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At least 19 recordsLinked to original sources
PubMed1981

Measuring outcome in psychodynamic psychotherapy: Psychodynamic vs symptomatic assessment.

Malan has argued forcefully that meaningful measurement of outcome in psychoanalytically oriented psychotherapy requires a complex clinical-judgment process by an expert clinician that is based on a psychodynamic hypothesis. Information pertaining only to symptom status before and after treatment was abstracted from each of 18 case summaries published by Malan. Each of these abstracted "cases" was related by a nonprofessional judge for global improvement and by me for symptomatic improvement. Correlations among these simple outcome ratings, "dynamic assessments" of treatment outcome made by the Tavistock group, and several theoretically important variables measuring transference manifestations during treatment were examined. Simple symptomatic improvement was an important component of the complex Tavistock outcome rating. The results raised questions as to the importance of the expert clinician and the psychodynamic hypothesis in the assessment of treatment outcome.

Adult↗
PubMed2002

[Gaining insight and structural capability as goals of psychodynamic psychotherapy].

Psychodynamic psychotherapy in the sense of German psychotherapy guidelines is currently the most frequently used treatment in outpatient psychotherapy. This report summarizes the psychodynamic fundaments of this method and distinguishes the conflict exposure and the structure formation as significant therapeutic aims. The subject of personality structure is dealt with according to the OPD (operationalized psychodynamic diagnosis) system which allows an operationalization and empirical investigation of structural aspects. The treatment techniques used to achieve structure-related therapy aims (e.g. the ability to differentiate affects, impulse control, empathy, emotional expression, attachment, separation, etc.) are described in detail.

Ambulatory Care↗
PubMed1999

Issues in teaching and learning time-limited psychodynamic psychotherapy.

Psychodynamic psychotherapy training is briefly reviewed, with particular attention to short-term forms of treatment and to empirical investigations of therapy training. There have been relatively few investigations of actual psychotherapy training, and the prospect is for even fewer in the future. The traditional pedagogic strategy for conceptualizing and developing psychodynamic training programs has been to adapt psychoanalytic clinical theory for instructional purposes. It is proposed that concepts, principles, and instructional strategies from the area of the cognitive sciences concerned with the development of generic expertise offers a potentially more fruitful theoretical/empirical framework for understanding therapeutic expertise and can be applied to developing improved psychotherapy teaching methods. The mental processes of therapists are discussed from this perspective. A teaching format based on multimedia computer technology and designed to fill a gap between didactic course work and actual therapy supervision is briefly described. In addition, recommendations are offered for improving psychotherapy training using existing methods.

Cognition↗
PubMed2004

Testing psychodynamic psychotherapy skills among psychiatric residents: the psychodynamic psychotherapy competency test.

OBJECTIVE: Training in psychodynamic psychotherapy remains a core requirement of psychiatric residency training programs, yet no standard measures of competency exist to document residents' knowledge and skills in this area. To address this issue, the authors developed a written test of applied knowledge of psychodynamic psychotherapy technique and theory, the Psychodynamic Psychotherapy Competency Test. Their goal in this article was to evaluate the validity of this test. METHOD: The test was given to a group of 36 psychoanalytic experts and 206 residents in their second, third, and fourth psychiatric postgraduate years from 10 programs located in different parts of the United States. Program directors provided information on the number of hours of psychodynamic didactic teaching, supervision, and resident-conducted psychodynamic psychotherapy and rated the psychodynamic psychotherapy skills of residents in their fourth postgraduate year on the basis of cumulative supervisor reports. RESULTS: There were significant differences in test performance between residents and faculty experts and between residents in their second and fourth postgraduate years: more advanced residents and experts had progressively better scores. The mean scores of fourth-year residents in different programs differed significantly, but the scores of second-year residents did not. Higher test scores were positively associated with both number of hours of resident-conducted psychotherapy and number of hours of supervision. Among fourth-year residents, test scores correlated significantly with program director evaluations. CONCLUSIONS: This initial study supports the validity of the Psychodynamic Psychotherapy Competency Test as well as the feasibility of testing psychotherapy skills in a standardized fashion.

Adult↗
PubMed2000

Individual psychodynamic psychotherapy and psychoanalysis for schizophrenia and severe mental illness.

