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PubMed1999

Physiologic and psychodynamic responses to the administration of therapeutic touch in critical care.

Recent publications have questioned the efficacy of therapeutic touch (TT). The focus of attention has been on substantiating the existence of the recipient's energy field rather than on the physiologic and psychodynamic responses to TT. In this article the physiologic and psychodynamic responses during and following the administration of TT is described. The project involved the implementation of a time series design in which the physiologic and psychodynamic responses were measured. It is acknowledged that critical care environments are stressful for patients in terms of invasive medical and nursing procedures. Continuous bright lighting, and excessive noise prohibits the potential for relaxation and sleep. Within this context, the control of confounding variables was not possible, and therefore not an object of concern in the study. Rather the responses to TT in the natural setting were of importance to discern. Statistical repeated measures analysis of variance (one way) indicated there was no significant difference between pre-, during and post-physiologic variables in response to TT. However psychodynamic responses demonstrated significant correlation's in terms of relaxation and sleep. The non significance of physiologic change in variables pre-, during and post-administration of TT indicates critically ill patients remained physiologically stable. Significant correlations of psychodynamic responses demonstrated it is possible for critically ill patients to experience periods of relaxation and sleep in an otherwise stressful environment. TT was found to be a useful therapy to enhance relaxation and sleep in critically ill patients.

Adult↗
PubMed2001

[Psychodynamic therapy in chronic pain patients: a systematic review].

Psychoanalysis has made fundamental contributions to our understanding of somatoform pain disorder; however, psychodynamic therapy procedures have not been accorded their due recognition in the treatment of chronic pain. This is due to the inadequate differential indication for the employment of psychodynamic treatment methods, on the one hand, and to the refusal of most of the psychoanalysts to modify the standard psychoanalytic procedures in accordance with the requirements of pain treatment. This article reviews evidence of the modification of psychodynamic therapy procedures and their outcome in chronic pain patients in the context of past research. We conducted a systematic computer-based literature research employing MEDLINE, EVIDENCE BASED MEDICINE, and PSYNDEX data-bases between 1980 and 2000. Psychodynamic therapy procedures are indicated in the first instance for patients with psychic co-morbidity and those with somatoform pain disorder. A modification of the psychotherapeutic technique, involving an approach that is more structured and is also rather supportive at least at the beginning, is necessary. While employing psychodynamic methods in the treatment of pain patients, greater importance should be attached to the physical level and to the 'holding function' of the therapist than is usually the case with the conventional psychoanalytic therapy procedures.

Chronic Disease↗
PubMed2006

Psychoanalytic and psychodynamic education in the 21st century.

Psychoanalytic and psychodynamic education over the past 50 years is reviewed in the context of the author's personal experience, as well as the changes that have taken place in psychiatry and psychoanalysis over the same time span. Several key issues are identified, including (1) the increasing biological reductionism of psychiatry; (2) the gradual de-emphasis of subjective experience along with the biopsychosocial explanation of human behavior and psychopathology; and (3) the increasing attention paid to neuroscience, psychopharmacology, and brief therapies during residency training. In order to address these issues, it is suggested that education in psychodynamic and psychoanalytic psychiatry be integrated into residency training. This would take the form of subspecialty training in either psychodynamic psychiatry or psycho analysis. Such training would promote an understanding of the connections between neurobiology and psychodynamics, versatility with a variety of dynamic psychotherapeutic techniques, and familiarity with research methodology. Psychiatrists educated in this type of integrated training program will be optimally equipped to advance psychodynamic and psychoanalytic treatment, theory, and research in the 21st century.

Clinical Competence↗
PubMed2005

[Does improvement of symptoms four weeks after the begin of psychodynamic inpatient psychotherapy correspond to long term outcome?].

