Psychoanalytic and psychodynamic therapies: the state of the art

Abstract

This article discusses major new developments in psychoanalytic and psychodynamic psychotherapy during the 21st Century. New developments are set in the context of the ‘crisis of psychoanalysis’ that occurred in the 1990s and are seen as a direct response to this crisis. The responses are categorized as an engagement in evidence-based medicine, the emergence of neuropsychoanalysis, and new therapy models adapted from traditional techniques of psychoanalytic psychotherapy. A description is given of the problems that evidence-based medicine poses for psychotherapy before a critique of this paradigm is outlined. New evidence and alternatives to narrow definitions of evidence-based medicine are then elaborated. New findings in functional neuroscience are discussed, particularly their relevance to psychoanalytic psychotherapy. These new findings demonstrate the neuroscientific basis for many of the theoretical proposals of the psychoanalytic model of the mind. The third area of development is of adaptations in psychotherapy that take account of these neurological findings. Five recent therapy developments are compared and contrasted and the evidence for each is discussed. Some conceptual developments in psychoanalytic psychotherapy are described. Finally, two adaptations of psychoanalytic psychotherapy for the treatment of post-traumatic stress disorder and panic disorder are described.