Psychodynamic Treatment Research Articles

Change in the Play of Children Who Experienced Early Relational Trauma: Theoretical and Clinical Reflections on Psychodynamic Intervention

ABSTRACT Children who experienced early relational trauma resulting from chronic exposure to maltreatment and neglect within the parent-child relationship in the early years of life are often trapped in traumatic play with no possibility of psychic elaboration or have difficulty using play in a manner that is beneficial to them in traditional play psychotherapy. The purpose of this article is twofold. Firstly, it describes how play changes in the course of psychotherapy with children who experienced early relational trauma. Secondly, it demonstrates how therapists must use different types of interventions to meet the needs of traumatized children, particularly their capacity to play to overcome the deleterious effects of trauma. A four-stage model of how play changes over the course of psychotherapy with children who suffered from early relational trauma is proposed. Finally, each stage is analyzed regarding the features expected in the play and the psychotherapeutic interventions that should be used accordingly. A clinical illustration is also discussed.

An International Survey of the Concept of Effective Psychodynamic Treatment During the Pandemic

An International Survey of the Concept of Effective Psychodynamic Treatment During the Pandemic

Reasons for Suggesting Group Psychotherapy to Patients.

There are many psychotherapy varieties, but all are delivered through two predominant modalities-individual and group. This article outlines differences between individual and group treatment and the advantages and disadvantages of each. The author focuses on psychodynamic treatment, but the differences between the two modalities apply across all theoretical orientations. Human beings are social animals with an innate drive for relationships. With the advent of mass transit and mass communication, many historic bastions of relationships, such as the family, the neighborhood, and religious institutions, have been disrupted, and the roots of relationships have become shallow. As a result, many people seek psychotherapy to help build and sustain more intimate and healthier relationships, a goal for which group therapy is well suited. As relationships develop in group psychotherapy, group members demonstrate the assets and liabilities of their relational styles. Their defenses against intimacy become apparent. For these reasons, group therapy is the treatment of choice for many people. The interpersonal nature of group psychotherapy provides an opportunity to recognize interpersonal behavior patterns and thus may provide tools to allow for more intimate relationships. When meeting a new patient, the therapist seeks not only the theoretical treatment that might be most amenable to the patient's individual needs but also the form of therapy that might work best. The aim of this article is to examine the unique features of group therapy and of the patients this modality may especially help.

TFP Extended: Development and Recent Advances

Recent advances in the understanding of personality pathology have contributed to an emphasis on the core of personality pathology as deficits in self-functioning and interpersonal functioning at different levels of severity that must be assessed for clinical intervention. In concert with these conceptual and empirical advances, transference-focused psychotherapy (TFP), an empirically supported psychodynamic treatment for borderline personality disorder, has been in constant development with extensive clinical use. This article describes an object relations model for conceptualizing and assessing levels of personality organization, a transdiagnostic approach to personality pathology, and related treatment modifications, thus expanding the utilization of TFP beyond borderline personality disorder to the full range of personality dysfunction. The core of this treatment approach is a sequential interpretive process between patient and therapist. This process takes place within the context of a structured treatment frame tailored to the unique individual with problems in self-functioning and interpersonal functioning in his/her particular environment.

Psychodynamic Interventions in Pregnancy and Infancy: Clinical and Theoretical Perspectives by BjörnSalomonsson. Published by Routledge, Abingdon and New York, 2018; £32.99 paperback.

He may be at pains to be a zealot (p 61) - I Psychodynamic Interventions i thrums with religious allusions - but Salomonsson clearly seeks to inspire Parent-infant psychotherapy promotes a certain looseness in the analyst's mind, Salomonsson argues Bjorn Salomonsson takes guesswork seriously;the sort of attentive, informed guesswork a parent in ordinary good-enough circumstances might use in deducing and attending to a baby's needs [Extracted from the article] Copyright of British Journal of Psychotherapy is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission However, users may print, download, or email articles for individual use This abstract may be abridged No warranty is given about the accuracy of the copy Users should refer to the original published version of the material for the full abstract (Copyright applies to all Abstracts )

The suicidal survivor: Considerations for treatment in psychodynamic psychotherapy

