Psychodynamic Psychotherapy Research Articles

Unlocking the mind: a psychodynamic approach to treating obsessive-compulsive disorder

There is limited evidence supporting the use of psychodynamic psychotherapy in the management of Obsessive-Compulsive Disorder (OCD). However, OCD is a disabling illness that often presents with comorbidities, and psychodynamic psychotherapy can be particularly beneficial in such cases. By targeting unconscious conflicts and bringing them to the surface, this therapeutic approach may help patients gain a deeper understanding of their illness. This article aims to explain the manifestation of symptoms through the lens of psychodynamic theory. It seeks to deepen the understanding of the nature of OCD by exploring unconscious processes and defence mechanisms. Furthermore, we will examine how addressing underlying psychological conflicts can complement traditional treatments and potentially improve patient outcomes.

Psychometric properties of comprehensive cognitive, affective, and psychomotor competency assessment scales in psychodynamic psychotherapy for borderline personality disorder

BackgroundPsychodynamic psychotherapy is a type of psychotherapy for individuals with borderline personality disorder (BPD). However, competency in conducting effective psychodynamic psychotherapy for BPD is difficult to evaluate. Therefore, this study aimed to identify the psychometric properties of a comprehensive scale to assess cognitive, affective, and psychomotor competencies (CS-CAPC) in psychodynamic psychotherapy for BPD.MethodsThis is a qualitative study. The first step used the Delphi technique to gather experts’ opinions on the cognitive, affective, and psychomotor competencies necessary to conduct psychodynamic psychotherapy for BPD. The experts comprised three psychotherapists, seven psychiatrists with experience in psychotherapy, and nine teaching staff. A panel discussion was conducted to obtain qualitative data. Thematic data analysis was adopted, and content validity testing was used to analyze the content validity of the CS-CAPC in psychodynamic psychotherapy for BPD.ResultsThe CS-CAPC comprised two scales assessing two specific competencies in psychodynamic psychotherapy for BPD: The first scale, the psychodynamic formulation competency assessment scale (PF-CAS), comprised six items, including the case description, etiology, and potential course of therapy. The second scale, the practical-competency assessment scale (PC-CAS) for psychodynamic psychotherapy for BPD, comprised 12 items, including building a therapeutic alliance, performing psychodynamic interventions while working through the therapeutic process, and closing the session. The scale-level content validity index (S-CVI) for the PF-CAS was 0.981, and that for the PC-CAS in psychodynamic psychotherapy for BPD was 1.00.ConclusionThe CS-CAPC in psychodynamic psychotherapy for BPD had good validity in assessing individual competency in the cognitive, affective, and psychomotor domains.

Fifteen Years of ISTDP in Norway.

The year 2024 celebrates the 15th anniversary of nationally organized training in and delivery of intensive short-term dynamic psychotherapy (ISTDP) in Norway. Accordingly, the authors provide an overview of the implementation of ISTDP in Norway, examine ISTDP's impact on mental health delivery, review research, reflect on practice, and discuss future directions for ISTDP in the country. Since its introduction in Norway, ISTDP has gained significant popularity and recognition in the mental health field. The training of Norwegian trainers and the founding of the Norwegian Institute for ISTDP allowed for the expansion and scalability of the ISTDP training program. Alignment of the training program with the existing framework for postgraduate specialization for psychologists and its accreditation by the Norwegian Psychological Association has ensured recognition and relevance in the mental health field. Private- and public-sector applications have further contributed to the growth and dissemination of the method in Norway. ISTDP has thus become an integral and important part of the therapeutic landscape, providing hope and healing to individuals facing various emotional challenges. ISTDP's influence is likely to keep growing, both within Norway and internationally, thus contributing to the advancement of effective psychotherapy practices worldwide.

Silence after narratives by patients in psychodynamic psychotherapy: a conversation analytic study

Silence after narratives by patients in psychodynamic psychotherapy: a conversation analytic study

Equine-Facilitated Psychotherapy (EFP) and Well-Being: Exploring the Experiences of UK Military Veterans Using a Dialogical Narrative Approach

