are reviewed from the perspectives of the patient, the therapist, and managed care. This is followed by a review of the historical background of BPT, in which credit is given to Freud, Rank, Ferenczi, Alexander, and Reich for their relevant technical and theoretical contributions. Next, the authors survey some of the research relevant to BPT. The chapter concludes with a comprehensive discussion on the learning and teaching of BPT. Once this groundwork is laid, the authors delve into a discussion of the major models of BPT currently practiced and researched. The authors group the BPTs along theoretical lines. (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)     

Psychodynamics, behavior therapy, and the implacable experimenter: An inquiry into the consistency of personality.

Considers that possible integrations of dynamic and behavioral approaches to theory and therapy have been obscured by polemics. One area of confusion concerns the degree of generality or specificity in personality. Variability in behavior from situation to situation has been misleadingly construed by some behavioral critics as casting doubt upon psychodynamic theories. This view is refuted, and a number of factors that account for the differing viewpoints of psychodynamic and behaviorally oriented approaches are considered. Among these are differences in Ss from which original ideas were generated, differences in phenomena of central interest (with special focus on the implications of psychodynamic concern with ambiguous affective phenomena), and the consequences of an experimental strategy (the "implacable experimenter") which limits the ways in which S may structure the environment in which he behaves. (58 ref.) (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)     

Use of transference in the here and now: Patient and therapist resistance.

Addresses the analysis of transference (TR) in psychodynamic therapy. Topics discussed include patient-centered and therapist-centered resistance. Patients may ignore real-life concerns, refuse to consider possible TR, and fear their own autonomy. Therapists may avoid here-and-now affect, overemphasize genetic investigation, present a posture of certainty, and prematurely interpret a patient's projection. From a theoretical standpoint, work with TR in psychodynamic treatment has progressed from static analysis of the genesis of TR to a more active interactional and interpersonal approach. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapeutic orientations: A comparison of conceptualizations, interventions, and treatment plan costs.

Delineated patterns of conceptualization and intervention for 4 psychotherapeutic orientations (psychodynamic, cognitive-behavioral, family systems, and eclectic) and then determined how these patterns related to treatment plan costs. 43 therapists with 1 of the 4 orientations responded to 2 case vignettes that each contained a psychosocial history and portions of a 3rd therapy session for a fictitious patient. Ss were asked to (a) conceptualize about information given by the patient, (b) verbally intervene with the patient, and (c) recommend a treatment plan consisting of types (modality/setting) and amounts (session/days) of treatment. Conceptualization and intervention responses were rated by 3 clinical raters using a psychotherapy judgment rating scale. As predicted, psychodynamic therapists recommended significantly more costly treatment plans. Conceptualization and intervention categories given more focus by the psychodynamic group correlated positively with treatment plan costs, and those categories given more focus by the other therapeutic groups correlated negatively with costs. (8 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)