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Jankowski PJ, Sandage SJ, Captari LE, Crabtree SA, Choe EJ, Gerstenblith J. A practice-based study of relational virtues and alliance correspondence in psychodynamic psychotherapy. J Clin Psychol 2024; 80:1323-1344. [PMID: 38408210 DOI: 10.1002/jclp.23669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 02/08/2024] [Accepted: 02/10/2024] [Indexed: 02/28/2024]
Abstract
OBJECTIVE Treatment outcome monitoring typically emphasizes pathology. In contrast, we responded to the need to establish psychodynamic psychotherapy as evidence-based by modeling changes in gratitude and forgiveness. METHOD We utilized a practice-based research design involving non-manualized outpatient treatment. We employed a longitudinal mixture modeling approach to evaluate treatment effectiveness. We did so by testing the theorized role for relational virtues (i.e., gratitude, forgiveness) as signs of progress in psychodynamic treatment, with relational virtues referring to the application of character strengths to specific situations. We modeled clients' self-reported level on the virtues as a joint process over five time points, and examined the influence of early treatment alliance correspondence on patterns of change using a sample of outpatient clients (N = 185; Mage = 40.12; 60% female; 74.1% White). RESULTS A 3-class solution best fit the data, with one class exhibiting growth in gratitude and forgiveness, improved symptoms, and a greater likelihood of symptom improvement relative to well-being gains. Alliance correspondence predicted the classes of change patterns, with greater similarity between clinicians' and clients' perceptions about the alliance predicting greater likelihood of belonging to the subgroup showing highest levels of virtues and well-being, lowest symptoms, and improved well-being. CONCLUSION Clinical implications involve monitoring gratitude and forgiveness as signs of progress and navigating the dialectic between implicit alliance processes and explicit virtue interventions. The former involves nurturing a strong alliance and repairing ruptures, whereas the latter involves direct in-session conversation and/or the practice of virtue interventions in and/or outside of session.
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Affiliation(s)
- Peter J Jankowski
- The Albert and Jessie Danielsen Institute, Boston University, Boston, Massachusetts, USA
- Bethel University, St. Paul, Minnesota, USA
| | - Steven J Sandage
- The Albert and Jessie Danielsen Institute, Boston University, Boston, Massachusetts, USA
| | - Laura E Captari
- The Albert and Jessie Danielsen Institute, Boston University, Boston, Massachusetts, USA
| | - Sarah A Crabtree
- The Albert and Jessie Danielsen Institute, Boston University, Boston, Massachusetts, USA
| | - Elise J Choe
- The Albert and Jessie Danielsen Institute, Boston University, Boston, Massachusetts, USA
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2
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Smith MM, Hewitt PL. The equivalence of psychodynamic therapy and cognitive behavioral therapy for depressive disorders in adults: A meta-analytic review. J Clin Psychol 2024; 80:945-967. [PMID: 38324666 DOI: 10.1002/jclp.23649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/07/2024] [Accepted: 01/14/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND Meta-analyses on the relative efficacy of psychodynamic psychotherapy (PDT) and cognitive behavioral therapy (CBT) for depressive disorders are limited by heterogeneity in diagnostic samples and comparators and a lack of equivalence testing. OBJECTIVE We addressed this through a meta-analytic test of the equivalence of manualized PDT and CBT in treating adults with depressive disorders as determined by diagnostic interviews. Sensitivity analyses evaluated the impact of pretreatment differences, mixed diagnostic samples, author allegiance, study quality, year of publication and outliers on findings. METHOD A comprehensive literature search across multiple databases using reliable screening methods identified nine randomized controlled trials directly comparing manualized PDT and CBT for diagnosed depressive disorders in adults. Following pre-registration, we employed random effect models for our meta-analyses and two one-sided test procedures for equivalence testing. RESULTS Independent raters determined that all studies were of adequate quality. Immediately posttreatment, depressive symptoms were statistically equivalent across PDT and CBT (k = 9; g = -0.11, 90% confidence interval [90% CI]: -0.24 to 0.02, pequivalence = .048, pNHST = .212, I2 = 32.7). At follow-up, the longest time point within a year, depressive symptoms were neither statistically equivalent nor statistically different (k = 6; g = -0.16, 90% CI: -0.31 to -0.02, pequivalence = .184, pNHST = .126, I2 = 0.00). CONCLUSION The efficacy of manualized PDT is equal to manualized CBT immediately at posttreatment for depressive disorders in the adult general population. Nevertheless, insufficient data exists to reach a conclusion regarding equivalence at follow-up.
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Affiliation(s)
- Martin M Smith
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Paul L Hewitt
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
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Schmalbach I, Witthöft M, Strauß B, Joraschky P, Petrowski K. The predictive value of cortisol in psychodynamic psychotherapy for social anxiety disorder: Extended results of the SOPHONET-Study. Transl Psychiatry 2024; 14:188. [PMID: 38605013 PMCID: PMC11009385 DOI: 10.1038/s41398-024-02882-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 03/06/2024] [Accepted: 03/15/2024] [Indexed: 04/13/2024] Open
Abstract
Psychotherapy is an effective treatment for anxiety disorders (AD), yet a vast majority of patients do not respond to therapy, necessitating the identification of predictors to enhance outcomes. Several studies have explored the relationship between stress response and treatment outcome, as a potential treatment mechanism. However, the latter remains under-researched in patients with social anxiety disorder (SAD). We studied N = 29 patients undergoing psychodynamic psychotherapy (PDT) within the SOPHONET-Study. Stress reactivity (i.e., area under the curve with respect to the increase; AUCi) was induced by a standardized psychosocial stressor (Trier Social Stress Test; TSST) and assessed by means of adrenocorticotropic hormone (ACTH), blood and salivary cortisol samples before (t1) treatment. Samples of these biomarkers were taken -1 min prior stress exposure and six more blood samples were collected post-TSST ( + 1, + 10, + 20, + 30, + 45, + 60 min.). The participants were diagnosed with SAD based on the Structured Clinical Interview for DSM-IV (SCID) and completed the Liebowitz Social Anxiety Scale as well as the Beck Depression Inventory before (t1) and after psychotherapy (t2). Pre-treatment stress reactivity significantly predicted changes in depression (salivary p < 0.001 and blood cortisol p = 0.001), as well as in avoidance behavior (blood cortisol p = 0.001). None of the biomarkers revealed significant results in fear or in the total LSAS-scores, except for ACTH with a trend finding (p = 0.06). Regarding therapy success, symptoms of social anxiety (p = 0.005) and depression (p < 0.001) were significantly reduced from pre (t1) to post-treatment (t2). Our study showed that stress reactivity pre-treatment may serve as a predictor of psychotherapy outcome. In this regard, alterations in stress response relate to changes in symptoms of social anxiety and depression after PDT. This implies that patients with chronic stress might benefit from a targeted interventions during psychotherapy, especially to manage fear in social contexts.
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Affiliation(s)
- Ileana Schmalbach
- Department of Medical Psychology and Medical Sociology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.
| | - Michael Witthöft
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Bernhard Strauß
- Institute for Psychosocial Medicine, Psychotherapy & Psychooncology, University Hospital Jena, Jena, Germany
| | - Peter Joraschky
- University Medical Center Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Katja Petrowski
- Department of Medical Psychology and Medical Sociology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
- Dresden University of Technology, Carl Gustav Carus Medical Faculty, Department of General Medicine/MK3, Dresden, Germany
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Spina DS, Aafjes-van Doorn K, Békés V. Development of a psychotherapy process prototype for the Real Relationship. Psychother Res 2024; 34:449-460. [PMID: 37014795 DOI: 10.1080/10503307.2023.2191801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 03/11/2023] [Indexed: 04/05/2023] Open
Abstract
OBJECTIVE The Real Relationship (RR) describes the aspect of the psychotherapy relationship that is based on a genuine connection and a realistic view between patient and therapist. In the current study, we aimed to develop a Psychotherapy Process Q-set (PQS) prototype of the RR to facilitate post-hoc assessment of the RR in psychotherapy session recordings. We also aimed to measure the association between the RR-PQS and current PQS measures of theoretical treatment principles and the working alliance. METHOD We developed an RR-PQS prototype based on ratings of an ideal RR session by eight RR experts. We assessed the associations between the RR-PQS and existing cognitive behavioral and psychodynamic process prototypes, and seven PQS items known to predict the working alliance. RESULTS RR experts agreed on the ideal RR session ratings to a high degree (ICC = 0.89). The RR-PQS was moderately related to both cognitive behavioral (r = 0.66, p < 0.01), and psychodynamic prototypes (r = 0.56, p < 0.01). PQS items predictive of the working alliance were characteristic of the RR-PQS. CONCLUSION The RR-PQS prototype appears to behave in theoretically predicted ways and may be a valid measure of the RR.
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Affiliation(s)
- Daniel S Spina
- Department of Psychology, The Pennsylvania State University, State College, PA, USA
| | | | - Vera Békés
- Ferkauf Graduate School of Psychology, Yeshiva University, New York, NY, USA
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Viederman M. Character Change in Less Frequent Therapies: Psychodynamic and Transference Implications. Psychodyn Psychiatry 2024; 52:80-95. [PMID: 38426751 DOI: 10.1521/pdps.2024.52.1.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
An approach to a once-weekly, or bimonthly (every second week), ongoing psychodynamic psychotherapy is described. The detailed description of individual sessions is intended to show the process of the uncovering of unconscious phenomena using this approach, though the therapies described are not complete. Important changes that have already occurred are described. The approach is characterized by a direct method of discovery of early painful situations that underlie specific problematic experiences in the present. The therapeutic stance is designed to establish a collaborative relationship with the patient that becomes the substrate of the relationship and often leads to an identification with the therapist who becomes an ongoing presence in the patient's life.
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Ross E, Alfonso CA. Psychodynamic Psychiatry and the Care of Persons with Vision Loss and Blindness. Psychodyn Psychiatry 2024; 52:1-7. [PMID: 38426754 DOI: 10.1521/pdps.2024.52.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
The authors describe the clinical relevance of the psychiatric concept of bidirectionality when caring for persons with comorbid disorders, and they propose a psychodynamic framework to guide the treatment of persons with vision loss and blindness. Since persons with vision loss have an increased risk of depressive and anxiety disorders, they recommend targeted screening, integrated services, and a biopsychosocial approach to clinical care. The psychoanalytic concept of aphanisis, first described by Ernest Jones and later developed by Lacan and Kohut, is briefly discussed. Common psychotherapy themes in the treatment of persons who experience vision loss from systemic illness include reactivation of memories of past traumas resulting in avoidance, social withdrawal, depressive states, catastrophic thinking, a sense of foreshortened future, anhedonia, and fear of disintegration and invisibility. Psychotherapy also serves to correct negative introjects from ableist societal attitudes.
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Affiliation(s)
- Edward Ross
- Lighthouse Guild International; New York Institute for Psychoanalytic Self-Psychology
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7
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Milo F, Imondi C, D’Amore C, Angelino G, Knafelz D, Bracci F, Dall’Oglio L, De Angelis P, Tabarini P. Short-term Psychodynamic Psychotherapy in Addition to Standard Medical Therapy Increases Clinical Remission in Adolescents and Young Adults with Inflammatory Bowel Disease: a Randomised Controlled Trial. J Crohns Colitis 2024; 18:256-263. [PMID: 37621051 PMCID: PMC10896630 DOI: 10.1093/ecco-jcc/jjad145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Inflammatory bowel diseases [IBD] are chronic and pervasive conditions of the gastrointestinal tract with a rising incidence in paediatric and young adult populations. Evidence suggests that psychological disorders might be associated with relapse of disease activity. This study aims to evaluate the efficacy of short-term psychodynamic psychotherapy [STPP] in addition to standard medical therapy [SMT] in maintaining clinical remission in adolescents and young adults [AYA] with quiescent IBD, compared with SMT alone. METHODS A two-arm, single-centre, randomised, controlled trial was conducted in 60 IBD AYA in clinical remission. Patients were randomised to receive an 8-week STPP + SMT [n = 30] or SMT alone [n = 30]. The primary outcome was the steroid-free remission rate at 52 weeks after treatment. Secondary outcomes included the overall hospitalisation rate within 52 weeks after treatment, and medication adherence obtained from patient's electronic medical records. RESULTS Intention-to-treat analysis showed significant improvement in maintaining disease remission rates in the 8-week STPP + SMT group compared with the control one. The proportion of patients maintaining steroid-free remission at 52 weeks was higher in patients in STTP group [93.1%] compared with patients randomised to control group [64.3%; p = 0.01]. There were no significant differences in secondary outcomes, except for depression reduction in STPP + SMT group. CONCLUSIONS An 8-week STPP intervention in addition to SMT effectively increases the steroid-free remission rates in AYA with quiescent IBD. Results do not support effects for other secondary outcomes, except for depression reduction.