Despite experiencing high rates of mental health and social difficulties, veterans face a range of internal and external barriers to accessing psychological therapy. Equine-facilitated psychotherapy (EFP) is a relatively new intervention, which a growing evidence base suggests can be effective, particularly for those who find it difficult to engage in traditional psychotherapies. EFP is underpinned by principles of psychodynamic psychotherapy, as well as theories regarding attachment, biophilia, and social support. Research on EFP with veterans is limited, with only a handful of studies, almost all of which have been conducted in North America. This first UK study explores veterans’ narratives of mental health difficulties and their experiences of EFP, using well-being to frame the shared experiences. Interviews were conducted with five veterans (three female, two male) who had received EFP. The analytical approach employed was dialogical narrative analysis. Themes identified across participant stories included relating to the horse, insight, self-regulation, focus of attention, a safe environment, personal relatedness, and empowerment. Dialogical questions elucidated how aspects of the veteran identity and cultural narratives contributed to the stories chosen. The findings provide significant insight into the EFP experiences of veterans, which were resoundingly positive. Well-being may be improved through the development of meaningful relationships with horses, facilitators, and peers, adaptive coping mechanisms, and a renewed sense of self and optimism. Future research directions are suggested, and clinical implications such as the impact of the environment, as well as the role of peer support for veterans’ mental health services, are considered.

Терапия расстройств пищевого поведения: от исследований к практике

<p>This digest reviews recent significant changes that can play a role in the treatment of eating disorders. It also contains proposals on improving the efficacy of treatment in general and investigation of the outcome of intensive treatment and psychodynamic group therapy for patients with eating disorders.</p>

How a Dream Led Me to Psychoanalysis.

This column addresses the role of dreams in psychoanalysis and psychodynamic therapy. It includes an autobiographical perspective on how a dream led this psychiatrist to become a psychoanalyst and an introduction to social dreaming.

Exploring therapeutic responsiveness: a comparative textual analysis across different models.

The purpose of this study is to examine therapeutic responsiveness across three different therapeutic models. The construct of responsiveness consists of two conceptual features: optimal responsiveness, which involves adapting therapist behavior to the unique therapeutic relationship, and appropriate responsiveness, a more refined concept. While aligned with interpersonal principles, the responsiveness construct challenges prevailing statistical methods by emphasizing the therapist's adaptive responses. A comparative analysis of Gestalt, psychodynamic, and systemic therapies revealed unique patterns of responsiveness within each model, ranging from an emphasis on empathy and intuition to the significance of countertransference. Methodologically, a literature review and textual analysis using Atlas.ti allowed for nuanced exploration. The results also revealed a core commonality-"experience"-across these models, positioning responsiveness as an "extra-specific" factor amidst shared conceptual ground. In conclusion, this study sheds light on the nuances of responsiveness, which is central to advancing psychotherapeutic practice in an evolving landscape. An in-depth examination of the construct of responsiveness helps identify therapist characteristics that can be enhanced, enriched, and supported during training and supervision.

Therapists’ experiences of negative effects in intensive short-term dynamic psychotherapy: A qualitative interview study

Objective: Negative effects of psychotherapy are a broad term that encompasses events such as non-response, deterioration, and novel symptoms. The aim of the present study was to explore experiences with negative effects among clinicians working within an intensive short-term dynamic psychotherapy (ISTDP) framework. Method: Eight ISTDP clinicians consented to participate and were interviewed using semi-structured video interviews. Data were transcribed and analyzed using a reflexive thematic analysis framework. Results: The thematic analysis resulted in five themes. Overall, the clinicians found it difficult to define negative effects, but that negative effects, regardless of cause, could be used therapeutically. Inaccurate assessment was seen as the main cause of negative effects. Other themes concerned the connection between dropout and negative effects, patient feedback, and the ISTDP community’s relationship to negative effects. Conclusions: The results are largely in line with qualitative studies of CBT clinicians’ views of negative effects although clinicians in the present study emphasized more strongly the therapeutic potential of these events. The research field could be further improved by using mixed-method designs while including both patients and therapists.

