Learning Psychodynamic Psychotherapy: A Case for a Casebook

Abstract

Learning psychodynamic psychotherapy is a complex process. As the editors of the casebook Practicing Psychodynamic Psychotherapy, Drs. Summers and Barber, point out, the learner has to go through consecutive stages of skills acquisition, including novice, competent, and expert levels. They add, “These levels reflect sequential accumulation of skills, knowledge, and their application. Thus, learning psychotherapy skills entails many steps and hours of training to develop the necessary expertise to treat patients” (p. 4). They continue, “We suggest that psychodynamic psychotherapy education and training have traditionally been robust and effective for those therapists who are already interested and have a reasonable knowledge base. But the early phases of learning, including initial exposure, early practice of technique, and the development of an initial synthesis and style, have been left to nature. The techniques for teaching novice skills and facilitating movement toward competence have not been as fully developed and attended to as the methods for further development of experienced psychodynamic psychotherapists. This is a gap we want to bridge with this book” (p. 4). Thus, the editors created this casebook. They asked a host of younger colleagues—most of them former trainees—to write 12 cases in a relatively standard format—with chief complaint and presenting problem, history, psychodynamic formulation, course of treatment, termination, and assessment of progress. The editors believed that “Written cases have advantages over videotaped sessions. They protect privacy much better, and are a more processed mode of presentation than video” (p. 5). They, however, also recognize that a written case is “clearly a production of the therapist and reflects to some degree his or her needs, biases, strengths, and limitations” (p. 5). The cases are conceptualized within the framework outlined by the editors’ previous book, Psychodynamic Therapy: A Guide to Evidence-Based Practice [1]. Within that model, they present the “reality of psychotherapy and focus on what is essential in driving a patient and therapist forward toward an active, energizing, and healthy interaction that results in change” (p. 1). Summers’ and Barber’s model of pragmatic psychodynamic psychotherapy influenced profoundly the selection of cases and how these cases are written up. As they write, their model “is based on the traditional conflict model of mental life and highlights the therapeutic alliance, core psychodynamic problem and formulation, as well as patient education and transparency, integration with other synergistic treatment modalities, and an active, engaged stance for the therapist... It differs from traditional psychodynamic psychotherapy, which is less focused, more hierarchical, diagnostically nonspecific, and not as easily integrated (conceptually and technically) with psychopharmacology and other concurrent treatments” ([1], p. 9). One of the building blocks of pragmatic psychodynamic psychotherapy is diagnosing the core psychodynamic problem. Summers and Barber contend that there are six core psychodynamic problems—depression, obsessionality, fear of abandonment, low self-esteem, panic anxiety, and trauma— which account for roughly 80–90 % of those who are appropriately treated with psychodynamic psychotherapy. The core problems “are not disease entities with the theoretical baggage of etiology, structure, course, and so forth. This is partly because we do not have an accurate model of what predicts the development of each core problem” (p. 15). The text includes a great table of the core psychodynamic problems, including their symptomatology; key conflicts and problems; predominant psychodynamic model used for formulation; typical core * Richard Balon rbalon@wayne.edu