IntroductionSuicide is a phenomenon that is increasing in prevalence. Exposure to suicide by a loved one can be experienced as a traumatic event, capable of precipitating or aggravating preexisting psychiatric conditions. As much as we are clinically aware of gravity situation experienced by suicide survivors, there is a marked lack of studies on psychotherapeutic interventions in this population group.ObjectivesThe present work aims to review the literature on the psychodynamic treatment of suicide survivors, considering their theoretical and technical aspects.MethodsNarrative review of psychiatric and psychoanalytic literature.ResultsThe initial reaction described on becoming aware of the suicide of someone close to you is of disbelief, shock and helplessness. This is followed by ambivalent feelings of hate and guilt, shame and hopelessness. Sometimes, a chronic depressive state expressed by the survivor’s guilt can emerge. The mourning work will initially encounter resistance to face the loss of the object, through mechanisms such as denial, repression and psychotic fantasies. The lost suicide has a traumatic impact, modifying relational patterns and it is commonly associated with important isolation. The survivor will be able to transfer via fear the death of the therapist and even fantasize that he will also kill himself.ConclusionsPsychodynamic psychotherapy with suicide survivors finds theoretical and practical foundations in the literature, mainly through discussions of reports clinical and theoretical reviews on the topic. Through transfer and therapeutic alliance, new patterns of object relation can be sketched, in a context of mourning so often complicated by shutdown pressures and loneliness.DisclosureNo significant relationships.

An examination of parent sessions in regulation-focused psychotherapy for children.

Collateral work with parents is a widely adopted practice within child psychotherapy. Therapeutic process within these parent sessions has not been empirically studied or defined, despite a sizable process-outcome literature in both child and adult individual therapy. This link between research and practice is particularly important among manualized, child-focused treatments, where the proposed therapeutic action and clinical approach to parent work is defined according to distinct theoretical principles. To address this gap in the child treatment literature, the present study used the Psychotherapy Process Q Set to examine the in-session processes of parent sessions from 16 treatments of regulation-focused psychotherapy for children (RFP-C). RFP-C is a manualized, psychodynamic treatment for children with disruptive behaviors that consists of 16 child sessions and four collateral parent sessions. The parent-session process ratings were compared to existing adult therapy prototypes and the RFP-C child session prototype. Results indicated that observer-coded psychotherapy process in RFP-C parent sessions was most similar to a cognitive-behavioral therapy prototype and moderately correlated with both a supportive-expressive psychodynamic psychotherapy and a reflective functioning prototype. Observer-coded parent session process was distinct from the RFP-C child prototype. Limitations and directions for future research and clinical practice are discussed. The findings of this study indicate the need to intentionally examine process in parent sessions, both within RFP-C and across modalities, as these sessions have their own unique mechanisms of therapeutic action that ultimately may be additive with regard to child outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Efficacy of parent-infant psychotherapy compared to care as usual in children with regulatory disorders in clinical and outpatient settings: study protocol of a randomised controlled trial as part of the SKKIPPI project

BackgroundThe first years of life are a significant period for child development, when children are particularly sensitive and prone to crises. This early phase lays the foundation for healthy growth. Clinical assessment of psychological symptoms in early infancy and adequate treatment are both important in improving the diagnostic outcome and preventing later long-term developmental consequences. The most common psychological problems in the first 3 years of life are regulatory disorders. The aim of this trial is to investigate the efficacy of Parent-Infant Psychotherapy (PIP) for infants and young children (aged 0–36 months, diagnosed with at least one regulatory disorder) and their mothers, compared to care as usual (CAU).MethodsIn this open multicentre randomised controlled trial, 160 mother-infant dyads are randomised to receive PIP or CAU for 6 weeks of intervention in clinical or outpatient (including home treatment) settings. The primary outcome is the maternal sensitivity (sensitivity scale of the Emotional Availability Scales (EAS)) after 6 weeks. Secondary outcomes include assessment of interaction, mental health problems, attachment, development, psychological factors, treatment adherence, health care system utilisation, and costs, after 6 weeks and 12 months.DiscussionThis study will evaluate whether a manualised focus-based short-term psychodynamic psychotherapeutic intervention in mother-child dyads improves the care situation for families of children diagnosed with regulatory disorders, and helps prevent long-term psychopathologies. Assessment of the intervention in different settings will support the development of more tailored interventions for affected infants and their mothers.Trial registrationGerman Clinical Trial Register, ID: DRKS00017008. Registered 03/20/2019.

