Capturing the Unconscious-The "Psychoanalytic Core Competency Q-Sort". An Innovative Tool Investigating Psychodynamic Therapeutic Skills

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.

How do adolescents with depression experience improvement in psychodynamic psychotherapy? A qualitative study

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.

[Evidence of the effect of psychodynamic psychotherapy]

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.

The efficacy of psychotherapy: focus on psychodynamic psychotherapy as an example

The growing number of individuals seeking treatment for mental disorders calls for intelligent and responsible decisions in health care politics. However, the current relative decrease in reimbursement of effective psychotherapy approaches occurring in the context of an increase in prescription of psychotropic medication lacks a scientific base. Using psychodynamic psychotherapy as an example, we review the literature on meta-analyses and recent outcome studies of effective treatment approaches. Psychodynamic psychotherapy is an effective treatment for a wide variety of mental disorders. Adding to the known effectiveness of other shorter treatments, the results indicate lasting change in many cases, especially for complex and difficult to treat patients, ultimately reducing health-care utilization. Research-informed health care decisions that take into account the solid evidence for the effectiveness of psychotherapy, including psychodynamic psychotherapy, have the potential to promote choice, increase mental health, and reduce society's burden of disease in the long run.

How clinicians feel about working in therapy with spouses of dementia patients

Clinicians who provide psychotherapy to spouses or partners of persons with dementia were solicited through LISTSERVs of psychodynamically oriented organizations. Interviews were conducted with the 14 clinicians who responded. In the aggregate these clinicians provide psychotherapeutic service to scores of caregivers. The interviews highlight the challenges commonly encountered by psychotherapeutic work with this cohort of patients.

Using the internet to provide psychodynamic psychotherapy

Over the last 15 years, there has been a substantial increase in research and clinical implementations of Internet-delivered, cognitive behavioral therapy (ICBT). Several studies on ICBT have been in the format of guided self-help where a therapist guides the patient throughout the whole treatment. ICBT is typically in the form of self-help material (e.g., text or video) which is provided to a client over the Internet with additional therapist contact by e-mail. ICBT has been shown to be effective for various conditions and, in some studies, has shown to be as effective as face-to-face cognitive behavioral therapy for mild to moderate depression, anxiety disorders, and somatic problems. Recently, the field has expanded to include other orientations including psychodynamic psychotherapy. Currently, there are three randomized controlled trials that have tested the efficacy of psychodynamic psychotherapy delivered in this format. The latest published trial focused on an affect-focused, psychodynamic psychotherapy delivered to a sample of participants with mixed depression and anxiety disorders. This article aims to provide a deeper understanding of the process of providing psychodynamic psychotherapy via the Internet. We will give a detailed description of our latest manual and show how psychotherapeutic work is conducted utilizing this text. Furthermore, we provide examples of dialogue between therapist and client from the online environment. Similarities and differences between psychodynamic psychotherapy delivered over the Internet and in face-to-face formats are discussed.

Psychodynamic approach as a creative factor in psychopharmacotherapy

The treatment of psychiatric disorders often consists of a combined approach that integrates both pharmacotherapy and psychotherapy. Unfortunately, psychiatric texts and the educational process in psychiatry training do not adequately address the combined approach. There is a lack of information concerned with the psychological aspect of prescribing medications. This is striking since many patients require both treatments. There is an inevitable psychological aspect of the administration of medication in psychiatry, and the meaning ascribed to the prescription of drugs has an impact on doctor-patient relationship. Understanding the psychodynamic issues is crucial for the success of psychopharmacology. Psychodynamic psychopharmacotherapy represents an integration of biological psychiatry and psychodynamic insights and techniques. This approach recognizes that many of the core discoveries of psychoanalysis are powerful factors in the complex relationship between the patient, the illness, the doctor, and the medications. Scientific pharmacotherapy is, as it should be, based upon patients' responses to treatments of specific target conditions. Enduring personality traits are being increasingly incorporated as targets for pharmacotherapy. However, in the real world of psychiatric practice we see that transference issues and a patient's character or set of personality traits have a greater impact on the selection, dosage, tolerability, and treatment outcome than is generally recognized or admitted. In contemporary psychiatry, a psychodynamic perspective must be preserved. Without it, meaning will be lost, and both diagnostic understanding and informed treatment planning will suffer.

The emerging evidence for long-term psychodynamic therapy

There is growing evidence from RCTs supporting the efficacy of both short-term (STPP) and long-term psychodynamic psychotherapy (LTPP) for specific mental disorders. In a first series of meta-analyses, LTPP was shown to be superior to shorter forms of psychotherapy, especially in complex mental disorders. However, the evidence for LTPP has not gone unchallenged. After several responses have addressed the raised concerns, a recent meta-analysis by Smit and colleagues (2012) again challenges the efficacy of LTPP.

METHOD

From a methodological perspective, a critical analysis of the Smit et al. meta-analysis was performed. Furthermore, we conducted two new metaanalyses adding studies not included in previous meta-analyses. The purpose was to examine whether the results of the previous meta-analyses are stable.

RESULTS

Due to differing inclusion criteria, the meta-analysis by Smit et al. actually compared LTPP to other forms of long-term psychotherapy. Thus, they essentially showed that LTPP was as efficacious as other forms of long-term therapy. For this reason the meta-analysis by Smit et al. does not question the results of previous meta-analyses showing that LTPP is superior to shorter forms of psychotherapy. In addition, the Smit et al. meta-analysis was shown to suffer from several methodological shortcomings. The new meta-analyses we performed did not find significant deviations from previous results. In complex mental disorders LTPP proved to be significantly superior to shorter forms of therapy corroborating results of previous meta-analyses.

CONCLUSIONS

Data on dose-effect relations suggest that for many patients with complex mental disorders, including chronic mental disorders and personality disorders, short-term psychotherapy is not sufficient. For these patients, long-term treatments may be indicated. The meta-analyses presented here provide further support for LTPP in these populations. Nevertheless, there is a need for more research in LTPP and other long-term psychotherapies.