Psychodynamic Psychotherapists Research Articles

Side Effects in Psychodynamic and Cognitive Behavior Therapy

AbstractTherapists and the public are becoming increasingly aware that psychotherapy can have side effects. The prevalence varies depending on the patients, treatments, settings, assessment methods and the researched type of side effect. Objective of this study is to assess side effects of routine outpatient psychodynamic and cognitive behaviour therapy. In a cross-sectional study cognitive behaviour therapist (n = 73) and psychodynamic psychotherapists (n = 57) were asked in a semi-structured interview about unwanted events and side effects in reference to their most recent patients (N = 276) using a domain inspection method. Their reports were cross-checked by an expert assessor. Multiple random-intercept models were conducted to investigate the influence of various variables. Therapists reported in 170 patients (61.4%) a total of 468 unwanted events. There was at least one side effect in 33.2% of the cases. Most frequent side effects were “strains in family relations” and “deterioration of symptoms”. Illness severity has a significant influence on the amount of side effects reported. The data confirm that side effects of psychotherapy are frequent. The difference between side effects and unwanted events shows the importance of such a distinction. The reporting of side effects for one in three patients may indicate an under recognition of side effects or reporting of only relevant or disturbing side effects.

Becoming a researcher: psychotherapists’ experience of starting a professional doctorate

ABSTRACT This paper explores the journey taken by experienced psychotherapists as they embark on doctoral research, highlighting the adjustments involved in moving from being a clinician to becoming a researcher. Having touched on the complex relationship between psychotherapy and research as a whole, including how badly this has affected the development of a robust evidence base for many approaches, the paper describes the development of a post-qualifying research programme for those grafting research skills onto their clinical roles. The paper then considers how the kind of research undertaken by psychodynamic psychotherapists has shifted from being primarily focussed on single case studies – so remaining closer to the clinical writing of the past – to including both more general social science research methodologies and more precise psychoanalytic methodologies, capable of exploring in depth the processes at work in the therapeutic encounter. The main focus of the paper is on the impact on the students of undertaking their first research project. At the beginning of this process nearly all students underestimated just how much of a shift in their thinking it would involve, and the paper captures some of the key issues and powerful moments reported after their first year. They speak of the humbling impact of conducting a structured literature review and of the complexity of finding a truly researchable question and viable design, as well as the appreciation of the difference between clinical illustration and evidence. They speak of the impact of thinking about the ethical issues involved in research, and of the need to interrogate their design in order to minimise bias. One of the interesting – and to them surprising – effects is that the shift to research-mindedness feeds back into their clinical identities, in a way that is both challenging and invigorating, overall boosting their confidence as practitioners.

The role of groups during individual development and within the clinical dyad.

The author proposes that group identifications have been under-appreciated by individual psychodynamic psychotherapists in their conceptualization of normative individual development. He identifies the routes by which the child begins to internalize small and large groups during the early years of identity formation. Through individual therapy vignettes, the author suggests modifications to customary technique so that developmental shortcomings in group attachment security can be shored up. He offers some guidelines for the individual therapist so that group experiences are accounted for as the clinical narrative is written. Finally, he distinguishes patients who may require additional group-level interventions to address their avoidance of group participation.

“Our time is up”: a patient’s perspective on psychotherapist retirement

Organic terminations in a “good-enough” treatment at their best end with feelings of warmth, pride, sadness, and a letting go. Psychotherapist retirement, however, is a unilateral ending imposed upon patients, sometimes causing not only feelings of loss and hurt, but bringing about damage, breaching the age-old mandate of the Hippocratic oath: “First, do no harm”. Yet, humans can avoid ageing only by early death. They retire, sometimes forced by necessities, sometimes beckoned by a readiness for a final life chapter filled in ways that do not include professional work. Some hurts, even harm, may be unavoidable. Despite a growing literature on the topic of psychotherapist retirement, the first-hand perspective of the retired-upon patient is as yet without a public voice. A retired psycho-dynamic psychotherapist myself, in this article I share my experience as a patient who lost a much-loved therapist to retirement. I write with a patient’s heart informed by a practitioner’s eyes, ending with suggestions for both members of the therapeutic dyad and also for the professional community.

Online Therapy as an Add-on to Psychoanalysis? What Needs for Online Therapy Modules do Psychodynamic Psychotherapists in Private Practice Express for Their Outpatient Work?