More than Meets the “I”: A Panoramic View of Epistemic Trust in Psychotherapy

Introduction: Epistemic trust (ET), the authenticity and personal relevance we assign to interpersonally transmitted knowledge, is considered an essential component of any effective therapy. Despite its clinical significance, comprehensive empirical support is still lacking regarding whether ET is an inherent characteristic of the patient or acts as a catalyst for therapeutic change. Consequently, unlike other critical components, a clear distinction between its aspects – the patient’s attributes, the therapist’s contribution, and their unique therapeutic relationship – remains elusive, leaving our understanding incomplete. The current study examines the constituents of ET in therapy and its related effects through three distinct lenses: a blended snapshot lens, a prognostic lens, and a lens focusing on state-like changes. The constituents of ET were measured as follows: patient attributes were measured using attachment orientation and interpersonal functioning scales; therapist contribution was evaluated through scales assessing the therapist’s use of techniques; and the patient-therapist therapeutic relationship was gauged using the working alliance scale. Methods: We collected and analyzed data from 116 patients who participated in manualized psychodynamic psychotherapy sessions to investigate the trait-like and state-like components of ET. Results: The results offer a comprehensive panoramic view with small to medium, but meaningful, correlations between ET and patients’ attributes (ranging from 0.18 to −0.26); therapists’ contributions (ranging between 0.15 and 0.28); and the patient-therapist therapeutic relationship (ranging between 0.17 and 0.23). Conclusion: While some findings were consistent with our expectations, others were contrary, highlighting the necessity of considering the variations between and within patients as they have distinct theoretical, clinical, and empirical implications. Employing these three distinct lenses helps therapists gain a better understanding of the clinical picture reflected by the patient over different treatment periods. This broad perspective is of prognostic importance and encourages clinicians to adjust the treatment focus to meet the evolving needs of their patients.

Brief psychodynamic psychotherapy for adolescents and their families in crisis: a pilot study

ABSTRACT The global rise in adolescent self-harm and suicidal behaviours has intensified the demand for mental health services in the UK. This has further strained already underfunded and understaffed resources, resulting in longer waiting times and increased emergency department visits among teenagers. To address the overwhelming need for effective community-based emergency support, a brief psychodynamic crisis therapeutic intervention was developed within a CAMHS adolescent crisis team, inspired by child psychotherapist Ruth Schmidt Neven’s work on time-limited psychotherapy with adolescents and their families. This 12-session intervention offers both individual therapy for the adolescent and sessions for their parents, along with regular family reviews. Two psychotherapists work closely together on each case – one with the young person, the other with the parents. The brief model views crises as opportunities for deeper understanding, moving beyond diagnostic and symptom-centred approaches, as well as standard risk management and safety-planning strategies, and underlines the centrality of parent involvement in adolescent crisis work. This paper outlines the intervention’s theoretical foundation, guiding principles, and practical design, and presents preliminary findings from a pilot study of 22 cases, run over two and a half years. Early results suggest broad potential for this psychodynamic crisis approach in various adolescent crises, and merit further investigation.

Fostering trust - a qualitative outcome study of psychodynamic group and individual psychotherapy for refugees with PTSD.

Background: Refugees and asylum-seekers have an elevated risk of mental health issues, such as depression and posttraumatic stress. Qualitative outcome studies can contribute by offering insight into patients' experiences of what they find beneficial and how they undergo the process of recovery. This study aligns with the small body of qualitative research focusing on refugees' perspectives of psychotherapeutic treatment for PTSD.Objective: This study investigates and compares the treatment experiences of refugees with posttraumatic stress disorder (PTSD) in psychoanalytic group therapy (PAGT) and individual psychodynamic therapy (PDT) within an outpatient context in Sweden.Method: 10 former patients were interviewed using a semi-structured interview schedule. Data were analysed and interpreted according to the principles of grounded theory.Results: The findings reveal distinct categories for each treatment modality, being reborn for PDT and building a home for PAGT. Being reborn involved persistent intrapersonal change and lasting improvement in posttraumatic symptoms. Building a home involved a sense of belonging, support and temporary relief from posttraumatic symptoms. Participants from both treatment modalities underscored the significance of cultivating trust in therapeutic relationships.Conclusions: The study emphasises the necessity for tailored therapeutic approaches, contributing valuable insights to the limited research on effective mental health interventions for this population.

Effectiveness of group analytic and psychodynamic psychotherapy in routine secondary-care practice

Group psychotherapy has been shown to be effective across a diverse range of participants and settings. However, few quantitative studies have examined outcomes of Group Analytic Psychotherapy (GAP) specifically, or compared this with alternative treatments. In the present study we compare outcomes of weekly group analytic psychotherapy (GAP) and individual psychodynamic psychotherapy (PPT) at a psychotherapy service within the UK’s National Health Service. The service collected Clinical Outcomes in Routine Evaluation (CORE) outcome measures between 2010 and 2020 as part of routine clinical practice, furnishing a large observational dataset (N=600 clients). We found that clients showed clinically significant improvement following either GAP (Cohen’s d=0.77) or PPT (d=0.68), and the rate of change during therapy exceeded that during a pre-treatment waiting period. There were no clinically significant differences in effectiveness between GAP and PPT, of either short-term (<1 year) or long-term (> 1 year) duration. These results support a conclusion that both GAP and PPT are effective in routine clinical practice. We consider the advantages and limitations of quantitative outcome measurement from a group analytic perspective and highlight the possible pitfalls of attempting to optimise therapy based on overly narrow criteria.