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Affiliation(s)
- Francesco Milo
- Clinical Psychology Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Chiara Imondi
- Digestive Endoscopy Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Carmen D’Amore
- Clinical Epidemiology Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Giulia Angelino
- Digestive Endoscopy Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Daniela Knafelz
- Hepatology, Gastroenterology and Nutrition Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Fiammetta Bracci
- Hepatology, Gastroenterology and Nutrition Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Luigi Dall’Oglio
- Digestive Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Paola De Angelis
- Digestive Endoscopy Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Paola Tabarini
- Clinical Psychology Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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8
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Kisely SR. Can new approaches to synthesising evidence help achieve a consensus in psychotherapy research? Australas Psychiatry 2024; 32:23-25. [PMID: 38079408 PMCID: PMC10809726 DOI: 10.1177/10398562231219851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
OBJECTIVE The recent debate around the College's Clinical Practice Guidelines on mood disorders have highlighted differences in opinion on interpreting evidence from randomised control trials (RCTs) for psychodynamic psychotherapy. This paper discusses new techniques of synthesising research evidence (e.g., umbrella reviews) that may help minimise disagreements in the interpretation of RCTs and foster greater consensus on treatment guidelines. CONCLUSIONS Findings from the latest umbrella review suggest that psychodynamic therapy is an evidence-based approach, among several, for common mental disorders.
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Affiliation(s)
- Stephen R Kisely
- School of Medicine, The University of Queensland, Brisbane, QLD, Australia; Metro South Health Service, Woolloongabba, QLD, Australia; and Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
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9
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Viederman M. Recognition: A Key for Understanding a Necessary Role of the Psychotherapist for the Successful Outcome of Psychotherapy. Psychiatry 2023; 86:317-328. [PMID: 38133682 DOI: 10.1080/00332747.2023.2274249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
The purpose of this paper is to focus on an aspect of psychodynamic psychotherapy that includes psychoanalysis to illustrate the important element in the psychotherapeutic relationship called recognition. This involves an emotional sharing with the patient of the importance of particular life experiences that he has had and as such this not only cements the relationship but becomes the substrate of change and an internalization of the therapist that persists after the end of treatment. This interaction parallels the experience with a responsive mother able to echo the infant's experience. The experience of recognition is illustrated with 10 case presentations that demonstrate the power of this factor in a variety of patients ranging from brief consultations to psychoanalysis.
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10
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Palmer S, Brockmeyer T, Zipfel S, Wild B, Resmark G, Teufel M, Giel K, de Zwaan M, Dinkel A, Herpertz S, Burgmer M, Löwe B, Tagay S, Rothermund E, Zeeck A, Herzog W, Friederich HC. Words count in psychotherapy: Differentiating language characteristics of cognitive behavioral therapy and focal psychodynamic therapy for anorexia nervosa. Psychotherapy (Chic) 2023; 60:488-496. [PMID: 37824236 DOI: 10.1037/pst0000499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
It is generally assumed that psychodynamic therapy and cognitive behavioral therapy (CBT) differ in terms of applied techniques and processes. To date, however, little is known about whether and how such differences can actually be observed at a basic linguistic level and in what the two treatment approaches differ most strongly (i.e., how psychodynamic and CBT therapists differ in what they actually say word-by-word in therapy sessions). Building on theoretical models and previous research that used observer ratings, we formulated specific hypotheses regarding which word categories psychodynamic and CBT therapists who treat patients with an eating disorder should differ in. To investigate these hypotheses, we used verbatim transcripts from 297 therapy sessions of a randomized controlled trial in which patients with anorexia nervosa (n = 88) received either focal psychodynamic therapy (FPT) or CBT. These transcripts were then examined using computerized quantitative text analysis. In line with our hypotheses, we found that CBT therapists overall spoke more than their FPT counterparts and that they used more words related to eating. Also in line with our hypotheses, FPT therapists used more words related to social processes. Contrary to our expectations, CBT therapists did not show a stronger focus on the future but talked more about emotions than FPT therapists. The latter effect, however, appears to be driven by a stronger focus on positive emotions. These findings suggest that computerized quantitative text analysis can differentiate meaningful language characteristics of CBT and FPT on spoken-word level and that it holds potential as a tool for researchers and therapists. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Simon Palmer
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Goettingen
| | - Timo Brockmeyer
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Goettingen
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, Center of Excellence in Eating Disorders, University Hospital Tuebingen
| | - Beate Wild
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, Heidelberg University Hospital
| | - Gaby Resmark
- Department of Psychosomatic Medicine and Psychotherapy, Center of Excellence in Eating Disorders, University Hospital Tuebingen
| | - Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR University Hospital
| | - Katrin Giel
- Department of Psychosomatic Medicine and Psychotherapy, Center of Excellence in Eating Disorders, University Hospital Tuebingen
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School
| | - Andreas Dinkel
- Department of PsychosomaticMedicine and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich
| | - Stephan Herpertz
- Department for Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr-University of Bochum
| | - Markus Burgmer
- Department of Psychosomatic Medicine and Psychotherapy, LWL-Hospital
| | - Bernd Löwe
- Institute and Outpatients Clinic for Psychosomatic Medicine and Psychotherapy, University Hospital Hamburg-Eppendorf
| | - Sefik Tagay
- Faculty of Social Sciences, TH Koln-University of Applied Sciences
| | - Eva Rothermund
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center
| | - Almut Zeeck
- Department of Psychosomatic Medicine and Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg
| | - Wolfgang Herzog
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, Heidelberg University Hospital
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, Heidelberg University Hospital
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11
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Kline KV, Hill CE, Lu Y, Gelso CJ. Transference and client attachment to therapist in psychodynamic psychotherapy. Psychotherapy (Chic) 2023; 60:467-476. [PMID: 37166938 DOI: 10.1037/pst0000492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Although there are theorized connections between client transference and their attachment to their therapists (Bowlby, 1969/1982), limited empirical research exists examining their association over the course of psychotherapy. We thus examined the association between positive and negative transference and client attachment to therapist across the course of open-ended psychodynamic psychotherapy for 49 cases with doctoral student therapists and adult community clients who had at least 32 sessions. Using a Bayesian multilevel structural equation model framework, results indicated that client secure attachment increased and avoidant-fearful attachment decreased across the course of psychotherapy. For clients with higher preoccupied-merger attachment at the beginning of therapy, therapists perceived more fluctuation in negative transference over time than for clients with other attachment styles. Implications for research, practice, and therapist training are offered. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | - Clara E Hill
- Department of Psychology, University of Maryland
| | - Yun Lu
- Department of Psychology and Behavioral Sciences, Zhejiang University
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12
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Güvenç D, Halfon S. Dynamic relations between mentalization techniques and therapeutic alliance in psychodynamic child therapy: An evidence-based case study. Psychotherapy (Chic) 2023; 60:548-559. [PMID: 37856405 DOI: 10.1037/pst0000505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Therapeutic alliance and mentalization are common factors inherent to all effective treatments. Mentalization-based interventions have the potential to create a safe relationship, which makes further mentalizing interventions possible. However, to date, no study has examined the bidirectional relationship between these variables in child psychotherapy. In an evidence-based case study design, psychodynamic therapy processes of two Turkish children (age: 9 and 10 years) who presented with social withdrawal problems were compared. All their sessions (34 sessions from Case No. 1 and 31 from Case No. 2) were coded using the Therapy Process Observational Coding System-Alliance Scale and Mentalization-Based Treatment for Children Adherence Scale. Outcome scales pertaining to symptoms, attachment, and mentalization were administered at baseline and at termination. Time-series Granger Causality tests revealed that in the case with clinically significant outcome, mentalization techniques predicted therapeutic alliance in the subsequent sessions, which predicted the use of further mentalization interventions. However, this relationship was not supported in the case with no significant improvement. Selected sessions were clinically analyzed with verbatim session vignettes. Our findings indicate that mentalization techniques in child therapy are closely related to the therapeutic relationship. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | - Sibel Halfon
- Department of Psychology, Istanbul Bilgi University
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13
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Rajagopalan A, Teck SCE, Sng ATT. Shared Fragility-Contemplating the Impact of Patients' Suicides on Clinicians. Psychodyn Psychiatry 2023; 51:409-433. [PMID: 38047664 DOI: 10.1521/pdps.2023.51.4.409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
The experience of patient suicide can have a profound impact on clinicians, yet there are limited opportunities for them to express and process their emotional responses. We organized a reflective group session for psychiatrists in Singapore who had encountered patient suicides. Ten psychiatrists participated, with five in the "inner" group (those who had experienced patient suicide) and the remaining five forming the "outer" group. Led by a senior psychiatrist trained in psychodynamic psychotherapy, the inner group shared their reflections on patient suicides, while the outer group provided their insights thereafter. Participants provided written feedback about their session experiences. The session was recorded, transcribed, and analyzed to identify key themes. Three main narrative themes emerged from the analysis. Firstly, there was the acute response to the suicide, involving intense emotional reactions. Secondly, the relationship between clinicians and patients with suicidal thoughts was explored, encompassing countertransferential responses, superego defenses, and resulting anxiety. Lastly, the study examined how clinicians feel about suicidality itself, shedding light on complex attitudes and perceptions. Our findings confirm previous research, indicating that the response to patient suicide is stressful and traumatic for clinicians, who grapple with emotions such as grief, guilt, incompetence, and fear. Moreover, we delve into the intricate connections clinicians have with the concept of suicidality, shaped not only by their own experiences but also by the insights of those who have yet to confront patient suicide. The reflections shared by the participants emphasize the significance of establishing therapeutic spaces for clinicians to process these complex emotions effectively.
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Affiliation(s)
- Arvind Rajagopalan
- Department of Psychological Medicine, Changi General Hospital, Singapore
| | - Samuel Cheng Eng Teck
- Grad. Dip. in Psychotherapy (Psychodynamic Track), M.Sc. (Epidemiology), Department of Psychological Medicine, Changi General Hospital, Singapore
| | - Andre Tay Teck Sng
- Department of Psychological Medicine, Changi General Hospital, Singapore
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14
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Levendosky AA, Turchan JE, Luo X, Good E. A re-introduction of the psychodynamic approach to the standard clinical psychology curriculum. J Clin Psychol 2023; 79:2439-2451. [PMID: 37310149 DOI: 10.1002/jclp.23551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 05/02/2023] [Accepted: 05/28/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVE There is a strong evidence-base for a psychodynamic approach, supporting primary theoretical tenets as well as the treatment effectiveness. Additionally, there are increasing calls from the field for more individualized treatment for clients, and the lack of training in multiple orientations limits the ability of students in clinical psychology Ph.D. programs in the United States to personalize their treatments. The accumulated evidence-base for contemporary relational psychodynamic theory and therapy places it in good standing to return to the standard clinical psychology curriculum, along with other evidence-based approaches. METHODS We use data from the Insider's Guide (which describes clinical Ph.D. programs in the United States) from three time points over 20 years to document the waning psychodynamic approach in clinical psychology programs. We review the scientific evidence for four primary tenets of a contemporary psychodynamic approach: three related to development-from healthy to psychopathological: (1) unconscious processes; (2) internal representations of self and other; (3) dimensional model of psychopathology, and a fourth tenet that builds on these three and is the foundation for a contemporary psychodynamic approach to psychotherapy: (4) therapeutic relationship as a primary mechanism of change. RESULTS/CONCLUSIONS Based on the review of the evidence, we make specific recommendations for clinical psychology training programs about how to include a psychodynamic approach in the curriculum.