OBJECTIVES: This study was conducted to explore differentiated aspects of outcome throughout and one year after psychodynamic inpatient psychotherapy with special regard to symptomatic distress and interpersonal behaviour. METHODS: Sixty-four patients of the Department of Psychotherapeutic Medicine of the Jerichow Hospital (Saxonia-Anhaltina) were investigated with the SCL-90-R and the IIP-D four times: at the beginning of inpatient psychotherapy (t0), four weeks after (t1), at the end (t2), and one year after discharge (t3). RESULTS: The improvement of symptoms four weeks after the beginning of psychodynamic inpatient psychotherapy is equivalent with long term outcome. The Global Severity Index of SCL-90-R demonstrated a statistically significant change from markedly psychological distress to lack of distress after four weeks psychodynamic inpatient psychotherapy (effect-size d(GSI) = 0.82). At the end of psychotherapy, three weeks later, the effect-size was d = 1.11, and one year after discharge the effect-size decreased again to d = 0.85. Major improvements demonstrated the SCL-90-R subscales Depression, Anxiety, and Obsessive/Compulsive. Regarding interpersonal problems, the subscales Dominance, and Competitive demonstrated statistically significant changes from low Stanine-scores at t0 to higher scores one year after discharge. The subscales Socially avoidant, Nonassertive, and Exploitable demonstrated statistical significant changes from high levels at t0 to lower scores after one year. DISCUSSION: In conclusion the first four weeks of psychodynamic psychotherapy are not sufficient to demonstrate an optimum level of low psychological distress as well as an optimum change in interpersonal problems. Regarding stability of the effects of psychodynamic inpatient psychotherapy it was demonstrated that the first four weeks initiated changes which improved at the end of psychotherapy until one year after discharge.

Adaptation, Psychological↗
PubMed2006

[Short-term psychodynamic psychotherapy].

BACKGROUND: The past twenty years have seen many developments in 'psychodynamic' psychotherapy. AIM: To provide an overview of recent developments in short-term psychodynamic psychotherapy. This involves summarizing current approaches and describing in detail the model developed by Malan and Davanloo. A summary is also given of empirical research into the effect of the various treatment modalities. METHOD: Modern manuals were consulted, which describe many of the recent developments and contain contributions by the leading representatives of the various therapeutic orientations. In addition, a literature survey was carried out; by means of Webspirs it was possible to search PsycINFO, Medline and Current Contents for studies relating to empirical research in the effect of psychodynamic psychotherapy. RESULTS There are several variants of the psychodynamic treatment modality. In each of them the treatment duration is reduced, mainly because the focus is on certain particular elements. In addition, a maximum number of sessions is specified. The frequency can be varied and the psychotherapist is much more actively involved than in classical psychoanalytic psychotherapy. Techniques from other therapeutic orientations are integrated, but the focus on defence and affect expressions is preserved. Especially shorter treatment has stimulated empirical research and gradually it is becoming possible to compare short-term treatment with other forms of treatment. CONCLUSION: Short term psychodynamic psychotherapy fits in with modern requirements with regard to efficiency, brevity and (empirical) transparency. This form of treatment deserves its own place in modern psychotherapy because it focuses directly on the patient's actual feelings and emotions. Research into the effectiveness of dynamic therapy has already begun, but more work needs to be done in this area.

Empirical Research↗
PubMed1986

[Psychodynamics of neurotically-induced kleptomania].

With a detailed case report of a patient suffering from kleptomania with neurotic causes, we are trying to obtain more detailed information about such patients' psychodynamics. The case history is preceded by a discussion of the concept of kleptomania. We give a list of the descriptive-empirical papers which prove that one cannot speak of an independent clinical picture, but rather that the kleptomaniac actions may be a symptom of multiple causes. Following the case history, the psychodynamics of this patient is discussed and compared with the existing interpretations, based on depth psychology, of other patients. We confirm the opinion expressed by other authors that kleptomania with neurotic causes is to be classified amongst the impulse neuroses. We criticize the fact that in the presently existing psychodynamic interpretation the sexual symbolism of the theft actions and of the stolen goods themselves has been overvalued. In an ego-psychological consideration, we then draw the attention to these patients' desperate and greedy search for an object which helps them to maintain control over their own destructive aggressiveness and at the same time preserves the object. Subsequently, we suggest distinguishing between two groups of kleptomaniac patients who can be differentiated with regard to their symptoms and psychodynamics. Some kleptomaniacs seem to be "fixed" on special objects when stealing. Others give the impression of being "de-differentiated" by the way they steal. In the latter group the structural ego weakness is the most important feature. These psychodynamic considerations are included in the forensicpsychiatric discussion of kleptomania at the end of this paper. Several criteria are presented, e.g., the symptomatic character of the patients' behaviour, the compulsion to repeat, the progredience of the symptoms, the de-differentiation of personality, which are to contribute to the evaluation of the independence and the automatism of the action with regard to the possibility of a patients' ego control.