In recent years, psychotherapists have been increasingly confronted with the challenge of meeting treatment needs efficiently with limited time resources and at the same time achieving stable treatment success in the long term. One way to address this is to integrate Internet-based interventions (IBI) into outpatient psychotherapy. While there is a lot of research on IBI based on cognitive-behavioral therapy, little is known about the same for psychodynamic treatment models. Therefore, the question will be answered as to what specific online modules would need to look like that psychodynamic psychotherapists would use in their outpatient practice to support their regular face-to-face therapies. In this study, 20 psychodynamic psychotherapists were asked about their requirements on the content of online modules that could be integrated into outpatient psychotherapy, using semi-structured interviews. The transcribed interviews were analyzed using Mayring's qualitative content analysis. Results showed that some psychodynamic psychotherapists already use exercises or materials which could be transferred into the online format. In addition, general requirements about online modules emerged, such as an easy handling or a playful character. At the same time, it became clear when and with what kind of patient groups online modules would be integrated into psychodynamic psychotherapy. The interviewed psychodynamic psychotherapists considered it an attractive approach to offer online modules as a supplement to psychotherapy and in a broad spectrum of content. They gave practical advice for the design of possible modules, both on the level of general handling and regarding concrete contents, words, and ideas. The results contributed to the development of online modules for use in routine care, the effectiveness of which will be investigated in a randomized controlled trial in Germany.

Psychodynamic psychotherapists online presence- conceptual considerations & survey study

Digital technologies have significantly increased the internet presence of psychodynamic psychotherapists (pdp) and thus fundamentally changed the framework of psychodynamic treatments. There is a lack of data on how pdp shape their online presence in relation to their psychodynamic anonymity as well as the possibility of self-expression. The use of the internet for communication and self-expression is increasingly being integrated into everyday life by the younger generation, which also applies to young pdp in training and young patients. During the 51st IPA Congress (July 24–27, 2019), an explorative paper-pencil survey was conducted on 50 pdp using a self-constructed questionnaire regarding their own online presence. A large proportion of those questioned (m: 88%, f: 70%) stated that their psychodynamic work had an impact on what they actually revealed about themselves online. Nonetheless, about half of the test persons stated that they were present online through photos (50%), social media such as facebook (54%) or scientific articles (54%). People who are younger than 50 years old differ from older people in that younger people use digital media significantly more and more frequently. Respondents over the age of 50 are significantly more likely to assume that pdp who share too much information online are ‘bad pdp’ than those under 50. These data suggest a discrepancy between the pdp‘s ideal and the pdp’s actual behaviour. In our opinion, the pdp’s decision to share information about themselves online is not based on an ethical debate and should not be conducted as such, especially in training associations with young pdp. It is about how this information is shared and treated in the psychodynamic process. These themes should be compulsorily anchored in psychodynamic training.

Videoconferencing psychotherapy from a psychodynamic point of view. A qualitative analysis.

There is a growing interest in delivering videoconferencing psychotherapy (VCP) due to the enormous impact of the COVID-19 pandemic on our lives since the beginning of severe restrictions worldwide in March 2020. Scientific literature has provided interesting results about the transition to remote sessions and its implications, considering different psychotherapy orientations. Less is known about whether and how VCP affects psychodynamic psychotherapeutic approaches and reports on remote work with severe and complex mental health problems such as severe personality disorders are still scarce. The aim of the study was to examine the experiences of psychodynamic psychotherapists, mainly delivering Transference-Focused Psychotherapy (TFP), with the transition and delivery of VCP during the first wave of the COVID-19 pandemic. Four hundred seventy-nine licensed psychotherapists completed an online survey during the peak of the pandemic. Survey data were analyzed using qualitative analysis. Results are presented and discussed concerning advantages and disadvantages regarding the access to psychotherapy, the specificity of the online video setting, bodily aspects, the quality of the therapeutic relationship, the therapeutic process including technical aspects and therapist's experience. Furthermore, we analyzed and discussed the statements concerning transference and countertransference reactions differentiating between high-level borderline and neurotic patients and low-level borderline patients. Our results support the importance to identify patients who potentially benefit from VCP. Further research including more prospective randomized controlled trials are needed to investigate the therapeutic implications of the findings.