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Affiliation(s)
- Alytia A Levendosky
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA
| | - Joshua E Turchan
- Counseling and Psychiatric Services, Michigan State University, East Lansing, Michigan, USA
| | - Xiaochen Luo
- Department of Counseling Psychology, Santa Clara University, Santa Clara, California, USA
| | - Evan Good
- Austen Riggs Center, Stockbridge, Massachusetts, USA
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15
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Driessen E, Fokkema M, Dekker JJM, Peen J, Van HL, Maina G, Rosso G, Rigardetto S, Cuniberti F, Vitriol VG, Andreoli A, Burnand Y, López Rodríguez J, Villamil Salcedo V, Twisk JWR, Wienicke FJ, Cuijpers P. Which patients benefit from adding short-term psychodynamic psychotherapy to antidepressants in the treatment of depression? A systematic review and meta-analysis of individual participant data. Psychol Med 2023; 53:6090-6101. [PMID: 36404677 PMCID: PMC10520584 DOI: 10.1017/s0033291722003270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Adding short-term psychodynamic psychotherapy (STPP) to antidepressants increases treatment efficacy, but it is unclear which patients benefit specifically. This study examined efficacy moderators of combined treatment (STPP + antidepressants) v. antidepressants for adults with depression. METHODS For this systematic review and meta-analysis (PROSPERO registration number: CRD42017056029), we searched PubMed, PsycINFO, Embase.com, and the Cochrane Library from inception to 1 January 2022. We included randomized clinical trials comparing combined treatment (antidepressants + individual outpatient STPP) v. antidepressants in the acute-phase treatment of depression in adults. Individual participant data were requested and analyzed combinedly using mixed-effects models (adding Cochrane risk of bias items as covariates) and an exploratory machine learning technique. The primary outcome was post-treatment depression symptom level. RESULTS Data were obtained for all seven trials identified (100%, n = 482, combined: n = 238, antidepressants: n = 244). Adding STPP to antidepressants was more efficacious for patients with high rather than low baseline depression levels [B = -0.49, 95% confidence interval (CI) -0.61 to -0.37, p < 0.0001] and for patients with a depressive episode duration of >2 years rather than <1 year (B = -0.68, 95% CI -1.31 to -0.05, p = 0.03) and than 1-2 years (B = -0.86, 95% CI -1.66 to -0.06, p = 0.04). Heterogeneity was low. Effects were replicated in analyses controlling for risk of bias. CONCLUSIONS To our knowledge, this is the first study that examines moderators across trials assessing the addition of STPP to antidepressants. These findings need validation but suggest that depression severity and episode duration are factors to consider when adding STPP to antidepressants and might contribute to personalizing treatment selection for depression.
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Affiliation(s)
- Ellen Driessen
- Department of Clinical Psychology, Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
- Depression Expertise Centre, Pro Persona Mental Health Care, Nijmegen, Netherlands
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Marjolein Fokkema
- Department of Methodology and Statistics, Leiden University, Leiden, Netherlands
| | - Jack J M Dekker
- Department of Research, Arkin Mental Health Care, Amsterdam, Netherlands
| | - Jaap Peen
- Department of Research, Arkin Mental Health Care, Amsterdam, Netherlands
| | | | - Giuseppe Maina
- Department of Neuroscience 'Rita Levi Montalcini', University of Turin, Turin, Italy
- Psychiatric Unit, San Luigi Gonzaga University Hospital of Orbassano, Turin, Italy
| | - Gianluca Rosso
- Department of Neuroscience 'Rita Levi Montalcini', University of Turin, Turin, Italy
- Psychiatric Unit, San Luigi Gonzaga University Hospital of Orbassano, Turin, Italy
| | - Sylvia Rigardetto
- Psychiatric Unit, San Luigi Gonzaga University Hospital of Orbassano, Turin, Italy
| | - Francesco Cuniberti
- Department of Neuroscience 'Rita Levi Montalcini', University of Turin, Turin, Italy
| | | | | | | | | | | | - Jos W R Twisk
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Frederik J Wienicke
- Department of Clinical Psychology, Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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16
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Fenski F, Böttcher J, Hörz-Sagstetter S. [Online Therapy as an Add-on to Psychoanalysis? What Needs for Online Therapy Modules do Psychodynamic Psychotherapists in Private Practice Express for Their Outpatient Work?]. Psychother Psychosom Med Psychol 2023; 73:346-352. [PMID: 37054741 DOI: 10.1055/a-2050-3413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
OBJECTIVE In recent years, psychotherapists have been increasingly confronted with the challenge of meeting treatment needs efficiently with limited time resources and at the same time achieving stable treatment success in the long term. One way to address this is to integrate Internet-based interventions (IBI) into outpatient psychotherapy. While there is a lot of research on IBI based on cognitive-behavioral therapy, little is known about the same for psychodynamic treatment models. Therefore, the question will be answered as to what specific online modules would need to look like that psychodynamic psychotherapists would use in their outpatient practice to support their regular face-to-face therapies. METHODS In this study, 20 psychodynamic psychotherapists were asked about their requirements on the content of online modules that could be integrated into outpatient psychotherapy, using semi-structured interviews. The transcribed interviews were analyzed using Mayring's qualitative content analysis. RESULTS Results showed that some psychodynamic psychotherapists already use exercises or materials which could be transferred into the online format. In addition, general requirements about online modules emerged, such as an easy handling or a playful character. At the same time, it became clear when and with what kind of patient groups online modules would be integrated into psychodynamic psychotherapy. DISCUSSION The interviewed psychodynamic psychotherapists considered it an attractive approach to offer online modules as a supplement to psychotherapy and in a broad spectrum of content. They gave practical advice for the design of possible modules, both on the level of general handling and regarding concrete contents, words, and ideas. CONCLUSION The results contributed to the development of online modules for use in routine care, the effectiveness of which will be investigated in a randomized controlled trial in Germany.
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Affiliation(s)
- Friederike Fenski
- Klinische Psychologie und Psychotherapie, Psychologische Hochschule Berlin
| | - Johanna Böttcher
- Klinische Psychologie und Psychotherapie, Psychologische Hochschule Berlin
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17
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Di Salvo G, Bianco M, Teobaldi E, Maina G, Rosso G. A Psychoanalytic-Derived Brief Psychotherapeutic Approach in the Treatment of Major Depression: Monotherapy Studies. Medicina (B Aires) 2022; 58:medicina58101335. [PMID: 36295496 PMCID: PMC9609679 DOI: 10.3390/medicina58101335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/14/2022] [Accepted: 09/19/2022] [Indexed: 11/16/2022] Open
Abstract
Over the years, short term psychodynamic therapy (STPP) has been broadly researched in order to evaluate its efficacy in the treatment of major psychiatric disorders. In particular, a consistent number of studies focused on assessing clinical outcomes of the principal psychodynamic techniques in treating depressive disorders. We conducted a narrative review in which we aimed to evaluate the efficacy of STPP in monotherapy in major depressive disorder and to assess possible features that may correlate with its clinical use. Databases searched were PubMed, Ovid, Scopus, PsycINFO and Cochrane Libraries from inception to July 2022. Our research underlined that STPP in monotherapy is particularly effective in moderately severe depression and in preventing depressive relapses. Moreover, a case-by-case evaluation of its efficacy should be performed when considering STPP for the treatment of major depression with other comorbid psychiatric conditions. Although such key points emerged from scientific evidence, STPP should be better studied in the long-term perspective; further research is needed to define the clinical scenarios in which STPP can be considered a first-line approach as monotherapy in major depressive disorder compared to medications or other types of psychotherapy.
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Affiliation(s)
- Gabriele Di Salvo
- Department of Neurosciences “Rita Levi Montalcini”, University of Turin, 10126 Turin, Italy
- Psychiatric Unit, San Luigi Gonzaga University Hospital, 10043 Turin, Italy
| | - Matteo Bianco
- Department of Neurosciences “Rita Levi Montalcini”, University of Turin, 10126 Turin, Italy
| | - Elena Teobaldi
- Department of Neurosciences “Rita Levi Montalcini”, University of Turin, 10126 Turin, Italy
| | - Giuseppe Maina
- Department of Neurosciences “Rita Levi Montalcini”, University of Turin, 10126 Turin, Italy
- Psychiatric Unit, San Luigi Gonzaga University Hospital, 10043 Turin, Italy
| | - Gianluca Rosso
- Department of Neurosciences “Rita Levi Montalcini”, University of Turin, 10126 Turin, Italy
- Psychiatric Unit, San Luigi Gonzaga University Hospital, 10043 Turin, Italy
- Correspondence: ; Tel.: +39-011-902-6504
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18
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Kuprian N, Aafjes-van Doorn K, Gutterman D, Barber JP. Therapeutic immediacy in psychodynamic psychotherapy for depression: A mixed-method study. Psychotherapy (Chic) 2022; 59:554-566. [PMID: 35913883 DOI: 10.1037/pst0000452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This exploratory study assesses the use and quality of therapeutic immediacy in short-term psychodynamic psychotherapy for depression. We aimed to identify what constitutes effective here-and-now discussions of the therapeutic relationship by examining a sample of four treatment cases drawn from a previous randomized clinical trial for depression. Transcripts of 16 treatment sessions (four time points per treatment) were analyzed using the consensual qualitative research for case study method. The therapists' contributions to therapeutic immediacy were assessed qualitatively by independent judges and then quantitatively analyzed in relation to immediate session outcome as well as overall treatment outcome (reduction in depressive symptoms). A total of 41 immediacy events were identified across 16 sessions, of which 35 were therapist-initiated and subsequently organized into 18 discrete categories. High-quality immediacy events (as assessed by the judges) were associated with higher patient involvement. Two immediacy categories were significantly different between good and poor outcome cases. Therapists "acknowledged their patient's progress in therapy" more often in good outcome cases, whereas they "assessed patients' feelings about the overall progress of therapy" more often in poor outcome cases. No significant relationship was found between frequency, rated quality of immediacy events, and treatment outcome. Four immediacy events rated by the judges as high- and low-quality are presented as clinical examples illustrating positive and negative therapists' contributions to therapeutic immediacy. Therapist behaviors that may improve the effectiveness of therapeutic immediacy are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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19
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Ren Z, Xie Z. The Journey of Individuation: Experiences of Chinese Patients Treated by Western Psychoanalysts in Online Psychodynamic Psychotherapy. J Am Psychoanal Assoc 2022; 70:733-754. [PMID: 36047625 DOI: 10.1177/00030651221115851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This qualitative study focuses on the process of treatment over the internet from a psychodynamic perspective based on the experiences of seventeen patients in China who underwent online treatment by psychoanalysts based in the United States or other Western nations. The data were collected and analyzed using psychodynamic themes. Seventeen participants involved in online cross-national and cross-cultural psychodynamic treatment were recruited in China. Various themes in regard to the process of online treatment in a cross-national and cross-cultural context emerged. Findings indicate the following: (1) in contrast to traditional relational patterns, psychodynamic treatment provides a new relationship model; (2) psychodynamic treatment creates a space of self-reflection for Chinese patients in terms of their relationships; (3) the therapeutic setting emphasizes clear boundaries, free space, equal relationships, and emotional expression for patients. The results provide new insights into self-examination, which frees patients from the inflexible aspects of traditional relationships, family hierarchies, and rigid cultural values. In addition, psychodynamic treatment in a cross-national and cross-cultural setting not only enables patients to work through their trauma but also empowers them to explore their unique journey of individuation.
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20
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Olano FJA, Rosenbaum B. [Short-term psychodynamic psychotherapy]. Ugeskr Laeger 2022; 184:V03220168. [PMID: 35786496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
There are different types of psychotherapy for anxiety, depression, and personality disorders with comparable effect. This review describes the theory, methods, and evidence of psychodynamic short-term therapy. After a description of nuances in the dominant tendencies, the common elements of the therapy are summarised. The therapeutic question is which treatment works best for which patient under which circumstances. In this context, psychodynamic short-term therapy must be part of a continuum of treatment options, adapted to the patients' personal characteristics, needs, and wishes.