Adult↗
PubMed1997

Symptoms and character traits in patients selected for long-term psychodynamic psychotherapy.

In this naturalistic study of 55 outpatients selected for long-term psychodynamic psychotherapy, two Swedish assessment instruments are presented (the Karolinska Psychodynamic Profile and the Karolinska Scales of Personality), and the significance of psychodynamic criteria for the selection of patients is discussed. Thirty patients (55%) fulfilled criteria for a DSM-III-R diagnosis. The most prominent psychodynamically defined character pathology was found in the areas of coping with aggressive affects; dependency and separation; frustration tolerance; and impulse control. Some psychodynamically defined character traits, particularly poor frustration tolerance, were related to symptomatic suffering.

Adult↗
PubMedDate not supplied

[Operationalized psychodynamic diagnosis in childhood and adolescence--a contribution to quality assurance].

Adopting a therapeutic view on diagnosis in child and adolescent psychiatry a psychodynamic diagnostic manual seems to be necessary, that may provide reliability in the assessment of intrapsychic processes. Multiaxial diagnosis of children's and adolescent's psychiatric disturbances may thus be completed with additional psychodynamic assessment procedures. In adults an operationalized procedure of psychodynamic assessment (OPD) already exists. In child and adolescent psychiatry a working group for psychodynamic diagnostic (OPD-KJ) has been founded. In 4 areas (subjective experiences of disturbances, relationships, intrapsychic conflicts and psychic structure) diagnostic manuals are being worked out. Fundamental questions of developmental psychopathology and diagnostic procedures have to be addressed. The basic proposition takes into account that children should not be psychodynamically compared with adults, but normally have a basic capacity to adapt to environment on a high level of psychic organisation in all developmental stages. Reports of the ongoing work are being given.

Adolescent↗
PubMed2004

The efficacy of short-term psychodynamic psychotherapy in specific psychiatric disorders: a meta-analysis.

BACKGROUND: The efficacy of psychodynamic therapy is controversial. Previous meta-analyses have reported discrepant results. OBJECTIVE: To test the efficacy of short-term psychodynamic psychotherapy (STPP) in specific psychiatric disorders by performing a meta-analysis of more recent studies. We assessed outcomes in target problems, general psychiatric symptoms, and social functioning. DESIGN: We identified studies of STPP published between January 1, 1970, and September 30, 2004, by means of a computerized search using MEDLINE, PsychINFO, and Current Contents. Rigorous inclusion criteria, included randomized controlled trials, use of treatment manuals and insurance of treatment integrity, therapists experienced or specifically trained in STPP, treatment of patients with specific psychiatric disorders, reliable and valid diagnostic measures, and data necessary to calculate effect sizes. Studies of interpersonal therapy were excluded. Seventeen studies fulfilled the inclusion criteria. The information was extracted by 3 raters. Effect sizes were calculated for target problems, general psychiatric symptoms, and social functioning using the data published in the original studies. To examine the stability of outcome, we assessed effect sizes separately for end of therapy and follow-up assessment. The effect sizes of STPP were compared with those of waiting-list control patients, treatments as usual, and other forms of psychotherapy. RESULTS: Short-term psychodynamic psychotherapy yielded significant and large pretreatment-posttreatment effect sizes for target problems (1.39), general psychiatric symptoms (0.90), and social functioning (0.80). These effect sizes were stable and tended to increase at follow-up (1.57, 0.95, and 1.19, respectively). The effect sizes of STPP significantly exceeded those of waiting-list controls and treatments as usual. No differences were found between STPP and other forms of psychotherapy. CONCLUSIONS: Short-term psychodynamic psychotherapy proved to be an effective treatment in psychiatric disorders. However, further research of STPP in specific psychiatric disorders is needed, including a study of the active ingredients of STPP. Effectiveness studies should be included.

Follow-Up Studies↗
PubMed2001

Effectiveness of behavioral and psychodynamic in-patient treatment of severe obesity--first results from a randomized study.