Entering terra incognita: Adapting Psychotherapists to Work During the COVID-19 Pandemic

Sudden historical events, such as the COVID-19 pandemic, may critically change the circumstances in which psychotherapy is conducted. The objective of this study was to analyze Polish psychodynamic psychotherapists’ experiences of working with patients at the onset of the pandemic and hence to understand the process of their coping with the external reality challenges. 183 Polish psychotherapists (160 women and 23 men) aged 26-66 years (average 38) completed a survey about their therapeutic work during the COVID-19 pandemic. Data were analyzed in accordance with Braun and Clarke’s thematic analysis framework. Five general themes were identified: (1) Facing a taboo; (2) One must work well (despite having doubts); (3) COVID-19 as the “Third”; (4) Who am I, what am I doing; and (5) Who is the author of the therapeutic principles? The themes show dilemmas that emerged in a psychotherapeutic community that explored a previously non-practiced form of work in the context of the pandemic. These experiences can reflect more general phenomena of the therapists’ adapting to unexpected yet critical external circumstances. Both a personal willingness to seek solutions flexibly and to remain in a dialogue with the professional community is an integral part of this process.

"It's Left a Bitter Taste" Psychotherapists' Perspectives on the Abolition of the German Assessment Procedure for Outpatient Psychotherapy

In 2019, the abolition and replacement of the present German assessment procedure for outpatient psychotherapy was resolved and adopted into law. This study examined what psychotherapists think about the new plan. We conducted semi-guided interviews with psychotherapists about their experience and opinion of the current psychotherapeutic care situation in Germany. Statements about the assessment procedure were evaluated using qualitative text analyses. We compared the psychotherapists' opinion on the assessment procedure with the psychotherapeutic approach as well as the age group. Of 41 psychotherapists 27 reported their thoughts about the assessment procedure. The following themes could be drawn from their statements: Appreciation as well as criticism of quality control of the procedure, worries about a future loss of economic and treatment certainty, perception that the assessment procedure questions one's competence, disapproval of the low remuneration of the reports, the connection between individual attitudes towards the assessment report and conscientiousness in writing the reports, and the lack of transparency of the legislative initiative. Psychodynamic psychotherapists wanted to keep the assessment procedure slightly more often compared to behavioural psychotherapists; child and youth psychotherapists wanted to keep it more often than psychotherapists for adults. Psychotherapists perceive the reform of the assessment procedure as a process with a substantial impact on their current clinical practice as well as their psychotherapeutical identity. To improve the quality and acceptance of the future quality assurance procedure, psychotherapists should be an active part of the development process.

The self-critical patient in clinical supervision: a qualitative study of therapists’ alliance struggles and emotional reactions in short-term psychodynamic psychotherapy for depression

ABSTRACT Self-critical perfectionism has been linked to alliance impairments due to patients’ distancing attitudes. However, systematic research on therapists’ emotional experiencing when working with self-critical patients is scarce. This qualitative study explores how therapists perceive, emotionally experience, and react to self-critical patients’ interpersonal dynamics. We studied narrative data from clinical supervisions where psychodynamic psychotherapists discussed self-critical patients (N = 7) within the context of an RCT on Major Depressive Disorder. Consensual Qualitative Research was applied to identify recurrent patterns in the data. As a global impediment to treatment, therapists observed a pattern of non-engagement. Patients’ superficial and avoidant way of communicating, hostility or aggressiveness in the alliance, and low or inaccurate treatment expectations emerged as main obstacles to the therapeutic process, evoking negative affect in therapists. More vulnerable aspects of the patient and case formulation emerged as having a mitigating effect on unfavorable therapist reactions. Our findings confirm longstanding clinical and theoretical accounts associating therapeutic work with self-critical patients with negative affect in therapists. Our study suggests that negative responses may be enacted in therapy which can reinforce poor alliance. We discuss the role of supervision in helping therapists to become aware of and manage negative responses, engage in case conceptualization, and advance clinical work.

