The work in this volume is offered in the spirit of incorporating psychodynamic psychotherapy in an effort to advance understanding of finding the right treatment for the right patient. We are pleased to once again thank the many supporters of our work at Massachusetts General Hospital's Department of Psychiatry.
Psychodynamic Psychotherapy Research: Process, Outcome, and the Brain
We therefore emphasize in this volume the contributions of several researchers who do just that. The reader will find up-to-date sections on: Outcome research; Theory, technique and process;.
Outcome Research
Theory, Technique, and Process
Single-Case Studies
Of course, patient and therapist have their subjective ideas about the critical components of therapy, but the chapter offers the view of an unbiased other. Interestingly, in this case, there are verbatim statements from the patient that suggest her idea of the critical processes that helped her change in line with that of the research team.
Assessing Change
The chapter also contains a partial explanation of the evaluation process and the thinking of individual evaluators, R.
Neuroimaging, Biomarkers, and Neurobiology
The study hopes to determine the specific areas of the brain affected by psychodynamic psychotherapy interventions, in this case a 16-session manualized CCRT treatment for depression. It is the hope of Ghaznavi, Witte, Levy and Roffman that findings will bring us closer to the goals of the new emphasis on personalized medicine, that is, finding the right treatment for the right person.
Appendices
Of course, we cannot draw firm conclusions from this penetrating and innovative work, but the findings indicate that psychotherapy has a direct impact on the brain in at least some depressed patients. Buchheim and her colleagues also suggest that the specific neural findings may provide evidence for the possible mechanisms related to the anxious intolerance of loneliness in these patients.
Conclusion
The second appendix, a list of Manualized Treatments in psychodynamic psychotherapy that have been used for research purposes, is presented by Kächele et al., which reviews the history and role of manualized treatments.
European Psychotherapy Research: The History, the Current State, and Recommendations for the Future
Extensive reference was made to Fenichel's report [2], also to the aforementioned 1935 BMJ discussion [3]; Eysenck's various contributions, especially his negative but very groundbreaking article on “The Effects of Psychotherapy” [4], were cited. 2 Some of the chapters included here are based on presentations at the conference on psychoanalytic process research.
Outcome Research
Single Case Studies
Johannes Lehtonen Department of Psychiatry, University of Eastern Finland, Kuopio University Hospital, Kuopio, Finland. Jenelle Slavin-Mulford Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Commentary: Research on Short- and Long-Term
8 ) to provide an excellent review of research on psychoanalytically oriented treatment of borderline personality disorder (BPD). Although the number of studies in this area is still limited, some are the most promising in this area.
Distinctive Features of Psychodynamic Technique
Psychodynamic psychotherapists explore early experiences, the relationship between the past and the present, and the ways in which the past tends to "live on" in the present. To the extent that there are recurring themes in a person's relationships and way of interacting, these themes tend to emerge in some form in the therapy relationship.
How Effective Is Psychotherapy in General?
Methodological differences between drug trials and psychotherapy trials are large enough that effect sizes may not be directly comparable, and the findings should not be interpreted as conclusive evidence that psychotherapy is more effective. Effect sizes for antidepressants are reported to provide reference points that will be familiar to many readers; for more comprehensive lists of effect size benchmarks, see e.g.
How Effective Is Psychodynamic Psychotherapy?
8 The pretreatment to posttreatment effect size was 1.03 for total score, which increased to 1.25 at long-term follow-up ( P < .01), a mean of 23 months posttreatment. For patients with severe personality pathology, the pretreatment to posttreatment effect was 0.94, which increased to 1.02 at long-term follow-up, an average of 5.2 years after treatment.
A Rose by Another Name: Psychodynamic Process in Other Therapies
The second variable assessed the therapist's implementation of the cognitive treatment model (ie, addressing distorted cognitions believed to cause depressive affect). Qualitative analysis of verbatim session transcripts suggested that the poorer outcomes associated with cognitive interventions were due to the implementation of the cognitive treatment model in dogmatic, overly insensitive ways by some therapists [58.
The Flight of the Dodo
Finds meaning in belonging to and contributing to a larger community (eg, organization, church, neighborhood, etc.). Able to find meaning and fulfillment in guiding, mentoring, or caring for others. He is able to form close and lasting friendships, which are characterized by mutual support and exchange of experiences.
Discussion
Short-term psychodynamic psychotherapy for somatic disorders: systematic review and meta-analysis of clinical trials. The effectiveness of psychodynamic therapy and cognitive behavioral therapy in the treatment of personality disorders: a meta-analysis.
Introduction
Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany Department of Psychology, University of Klagenfurt, Austria. Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany e-mail: [email protected].
Effectiveness of Long-Term Psychodynamic Psychotherapy: First Meta-Analytic Evidence
Until 2008, no meta-analysis addressing the outcome of LTPP had been published, although preliminary data were reported by Lamb [22. This chapter reports the first meta-analysis on the effectiveness of LTPP, published in the Journal of the American Medical Association v.
