Dynamic Interpersonal Therapy Research Articles

Dynamic interpersonal therapy in an NHS tertiary level specialist psychotherapy service

We describe the introduction of dynamic interpersonal psychotherapy (DIT) into an National Health Service (NHS) tertiary psychoanalytic specialist psychotherapy service. Training in DIT began as our contribution to Improving Access to Psychological Therapies and primary care services, supporting the training and supervision of their DIT practitioners. We then discovered DIT could be a valuable treatment within our own tertiary NHS service for patients with complex presentations. Currently fighting for survival, like many NHS psychoanalytic psychotherapy services nationally, we have adopted a manual-guided, psychoanalytically based therapy to broaden our tertiary clinical psychoanalytic service and accommodate trends in mental health service provision, whilst protecting the quality and integrity of our psychotherapy. DIT helped us continue providing relevant and beneficial psychoanalytic and psychodynamic services to individual patients despite limitations of the financially challenged NHS, NICE guidelines and Payment by Results. We outline the progress and outcomes for patients with complex mental health presentations, include individual case discussion and our experience of using the DIT approach within a traditionally longer term psychoanalytic psychotherapy service.

Clients’ experiences of dynamic interpersonal therapy (DIT): opportunities and challenges for brief, manualised psychodynamic therapy in the NHS

Dynamic interpersonal therapy (DIT) is a brief manualised psychodynamic intervention for depression. This is a first study exploring clients’ experiences of DIT specifically and brief, manualised psychodynamic psychotherapy (PP) in general. Interpretative phenomenological analysis was the methodology employed. Five participants completed a semi-structured interview, three weeks to ten months after completing DIT. The scores of pre- and post-therapy outcome measures of depression and anxiety were also available. Two emerging superordinate themes are presented here: (1) ‘The Distinct Features of DIT’, referring to how its therapeutic style and time limitations were experienced and (2) the ‘Impact of Therapy’, referring to perceived outcomes. While previous findings showed that therapist’s perceived limited activity in long-term PP was experienced as hindering/unhelpful, the perceived sense of direction in DIT appeared adequate to most participants. Secondly, the time limitations provoked complex responses. Reactions to the distinct elements of DIT are to be treated both as therapeutic opportunities and as challenges. Further, in line with psychoanalytic theory, most participants described relational changes that went beyond symptom relief and remained in progress after therapy ended. Intriguingly, there was no consistency between participants’ qualitative accounts of change and the scores of the outcome measures.

An investigation into the effectiveness of Dynamic Interpersonal Therapy (DIT) as a treatment for depression and anxiety in IAPT

This paper describes a preliminary investigation on the effectiveness of Dynamic Interpersonal Therapy (DIT). The research was undertaken in an inner London primary care psychological therapies service. Outcome data on the symptoms of depression [Patient Health Questionnaire-9 (PHQ-9)] and anxiety [Generalised Anxiety Disorder-7 (GAD-7)] were collected from service-users (n = 24) at the first and last episodes of treatment. There were statistically significant reductions in depression (PHQ-9) and anxiety (GAD-7) associated with DIT, with medium and large effect sizes, respectively. Overall, 75% of patients showed an improvement on the PHQ-9 and GAD-7 following DIT. When this was calculated as statistically reliable change, the improvements reduced to 42% for anxiety and 25% for depression. As this study was uncontrolled, the significance cannot be reliably attributed to DIT. Future research may aim to investigate DIT's effectiveness in different settings with a larger sample size, using appropriate comparison groups under controlled conditions.

A Brief Commentary on the Systematization of Psychoanalytic Therapy: History and Present Perspectives

The Authors outline the history of the systematization of psychoanalytic therapy and report on the recent development of a new Dynamic Interpersonal Therapy protocol for depression and anxiety disorders.

Dynamic Interpersonal Therapy (DIT): Developing a New Psychodynamic Intervention for the Treatment of Depression

This article outlines the development of a manualized, brief (16 session) psychodynamic intervention—Dynamic Interpersonal Therapy (DIT)1—for the treatment of depression. DIT is based on a distillation of the evidence-based brief psychoanalytic/psychodynamic treatments pooled together from manualized approaches that were reviewed as part of the competence framework for psychological therapies first commissioned in the United Kingdom by the Department of Health. This article begins with a description of the methodology underpinning the competence framework, followed by an overview of the model, its relevance to depression, and, finally, its strategies and techniques, which are illustrated through a case study. 1DIT is easily confused with Interpersonal Therapy (IPT), because both therapies are interpersonal in their focus. However, IPT is not a psychodynamic therapy and this is reflected in the competences required to deliver it (Lemma, Roth, and Pilling, 2010), which are quite different to the psychoanalytic competences required to deliver DIT.

Feasibility study of a psychodynamic online group intervention for depression.

Dynamic Interpersonal Therapy (DIT) was originally developed as a brief psychodynamic intervention for the treatment of depression and anxiety. More recently it has become the psychodynamic protocol for depression specifically within Improving Access to Psychological Therapies services across the U.K. The aim of the present study was to pilot and evaluate the feasibility of a group online version of DIT—Online Group Dynamic Interpersonal Therapy—and the perceived helpfulness of psychodynamically informed self-help materials. Twenty-four participants were randomly assigned to three groups. Participants in Condition A (n = 8) took part in an online DIT group, with self-help materials, facilitated by a therapist. Participants in Condition B (n = 8) were given access to a closed virtual group space where they could interact with each other and were supplied with the same self-help materials used by participants in Condition A, but without online therapist facilitation. Participants in Condition C (n = 8) received no instructions or facilitation, but had access to an online mental well-being site where they could meet virtually in a large, open, moderated virtual group space to discuss their psychological difficulties. This feasibility study was underpowered to detect significant differences in rates of change between facilitated and unfacilitated provision of material, but decline in symptoms appeared to be superior to control only for the facilitated group when the groups were considered separately. The response of the combined treated groups against control suggests that the DIT self-help materials may be helpful and appear to support the process of change. Further work is required.