Attachment and the therapeutic bond in a community mental health clinic: A pilot study

AbstractThis study explored attachment theory and related concepts as related to mental health treatment. While attachment has traditionally been conceived as a robust element of one's personality, its relationship to therapeutic relations has not been fully explored. In this study, we attempted to assess the relations between general attachment style, the specific attachment one creates with one's therapist and the therapeutic bond. The study took place in a public mental health clinic, in which several mental health workers provide treatment for patients with a wide array of diagnoses. Attachment to the therapists was generally higher (more secure) than personal habitual attachment style. No significant relations were found with therapeutic bonding. Avoidantly attached patients seem to weaken their habitual (avoidant) attachment in the therapeutic relationship more than anxiously attached patients do. Avoidant patients seem to be less avoidant when working with psychodynamic psychotherapists, while Cognitive Behavioural Therapy (CBT) therapists seem to be more suitable for anxious patients. These findings may bear far‐reaching implications concerning the nature of the therapeutic process, which may alter the patient's habitual attachment style. In other words, mental health treatment may affect the patients' modes of attachment. However, generalisability of the study is limited, mainly due to a small number of subjects and therapists, location of a single clinic, a single language of the questionnaires and limitations of the measurement tools.

On ‘The Hatred of Learning from Experience’: A Work Journal Revisited

In January 1999, I started a two‐year course in psychodynamic counselling. One of the course requirements was to produce several work journals each term. They could be on any topic the student wished to think about or explore that pertained to the course, be it clinical or theoretical work, or professional/personal development. Three months later, I wrote one on Bion's (1962) concept of ‘the hatred of learning from experience’, after a seminar on his work. In Section 1, I present the work journal itself, in which I described my difficulties with anxiety about the course in relation to this concept: how I felt I needed to be a perfect student who ‘knew everything’; my intolerance of making mistakes; and my hatred of not knowing; in tandem with my envy of others' knowledge. In Section 2, I describe my current understanding of what I was rather desperately attempting to work out in the journal – taking into consideration both my emerging feelings, in light of my own history and state of mind, together with what I had come to understand – that the course was poorly structured and did not provide an adequately safe framework for clinical work and learning. This resulted in my decision to leave. In Section 3, I write about the arduous but ultimately rewarding process of returning to training, eventually culminating in my qualification as a psychodynamic psychotherapist. My final thoughts are presented in Section 4.

Patients Characteristics and Psychosocial Treatment in Psychodynamic and Cognitive Behavior Therapy.

Introduction: The most prevalent psychotherapy schools are psychodynamic (PDT) and cognitive behavior therapy (CBT). There are no scientific guidelines on which type of patient should be treated by which therapist, and how they can find the best one. Part of the answer can be derived from data on who is treated in which way.Objective: Objective of this study was to compare patients in routine PDT and CBT to describe similarities and differences in regard to patient status and treatment.Materials and Methods: A research psychotherapist visited 73 cognitive behavior therapists and 58 psychodynamic psychotherapists in their office and asked them to report about the last cases they had seen. There were 188 CBT and 134 PD case reports.Results: There were no significant differences in socio-demographics between PDT and CBT patients. The average number of treatment session so far was significantly higher in PDT than CBT. There were longer duration of illness, more parallel medical treatments and higher rates of sick leave in CBT patients. While assessment of capacities with the Mini-ICF-APP showed no differences, more participation restrictions were found in CBT patients. Correspondingly there were more sociomedical interventions, especially in regard to work.Conclusions: The differences between PDT and CBT may be explained by the fact that PDT requires analytical capabilities on the side of the patient, which may exclude patients with social problems, while CBT is coping oriented which allows the inclusion of all kinds of patients. Still, in both treatment modes, complex patients are treated with multidimensional interventions.

A Psychodynamic Psychotherapist Dies: Grief and Dismantling a Practice as Professional Executor

For psychotherapists in private practice, drawing a professional will fulfills the ethical obligation to plan for the impact on patients of sudden termination due to illness or death. The named Practice Executor assumes these responsibilities only when faced with the tragic loss of a colleague, and personal grief affects professional duty. Narrated in first-person voice, this paper conveys the emotional challenges and elucidates the clinical, business, and practical decision-making required to facilitate closure of a psychodynamic psychotherapy practice. Guidelines for Practice Executors, as well as considerations for psychotherapists preparing their own directives, are provided.

Breathing and relating: exploring a therapist’s heuristic experience

ABSTRACT What is my experience of consciously breathing while in sessions with clients? As a beginning psychodynamic psychotherapist with a passion for body psychotherapy, this research question sparked a year of exploration into breathing and relating. Following a heuristic self-search methodology, I closely examined my subjective experience of breathing while in sessions with clients, and in the process my relationship with my own breath was illuminated. I discovered that I recruit my breath as a protective defence against feeling. With my clients, I discovered that my experience of breathing shifts from unconscious to conscious, and that shifting breath consciousness is influenced by intersecting client and therapist histories. My research demonstrates the potential for practising conscious breathing in psychotherapy. I explore the importance of breath in investigating the therapist’s somatic countertransference and establishing breathing space between therapist and client.