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21
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Abstract
OBJECTIVE This study examined the reciprocal effects between therapeutic agency, working alliance, and symptoms during psychotherapy. We aimed to predict symptom improvement by previous changes in either agency or alliance. In addition, we examined whether alliance development was predicted by previous changes in agency. METHOD A sample of 386 patients in psychodynamic outpatient psychotherapy answered the Therapeutic Agency Inventory (TAI), the Working Alliance Inventory-SR (WAI-SR), and the Symptom Checklist-K11 (SCL-K11) after Sessions 1, 5, 10, 15, and 20. Dynamic panel models were estimated using structural equation modeling. Associations were tested while controlling for autoregressive effects and differentiating within-person changes over time from between-person differences. RESULTS Increases in agency predicted subsequent symptom improvement. Similarly, increases in alliance predicted subsequent symptom improvement. For agency and alliance, we found a more complex pattern with varying reciprocal effects over time. CONCLUSIONS Findings show evidence for agency and alliance as curative change factors in psychodynamic psychotherapy. The study supports the importance of both agency and alliance and further suggests that both mechanisms may need to be balanced in successful psychotherapies. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Julia Huber
- Department of General Internal Medicine and Psychosomatics
| | | | | | | | - Ulrike Dinger
- Department of General Internal Medicine and Psychosomatics
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22
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Pec O, Bob P, Pec J, Ludvikova I. Psychodynamic day treatment program for borderline personality disorder: factors that predict outcome and dropout: An observational study. Medicine (Baltimore) 2021; 100:e25186. [PMID: 33726008 PMCID: PMC7982198 DOI: 10.1097/md.0000000000025186] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/24/2021] [Indexed: 01/05/2023] Open
Abstract
The objective of this study was to ascertain changes in symptoms of patients with borderline personality disorder undergoing psychodynamic day treatment with a duration of 9 months and the factors that predict clinical outcome or dropouts from the program.In an observational study, demographic characteristics (age, number of psychiatric hospitalizations, number of suicide attempts, current involvement in work or study activities), day doses of antipsychotic and antidepressant medication, psychiatric symptoms, and social functioning (Health of the Nation Outcome Scales), and symptoms of dissociation (Dissociative Experiences Scale) were assessed in patients at the beginning of treatment (N = 105). Further, psychiatric symptoms and social functioning were assessed at 3 stages: beginning of the program, end of the program, and 1-year follow-up. To study the differences between baseline values and values at the end of the treatment and follow-up values, the Wilcoxon signed-rank test was used. To discover baseline factors related to the effect of the treatment, Spearman correlation coefficients were calculated. To evaluate the differences between patients who completed the program (N = 67) and patients who dropped out (N = 38), differences in baseline factors between both groups were compared, using the Mann-Whitney test for independent samples.Improvement in symptoms (Health of the Nation Outcome Scales - version for external evaluators) at the end of the therapy (N = 67, P < .001) and at the 1-year follow-up (N = 46, P < .001) was found. Experience of an intimate relationship was positively related to clinical improvement at follow-up examinations (P < .001). Predictors of dropout included a higher number of psychiatric hospitalizations (P = .004), suicide attempts (P = .004), more severe pretreatment symptoms (P = .002), and symptoms of dissociation (P = .046).The results indicate that a psychodynamic day treatment is feasible for the treatment of less clinically disturbed patients with a history of intimate relationships. Patients with a higher number of previous psychiatric hospitalizations, more suicide attempts in the past, more severe pretreatment symptoms, and symptoms of dissociation are more likely not to complete the program.
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Affiliation(s)
- Ondrej Pec
- Center for Neuropsychiatric Research of Traumatic Stress, Department of Psychiatry and UHSL, First Faculty of Medicine, and Department of Psychiatry, Faculty of Medicine Pilsen, Charles University
- ESET, Psychotherapeutic and Psychosomatic Clinic, Prague, Czech Republic
| | - Petr Bob
- Center for Neuropsychiatric Research of Traumatic Stress, Department of Psychiatry and UHSL, First Faculty of Medicine, and Department of Psychiatry, Faculty of Medicine Pilsen, Charles University
| | - Jan Pec
- ESET, Psychotherapeutic and Psychosomatic Clinic, Prague, Czech Republic
| | - Irena Ludvikova
- ESET, Psychotherapeutic and Psychosomatic Clinic, Prague, Czech Republic
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23
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Røssberg JI, Evensen J, Dammen T, Wilberg T, Klungsøyr O, Jones M, Bøen E, Egeland R, Breivik R, Løvgren A, Ulberg R. Mechanisms of change and heterogeneous treatment effects in psychodynamic and cognitive behavioural therapy for patients with depressive disorder: a randomized controlled trial. BMC Psychol 2021; 9:11. [PMID: 33482927 PMCID: PMC7821688 DOI: 10.1186/s40359-021-00517-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 01/15/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is a prevalent psychiatric condition associated with significant disability, mortality and economic burden. Cognitive behavioral therapy (CBT) and psychodynamic psychotherapy (PDT) are found to be equally effective for patients with depression. However, many patients do not respond sufficiently to either treatment. To offer individualized treatment, we need to know if some patients benefit more from one of the two therapies. At present little is known about what patient characteristics (moderators) may be associated with differential outcomes of CBT and PDT, and through what therapeutic processes and mechanisms (mediators) improvements occur in each therapy mode. Presently only theoretical assumptions, sparsely supported by research findings, describe what potentially moderates and mediates the treatment effects of CBT and PDT. The overall aim of this study is to examine theoretically derived putative moderators and mediators in CBT and PDT and strengthen the evidence base about for whom and how these treatments works in a representative sample of patients with MDD. METHODS One hundred patients with a diagnosis of MDD will be randomized to either CBT or PDT. Patients will be treated over 28 weeks with either CBT (one weekly session over 16 weeks and three monthly booster sessions) or PDT (one weekly session over 28 weeks). The patients will be evaluated at baseline, during the course of therapy, at the end of therapy, and at follow-up investigations 1 and 3 years post treatment. A large range of patient and observer rated questionnaires (specific preselected putative moderators and mediators) are included. DISCUSSION The clinical outcome of this study may better guide clinicians when deciding what kind of treatment any individual patient should be offered. Moreover, the study aims to further our knowledge of what mechanisms lead to symptom improvement and increased psychosocial functioning. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03022071.
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Affiliation(s)
- J. I. Røssberg
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4959, 0424 Nydalen, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, P.O. Box 1171, 0318 Blindern, Oslo, Norway
- Division of Psychiatric Treatment Research, Oslo University Hospital, Oslo, Norway
| | - J. Evensen
- Nydalen Outpatient Clinic, P.O. Box 4959, 0424 Nydalen, Oslo, Norway
| | - T. Dammen
- Department of Behavioural Science in Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - T. Wilberg
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4959, 0424 Nydalen, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, P.O. Box 1171, 0318 Blindern, Oslo, Norway
| | - O. Klungsøyr
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4959, 0424 Nydalen, Oslo, Norway
| | - M. Jones
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4959, 0424 Nydalen, Oslo, Norway
| | - E. Bøen
- Department of Psychiatry, Diakonhjemmet Hospital, Oslo, Norway
| | - R. Egeland
- Department of Psychiatry, Diakonhjemmet Hospital, Oslo, Norway
| | - R. Breivik
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4959, 0424 Nydalen, Oslo, Norway
| | - A. Løvgren
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4959, 0424 Nydalen, Oslo, Norway
| | - R. Ulberg
- Institute of Clinical Medicine, University of Oslo, P.O. Box 1171, 0318 Blindern, Oslo, Norway
- Department of Psychiatry, Diakonhjemmet Hospital, Oslo, Norway
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Baumeister H, Terhorst Y, Grässle C, Freudenstein M, Nübling R, Ebert DD. Impact of an acceptance facilitating intervention on psychotherapists' acceptance of blended therapy. PLoS One 2020; 15:e0236995. [PMID: 32785245 PMCID: PMC7423074 DOI: 10.1371/journal.pone.0236995] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 07/17/2020] [Indexed: 11/19/2022] Open
Abstract
Blended therapy is a new approach combining advantages of face-to-face psychotherapy and Internet- and mobile-based interventions. Acceptance is a fundamental precondition for its implementation. The aim of this study was to assess 1) the acceptance of psychotherapists towards blended therapy, 2) the effectiveness of an acceptance facilitating intervention (AFI) on psychotherapists' acceptance towards blended therapy and 3) to identify potential effect moderators. Psychotherapists (N = 284) were randomly assigned to a control (CG) or an intervention group (IG). The IG received a short video showing an example of blended therapy, the CG an attention placebo video. Both groups received a reliable online questionnaire assessing acceptance, effort expectancy, performance expectancy, facilitating conditions, social influence and internet anxiety. Between group differences were examined using t-tests and Mann-Whitney tests. Exploratory analysis was conducted to identify moderators. Psychotherapists in CG showed mixed baseline acceptance towards blended therapy (low = 40%, moderate = 33%, high = 27%). IG showed significantly higher acceptance compared to CG (d = .27, pone-sided = .029; low = 24%, moderate = 47%, high = 30%). Bootstrapped confidence intervals were overlapping. Performance expectancy (d = .35), effort expectancy (d = .44) and facilitating conditions (d = .28) were significantly increased (p < .05). No effects on social influence and internet anxiety were found (p>.05). Exploratory analysis indicated psychodynamic oriented psychotherapists profiting particularly from the AFI. Blended therapy is a promising approach to improve healthcare. Psychotherapists show mixed acceptance, which might be improvable by AFIs, particularly in subpopulations of initially rather skeptical psychotherapists. Forthcoming studies should extend the present study by shifting focus from attitudes to the impact of different forms of AFIs on uptake.
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Affiliation(s)
- Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Yannik Terhorst
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Cora Grässle
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Maren Freudenstein
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Rüdiger Nübling
- Chamber of Psychotherapists Baden-Württemberg, Stuttgart, Germany
| | - David Daniel Ebert
- Faculty of Behavioural and Movement Sciences, Clinical, Neuro- & Developmental Psychology, VU Amsterdam, Amsterdam, The Netherlands
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25
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Fonagy P, Lemma A, Target M, O'Keeffe S, Constantinou MP, Ventura Wurman T, Luyten P, Allison E, Roth A, Cape J, Pilling S. Dynamic interpersonal therapy for moderate to severe depression: a pilot randomized controlled and feasibility trial. Psychol Med 2020; 50:1010-1019. [PMID: 31084635 DOI: 10.1017/s0033291719000928] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Improving Access to Psychological Therapies (IAPT) services treat most patients in England who present to primary care with major depression. Psychodynamic psychotherapy is one of the psychotherapies offered. Dynamic Interpersonal Therapy (DIT) is a psychodynamic and mentalization-based treatment for depression. 16 sessions are delivered over approximately 5 months. Neither DIT's effectiveness relative to low-intensity treatment (LIT), nor the feasibility of randomizing patients to psychodynamic or cognitive-behavioural treatments (CBT) in an IAPT setting has been demonstrated. METHODS 147 patients were randomized in a 3:2:1 ratio to DIT (n = 73), LIT (control intervention; n = 54) or CBT (n = 20) in four IAPT treatment services in a combined superiority and feasibility design. Patients meeting criteria for major depressive disorder were assessed at baseline, mid-treatment (3 months) and post-treatment (6 months) using the Hamilton Rating Scale for Depression (HRSD-17), Beck Depression Inventory-II (BDI-II) and other self-rated questionnaire measures. Patients receiving DIT were also followed up 6 months post-completion. RESULTS The DIT arm showed significantly lower HRSD-17 scores at the 6-month primary end-point compared with LIT (d = 0.70). Significantly more DIT patients (51%) showed clinically significant change on the HRSD-17 compared with LIT (9%). The DIT and CBT arms showed equivalence on most outcomes. Results were similar with the BDI-II. DIT showed benefit across a range of secondary outcomes. CONCLUSIONS DIT delivered in a primary care setting is superior to LIT and can be appropriately compared with CBT in future RCTs.