OBJECTIVE: To compare treatment effectiveness of psychodynamic and behavioral in-patient treatment of patients with severe obesity. DESIGN: : Randomized longitudinal study of obese patients (BMI> or =35 kg/m(2)) randomly assigned to behavioral or to psychodynamic psychosomatic rehabilitation. SUBJECTS: Ninety eight, mostly female (88%), obese patients (age 20-64 y, BMI 36-74 kg/m(2)). MEASUREMENTS: Standardized self-report scales on distress (SCL-90R), eating behavior (FEV), interpersonal problems (IIP), body image (FKB-20), life satisfaction (IRES). RESULTS: During the 6 weeks of in-patient treatment patients lost an average of 5.4 kg (4.3%) in the behavioral (n=46) and 6.2 kg (4.7%) in the psychodynamic setting (n=52). In both settings, a significant improvement was also found for eating behavior, well-being, body image and life satisfaction. Weight reduction was more pronounced for those with a higher weight at onset, more distress in public at admission, and a longer treatment. CONCLUSION: Despite considerable differences in the behavioral vs psychodynamic treatment settings, both were equally effective. However, some common treatment elements were perceived differently by patients in the two settings. Analysis of the follow-up data will hopefully provide evidence as to which patients benefit more from which approach.

Adult↗
PubMed1978

Psychodynamics, homosexuality, and the question of pathology.

A persistent polarity has existed among theories concerning the origins and the nature of preferred homosexuality. One major group of theories, including most psychoanalytic approaches, stresses early developmental contributions and tends to view homosexuality as psychopathological--a deviation from healthy and fully mature living. The other major group of theories assumes homosexuality not to be psychopathological and views homosexuality as either a spontaneous expression of a natural, polymorphous sexuality, or as one possible outcome, among many equally healthy and rewarding outcomes, of social conditioning. Common to both groups of theories is the shared assumption that psychodynamic contributions and etiology imply pathology--a psychodynamic dimension is either accepted and pathology is assumed, or pathology is denied and any possible psychodynamic contribution is debunked. The notion that psychodynamic causes and contributions imply pathology is, as I will show, a historical artifiact deriving from Freud's original libidinal fixation theory of neurosis. Such an assumption is not only no longer necessary, but also is inconsistent with a more contemporary psychondynamic understanding of human experience and several important psychoanalytic principles. I will explore the manner in which this assumption has been responsible for polarization and miscommunication among various contributions in psychoanalytic, sociological and political literature on the nature of homosexuality--including the presumption of pathology that is built into the very language and choice of metaphors employed in psychoanalytic discussions of homosexuality. I will also suggest an alternative conceptual approach.

Adaptation, Psychological↗
PubMed1989

An examination of three methods of psychodynamic formulation based on the same videotaped interview.

While psychodynamic theory and therapy are approaching their centennial, the science of psychodynamics is still in an earlier developmental stage. Any scientific field generates the most controversy and excitement when it is still developing. For psychodynamic psychology this means that its basic units of observation as well as its rules for justifying clinical inference in formulating and testing dynamic hypotheses require more development. In short, we are still evaluating different methods for both discovering and validating psychodynamic propositions. This is especially true for central features of dynamic psychology, including intrapsychic conflict, relationships, and transference patterns. This report compares three different methods for making a dynamic case formulation: 1) the Core Conflictual Relationship Theme (CCRT) of Luborsky (Crits-Christoph and Luborsky 1985a,b; Luborsky 1976, 1977, 1984, and companion paper in this issue; Levine and Luborsky 1981), 2) the Plan Diagnosis (PD) method of Silberschatz, Curtis and colleagues of the Mount Zion group (Caston 1986; Curtis and Silberschatz 1986; Rosenberg et al. 1986; Curtis et al. 1988) and, 3) the Idiographic Conflict Formulation (ICF) of Perry and Cooper (1985, 1986, and companion paper in this issue). Each has a slightly different focus. The CCRT focuses on relationship patterns as the central feature of individual dynamics and transference in or out of the treatment situation. The Plan Diagnosis focuses on dynamic features related to transference, resistance and insight in therapy. The Idiographic Conflict Formulation focuses on stress and internal conflict, and the individual's adaptation to them in or out of treatment.

Adjustment Disorders↗
PubMed1975

Behavioral and psychodynamic dimensions of the new sex therapy.

The new sexual therapy, a brief outpatient treatment of sexual dysfunction consisting of structured sexual exercises and conjoint therapeutic sessions, is a systematic intergration of behavioral and psychodynamic elements. Formally consisting of many defining characteristics of a behavior therapy including the direct treatment of a specified problem and the application of behavioral principles, the new sex therapy also relies on psychodynamic understanding. The result is synergistic. Psychodynamic understanding underlies appropriate behavioral intervention, and psychodynamic exploration of resistance enhances the effectiveness of behavioral methods. Behavioral techniques facilitate the most rapid implementation of therapeutic insight. The integration of approaches in the new sex therapy has general significance for psychotherapeutic theory and practice.