A White Person Problem: Conducting White/White Treatment with a Social Justice Lens

In this paper, I advance the view that racism, experienced as an intrapsychic, interpersonal, cultural and socio-political phenomenon, is fundamentally a problem that white people are responsible for solving. I begin with an assumption that white practitioners, specifically those of us who strive to offer social justice-informed psychodynamic treatment, are responsible for addressing this problem by attending to the relational dynamics that unfold in the consulting room with white clients. I utilize case material from my own practice to explore ways to do this and clinical quandaries that might arise, particularly in cases where the question of race does not explicitly present as a topic of concern. I suggest that there are multiple ways to address racism, as well as other socio-political issues, including investigating how the words we use are culturally and socio-politically determined, investigating in what way our clinical interventions are operating in collusion with or in opposition to parts of a client’s social and familial context (systemic enactment), analyzing and de-centering cultural and social expressions in clients that are reflections of a larger system of racial superiority and oppression, and linking intrapsychic and relational development with racial identity formation.

Vulnerable narcissism as beneficial factor for the therapeutic alliance in borderline personality disorder.

Evidence suggests that narcissism and borderline personality disorder are associated with each other. This naturalistic study investigated the predictive value of grandiose and vulnerable narcissism on the development of the therapeutic alliance in short-term psychodynamic treatment across 12 weeks. The sample consisted of 99 patients with borderline personality disorder. Narcissism was assessed with the Pathological Narcissism Inventory at treatment onset. The therapeutic alliance was rated with the Scale to Assess Therapeutic Relationships by both patient and therapist at four time points during treatment. Results showed a significant predictive value of vulnerable narcissism on the therapeutic alliance, revealing a more beneficial progression for patients with higher vulnerable narcissism. Grandiose narcissism had no predictive value on the therapeutic alliance. The study strengthens the clinical utility of the concept of vulnerable narcissism towards the evaluation of treatment processes in borderline personality disorder.

Countertransference responses mediate the relationship between patients’ overall defense functioning and therapists’ interventions

Objective: The aim of this work was to investigate the relationship between therapists’ techniques (supportive/expressive intervention level – ESIL), therapists’ countertransference (CT) and patients’ defense level of functioning (ODF). We hypothesized that CT could play a mediating role in the relationship between patients’ ODF and therapists’ ESIL. Method: 65 psychotherapy sessions were rated by two different raters each with the Psychodynamic Interventions Rating Scale and the Defense Mechanisms Rating Scale. Clinicians used the Therapist Response Questionnaire to provide information on their CT. The 65 sessions referred to 65 clinicians (25 = females, 40 = males; 38 = psychodynamic, 27 = cognitive). More than half of the patients (n = 40; 61.5%) had a diagnosis of personality disorder. Among clinical disorders the most frequent were mood (n = 12) and anxiety disorders (n = 11). Five patients had no diagnosis. Results: Four CT responses (parental; positive; criticized; overinvolved) completely mediated the relationship between patients’ ODF and therapists’ ESIL, while no effect resulted in relation to overwhelmed, helpless, sexualized and disengaged CTs. No effect of theoretical orientations on mediation pathways was found. Conclusion: Both positive and negative CT feelings seemed to play a crucial role in the relationship between therapists’ interventions and patients’ ODF.

Psychotherapy of anxiety disorders: state of the art

Alongside depression, anxiety disorders are the most frequent reason for consulting apsychotherapist. This article describes the recent progress in understanding basic learning processes in anxiety treatment, the resulting therapeutic procedures, the current state of knowledge on the efficacy of the various psychotherapeutic procedures and on the moderators of the success of treatment. The English and German language literature was reviewed and compiled, with an emphasis on the last 10years. Cognitive-behavioral therapy (CBT) achieves the best and broadest level of evidence across all anxiety disorders. Initial studies have also provided emerging evidence for the efficacy of manualized short-term psychodynamic treatment. The most discussed mechanism of action is that of inhibitory learning. Augmentation strategies and personalized treatment approaches are gaining in relevance. Current models of inhibitory learning are rooted in basic research and foster adeeper understanding of the underlying neurobiological mechanisms. In order to optimize success of exposure treatment in vulnerable subgroups of patients, many procedural, device-based and pharmacological augmentation strategies are currently under investigation, whereby the latter are mostly still in the stage of (pre)clinical testing.

Psychodynamic technique and therapeutic alliance in prediction of outcome in psychodynamic child psychotherapy.