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Affiliation(s)
- Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Anna Freud National Centre for Children and Families, London, UK
| | - Alessandra Lemma
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Mary Target
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Sally O'Keeffe
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Anna Freud National Centre for Children and Families, London, UK
| | - Matthew P Constantinou
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Tamara Ventura Wurman
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Patrick Luyten
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
| | - Elizabeth Allison
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Anthony Roth
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - John Cape
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Stephen Pilling
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Barber JP, Milrod B, Gallop R, Solomonov N, Rudden MG, McCarthy KS, Chambless DL. Processes of therapeutic change: Results from the Cornell-Penn Study of Psychotherapies for Panic Disorder. J Couns Psychol 2020; 67:222-231. [PMID: 32105128 PMCID: PMC7112164 DOI: 10.1037/cou0000417] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
To examine process of changes in two distinct psychotherapies-cognitive-behavioral therapy (CBT) and Panic-Focused Psychodynamic Psychotherapy (PFPP). Two hypothesized processes of change-misinterpretation of bodily sensations and Panic Specific Reflective Function (PSRF)-were tested in the CBT and PFPP arms of the Cornell-Penn Study of Psychotherapies for Panic Disorder. The Brief Bodily Sensations Interpretation Questionnaire (BBSIQ) measures misinterpretation of bodily sensations-a focus of CBT interventions. PSRF, a target of PFPP, assesses the capacity to reflect on the underlying meaning of panic symptoms. A sample of 138 patients (37.7% men, 72.56% Whites, and 16.7% Latinx) with primary Diagnostic and Statistical Manual for Mental Disorders-Fourth Edition (DSM-IV) panic disorder were included in the present analyses. Mixed effects models tested the effects of early change in BBSIQ and PSRF (intake through Week 5) on subsequent change in the Panic Disorder Severity Scale (PDSS; Week 5 through termination). Early change on both PSRF and BBSIQ predicted subsequent change in panic severity across the two treatments. As predicted, PSRF changed more in PFPP than in CBT, but, contrary to expectation, BBSIQ showed comparable changes in both groups. Counterintuitively, CBT patients benefited more in terms of panic symptom improvement when their PSRF improved than did PFPP patients. This is the first demonstration of general processes of change (PSRF and BBSIQ) across psychotherapies for panic disorder, suggesting that to the extent patients change their beliefs about the meaning of panic, their panic symptoms improve in time-limited, panic-focused psychotherapies. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | | | - Kevin S McCarthy
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania
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Solomonov N, Falkenström F, Gorman BS, McCarthy KS, Milrod B, Rudden MG, Chambless DL, Barber JP. Differential effects of alliance and techniques on Panic-Specific Reflective Function and misinterpretation of bodily sensations in two treatments for panic. Psychother Res 2020; 30:97-111. [PMID: 30821630 PMCID: PMC6778028 DOI: 10.1080/10503307.2019.1585591] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 01/21/2019] [Accepted: 01/21/2019] [Indexed: 10/27/2022] Open
Abstract
ABSTRACTObjective: To examine whether working alliance quality and use of techniques predict improvement in Panic-Specific Reflection Function (PSRF), and misinterpretation of bodily sensations in treatments for panic disorder. Method: A sample of 161 patients received either CBT or PFPP (Panic-focused Psychodynamic therapy) within a larger RCT. Data were collected on patient-reported working alliance, misinterpretations, PSRF, observer-coded use of techniques, and interviewer-rated panic severity. Random-Intercept Cross-Lagged Panel Models assessed bi-directional associations, disentangling within- and between-patient effects, and accounting for prior change. Results: Higher alliance predicted subsequent within-patient improvement in PSRF in PFPP, but worsening in CBT. In both treatments, focus on interpersonal relationships predicted PRSF improvement (with stronger effects in CBT), while focus on thoughts and behaviors predicted worsening in PSRF. In CBT only, early focus on affect and moment-to-moment experience predicted reduced misinterpretation, while high focus on thoughts and cognitions predicted subsequent increase in misinterpretation. Conclusion: The quality of the alliance has differential effects on PSRF in distinct treatments. Interpersonal, rather than cognitive or behavioral focus, even when delivered differently within distinct treatments with high adherence, could facilitate improvement in PSRF. Additionally, early focus on affect and moment-to-moment experiences in CBT could reduce misinterpretations.
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Affiliation(s)
- Nili Solomonov
- The Gordon F. Derner School of Psychology, Adelphi University, Garden City, NY
- Weill Cornell Geriatric Psychiatry Institute, Weill Cornell Medical College, White Plains, NY
- Department of Psychiatry, Weill Cornell Medical College, New York, NY
| | - Fredrik Falkenström
- Center for Clinical Research Sörmland and Department of Neuroscience, Uppsala University, Sweden
| | - Bernard S. Gorman
- The Gordon F. Derner School of Psychology, Adelphi University, Garden City, NY
| | - Kevin S. McCarthy
- Chestnut Hill College, Philadelphia, PA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Barbara Milrod
- Department of Psychiatry, Weill Cornell Medical College, New York, NY
| | - Marie G. Rudden
- Department of Psychiatry, Weill Cornell Medical College, New York, NY
| | | | - Jacques P. Barber
- The Gordon F. Derner School of Psychology, Adelphi University, Garden City, NY
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Abstract
OBJECTIVE To outline the successful psychotherapeutic intervention of two older patients. CONCLUSION Psychodynamic principles should be considered more readily in the treatment of older people.
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Affiliation(s)
- Neil Jeyasingam
- Unit Clinical Director, Northern Beaches Mental Health Service, Senior Clinical Lecturer, Sydney University, Sydney, NSW, Australia
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Parth K, Wolf I, Löffler-Stastka H. Capturing the Unconscious-The "Psychoanalytic Core Competency Q-Sort". An Innovative Tool Investigating Psychodynamic Therapeutic Skills. Int J Environ Res Public Health 2019; 16:ijerph16234700. [PMID: 31779100 PMCID: PMC6926890 DOI: 10.3390/ijerph16234700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 11/21/2019] [Accepted: 11/22/2019] [Indexed: 02/07/2023]
Abstract
The Psychoanalytic Core Competency Q-Sort (PCC Q-Sort) is a newly developed empirical research tool that allows for the description and illustration of the ways psychodynamically-oriented psychotherapists work. It provides a simple, straightforward rating procedure utilizing a well-established q-sort method. The present pilot study describes the psychoanalytic core competency items and discusses the development procedure of the instrument as well as statistical analysis of ratings from psychoanalytic sessions, including inter-rater reliability as well as preliminary findings on possible construct validity. Additionally, a factor analysis was performed. Values were assessed by applying the PCC Q-Sort to 30 audio recordings of psychoanalytic sessions. The results of the present study indicate that the PCC Q-Sort is a reliable process research instrument that allows for a detailed investigation of psychotherapy processes in psychodynamic psychotherapies and change processes.
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Affiliation(s)
- Karoline Parth
- Department of Psychoanalysis and Psychotherapy, Medical University, A-1090 Vienna, Austria;
| | - Isabelle Wolf
- University Program for Psychotherapy Research, Postgraduate Unit, Medical University, A-1090 Vienna, Austria;
| | - Henriette Löffler-Stastka
- Department of Psychoanalysis and Psychotherapy, Medical University, A-1090 Vienna, Austria;
- University Program for Psychotherapy Research, Postgraduate Unit, Medical University, A-1090 Vienna, Austria;
- Correspondence: ; Tel.: +43-1-40400-30700
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Brugnera A, Carlucci S, Compare A, Tasca GA. Persistence of friendly and submissive interpersonal styles among those with binge-eating disorder: Comparisons with matched controls and outcomes after group therapy. Clin Psychol Psychother 2019; 26:603-615. [PMID: 31219207 DOI: 10.1002/cpp.2385] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 05/22/2019] [Accepted: 06/05/2019] [Indexed: 02/06/2023]
Abstract
Interpersonal problems play a prominent role in the development of binge-eating disorder (BED), so reducing their intensity may be a key focus of many psychological interventions. In recent years, several interpersonal treatments for BED were developed, which posit that binge eating arises to manage relational problems. However, few studies have evaluated the prototypical interpersonal problems, and no studies evaluated the longitudinal changes in interpersonal functioning after treatment within this population. We investigated the severity and prototypicality of interpersonal problems of 101 overweight women with BED from pre-group psychodynamic-interpersonal psychotherapy (GPIP) to 12 months post-GPIP. At baseline, we compared patients' interpersonal problems with two groups of matched controls (46 overweight and 49 normal weight women without a diagnosis of BED) and examined circular correlations between relational problems, depressive symptoms, and binge-eating frequency. Results showed that participants with BED had significantly higher levels of interpersonal problems compared with the matched control samples, with predominantly nonassertive and exploitable styles. Depressive symptoms were related to the presence of friendly-submissive interpersonal problems only among those with BED. Although the intensity of nonassertive interpersonal problems of patients with BED decreased post-group treatment, their profiles remained prototypically nonassertive and exploitable across all time points. Women with BED experience higher levels of interpersonal difficulties exemplified by an exploitable/nonassertive style that significantly improve but continue to prevail even after treatment. Clinicians might modify interventions to focus on increasing interpersonal skills and decreasing interpersonal dysfunctions among those with BED.
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Affiliation(s)
- Agostino Brugnera
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | | | - Angelo Compare
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | - Giorgio A Tasca
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
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Marble A, Høglend P, Ulberg R. Patients' Representation of the Therapeutic Dialogue and the Outcome of Therapy. Psychother Psychosom 2019; 88:39-40. [PMID: 30149384 DOI: 10.1159/000492618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 08/01/2018] [Indexed: 11/19/2022]
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Løvgren A, Røssberg JI, Nilsen L, Engebretsen E, Ulberg R. How do adolescents with depression experience improvement in psychodynamic psychotherapy? A qualitative study. BMC Psychiatry 2019; 19:95. [PMID: 30898111 PMCID: PMC6429792 DOI: 10.1186/s12888-019-2080-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 03/18/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND There is emerging evidence for the effectiveness of psychodynamic psychotherapy for depressive disorders. However, we know less of how this relation-focused therapy mode is experienced and what the patients themselves identify as helpful. Hence, the purpose of this study is to explore adolescents' experiences of factors promoting improvement in psychodynamic therapy. METHODS Eight female patients participating in a Norwegian study on psychodynamic therapy, the First Experimental Study of Transference Work - In Teenagers (FEST-IT), were included. The participants were offered a total number of 28 sessions. Semi-structured qualitative interviews about experiences with therapy were then conducted and analysed with systematic text condensation and hermeneutic interpretation. RESULTS The analysis revealed four main themes. 'Exploring oneself' comprises autonomy and acknowledgment, openness, insight and acceptance of oneself. 'Therapist relation and characteristics' includes confidence and trust in and support from the therapist as well as having a trustworthy and experienced therapist. 'Focusing on everyday life' includes learning and practical orientation. 'Time factors' refers to duration and frequency. CONCLUSIONS Together with a supportive and listening therapist, the adolescents improve by exploring themselves within the frames of a time-limited treatment period. Improvement seems to be experienced through better relations to oneself and to others and by finding one's place in the family, or at school. Adolescents value problem solving and help with concrete challenges. Hence, therapy should be tailored to the needs of adolescents with depression and incorporate the challenges they face in their everyday life. TRIAL REGISTRATION ClinicalTrials.gov . Id: NCT01531101. Date of registry: 8 February 2012, retrospectively registered.