BACKGROUND: People with schizophrenia and severe mental illness may need much support from health care professionals, in most cases over a long period of time. Research on the effects of psychotherapy for schizophrenia shows mixed results. Although pharmacological interventions remain the treatment of choice for schizophrenia patients, it is also of interest to look at the effects of treatment methods focusing on psychosocial factors affecting schizophrenia. OBJECTIVES: To review the effects of individual psychodynamic psychotherapy and/or psychoanalysis for people with schizophrenia or severe mental illness. SEARCH STRATEGY: Electronic searches of Biological Abstracts (1985-1999), CINAHL (1982-1999), The Cochrane Library CENTRAL (Issue 1, 1999), The Cochrane Schizophrenia Group's Register (1999), Dissertation Abstracts On disc (1866-1999), EMBASE (1980-1999), MEDLINE (1966-1999), PsycLIT (1974-1999), and Sociofile (1974-1998) were made. Authors of included trials were contacted for information on further trials. SELECTION CRITERIA: All randomised trials of individual psychodynamic psychotherapy or psychoanalysis for people with schizophrenia or severe mental illness (however defined) were selected. DATA COLLECTION AND ANALYSIS: Data were independently extracted by at least two reviewers. For dichotomous data relative risks (RR) were calculated and for continuous data weighted mean differences (WMD) between groups were calculated. MAIN RESULTS: No trials of a psychoanalytic approach were identified. Data are sparse for all comparisons involving a psychodynamic approach. There is no evidence of any positive effect of psychodynamic therapy and the possibility of adverse effects seems never to have been considered. The psychodynamic approach may be more acceptable to people than a more cognitive reality-adaptive therapy. REVIEWER'S CONCLUSIONS: Current data do not support the use of psychodynamic psychotherapy techniques for hospitalised people with schizophrenia. If psychoanalytic therapy is being used for people with schizophrenia there is an urgent need for trials.

Humans↗
PubMed2002

[Specific countertransference experience and interpersonal problem description in psychodynamic psychotherapy].

In psychodynamic psychotherapy, countertransference and its professional use is seen as an important means to identify central difficulties of patients. The present study examines the correspondence of countertransference and interpersonal difficulties in 30 therapist-patient couples in day hospital psychodynamic psychotherapy. Interpersonal problems were recorded using the inventory of interpersonal problems (IIP) and countertransference was measured using the impact message inventory (IMI). Correspondence was measured as the correlation of IIP data from the patients and IMI data from the therapists. Data were collected at the start of therapy, after 4 weeks of treatment, and at the end of treatment. Over the course of the therapy, an increase in the correspondence of interpersonal problems as reported by patients and countertransference could be observed, starting with r = 0.22 at the beginning of therapy and continuing through r = 0.47 after 4 weeks to r = 0.58 at the end of therapy. The mean correlation was slightly above that of a control group of 20 nonclinical couples associated for at least 6 months.

Adult↗
PubMed2007

Childhood depression: a place for psychotherapy. An outcome study comparing individual psychodynamic psychotherapy and family therapy.

BACKGROUND: Although considered clinically effective, there is little systematic research confirming the use of Individual Psychodynamic Psychotherapy or Family Therapy as treatments for depression in children and young adolescents. AIMS: A clinical trial assessed the effectiveness of these two forms of psychotherapy in treating moderate and severe depression in this age group. METHODS: A randomised control trial was conducted with 72 patients aged 9-15 years allocated to one of two treatment groups. RESULTS: Significant reductions in disorder rates were seen for both Individual Therapy and Family Therapy. A total of 74.3% of cases were no longer clinically depressed following Individual Therapy and 75.7% of cases were no longer clinically depressed following Family Therapy. This included cases of Dysthymia and "Double Depression" (co-existing Major Depressive Disorder and Dysthymia). There was also an overall reduction in co-morbid conditions across the study. The changes in both treatment groups were persistent and there was ongoing improvement. At follow up six months after treatment had ended, 100% of cases in the Individual Therapy group, and 81% of cases in the Family Therapy group were no longer clinically depressed. CONCLUSIONS: This study provides evidence supporting the use of focused forms of both Individual Psychodynamic Therapy and Family Therapy for moderate to severe depression in children and young adolescents.

Adolescent↗
PubMed1996

Perceptions of the significant other of the effects of psychodynamic psychotherapy. Implications for thinking about psychodynamic and systemic approaches.