Review of Brief dynamic interpersonal therapy: A clinician's guide.

Review of Brief dynamic interpersonal therapy: A clinician's guide.

Brief Dynamic Interpersonal Therapy – is it fitting in primary care?

Family doctors and psychodynamic practitioners, in their different ways, tend to be aware of long perspectives in their patients' lives. In ‘Reference Back', the poet Philip Larkin (1964) tells us ...

The Development of a Brief Psychodynamic Intervention (Dynamic Interpersonal Therapy) and Its Application to Depression: A Pilot Study

This paper describes a protocol for a brief psychodynamic intervention (Dynamic Interpersonal Therapy; DIT) for use with depressed patients and a pilot study set out to test its acceptability and compatibility with session-by-session monitoring as a prelude to a future randomized controlled trial. Sixteen consecutively referred, depressed patients (aged 20-53) were offered 16 sessions of DIT. Patient outcomes were collected pre-post, and on a session-by-session basis, using the PHQ-9 and GAD-7. Therapist and supervision feedback indicates that this structured psychodynamic treatment could be effectively taught, and that the key competences involved were acquired and demonstrated in the clinical work supervised. Patients found the treatment acceptable and relevant to their problems. The treatment appeared compatible with session-by-session monitoring of symptoms of anxiety and depression. DIT was associated with a significant reduction in reported symptoms in all but one case, to below clinical levels in 70% of the patients. Random regression models revealed highly significant linear and quadratic components, confirming the decrease in reported symptom severity but cautioning about slight increase in symptoms around the ending phase of the treatment. The results suggest that DIT is promising in its acceptability and effectiveness with an unselected group of primary care patients, and is easily acquired by psychodynamically trained clinicians.

The development of a brief psychodynamic protocol for depression: Dynamic Interpersonal Therapy (DIT)

This paper outlines the development of a manualized, brief (16-session) psychodynamic intervention – Dynamic Interpersonal Therapy (DIT)1 – for the treatment of depression. DIT is based on a distillation of the evidence-based brief psychoanalytic/psychodynamic treatments pooled together from manualized approaches that were reviewed as part of the competence framework for psychological therapies first commissioned by Skills for Health. DIT has now been selected as the brief psychodynamic protocol that will be provided nationally in the UK as part of the IAPT programme. This paper will first describe the methodology underpinning the competence framework followed by an overview of the model, its relevance to depression, and finally its strategies and techniques.

Dynamic Interpersonal Therapy (DIT): Providing a focus for time-limited psychodynamic work in the National Health Service

In this paper we outline the experience of our involvement as clinicians in a pilot feasibility study of a new brief psychoanalytically-based protocol – Dynamic Interpersonal Therapy [DIT] (see also Lemma, Target, & Fonagy, this issue). We discuss how the DIT model has helped us to integrate more coherently the brief psychoanalytically-based work we have been doing in the London Borough of Tower Hamlets, an area of ethnic diversity and high levels of deprivation. We describe the experience of using standardized outcome measures in a brief psychoanalytic therapy. We also include some case studies of clinical work undertaken using the DIT model.

The ongoing struggle for psychoanalytic research: Some steps forward

Although the need for psychoanalytic research is increasingly acknowledged, many psychoanalysts remain resistant to the performance and findings of this research. Objections to research include a continuing mistrust of research tools and approaches, combined with a belief in the effectiveness of psychoanalytic treatments based on clinical lore and individual experience. Furthermore, as psychoanalytic literature continues to function within its own separate domain, even well-read psychoanalysts can be sequestered from central scientific conversations occurring in the larger literature about mental health. In part due to these factors, few adequate studies of psychoanalytic treatment approaches have been performed. The lack of efficacy research has added to the marginalization of psychoanalytic treatments. Fortunately, in recent years groups of clinicians and researchers have begun to study psychoanalytic treatments, particularly approaches to specific disorders. In this context, this issue provides a welcome addition to the literature in the trailblazing work and papers of Lemma, Target, & Fonagy and Gelman, McKay, & Marks. They have developed an exportable and specific psychoanalytic psychotherapy, which has been employed in the UK's National Health Service Improving Access to Psychological Therapies (IAPT) programme. Work on manualized treatments, such as the Dynamic Interpersonal Therapy of Lemma et al., has allowed psychoanalysts to better clarify and illustrate their treatment approaches. Thus psychoanalytic research, in addition to assessing efficacy, can potentially lead to the development of more effective and rapid relief of symptoms, in a broader population of patients.

Culture and Masculinity: When Therapist and Patient are Latino Men

Treating clients from diverse cultural backgrounds, and supervising clinicians who are treating clients of the same ethnicity and gender, are now common experiences in our mental health system. As the growth of minorities in the US greatly outpaces the training of minority clinicians, more attention to these situations is needed. Operating from the premise that interpersonal sensitivity is a fundamental aspect of cross-cultural and cross-ethnic sensitivity, we describe the treatment of a Latino male by a Latino male clinician, in this case both of Puerto Rican descent. We outline the contours of the therapy with a man whose life history included numerous incidents of humiliation and thwarted efforts at efficacy, mastery, agency, and competence, resulting in an adult character structure based on shame and self-doubt. We also discuss the challenges to the clinician posed by working with a man whose traditional upbringing mirrored his own, with all the positives and negatives that must be considered in the countertransference. We describe clinical and cultural reasons for various interventions, and their resulting outcome. The framework of a dynamic interpersonal therapy and the challenges of transference, countertransference, therapist disclosure, and working-through are covered.