This study is the first to investigate the effect of psychodynamic technique (PT), therapeutic alliance, and their interactions with outcome in psychodynamic child psychotherapy. The sample comprised 79 Turkish children (mean age = 6.86 years, 38% girls) with discrete internalizing (22%), discrete externalizing (11%) and comorbid internalizing and externalizing (67%) problems. Independent raters coded 359 sessions from different phases of treatment using the Child Psychotherapy Process Q-Sort for PT and Therapy Process Observational Coding System-Alliance Scale. Problem-assessment measures were collected at intake and every 10th session in treatment using the Children's Behavior Checklist and Brief Problem Monitor. Multilevel modeling analyses indicated that the PT and therapeutic alliance interacted such that more use of the PT in the context of high therapeutic alliance predicted less problem behaviors, whereas in the context of low therapeutic alliance PT predicted more problem behaviors. This relationship was moderated by problem comorbidity such that for children with comorbid problems, though a strong therapeutic alliance was indicated, an increase in PT use did not have a significant effect. Findings suggest that the use of psychodynamic interventions is indicated in the context of a strong therapeutic alliance, especially for children with noncomorbid problems. Psychodynamic interventions may have an adverse effect if a therapeutic alliance is not established. For children with comorbid problems, keeping the relationship strong is important. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Impulsiveness in borderline personality disorder predicts the long-term outcome of a psychodynamic treatment programme.

Despite the preponderance of treatment outcome predictors in patients with borderline personality disorder (BPD), the predictive value of measures of impulsiveness is inconclusive. This naturalistic study consecutively included hospitalized patients with BPD (N=99) who underwent a standardized and structured 12-week inpatient treatment programme, which integrated cognitive-behavioural and psychodynamic elements. The Brief Symptom Checklist (BSCL) was applied as outcome measure over four time points: pretreatment, posttreatment, first follow-up at 6 to 8weeks and second follow-up at 1year after discharge. Impulsiveness was measured using the Barratt Impulsiveness Scale (BIS) at the pretreatment time point. The BSCL significantly decreased between pretreatment and posttreatment, followed by an increase after posttreatment without reaching pretreatment extent. The temporal course of the BSCL significantly varied with pretreatment BIS in that patients with higher impulsiveness revealed a stronger re-increase of symptom severity from posttreatment to end of follow-up than those with lower impulsiveness. The least impulsive patients thereby showed no rebound effect. The robustness of the results was examined by cross-validation. The results indicate that irrespective of the level of impulsiveness, patients with BPD profit from a structured inpatient treatment. However, long-term treatment success was impaired in patients with high level of impulsiveness at pretreatment. Thus, self-ratings of impulsiveness in BPD patients can be utilized for treatment planning. After discontinuation of interventions, relapse prevention should be implemented early in high impulsive patients as symptoms recrudesce in the course after discharge.

Violence and desire described by committed football-supporters in substance abuse treatment. Clinical psychodynamic findings

This study concerns male clients in substance abuse treatment, who were or had been football supporters, engaged in violence. Previous research has acknowledged the connection between football and violence, substances, homosociality and masculinity. Desire and treatment needs have however not been investigated. This study contributes to this knowledge gap. It is written from a treatment viewpoint, acknowledging current psychodynamic/analytical perspectives on gender, relationships, and affects. The study is based on the author’s clinical encounters with supporters who were in psychodynamic treatment due to problems with substance use. A thematic analysis of the author’s memories of the clinical encounters was performed. Three themes were identified; Alcohol and drugs, Desire and Clinical interaction. The results show that consumption of alcohol and cocaine was intermingled with the homosocial supporter-culture and accordingly with the clients’ social life, which needs to be acknowledged in treatment. Moreover, violence was not only connected to homosocial strivings and hypermasculine behaviors, but also to desire. Same-sex desire could for example arise during fighting, which could be an alluring part of violence, while simultaneously shame-provoking. The study shows that supporters, and possibly other homosocial groups, are more diverse than sometimes presented. Accordingly, clinicians who encounter committed football supporters should be open to questions of desire, including non-normative sexual experiences, while acknowledging that the topic might be difficult for clients. Clinicians also need to understand how intertwined supporter-culture and substances are, and discuss affects and relationships with clients.

The Internalization of a Representation of the Therapist as an Element in Psychotherapeutic Gain

This paper illustrates the beneficial effect of a positive benevolent transference in the development of an internalized representation of the therapist/analyst in a variety of patients in psychodynamic treatments ranging from consultation to psychoanalysis itself. This is described in patient presentations. In those who have had substantial early nurturant life experience and now find themselves in a dysphoric state due to crisis, the effect lies in the transference reactivation of these positive object relations that relieve their distress. In those who have been deprived of such early experience, the positive transference may emerge during the intensive work of psychoanalysis and may lead to the internalization of a new positive object representation of the analyst generated in the transference that persists after termination of treatment. In both of these situations, the patient discovers a sense of greater harmony with self and the world. The special conditions that permit and facilitate this process are described since this does not occur in all psychodynamic interventions.