A Novel Approach to Examining Working Alliance Instability During Psychotherapy for Borderline Personality Disorder.

This study aimed to quantify the instability of psychotherapy process variables by using a novel data-analytic approach. The study explored instability of the working alliance over 10 treatment sessions and its relationship with self-esteem. Data were extracted from a randomized controlled trial, conducted in Switzerland, of a short-term intervention for borderline personality disorder. Sixty clients diagnosed as having borderline personality disorder were randomly assigned to receive either 10 sessions of good psychiatric management-brief version (GPM-BV) or GPM-BV combined with a relational principle called motive-oriented therapeutic relationship. Square successive differences were calculated for client and therapist ratings of alliance instability. Multilevel models were used to test within- and between-person associations of alliance instability with self-esteem. Although some preliminary analyses showed an association between a more stable alliance and higher self-esteem at the start of psychotherapy, the alliance did not become more stable over time. Alliance instability was not associated with self-esteem at either the within- or between-person level. This study highlights the advantages, procedures, and challenges of applying square successive differences to psychotherapy research data. The results suggest that the working alliance develops in complex ways and indicate the importance of continuing to use novel methods to capture dynamic psychotherapy processes.

The D*Phase-study: Comparing short-term psychodynamic psychotherapy and cognitive behavioural therapy for major depressive disorder in a randomised controlled non-inferiority trial

BackgroundGiven both the large volume and manifold preferences of patients with depression, the availability of various effective treatments is important. Psychodynamic psychotherapy (PDT) has received less research in comparison to cognitive behavioural therapy (CBT) for major depressive disorder (MDD). This study aimed to establish whether short-term psychodynamic supportive psychotherapy (SPSP) is non-inferior to CBT in the treatment of MDD. MethodsA non-inferiority trial was conducted in a Dutch mental health setting, with 290 patients randomised to receive 16 sessions of either CBT or SPSP, over eight weeks. Primary outcome was depressive symptom severity assessed using the self-rated Inventory of Depressive Symptomatology (IDS-SR). The non-inferiority margin was prespecified as a − 5 post-treatment difference on the IDS-SR. Secondary outcome measures were functional impairment caused by symptoms assessed using the Sheehan disability scale (SDS), and wellbeing measured by the Mental Health Continuum-Short Form (MHC-SF). ResultsBoth intention-to-treat (baseline-adjusted mean difference 1.62, 95 % CI -1.82 to 5.05) and per-protocol analyses (mean difference 2.54; 95 % CI -0.63 to 5.72) showed SPSP to be non-inferior to CBT in reducing depressive symptoms. SPSP showed slightly but significantly higher remission rates and wellbeing scores. LimitationsPatients opting for other therapies or medication did not take part in the trial. Follow-up measures or clinician-rated questionnaires were not included. ConclusionsThe findings support SPSP as a viable treatment option for MDD, expanding the available choices for patients and broadening treatment options.

Modern approaches to psychoterapy of somatoform disorders

The scientific review focuses on the relevant for modern medicine problem of psychotherapy of somatoform disorders (SFD). It is based on the analysis of 106 publications on this topic (46 of them in Russian and 60 in English). The search for publications was carried out in the RSCI and Medline bibliographic databases. The purpose of the review was to form ideas about the current state of the psychotherapy of SFD with the highlighting and comparison of the main current approaches in this area. The review analyzes the overall effectiveness of psychotherapy of SFD and considers the following modern its directions: cognitive behavioral therapy, mindfulness-based psychotherapy, dynamic psychotherapy, group psychotherapy, other (rarely mentioned) psychotherapeutic methods, as well as polymodal and remote approaches to psychotherapy of SFD.The summary of the literary information presented in the review allows to conclude that psychotherapy today is considered by most authors as an important, possibly even leading component of the treatment of the considered mental pathology type. At the same time, data on its clinical effectiveness, especially in isolated use, remains ambiguous, in addition, among researchers there is still no unity of views on the main targets of psychotherapeutic impacts in SFD, as well as on the most suitable forms and methods of psychotherapy for the treatment of this pathology. Information on the clinical effectiveness of specific psychotherapeutic methods currently used for the treatment of SFD is either ambiguous or incomplete, and the polymodal approaches to psychotherapy of SFD proposed by some authors have insufficient scientific justification for the methodological combinations used in them. The future of psychotherapy of SFD is seen by the authors of this review in the development of integrative psychotherapeutic programs that combine elements of several multidirectional methods of psychotherapy, but that are based on knowledge of the general personal and psychological characteristics of patients suffering from SFD.