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Affiliation(s)
- André Løvgren
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. box 4959, N-0424 Nydalen, Oslo Norway
- University of Oslo, Institute of Clinical Medicine, P.O. box 1171, 0318 Blindern, Oslo Norway
| | - Jan Ivar Røssberg
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. box 4959, N-0424 Nydalen, Oslo Norway
- University of Oslo, Institute of Clinical Medicine, P.O. box 1171, 0318 Blindern, Oslo Norway
| | - Liv Nilsen
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. box 4959, N-0424 Nydalen, Oslo Norway
| | - Eivind Engebretsen
- University of Oslo, Institute of Health and Society, P.O. box 1130, 0318 Blindern, Oslo Norway
| | - Randi Ulberg
- University of Oslo, Institute of Clinical Medicine, P.O. box 1171, 0318 Blindern, Oslo Norway
- Vestfold Hospital Trust, Division of Mental Health, Research Unit, P.O. box 2169, 3125 Tønsberg, Norway
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Ravitz P, Lawson A, Fefergrad M, Rawkins S, Lancee W, Maunder R, Leszcz M, Kivlighan DM. Psychotherapy Competency Milestones: an Exploratory Pilot of CBT and Psychodynamic Psychotherapy Skills Acquisition in Junior Psychiatry Residents. Acad Psychiatry 2019; 43:61-66. [PMID: 29858773 DOI: 10.1007/s40596-018-0940-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 05/10/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Psychiatry residents train in Psychodynamic Psychotherapy and Cognitive Behavioral Therapy (CBT), evidence-supported treatments used in mental health care that can facilitate clinical reasoning, foster therapeutic alliances, and improve clinical outcomes. However, empirically derived milestones are needed to evaluate competency. This exploratory pilot examined changes over 1 year of training in junior psychiatry residents' competency milestone elements in Psychodynamic Psychotherapy and CBT. METHODS Seventy-nine randomly selected audio-recorded sessions from differing phases of Psychodynamic Psychotherapy and CBT with five junior residents and ten patients were rated using the Psychotherapy Process Q-sort (PQS). RESULTS In both treatments, patient engagement with attention to in-session emotions improved. In CBT, residents were directive, supported patients' self-efficacy, emphasized patients' accepting responsibility for their problems, discussed homework such as thought records, and focused on termination in the concluding sessions. In Psychodynamic Psychotherapy, residents attended to emotional arousal and linked patients' feelings or perceptions to past situations or behavior. Growth and hierarchical linear modeling differentiated these treatments, with CBT v. Psychodynamic adherence to PQS modality-specific ideal elements being 52% v.19%. CONCLUSION Teaching and observation using empirically derived observable psychotherapy practice behaviors is feasible and can be used to assess milestone elements for competency-based education of psychiatry trainees.
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Lindfors O, Knekt P, Lehtonen J, Virtala E, Maljanen T, Härkänen T. Effectiveness of psychoanalysis and long-term psychodynamic psychotherapy on personality and social functioning 10 years after start of treatment. Psychiatry Res 2019; 272:774-783. [PMID: 30832198 DOI: 10.1016/j.psychres.2018.12.082] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 11/30/2018] [Accepted: 12/16/2018] [Indexed: 11/18/2022]
Abstract
The evidence on potentially greater benefits of psychoanalysis (PA) vs. long-term psychodynamic psychotherapy (LPP) is scarce. This study compared the effectiveness of PA and LPP on personality and social functioning during a 10-year follow-up from the beginning of the treatments. The eligible patients, 41 self-selected for PA and 128 assigned to LPP, were 20-45 years of age and had anxiety or mood disorder. Outcomes were analyzed using ten standard measures of personality and social functioning, carried out 5-9 times during the follow-up. Different change patterns by time in PA and LPP emerged, suggesting less benefit of PA during the first years of follow-up and more benefit in most outcomes thereafter. Greater post-treatment improvement in PA than in LPP was seen up to 1-2 years after PA had ended in more mature defense style (DSQ), level of personality organization (LPO), more positive self-concept (SASB), more improved social adjustment (SAS-SR) and sense of coherence (SOC). However, at the 10-year follow-up the differences were non-significant. In conclusion, PA may give some additional benefits when long-term aims are linked to personality and social functioning. The relatively small differences and higher costs in comparison to LPP may restrict the feasibility of PA.
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Affiliation(s)
- Olavi Lindfors
- National Institute for Health and Welfare, P. O. Box 30, 00271, Helsinki, Finland; University of Helsinki, Helsinki, Finland.
| | - Paul Knekt
- National Institute for Health and Welfare, P. O. Box 30, 00271, Helsinki, Finland; Biomedicum Helsinki, Helsinki, Finland
| | - Johannes Lehtonen
- National Institute for Health and Welfare, P. O. Box 30, 00271, Helsinki, Finland; University of Eastern Finland, Kuopio, Finland
| | - Esa Virtala
- National Institute for Health and Welfare, P. O. Box 30, 00271, Helsinki, Finland
| | - Timo Maljanen
- The Social Insurance Institution, Helsinki, Finland; National Institute for Health and Welfare, P. O. Box 30, 00271, Helsinki, Finland
| | - Tommi Härkänen
- National Institute for Health and Welfare, P. O. Box 30, 00271, Helsinki, Finland
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Löffler-Stastka H, Sell C, Zimmermann J, Huber D, Klug G. Is countertransference a valid source of clinical information? Investigating emotional responses to audiotaped psychotherapy sessions. Bull Menninger Clin 2019; 83:353-375. [PMID: 31180236 DOI: 10.1521/bumc_2019_83_02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The study aimed to test whether countertransference reactions contain valid information about the patient. The authors examined whether a significant part of the variance in emotional, cognitive, and motivational responses to recorded therapy sessions is attributable to the patient. Six student raters listened to 605 audiotaped sessions of 81 patients with major depression treated by 19 therapists and indicated their reactions using a modified version of the Countertransference Questionnaire. The relative amount of variance in countertransference reactions due to differences between patients, ranging from 2% to 16%, was significant for most of the countertransference dimensions. Reactions were influenced by type of treatment and severity of depression but not by comorbid personality disorder or interpersonal problems. The relative amount of variance due to differences between raters was large, averaging at 23%. The authors conclude that-albeit having a relatively low "signal-to-noise ratio"in raters without psychotherapy training-countertransference reactions contain valid clinical information.
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Affiliation(s)
| | | | | | - Dorothea Huber
- International Psychoanalytic University Berlin, Berlin, Germany
| | - Guenther Klug
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Technische Universität München, Germany
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Clemons M, Mazzarello S, Pond G, Amir E, Asmis T, Berry S, Brackstone M, Brule S, Goodwin R, Hilton JF, Julião M, Nicholas G, Stewart DJ, Wheatley-Price P, Cholmsky L, Krentel A, Hutton B, Joy AA. A prospective intervention to improve happiness and reduce burnout in oncologists. Support Care Cancer 2018; 27:1563-1572. [PMID: 30506102 DOI: 10.1007/s00520-018-4567-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 11/20/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is a paucity of data about effective interventions to improve happiness and reduce burnout in oncologists. Benjamin Franklin developed a 13-week program of "necessary activities" or "virtues" (temperance, silence, order, resolution, frugality, industry, sincerity, justice, moderation, cleanliness, tranquility, chastity, and humility) to follow, in his attempt at self-improvement. In this pilot study, we explored whether using a modified version of this was associated with any discernable impact on physician happiness, burnout, or compliance with each of the virtues. METHODS Self-reported happiness (Oxford happiness scores) and burnout (Abbreviated Maslach Burnout Inventory) were completed at baseline (pre-study), week 13, and 1 month after completion of the program. Each day during the 13-week program, oncologists were emailed a list of virtues to focus on and scored how they felt they were complying with them. The oncologist's spouses also assessed how they felt the oncologist was complying with the virtues. RESULTS Thirteen physicians completed the baseline scores, 11 completed Maslach/Oxford scores at the end of the study, and 8 the 1-month post-study assessment. No significant improvements in happiness and burnout (emotional exhaustion, depersonalization, personal accomplishment) scores were observed. Statistically significant changes in self-rated virtue scores were observed for temperance (p = 0.046), order (p = 0.049), and resolution (p = 0.014). Additionally, although not reaching statistical significance, 11 of 13 virtues (excepting sincerity and chastity) assessed by spouses indicated a positive change over time. CONCLUSION In this hypothesis generating study, daily reflection on personal virtues was not associated with any statistically significant change in happiness or burnout scores. Alternative strategies should be considered.
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Affiliation(s)
- Mark Clemons
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital and University of Ottawa, 501 Smyth Road, Box 912, Ottawa, ON, K1H 8L6, Canada.
- Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Canada.
| | - Sasha Mazzarello
- Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Canada
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada
| | - Gregory Pond
- Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Canada
| | - Eitan Amir
- Princess Margaret Cancer Centre, Toronto, Canada
| | - Timothy Asmis
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital and University of Ottawa, 501 Smyth Road, Box 912, Ottawa, ON, K1H 8L6, Canada
- Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Canada
| | - Scott Berry
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Canada
| | | | - Stephanie Brule
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital and University of Ottawa, 501 Smyth Road, Box 912, Ottawa, ON, K1H 8L6, Canada
| | - Rachel Goodwin
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital and University of Ottawa, 501 Smyth Road, Box 912, Ottawa, ON, K1H 8L6, Canada
| | - John F Hilton
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital and University of Ottawa, 501 Smyth Road, Box 912, Ottawa, ON, K1H 8L6, Canada
- Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Canada
| | - Miguel Julião
- Equipa Comunitária de Suporte em Cuidados Paliativos ACES Sintra, Sintra, Portugal
| | - Garth Nicholas
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital and University of Ottawa, 501 Smyth Road, Box 912, Ottawa, ON, K1H 8L6, Canada
| | - David J Stewart
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital and University of Ottawa, 501 Smyth Road, Box 912, Ottawa, ON, K1H 8L6, Canada
- Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Canada
| | - Paul Wheatley-Price
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital and University of Ottawa, 501 Smyth Road, Box 912, Ottawa, ON, K1H 8L6, Canada
- Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Canada
| | - Laurel Cholmsky
- Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Canada
| | | | - Brian Hutton
- Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Canada
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada
| | - Anil A Joy
- Division of Medical Oncology, Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, Canada
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Sankar A, Melin A, Lorenzetti V, Horton P, Costafreda SG, Fu CHY. A systematic review and meta-analysis of the neural correlates of psychological therapies in major depression. Psychiatry Res Neuroimaging 2018; 279:31-39. [PMID: 30081291 DOI: 10.1016/j.pscychresns.2018.07.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 07/22/2018] [Accepted: 07/25/2018] [Indexed: 12/18/2022]
Abstract
Longitudinal neuroimaging studies in major depression have revealed cortico-limbic abnormalities which are modulated by treatment. We performed a systematic review and meta-analysis of psychotherapy treatment studies measuring neural function and metabolism using fMRI, PET, SPECT and MRS. Seventeen studies were included in the systematic review, total of 200 major depression participants (mean age 37.6 years), all medication free, and 116 healthy controls (mean age 36.4 years). Neuroimaging assessments were performed prior to initiation of treatment and following course of treatment. Treatment durations were: 16-30 weeks for CBT, 11 weeks for behavioral activation therapy, and up to 15 months for psychodynamic psychotherapy. The meta-analysis consisted of studies in which both groups had same serial scans and comparable tasks; total of 5 studies with visual presentation tasks of emotional stimuli: 55 patients (mean age: 38.7 years) and 55 healthy controls (mean age: 36.3 years). The meta-analysis revealed a significant group by time effect in left rostral anterior cingulate, in which patients showed increased activity following psychotherapy while healthy controls showed a decrease at follow up. Longitudinal treatment effects revealed reduced left precentral cortical activity in major depression. Findings could be indicative of improvements in emotion responsivity that may be achieved following psychotherapy.
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Affiliation(s)
- Anjali Sankar
- Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Alice Melin
- School of Psychology, College of Applied Health and Communities, University of East London, London, UK
| | - Valentina Lorenzetti
- School of Psychology, Australian Catholic University, Melbourne, VIC, Australia; Department of Psychological Sciences, Institute of Health and Society, University of Liverpool, Liverpool, UK
| | - Paul Horton
- Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sergi G Costafreda
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Cynthia H Y Fu
- Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; School of Psychology, College of Applied Health and Communities, University of East London, London, UK.