First Meta-Analysis on the Effectiveness of LTPP
The point-biserial correlation also allowed us to test for between-group effect sizes of LTPP versus other forms of psychotherapy. Again, only post-treatment effect sizes could be examined due to the small number of studies that provided follow-up data.
Response to Meta-Analytic Evidence
Although it is not true that we included wait-list groups in the control conditions, it is true that the control conditions included more treatment-than-usual (TAU) conditions, reducing the average effect size of the alternative treatments. However, it is also true that the control conditions included a specific long-term psychotherapy (eg, DBT), which in turn increased the mean effect of the alternative treatments.
Résumé
Due to the clinic's limited resources, the random assignment began with psychoanalytic and psychodynamic therapy, and later cognitive-behavioral therapy was added. However, close examination of BDI and GSI SCL-90-R total scores at posttreatment and at 1-year follow-up reveals that patients in the cognitive-behavioral.
The Helsinki Psychotherapy Study
Research Department, Social Insurance Institution of Finland, Helsinki, Finland e-mail: [email protected]. Both short- and long-term psychotherapies have been shown to be effective in treating patients suffering from mood or anxiety disorders [1-4.
Effectiveness, Suffi ciency, and Suitability of Short- and Long-Term Psychotherapy
Long-term therapies, often psychodynamic, although widely used in clinical practice, have been studied to a lesser extent, and comparative research into the effectiveness of long-term and short-term therapies is particularly scarce. However, little is known about the incidence and determinants of additional psychiatric treatments after initiating short-term or long-term psychotherapy.
The study protocol was approved by the ethical board of the Helsinki University Central Hospital. The quality of the interview data was continuously controlled and evaluated in several separate designs [19.
Results
However, excluding the patients who used additional treatment during follow-up in the AT analysis significantly changed the results. The use of psychotropic medication was most common in the STPP group (61%) and least common in the PA group (33%).
Patients with better dispositions (ie, good values in the suitability index, e.g., more reflective ability) appeared to benefit sufficiently from short-term treatment, whereas patients with worse dispositions appeared to need long-term treatment or other treatment to recover. An extensive group of researchers representing different disciplines and expertise, clinicians and organizational resources have been involved in the study.
Future Perspectives and Conclusions
A randomized trial of the effect of four forms of psychotherapy on depressive and anxiety disorders. Psychological predictors of recovery from depression or anxiety disorder in short- and long-term psychotherapy during a 3-year follow-up, submitted for publication.
Psychoanalytic and Psychodynamic Therapies for Depression: The Evidence Base *
Their potency means that treatment decisions should be based on explicit assessments of the evidence. In this light, when we look at the effectiveness of psychoanalytic and psychodynamic therapies in the treatment of depressive disorders, we find that the restrictive definition of evidence-based mental health medicine that I have just mentioned leads to an already too negative a view of the empirical evidence available to support its use.
A Frame of Reference for a Developmental/Psychoanalytic View of Depressive Disorders
In the course of a depressive illness, the severity of the superego increases, sometimes reaching delusional levels. The loss of the love and approval of the super-ego represents the greatest dangers to the self.
The Outcome Evidence for Psychoanalytic/Psychodynamic Approaches in the Treatment of Depression
A mixture of genetic and environmental factors influence the varying degrees of severity, chronicity, and unresponsiveness at which depression exists.
Short-Term Psychodynamic Psychotherapy (STPP)
The efficacy of STPP compared with no or minimal treatment controls in the treatment of common mental disorders. The effectiveness of STPP specifically compared with cognitive-behavioral therapy and behavioral therapy in the treatment of depression.
Longer -Term Psychoanalytic Treatments (LTPP)
The condition was chronic in 71% of the total of 274 patients involved in these five studies. Blatt and Shahar [87] addressed the question of the unique nature and efficacy of psychoanalysis.
Discussion and Conclusions
According to their results, psychoanalysis contributed significantly to the development of adaptive interpersonal capacities and to the reduction of maladaptive interpersonal behavior, especially with the most self-reflective patients. While this more sophisticated conception of the evidence base cannot tell us directly which treatments will be effective, it does allow us to know the parameters of the disorder and the limits of persons' plasticity.
Conclusions
A systematic review of controlled trials of the effectiveness and cost-effectiveness of brief psychological treatments for depression. The effectiveness of psychoanalytic therapy: first results of the Göttingen study of psychoanalytic and psychodynamic therapy.
Prevalence, Course, and Comorbidity of Anxiety Disorders
Evidence-Based Psychodynamic Treatments for Anxiety Disorders: A Review
The Need for Empirical Research on Treatments for Anxiety Disorders
A Brief Account of the Psychodynamic Understanding of Anxiety
In fact, although Sullivan, Fromm-Reichmann, Klein, Fairbairn and Bowlby explain different aspects, functions and types of anxiety, internalized object relations and interpersonal relations are extremely important in each author's theory. As highlighted in the discussion of Sullivan, Fromm-Reichmann, Klein, Fairbairn, and Bowlby, dynamic theorists often link anxiety to object relations and/or interpersonal relations.