BACKGROUND: Clinical suggests that partners of psychotherapy patients often have powerful feelings about the therapy and therapist. The repercussions of psychotherapy on those close to the patient are rarely considered. A small exploratory study was therefore conducted. METHOD: All patients who had completed at least two months of weekly psychodynamic psychotherapy in 1990 at an out-patient unit of a psychiatric hospital (n = 35) and had a partner with whom they were living at the time of starting therapy (n = 23) were contacted. Eight gave permission for their partner to be contacted directly. All eight partners agreed to participate in a semi-structured interview exploring their perceptions of the effects of the therapy on a number of family relationships. The impact of the process of the study was also investigated by means of a questionnaire sent to all partners some weeks after the interview. RESULTS: Considerable changes were perceived to have taken place in association with therapy affecting not only the relationship between the couple but also their parenting relationship, the children, and at time members of the extended family. Partner's views about the direction of such changes seemed to influence other perceptions about the therapy. CONCLUSION: The repercussions of individual psychotherapy may well spread extensively within a family. This further blurs the boundary between individual and family therapy, both theoretically and clinically. Research procedures are themselves a major intervention and may have a considerable emotional impact on participants.

Adult↗
PubMed1997

Psychodynamic psychotherapy for cancer patients.

Psychodynamic psychotherapy is effective as an approach to understanding the psychological conflicts and the psychiatric symptoms of cancer patients as well as to planning useful psychological interventions. The author recommends that the psychotherapist who treats cancer patients be familiar with the following: 1) the natural course and treatment of the illness, 2) a flexible approach in accord with the medical status of the patient, 3) a common sense approach to defenses, 4) a concern with quality-of-life issues, and 5) counter-transference issues as they relate to the treatment of very sick patients. Case reports illustrate the unique problems facing psychotherapists who are treating cancer patients. Further, these cases show the effective use of psychodynamic principles to inform the therapist of successful psychotherapeutic interventions.

Adult↗
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↗
PubMed2003

Experienced therapists' opinions on central issues in psychodynamic psychotherapy of patients with personality disorders.

Individual psychodynamic psychotherapy is a recommended, but controversial, treatment for patients with personality disorders (PDs). The aim of this study was to examine the relationship between demographic and professional characteristics of experienced psychotherapists and their attitudes and opinions towards aspects of this kind of psychotherapy. A questionnaire covering these issues of psychodynamic psychotherapy with patients belonging to all three DSM-IV clusters of PD was developed. A sample of 324 Norwegian psychiatrists and clinical psychologist with considerable experience in individual dynamic psychotherapy of patients with PDs filled in valid questionnaires. The therapists' age, gender, profession, postgraduate courses and degree of experience were examined as to their opinions on the following issues: alliances, aims, contraindications, needs to terminate, suicides, use of drugs, length of treatment, need for supervision and complaints to colleagues about patients' behaviour in such therapy with PD patients. Independent sample t-tests of the mean z-transformed group scores were the main statistical method applied. Therapist experience made the most significant differences as to treatment issues, while some differences also were found for age, gender and profession. The influence of postgraduate courses was negligible. Our study might have a selection bias towards therapist with strong psychodynamic orientation and particular interest in the psychotherapy of patients with PDs.

Adult↗
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↗
PubMed2006

Psychodynamic psychotherapy in the treatment of mood disorders.

PURPOSE OF REVIEW: This article summarizes recent studies of psychodynamic psychotherapy for mood disorders. It is important to note whether the therapy studied is adhering to the principles of psychodynamic psychotherapy, whether it is manual based or flexibly responsive to patient developments, whether it is short term or long term and whether it is combined with pharmacotherapy. RECENT FINDINGS: A review of recently published studies has found that all studies show a significant improvement in symptoms in patients who were depressed before treatment with psychodynamic psychotherapy. It is rare, however, for a study to meet the criteria of randomized clinical trials: use of treatment manuals and assured adherence, a sample of patients specifically diagnosed with depression and relevant measures. In one metaanalysis of studies meeting the above criteria, two of 17 studies included a sample with a diagnosis of depression, and short-term psychodynamic psychotherapy achieved similar results as other psychotherapies. Naturalistic studies show improvement with dynamic psychotherapy over time in both symptoms and dynamic measures, such as defense styles and frustration tolerance. SUMMARY: In the last year there were few randomized controlled studies specifically examining psychodynamic psychotherapy for mood disorders. Most evidence from naturalistic and various efficacy studies indicates that dynamic psychotherapy, with or without pharmacotherapy, is associated with improvement in symptoms and some character features. Longer follow-ups provide useful data for what can be a chronic or recurring illness. There are no data showing that psychodynamic therapy is more or less effective than other forms of psychotherapy.

Humans↗
PubMed2006

Cognitive-behavioral therapy and psychodynamic psychotherapy: techniques, efficacy, and indications.