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Beutel ME, Greenberg L, Lane RD, Subic-Wrana C. Treating anxiety disorders by emotion-focused psychodynamic psychotherapy (EFPP)-An integrative, transdiagnostic approach. Clin Psychol Psychother 2018; 26:1-13. [PMID: 30255535 DOI: 10.1002/cpp.2325] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 08/03/2018] [Accepted: 08/03/2018] [Indexed: 11/07/2022]
Abstract
Anxiety disorders are characterized by high levels of anxiety and avoidance of anxiety-inducing situations and of negative emotions such as anger. Emotion-focused therapy (EFT) and psychodynamic psychotherapy (PP) have underscored the therapeutic significance of processing and transforming repressed or disowned conflicted or painful emotions. Although PP provides sophisticated means of processing intrapsychic and interpersonal conflict, EFT has empirically tested a set of techniques to access, deepen, symbolize, and transform emotions consistent with current conceptualizations of emotions and memory. Based on our clinical experience, we propose that an integrative emotion-focused and psychodynamic approach opens new avenues for treating anxiety disorders effectively, and we present a transdiagnostic manual for emotion-focused psychodynamic psychotherapy. The therapeutic approach takes into account both the activation, processing, and modification of emotion and the underlying intrapsychic and interpersonal conflicts. The short-term treatment is based on the three phases of initiating treatment, therapeutic work with anxiety, and termination. Emotional poignancy (or liveliness) is an important marker for emotional processing throughout treatment. Instead of exposure to avoided situations, we endorse enacting the internal process of generating anxiety in the session providing a sense of agency and access to warded-off emotions. Interpretation serves to tie together emotional experience and insight into the patterns and the nature of underlying intrapersonal and interpersonal conflict. Treatment modules are illustrated by brief vignettes from pilot treatments.
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Affiliation(s)
- Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, Johannes Gutenberg University Mainz, Mainz, Germany
| | | | - Richard D Lane
- Department of Psychiatry, University of Arizona, Tucson, Arizona, USA
| | - Claudia Subic-Wrana
- Department of Psychosomatic Medicine and Psychotherapy, Johannes Gutenberg University Mainz, Mainz, Germany
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Kool M, Van HL, Bartak A, de Maat SCM, Arntz A, van den Eshof JW, Peen J, Blankers M, Bosmans JE, Dekker JJM. Optimizing psychotherapy dosage for comorbid depression and personality disorders (PsyDos): a pragmatic randomized factorial trial using schema therapy and short-term psychodynamic psychotherapy. BMC Psychiatry 2018; 18:252. [PMID: 30086730 PMCID: PMC6081852 DOI: 10.1186/s12888-018-1829-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 07/25/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Patients with comorbid depression and personality disorders suffer from a heavy disease burden while tailored treatment options are limited, accounting for a high psychological and economic burden. Little is known about the effect of treatment dosage and type of psychotherapy for this specific co-morbid patient population, in terms of treatment-effect and cost-effectiveness. This study aims to compare treatment outcome of 25 versus 50 individual therapy sessions in a year. We expect the 50-session condition to be more effective in treating depression and maintaining the effect. Secondary objectives will be addressed in order to find therapy-specific and non-specific mechanisms of change. METHODS In a mono-center pragmatic randomized controlled trial with a 2 × 2 factorial design, 200 patients with a depressive disorder and personality disorder(s) will be included. Patients will be recruited from a Dutch mental health care institute for personality disorders. They will be randomized over therapy dosage (25 vs 50 sessions in a year) and type of therapy (schema therapy vs short-term psychodynamic supportive psychotherapy). The primary clinical outcome measure will be depression severity and remission. Changes in personality functioning and quality of life will be investigated as secondary outcomes. A priori postulated effect moderators and mediators will be collected as well. All patients are assessed at baseline and at 1, 2, 3, 6, 9-12 months (end of therapy) and at follow up (6 and 12 months after end of treatment). Alongside the trial, an economic evaluation will be conducted. Costs will be collected from a societal perspective. DISCUSSION This trial will be the first to compare two psychotherapy dosages in patients with both depression and personality disorders. Insight in the effect of treatment dosage for this patient group will contribute to both higher treatment effectiveness and lower costs. In addition, this study will contribute to the limited evidence base on treating patients with both depression and personality disorders. Understanding the processes that account for the therapeutic changes could help to gain insight in what works for whom. TRIAL REGISTRATION This trial has been registered on July 20th 2016, Netherlands Trial Register, part of the Dutch Cochrane Centre ( NTR5941 ).
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Affiliation(s)
- Marit Kool
- Arkin Mental Health Care, Domselaerstraat 128, 1093 MB Amsterdam, the Netherlands
| | - Henricus L. Van
- Arkin Mental Health Care, Domselaerstraat 128, 1093 MB Amsterdam, the Netherlands
| | - Anna Bartak
- Arkin Mental Health Care, Domselaerstraat 128, 1093 MB Amsterdam, the Netherlands
| | - Saskia C. M. de Maat
- Arkin Mental Health Care, Domselaerstraat 128, 1093 MB Amsterdam, the Netherlands
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Jaap Peen
- Department of Research, Arkin Mental Health Care, Amsterdam, the Netherlands
| | - Matthijs Blankers
- Department of Research, Arkin Mental Health Care, Amsterdam, the Netherlands
- Amsterdam UMC, Location AMC, Department of Psychiatry, University of Amsterdam, Amsterdam, the Netherlands
- Trimbos Institute – Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Judith E. Bosmans
- Department of Health Sciences, Faculty of Earth & Life Sciences, Free University Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Jack J. M. Dekker
- Department of Research, Arkin Mental Health Care, Amsterdam, the Netherlands
- Department of Clinical Psychology, VU University of Amsterdam, Amsterdam, the Netherlands
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Franklin TN. Psychodynamic Psychiatry: Clinical, Practical, Patient Centered, and Evidence-Based. Psychiatr Clin North Am 2018; 41:xv-xvi. [PMID: 29739532 DOI: 10.1016/j.psc.2018.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Thomas N Franklin
- The Retreat at Sheppard Pratt, Sheppard Pratt Health System, 6501 North Charles Street, Baltimore, MD 21204, USA.
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41
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Driessen E, Abbass AA, Barber JP, Connolly Gibbons MB, Dekker JJM, Fokkema M, Fonagy P, Hollon SD, Jansma EP, de Maat SCM, Town JM, Twisk JWR, Van HL, Weitz E, Cuijpers P. Which patients benefit specifically from short-term psychodynamic psychotherapy (STPP) for depression? Study protocol of a systematic review and meta-analysis of individual participant data. BMJ Open 2018; 8:e018900. [PMID: 29463590 PMCID: PMC5855455 DOI: 10.1136/bmjopen-2017-018900] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Short-term psychodynamic psychotherapy (STPP) is an empirically supported treatment that is often used to treat depression. However, it is largely unclear if certain subgroups of depressed patients can benefit specifically from this treatment method. We describe the protocol for a systematic review and meta-analysis of individual participant data (IPD) aimed at identifying predictors and moderators of STPP for depression efficacy. METHOD AND ANALYSIS We will conduct a systematic literature search in multiple bibliographic databases (PubMed, PsycINFO, Embase.com, Web of Science and Cochrane's Central Register of Controlled Trials), 'grey literature' databases (GLIN and UMI ProQuest) and a prospective trial register (http://www.controlled-trials.com). We will include studies reporting (a) outcomes on standardised measures of (b) depressed (c) adult patients (d) receiving STPP. We will next invite the authors of these studies to share the participant-level data of their trials and combine these data to conduct IPD meta-analyses. The primary outcome for this study is post-treatment efficacy as assessed by a continuous depression measure. Potential predictors and moderators include all sociodemographic variables, clinical variables and psychological patient characteristics that are measured before the start of treatment and are assessed consistently across studies. One-stage IPD meta-analyses will be conducted using mixed-effects models. ETHICS AND DISSEMINATION Institutional review board approval is not required for this study. We intend to submit reports of the outcomes of this study for publication to international peer-reviewed journals in the fields of psychiatry or clinical psychology. We also intend to present the outcomes at international scientific conferences aimed at psychotherapy researchers and clinicians. The findings of this study can have important clinical implications, as they can inform expectations of STPP efficacy for individual patients, and help to make an informed choice concerning the best treatment option for a given patient. PROSPERO REGISTRATION NUMBER CRD42017056029.
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Affiliation(s)
- Ellen Driessen
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Allan A Abbass
- Centre for Emotions & Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jacques P Barber
- Gordon F. Derner School of Psychology, Adelphi University, Garden City, New York, USA
| | | | - Jack J M Dekker
- Department of Research, Arkin Mental Health Care, Amsterdam, Netherlands
| | - Marjolein Fokkema
- Department of Methodology and Statistics, Leiden University, Leiden, Netherlands
| | - Peter Fonagy
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Steven D Hollon
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA
| | - Elise P Jansma
- University Library, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Saskia C M de Maat
- Dutch Psychoanalytic Institute, Arkin Mental Health Care, Amsterdam, Netherlands
| | - Joel M Town
- Centre for Emotions & Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jos W R Twisk
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Amsterdam, Netherlands
| | - Henricus L Van
- Dutch Psychoanalytic Institute, Arkin Mental Health Care, Amsterdam, Netherlands
| | - Erica Weitz
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Bachar E. Evidence Basis for Psychodynamic Self-Psychology in Eating Disorders - A Review Paper. Isr J Psychiatry 2018; 55:19-24. [PMID: 29916403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The purpose of the present study is to present the empirical basis for the capability of the theory of psychodynamic self-psychology to predict in crosssectional and prospective longitudinal studies, both the development of and the remission from eating disorders. In addition, we present the effectiveness of psychodynamic self-psychological treatment in a randomized control study over two other techniques. Theoretical constructs of the theory and technique suggestions will be weaved into the empirical data.
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Affiliation(s)
- Eytan Bachar
- Department of Psychiatry, Hadassah University Medical Center, and the Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel
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Abstract
The study and use of resilience is of the utmost importance to psychodynamic psychiatry. It is deeply ingrained in ideas about well-being and the treatment and care of patients. However, its neurobiology is incompletely understood, its terminology and relation to trauma and coping not well defined, and its efficacy underutilized in clinical practice. This article reviews the scientific literature on resilience, especially as it relates to trauma and coping. It also attempts to point the way for its greater application in psychiatry and mental health by utilizing resilience in more informed and individualized approaches.
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Affiliation(s)
- Ahron Friedberg
- Clinical Professor of Psychiatry at Mount Sinai in New York City
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Strauss B, Koranyi S, Altmann U, Nolte T, Beutel ME, Wiltink J, Herpertz S, Hiller W, Hoyer J, Joraschky P, Nolting B, Stangier U, Willutzki U, Salzer S, Leibing E, Leichsenring F, Kirchmann H. Partner-related attachment as a moderator of outcome in patients with social anxiety disorder-a comparison between short-term cognitive-behavioral and psychodynamic therapy. ACTA ACUST UNITED AC 2017; 54:339-350. [PMID: 29251953 DOI: 10.1037/pst0000129] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study investigated whether partner-related attachment characteristics differentially predict premature treatment termination as well as posttreatment and 1-year follow-up outcome in patients with social anxiety disorder treated with a manualized cognitive-behavioral therapy (CBT) or short-term psychodynamic therapy (PDT) in the SOPHO-NET (Social Phobia Psychotherapy Network) trial. Participants were 412 patients with social anxiety disorder (57% female) with a mean age of 35.4 years (SD = 12.1) who were randomized to either CBT or PDT. Partner-related attachment characteristics were measured using the revised Experiences in Close Relationships Questionnaire (ECR-R) at pretreatment. The Liebowitz Social Anxiety Scale was administered at pretreatment, posttreatment, and a 1-year follow-up. To address our research questions, linear regression models were applied. Furthermore, we compared CBT versus PDT patients within ECR-R quartiles. Treatment dropout did not differ between CBT and PDT and was not predicted by pretreatment attachment. In both treatment conditions, there was a trend for higher attachment anxiety to be associated with a more limited reduction in symptoms if controlling for pretreatment Liebowitz Social Anxiety Scale scores. Exploratory analyses showed that patients assigned to the highest quartile of the ECR-R-Avoidance distribution showed more benefit within the CBT condition posttreatment and at follow-up than the PDT condition. Our findings suggest that it may be useful to assess attachment characteristics in patients with social anxiety disorder before psychotherapeutic treatment. Patients characterized by very high pretreatment attachment avoidance (ECR-R-Avoidance >3.87) may specifically benefit more from CBT than from PDT. However, replication studies are needed that also should investigate nonlinear effects of pretreatment attachment. (PsycINFO Database Record
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Affiliation(s)
- Bernhard Strauss
- Institute of Psychosocial Medicine and Psychotherapy, University Hospital Jena
| | - Susan Koranyi
- Institute of Psychosocial Medicine and Psychotherapy, University Hospital Jena
| | - Uwe Altmann
- Institute of Psychosocial Medicine and Psychotherapy, University Hospital Jena
| | | | - Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg University of Mainz
| | - Jörg Wiltink
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg University of Mainz
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Clinic Bochum, Ruhr-University Bochum
| | - Wolfgang Hiller
- Department of Clinical Psychology and Psychotherapy, Johannes Gutenberg University of Mainz
| | - Jürgen Hoyer
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden
| | - Peter Joraschky
- Department of Psychotherapy and Psychosomatic Medicine, Technische Universitaet Dresden
| | | | - Ulrich Stangier
- Department of Clinical Psychology and Psychotherapy, Goethe University Frankfurt
| | - Ulrike Willutzki
- Department of Psychology and Psychotherapy, University Witten/Herdecke
| | - Simone Salzer
- Department of Psychosomatic Medicine and Psychotherapy, University Medicine, Georg-August-University Goettingen
| | - Erik Leibing
- Department of Psychosomatic Medicine and Psychotherapy, University Medicine, Georg-August-University Goettingen
| | - Falk Leichsenring
- University Hospital of Psychosomatics and Psychotherapy, Justus-Liebig-University Giessen
| | - Helmut Kirchmann
- Institute of Psychosocial Medicine and Psychotherapy, University Hospital Jena
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Abstract
This essay reviews the most significant contributions of psychodynamic thought to the field of couple therapy. It distills the work of numerous clinicians and researchers who, though writing from diverse perspectives, share fundamental assumptions and concerns. Rather than emphasizing differences between schools of thought, this paper mines their best contributions in a discussion of five central therapeutic targets: underlying issues, divergent subjective experiences, transferences, projective identification, and acceptance. Two detailed cases illustrate the benefits and techniques for targeting these five therapeutic domains. Video Abstract is found in the online version of the article.