Clinical Example
These findings support psychodynamic theorists' proposition that there is a link between anxiety and object relations or interpersonal relations. In short, psychodynamic theories provide an explanation for the etiology and pathogenesis of anxiety that often includes an emphasis on the underlying meaning of symptoms, unconscious conflict, defenses, and both object relations and interpersonal relations.
The Outcome Evidence for Psychodynamic Treatments of Anxiety Disorders
However, they are similar in that they both provide encouraging results for psychodynamic therapy in the treatment of anxiety. But they are not aware of the effectiveness of psychodynamic therapy in the absence of medication.
Pre-Post Within-Group Effectiveness of Psychodynamic Therapy in the Treatment of Anxiety
Specifically, the effect sizes found on the Panic Disorder Severity Scale at termination in Milrod et al.'s [21] study were 2.08. 7 Thus, like Crits-Christoph et al.'s [27] findings, this suggests that psychodynamic therapy is highly effective in the treatment of anxiety disorders and that these large changes in the group are consistent with the changes found in the group. in CBT.
Summary and Future Directions
An open trial of brief supportive-expressive psychotherapy in the treatment of generalized anxiety disorder. Efficacy of applied relaxation and cognitive behavioral therapy in the treatment of generalized anxiety disorder.
Psychodynamic Psychotherapy for Borderline Personality Disorder
Department of Psychiatry, Weill Medical College at Cornell University, New York, NY, USA e-mail: [email protected]. Keywords Borderline personality disorder • Dialectical behavior therapy • Empirically supported treatment • Evidence-based treatment • Personality disorder • Psychoanalysis • Psychodynamic psychotherapy • Psychotherapy outcome • Psychotherapy research • Schema-focused psychotherapy.
An Update and Overview of the Empirical Evidence for Transference-Focused Psychotherapy and Other
We will discuss recent findings from the TFP RCT by Doering et al. We will conclude with a summary of the conclusions that can be drawn from the literature.
What Constitutes Empirical Evidence?
Before reviewing the empirical evidence for the efficacy and effectiveness of TFP, we will discuss three other major treatments for BPD that have shown efficacy in randomized controlled trials (RCTs): Dialectical Behavior Therapy [23], Mentalization-Based [23] 24 ], and Schema-Focused Therapy [25. We will then examine the empirical support in light of the recommendation from Division 12 of the American Psychological Association, which concluded that “TFP has been determined to have questionable research support due to mixed strands of findings.
The Rise of Dialectical Behavior Therapy: Benefi ts and Risks
Also, highly publicized was that the percentage of individuals who attempted suicide was significantly lower in the DBT group when the treatment-year data was combined with the follow-up year data. Taken together, this suggests few differences between treatment groups despite the relative advantages in the DBT group (experienced and well-supervised therapists carrying out a treatment manual with a specific and relevant patient population) and the relative disadvantages in the CTBE group (less qualified and fewer supervised therapists who were less likely to have training in a specific BPD treatment or with BPD patients in general, and of which only half of the patients were in treatment).
Mentalization-Based Therapy
Second, differences between the two groups were only evident in the intention-to-treat analyses, but not in the more complete analyses. A major factor in this difference appeared to be that patients in the TFP condition were significantly more likely to drop out of treatment early.
Transference-Focused Psychotherapy
TFP also differs from other expressive psychodynamic approaches with a persistent focus on the here-and-now and an empathy with the patient's total inner experience. The therapist's help in cognitively structuring what at first seemed chaotic also provides a containing function for the patient's affects.
TFP Case Example
Exploring this fear helped the patient to understand that her behavior was rooted in an anxiety stemming from an internal image of the other that determined how she experienced her therapist. The next step in the therapy was marked by the patient's increasing criticism of the therapist, which she did not recognize as such consciously.
Contrasting Clinical Approaches in TFP and MBT
In contrast, an MBT therapist would be more likely to focus on the manifest influence of anger and the patient's own understanding of those "rights". In contrast, a TFP therapist will be interested in helping the patient make links between diverse experiences of herself in relation to the therapist as those affects appear in treatment as a way of integrating these affect-laden representations of herself and others. .
Contrasting Clinical Approaches in TFP and DBT
More like MBT, the DBT therapist would accept the patient's subjective experience as "real" and. In contrast, a DBT therapist would be concerned that interventions that focus on the patient's underlying narcissism only pathologize the patient.
Empirical Evidence for Transference-Focused Psychotherapy
The supervisor reported no concerns regarding compliance and competence during the course of the study. A critique of the American Psychiatric Practice Guideline for the treatment of patients with borderline personality disorder.