UNLABELLED: In this article, we provide an overview of the techniques and efficacy of the two most commonly used psychotherapeutic treatments of psychiatric disorders in adults: cognitive-behavioral and psychodynamic therapy. Psychotherapeutic techniques, major indications, and empirical evidence will be presented. The focus will be on empirically supported models of treatment. CONTEXT: Cognitive-behavioral therapy and psychodynamic psychotherapy are the most frequently applied methods of psychotherapy in clinical practice. OBJECTIVE: To give an up-to-date description of cognitive-behavioral therapy and psychodynamic psychotherapy and to review empirical evidence for efficacy in specific mental disorders. DATA SOURCES: Systematic reviews of psychotherapy outcome research based on evidence-based methods were used. In order to identify more recent trials, Medline, Psyclnfo, Pubmed, and Current Contents were searched in addition in July 2005 using database-specific keywords. In October 2005, the search was updated. Text books and journal articles were used as well. STUDY SELECTION: The authors reviewed the available systematic surveys and meta-analyses as well as the additionally identified studies using established inclusion criteria. DATA EXTRACTION: Following the evidence-based methods of the Canadian Task Force on Preventive Health Care, an established hierarchy of study designs was applied. Using rigorous criteria, only evidence from randomized controlled trials (Type 1 studies) was included. The authors independently assessed for which mental disorders randomized controlled trials provide evidence for the efficacy of cognitive-behavioral therapy or psychodynamic psychotherapy in specific disorders. DATA SYNTHESIS: The efficacy of cognitive-behavioral in many mental disorders has been demonstrated by a substantial number of randomized controlled trials and several meta-analyses. However, for specific disorders the rates of treatment responders are not yet sufficient. For psychodynamic psychotherapy, clearly less efficacy studies are available. However, the available studies provided evidence that psychodynamic psychotherapy is an effective treatment of specific mental disorders as well. CONCLUSIONS: Although there is substantial evidence for the efficacy of cognitive-behavioral therapy and some evidence for the efficacy of psychodynamic psychotherapy, further studies are required to improve the positive outcome rates of treatment responders in specific mental disorders. For psychodynamic psychotherapy further studies of specific forms of treatment in specific mental disorders are required to corroborate the available results.

Cognitive Behavioral Therapy↗
PubMed2001

A pilot open trial of brief psychodynamic psychotherapy for panic disorder.

This is a complete report of an open trial of manualized psychodynamic psychotherapy for treatment of panic disorder, Panic-Focused Psychodynamic Psychotherapy (PFPP). Twenty-one patients with PD were entered into a trial of twice-weekly, 24-session treatment. Sixteen of 21 experienced remission of panic and agoraphobia. Treatment completers with depression also experienced remission of depression. Improvements in symptoms and in quality of life were substantial and consistent across all measured areas. Symptomatic gains were maintained over 6 months. This report was prepared specifically to describe 6-month follow-up on these patients. Psychodynamic psychotherapy appears to be a promising nonpharmacological treatment for panic disorder.

Adult↗
PubMed1997

Structuring training goals for psychodynamic psychotherapy.

A multiaxial model that structures educational goals for psychodynamic psychotherapy has been developed. It specifies core aspects of psychodynamic psychotherapy, clusters them in categories that further define and link related areas, and presents a sequence that enables educators and students to focus on training goals in a consistent progression. This model has been used by the Director of Education as a basis for developing the curriculum, by students as a way of focusing learning and giving perspective to current work, and by supervisors to link individual teaching to the goals of the training program. This method has enhanced consistency, clarity, and efficiency in the psychotherapy program.

Curriculum↗
PubMed2006

Teaching psychodynamic psychotherapy in the 21st century.

Special challenges face the 21st century teacher of psychodynamic psychotherapy. Time for careful psychodynamic reflection, of necessity, competes for space with the current explosion of psychiatric knowledge in psychopharmacology, genetics, health care policy and multiple other agendas. Thus educators must be clear about the goals of psychodynamic psychotherapy, engage students in the special interviewing techniques to elicit sensitive information and appreciate the special needs of today's physicians launching into this field. Educational objectives must be clear, the goals of psychoanalysis and psychoanalytic psychotherapy well articulated and the means to gather information enhanced. With the expansion of neuroscience into the mysteries of implicit and explicit memory this is also an area where the 21st century educator must develop integrative expertise. There are tools available to expand ones proficiency in each of these areas.

Curriculum↗