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Gumz A, Neubauer K, Horstkotte JK, Geyer M, Löwe B, Murray AM, Kästner D. A bottom-up approach to assess verbal therapeutic techniques. Development of the Psychodynamic Interventions List (PIL). PLoS One 2017; 12:e0182949. [PMID: 28837582 PMCID: PMC5570429 DOI: 10.1371/journal.pone.0182949] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 07/27/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Knowing which specific verbal techniques "good" therapists use in their daily work is important for training and evaluation purposes. In order to systematize what is being practiced in the field, our aim was to empirically identify verbal techniques applied in psychodynamic sessions and to differentiate them according to their basic semantic features using a bottom-up, qualitative approach. METHOD Mixed-Method-Design: In a comprehensive qualitative study, types of techniques were identified at the level of utterances based on transcribed psychodynamic therapy sessions using Qualitative Content Analysis (4211 utterances). The definitions of the identified categories were successively refined and modified until saturation was achieved. In a subsequent quantitative study, inter-rater reliability was assessed both at the level of utterances (n = 8717) and at the session level (n = 38). The convergent validity of the categories was investigated by analyzing associations with the Interpretive and Supportive Technique Scale (ISTS). RESULTS The inductive approach resulted in a classification system with 37 categories (Psychodynamic Interventions List, PIL). According to their semantic content, the categories can be allocated to three dimensions: form (24 categories), thematic content (9) and temporal focus (4). Most categories showed good or excellent inter-rater reliability and expected associations with the ISTS were predominantly confirmed. The rare use of the residual category "Other" suggests that the identified categories might comprehensively describe the breadth of applied techniques. CONCLUSIONS The atheoretical orientation and the clear focus on overt linguistic features should enable the PIL to be used without intensive training or prior theoretical knowledge. The PIL can be used to investigate the links between verbal techniques derived from practice and micro-outcomes (at the session level) as well as the overall therapeutic outcomes. This approach might enable us to determine to what extent the outcome of therapy is due to unintended or non-theoretically relevant techniques.
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Affiliation(s)
- Antje Gumz
- Berlin University of Psychology (PHB), Berlin, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Hamburg-Eppendorf and Schön Klinik Hamburg Eilbek, Hamburg, Germany
- * E-mail:
| | - Karolin Neubauer
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Hamburg-Eppendorf and Schön Klinik Hamburg Eilbek, Hamburg, Germany
| | | | | | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Hamburg-Eppendorf and Schön Klinik Hamburg Eilbek, Hamburg, Germany
| | - Alexandra M. Murray
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Hamburg-Eppendorf and Schön Klinik Hamburg Eilbek, Hamburg, Germany
| | - Denise Kästner
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Hamburg-Eppendorf and Schön Klinik Hamburg Eilbek, Hamburg, Germany
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Olano FA, Rosenbaum B. [Evidence of the effect of psychodynamic psychotherapy]. Ugeskr Laeger 2017; 179:V11160794. [PMID: 28504637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Evidence of the effect of psychodynamic psychotherapy (PDT) has been called into question. Thus, an updated review of the effect of short-term and long-term PDT (STPP and LTPP) for anxiety, depression and personality disorders seems necessary. A systematic search of randomized controlled studies of PDT published from January 2000 to May 2016 was conducted, and we found 57 single studies and 13 meta-analyses fulfilling the criteria for inclusion. The studies show that PDT has therapeutic efficacy and effectiveness matching other forms of psychotherapy. LTPP shows better effect than STPP in the treatment of complex psychiatric disorders and long-term depression.
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Abstract
Clinical errors tend to be underreported even though examining them can provide important training and professional development opportunities. The group therapy context may be prone to clinician errors because of the added complexity within which therapists work and patients receive treatment. We discuss clinical errors that occurred within a group therapy in which a patient for whom group was not appropriate was admitted to the treatment and then was not removed by the clinicians. This was countertherapeutic for both patient and group. Two clinicians were involved: a clinical supervisor who initially assessed and admitted the patient to the group, and a group therapist. To complicate matters, the group therapy occurred within the context of a clinical research trial. The errors, possible solutions, and recommendations are discussed within Reason's Organizational Accident Model (Reason, 2000). In particular, we discuss clinician errors in the context of countertransference and clinician heuristics, group therapy as a local work condition that complicates clinical decision-making, and the impact of the research context as a latent organizational factor. We also present clinical vignettes from the pregroup preparation, group therapy, and supervision. Group therapists are more likely to avoid errors in clinical decisions if they engage in reflective practice about their internal experiences and about the impact of the context in which they work. Therapists must keep in mind the various levels of group functioning, especially related to the group-as-a-whole (i.e., group composition, cohesion, group climate, and safety) when making complex clinical decisions in order to optimize patient outcomes. (PsycINFO Database Record
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Abstract
Obsessive-compulsive disorder (OCD) is a debilitating psychiatric disorder that often runs a chronic unremitting course. Treatment outcomes can be unsatisfactory despite the availability of various somatic and psychological therapies. Psychodynamic psychotherapy in combination with cognitive behavioral therapy (CBT) with exposure and response prevention (ERP) could help patients with treatment-resistant OCD achieve better outcomes. An integrative approach can help patients gain insight, strengthen the therapeutic alliance, improve treatment adherence, and provide symptomatic relief when other treatments seem insufficient or have failed. We describe the treatment process of a person with treatment-resistant OCD who received pharmacotherapy, concurrent CBT/ERP, and a brief course of psychodynamic psychotherapy. Case formulations from cognitive behavioral and psychodynamic perspectives are presented. The authors discuss the advantages of doing a psychodynamic assessment and formulation in treatment refractory cases and the wisdom of integrating psychotherapy interventions for OCD, as well as the unique clinical features of cases that warrant a multimodal treatment approach.
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Affiliation(s)
- Luke Sy-Cherng Woon
- Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
| | - Anita Kanapathy
- Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
| | - Hazli Zakaria
- Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
| | - César A Alfonso
- Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
- Columbia University Medical Center Department of Psychiatry, New York
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50
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Egger N, Wild B, Zipfel S, Junne F, Konnopka A, Schmidt U, de Zwaan M, Herpertz S, Zeeck A, Löwe B, von Wietersheim J, Tagay S, Burgmer M, Dinkel A, Herzog W, König HH. Cost-effectiveness of focal psychodynamic therapy and enhanced cognitive-behavioural therapy in out-patients with anorexia nervosa. Psychol Med 2016; 46:3291-3301. [PMID: 27609525 DOI: 10.1017/s0033291716002002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Anorexia nervosa (AN) is a serious illness leading to substantial morbidity and mortality. The treatment of AN very often is protracted; repeated hospitalizations and lost productivity generate substantial economic costs in the health care system. Therefore, this study aimed to determine the differential cost-effectiveness of out-patient focal psychodynamic psychotherapy (FPT), enhanced cognitive-behavioural therapy (CBT-E), and optimized treatment as usual (TAU-O) in the treatment of adult women with AN. METHOD The analysis was conducted alongside the randomized controlled Anorexia Nervosa Treatment of OutPatients (ANTOP) study. Cost-effectiveness was determined using direct costs per recovery at 22 months post-randomization (n = 156). Unadjusted incremental cost-effectiveness ratios (ICERs) were calculated. To derive cost-effectiveness acceptability curves (CEACs) adjusted net-benefit regressions were applied assuming different values for the maximum willingness to pay (WTP) per additional recovery. Cost-utility and assumptions underlying the base case were investigated in exploratory analyses. RESULTS Costs of in-patient treatment and the percentage of patients who required in-patient treatment were considerably lower in both intervention groups. The unadjusted ICERs indicated FPT and CBT-E to be dominant compared with TAU-O. Moreover, FPT was dominant compared with CBT-E. CEACs showed that the probability for cost-effectiveness of FTP compared with TAU-O and CBT-E was ⩾95% if the WTP per recovery was ⩾€9825 and ⩾€24 550, respectively. Comparing CBT-E with TAU-O, the probability of being cost-effective remained <90% for all WTPs. The exploratory analyses showed similar but less pronounced trends. CONCLUSIONS Depending on the WTP, FPT proved cost-effective in the treatment of adult AN.
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Affiliation(s)
- N Egger
- Department of Health Economics and Health Services Research,Hamburg Center for Health Economics (HCHE), University Medical Center Hamburg-Eppendorf,Hamburg,Germany
| | - B Wild
- Department of General Internal Medicine and Psychosomatics,Heidelberg University Hospital,Heidelberg,Germany
| | - S Zipfel
- Department of Psychosomatic Medicine and Psychotherapy,University Hospital Tübingen,Tübingen,Germany
| | - F Junne
- Department of Psychosomatic Medicine and Psychotherapy,University Hospital Tübingen,Tübingen,Germany
| | - A Konnopka
- Department of Health Economics and Health Services Research,Hamburg Center for Health Economics (HCHE), University Medical Center Hamburg-Eppendorf,Hamburg,Germany
| | - U Schmidt
- Section of Eating Disorders,Department of Psychological Medicine,King's College London,London,UK
| | - M de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy,Hannover Medical School,Hannover,Germany
| | - S Herpertz
- Department of Psychosomatic Medicine and Psychotherapy,LWL-University Clinic Bochum, Ruhr-University Bochum,Bochum,Germany
| | - A Zeeck
- Department of Psychosomatic Medicine and Psychotherapy,University Hospital Freiburg,Freiburg,Germany
| | - B Löwe
- Department of Psychosomatic Medicine and Psychotherapy,University Medical Center Hamburg-Eppendorf, and Schön Klinik Hamburg-Eilbek,Hamburg,Germany
| | - J von Wietersheim
- Department of Psychosomatic Medicine and Psychotherapy,University Hospital of Ulm,Ulm,Germany
| | - S Tagay
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR Hospital Essen, University of Duisburg-Essen,Essen,Germany
| | - M Burgmer
- Department of Psychosomatics and Psychotherapy,University Hospital Münster,Münster,Germany
| | - A Dinkel
- Department of Psychosomatic Medicine and Psychotherapy,Klinikum rechts der Isar, Technische Universität München,Munich,Germany
| | - W Herzog
- Department of General Internal Medicine and Psychosomatics,Heidelberg University Hospital,Heidelberg,Germany
| | - H-H König
- Department of Health Economics and Health Services Research,Hamburg Center for Health Economics (HCHE), University Medical Center Hamburg-Eppendorf,Hamburg,Germany
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