Equine-Assisted Short-Term Psychodynamic Psychotherapy and the Role of Personality Functioning, Emphasizing Self-Control and Identity integration

Equine-Assisted Short-Term Psychodynamic Psychotherapy and the Role of Personality Functioning, Emphasizing Self-Control and Identity integration

When and how patients' self-claims are challenged in psychotherapy

Abstract The article describes the practices through which patients’ self-presentations are challenged in psychotherapy. Based on the analysis of thirty-eight instances from psychodynamic psychotherapy and psychoanalysis, analyzed with methods of conversation analysis, narrative analysis, and coding, this article reports on how therapists challenge patients’ self-conceptualizations in response to patients’ self-presentations. Challenges mostly follow patients’ descriptive, narrative, or evaluative accounts that include a strong claim about their self. Challenges to the self pertain to core issues of the therapeutic projects. They are mostly built in ways that show its sensitivity to probable rejection by the patient. Overwhelmingly, the challenge is accounted for by reference to shared knowledge built in the participants’ shared interactional history. Arguably, psychotherapy is a particular setting where the organization of face-work is modified, as occasional challenging of the co-interactant's self-presentation is part of the institutional task of the professional participant. Data are in Finnish and German. (Self, psychotherapy, Goffman, conversation analysis)*

Video analysis of music therapy interaction for children experiencing neurodevelopment delay

Children experiencing neurodevelopmental delay have motor, linguistic, and cognitive problems that affect their skills in various domains, especially interpersonal ones. Since music therapy is based on musical exchange, these three case studies explore how child–music therapists’ interactions change within and between sessions. Moreover, we evaluated whether the children’s and parents’ musical interaction changed in everyday life. Three children experiencing neurodevelopmental delay participated in 70 psychodynamic music therapy sessions, relying primarily on musical improvisation techniques. The initial (i.e. pre-test) and final sessions (i.e. post-test) were video recorded and codified with the Kategoriensystem Musik Therapie (KAMUTHE) in the 10th and 30th minutes. Videos were analyzed using the Behavioral Observation Research Interactive Software (BORIS). In addition, parents completed the Music in Everyday Life (MEL) Scale to evaluate how they experienced musical activities with their children. Reliable Change Indexes (RCIs) were calculated to assess significant changes in everyday musical activities. Based on video analysis, three children were more active at the 30th minute and the post-test, while Music Therapists stimulated them less. In addition, therapists adapted the activities and stimuli based on the children’s responses. Based on RCIs, parents reported an increased musical engagement with two children. Music therapy might help children experiencing neurodevelopmental delays modify their interaction style and improve motor and interpersonal skills.

The efficacy of psychodynamic psychotherapy for young adults: a systematic review and meta-analysis.

One in six young adults presents with at least one mental health problem. However, so far, little attention has been directed to the mental health needs and the efficacy of therapeutic interventions for young adults. We conducted a systematic review and meta-analysis of the type, quality and efficacy of psychoanalytic psychotherapy for young people. We searched the PsycInfo, PubMed, Embase, and Cochrane databases to identify all the published randomized controlled trials (RCT), and naturalistic and observational studies of psychodynamic or psychoanalytic psychotherapies. We calculated the standardized mean difference in scores of psychodynamic interventions versus control conditions, adopting a random effects model (Hedges' g). We identified 22 eligible studies, including 14 RCTs, and 8 naturalistic studies. Statistical analyses showed no significant difference between psychodynamic psychotherapy and other comparison treatments (psychotherapy or pharmacological interventions) for young adults (Hedges'g - 0.34 [95% CI: -0.991;-0.309], p = 0.304). Nevertheless, there was a significant effect of psychodynamic psychotherapy when compared with control conditions (waiting list or treatment as usual) for target symptoms (Hedges'g - 1.24 [95% CI: -1.97;-0.51], p < 0.001). Our systematic review highlights important clinical implications in identifying the efficacy of psychoanalytic interventions for specific at-risk groups and suggests developing prevention strategies for mental health problems in young adulthood across cultures and context.