Behavior Therapy↗
PubMed1999

What patient characteristics make therapists recommend psychodynamic psychotherapy or other treatment forms?

In order to study factors that psychodynamic therapists considered to be important for recommendation of treatment, psychiatric diagnoses (DSM-III-R Axes I and II and the GAF) as well as character traits assessed by the Karolinska Psychodynamic Profile (KAPP) were retrospectively assessed in interview case-notes of patients applying for psychodynamic psychotherapy. Recommendation of psychotherapy was predicted by the absence of a personality disorder and high GAF scores, but not by the presence of a psychiatric syndrome. The KAPP differentiated between patients with and without disorders on Axis II, but not on Axis I. Patients who were recommended psychodynamic psychotherapy were healthier on all central KAPP variables compared to those who were recommended other treatments, and they were also characterized by predominantly neurotic personality organization, with inhibition as the most prominent defence.

Adult↗
PubMed1997

Psychodynamic perspectives on psychosis and psychotherapy. I: Theory.

Psychotherapy with sufferers of psychosis may usefully draw on both cognitive--behavioural and psychodynamic theory. The latter has a long history with fluctuating popularity, whilst cognitive--behavioural approaches are currently attracting the attention of clinicians. Some of the factors which may reduce interest in psychodynamic approaches are reviewed, followed by an overview of core psychodynamic theories of psychosis under the major headings of vulnerability of defence and vulnerability of the ego. A vulnerability-stress formulation of psychodynamic theory is then considered together with implications for intervention.

Cognitive Behavioral Therapy↗
PubMed1997

Psychodynamic perspectives on psychosis and psychotherapy. II: Practice.

Psychodynamic theory has a contribution to make to the overall care and management of people suffering from psychosis. The research literature in support of these contributions is reviewed and key psychodynamic concepts of value in understanding psychosis are illustrated by the case example of a two-year supportive psychodynamic psychotherapy with a man experiencing paranoid and grandiose delusions. The contribution psychodynamic approaches may make to currently evolving cognitive--behavioural therapies, and to the overall provision of care are discussed.

Adult↗
PubMed1998

A current psychodynamic understanding of panic disorder.

While there has been burgeoning interest in the psychiatric literature about the phenomenology and biology of panic disorder, there is little new information about the psychodynamics of this condition. The reintroduction of a psychodynamic perspective could be useful in guiding research strategies to identify traits which predispose to panic and in designing treatments to address such traits. A psychodynamic model hypothesizes a relationship between current psychological functioning, early experiences, and ongoing psychological traits. Recent published reports about the nature of underlying psychodynamics and psychological characteristics of panic disorder are discussed.

Adult↗
PubMed2006

Mid-term effectiveness of behavioral and psychodynamic inpatient treatments of severe obesity based on a randomized study.

BACKGROUND: The objective of this study was to compare the effectiveness of psychodynamic and behavioral inpatient treatments of severely obese patients regarding weight and distress. METHODS: In a longitudinal study obese patients (body mass index, BMI >or=35) were randomly assigned to behavioral or to psychodynamic inpatient treatment. Mostly female (n = 267; 85%) obese patients with psychiatric and somatic comorbidity (age 20-64 years, BMI 35-74) were examined with standardized self-report scales on distress (SCL-90R), interpersonal problems (Inventory of Interpersonal Problems), eating behavior (Fragebogen zum Essverhalten) and body image (Fragebogen zum Korperbild). RESULTS: During 49 days (mean) of inpatient treatment, patients lost an average of 5.6 kg (4.4%) in the behavioral (n = 130) and 5.7 kg (4.4%) in the psychodynamic setting (n = 137). In both settings, eating behavior, well-being and body image also improved significantly. One year after discharge, return rate was 73%. Forty percent had further reduced their weight (by more than 5% compared to intake), 36% had regained weight, but were still below intake level, and another 24% had increased weight above intake. CONCLUSION: Behavioral and psychodynamic treatments were equally effective reducing weight and distress over 1 year.

Adult↗