"We can work it out": Working through termination ruptures.

Supportive-expressive (SE) psychodynamic treatment is based on the identification of and working through the patient's signature core conflictual relationship theme. According to the SE framework, when termination is anticipated, separation conflict arises, and the actualization of the patient's interpersonal wish in the relationship with the therapist is no longer possible. The disactualization of the patient's wish in the relationship with the therapist may cause patients to regress to their maladaptive prototype responses (Nof, Leibovich, & Zilcha-Mano, 2017), which may manifest as a rupture in the therapeutic alliance. The present work integrates constructs based on the SE framework, specifically the disactualization of the patient's wish at the end of treatment, with the framework of alliance ruptures and their resolution (Safran & Muran, 2000). We propose a conceptual clinical model to guide therapists in the successful resolution of alliance ruptures, which are the result of the disactualization of the patient's interpersonal wish. We propose a two-stage process to achieve successful resolution of termination ruptures: (a) identification of termination ruptures and (b) addressing and resolving termination ruptures. For each stage, we propose practice-based guidelines and steps to follow. We demonstrate the proposed guidelines based on the case study of a patient with major depressive disorder. We used three sources of information from the case study: verbal transcripts of the therapy sessions, questionnaires, and semistructured posttreatment interviews. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Efficacy of Internet-Delivered Psychodynamic Therapy: Systematic Review and Meta-Analysis

Recent years have seen an increase of internet-delivered interventions based on psychodynamic treatment models. To test the efficacy of internet-delivered psychodynamic therapy (IPDT), we conducted a systematic review and meta-analysis of randomized controlled trials. Following literature searches, we identified seven studies meeting inclusion criteria. The total number of participants was 528 in the treatment group and 552 in the control conditions. We found small effects favoring IPDT compared to inactive control conditions for main outcomes (g = 0.44), depression (g = 0.46), anxiety (g = 0.20), and quality of life (g = 0.40). There was significant heterogeneity between studies for main outcomes and depression. Within-group effects ranged from Hedges's g = 0.32-0.99. The effects of IPDT were maintained or increased at follow-up. Study quality varied but was generally high. No indications of publication bias were found. In conclusion, IPDT is a promising treatment alternative, especially for depression, although the small number of studies limits the generalizability of the findings.

Psychodynamic Psychotherapy for Patients With Functional Somatic Disorders and the Road to Recovery.

Patients with functional somatic disorders (FSDs) are commonly encountered in clinical practice and are often considered difficult to treat. This article summarizes recent advances in the understanding of these disorders that have opened new avenues for treatment. Findings concerning the role of three related key biobehavioral systems (attachment, mentalizing, and impairments in epistemic trust) that seem to be centrally involved in FSDs, as viewed from a psychodynamic perspective, are discussed as well as empirical evidence supporting the efficacy of psychodynamic psychotherapy for patients with FSDs. Finally, the basic treatment principles of dynamic interpersonal therapy, an integrative psychodynamic treatment adapted for patients with FSDs, are outlined through a description of the treatment of a woman with chronic widespread pain and irritable bowel syndrome.

Intermittent Treatment with the Psychodynamic Psychiatrist: A Patient-Centered Approach.

This study examines the experiences of patients in treatment with psychodynamic psychiatrists on an intermittent basis following an initial brief period of intensive psychotherapy and stabilization. Patients with non-psychotic disorders who received intermittent treatment answered a web-based questionnaire describing the usefulness of various supportive, cognitive-behavioral, and psychodynamic interventions. Forty-eight out of 58 patients invited to participate completed the survey (83% response rate). The majority (75%) of respondents welcomed the intermittent treatment frame. Therapeutic factors deemed to be most helpful included supportive interventions such as ability to relate to the clinician, ability of clinician to listen empathically, and feeling supported by a non-judgemental therapist when talking about private matters. The majority of respondents also endorsed as highly beneficial various cognitive-behavioral interventions such as understanding how thinking patterns impact behavior and feelings and discussing alternative coping skills. Also highly rated were psychodynamic interventions, including understanding how the present is modeled from past experiences and expression and regulation of affect. In the open-ended qualitative feedback, therapeutic factors including collaboration, forming an alliance, and empathic attunement emerged as important. Our preliminary findings suggest that the intermittent psychodynamic treatment frame is well received by patients. Patients welcome integration of different psychotherapeutic approaches to individualize treatment. The common factors in psychotherapy are important patient-reported therapeutic factors in the intermittent treatment approach.