Joint Consultation by a Neurogeneticist of Movement Disorders and a Psychodynamic Psychotherapist: An Occasion for Subjectivization.

We set out to model a joint therapeutic setting meant to address both medical care and the transferential processes at stake in specialized neurogenetics consultations. Previous authors have explored joint consultation settings with a specialized physician and a psychodynamically oriented psychotherapist, however, few have attempted to provide a model of its transfero-countertransferential dynamics. We aim to do the latter by focusing on a subset of patients to whom such consultations are offered “on the spot.” We want to explore situations in which they initially deny the transference’s contribution to their complaint, when addressing it would instead prove to be beneficial to them, even medically speaking. Standard neurogenetics consultations put the physician in a double-bind position. These patients’ conflicting complaint both manifests transferential expectations and denies them by adhering to medical elements. Since the physician’s challenge is to avoid colluding with the patient’s denial, a joint setting would enable him to address the medical content of the patient’s complaint while simultaneously letting its transferential elements emerge, allowing for the psychotherapist to use them to induce subjective integration (subjectivization). We conceptualize this jointly induced subjectivization by drawing on Fain’s work on primary hystericization of the complaint (inspired by Freud’s late indications). We finish with an example of subjectivization of a family’s complaint based on an adolescent’s limb tremor, which had no genetic or neurological etiology. Its seemingly conversional nature appeared in light of her father’s reaction to our subjectivizing response: his latent transference was likely underlying his daughter’s symptom.

Living the Theory: The Complexity of Being Both a Psychodynamic Psychotherapist and a Mother

Psychodynamic psychotherapists through their vocational training, and especially through developmental and psychoanalytic theories, are exposed to intense discursive and theoretical models of ideal motherhood and child development that they use to inform their therapeutic practice. In this article, nine psychodynamic psychotherapist-mothers are interviewed to examine how the identities of psychotherapist and mother shape, enrich, and conflict with one another. The results of these interviews suggest that the identity shifts involved in becoming a mother are continuous and that—alongside the negotiation of the relational demands of an infant—, psychotherapist-mothers experience transitions in their relationships to theory. The voice of theory was found to act as both an analytic and/or anti-analytic third. The experience appears to be one of the constantly evolving re-integration. Overall, the challenge for psychotherapist-mothers is to reflect on their relationships to theory, in order to acknowledge and explore those aspects that feel punitive and those that feel helpful.

CAPA in China

ABSTRACTThis is the story of the self-organized alumni association called “CAPA in China (CIC),” voluntarily formed by graduates and students of the China American Psychoanalytic Alliance. It presents a picture of the new generation of Chinese psychodynamic psychotherapists who are building a home for themselves and for psychotherapy and psychoanalysis in China by their continuous striving for professionalism and identity.

Psychotherapists’ experiences of withdrawn psychotic patients

ABSTRACTPsychotic patients frequently struggle to relate to the external world and to others, including their psychotherapist. This does not imply that there is no attempt at relating, but rather that the attempt does not seem to acknowledge the full existence of the psychotherapist as other. If the patient’s attempt at relating is missed, they are at risk of being abandoned to the dread of their separation and loneliness. Psychotherapists see the process of establishing some form of relationship with their patient as a key component of a viable therapeutic endeavour. The point at which the withdrawn psychotic patient and the psychotherapist meet potentially marks the beginnings of relatedness disturbed by conflicting needs and wishes, the experience of which can potentially deter psychotherapists from further engagement. In this paper, psychodynamic psychotherapists’ accounts of engaging therapeutically with withdrawn psychotic patients are used to highlight therapists’ experiences and reactions to the specific phenomenon of withdrawal encountered in some psychotic patients. This dynamic is explored via the interaction between the therapist’s multidetermined need for relatedness and the patient’s psychotic withdrawal, and is discussed via three themes; The therapist’s need for relatedness, The therapist’s ego strength, and Reviving relatedness.

A hermeneutic study of integrating psychotherapist competence in postnatal Child Health Care: Parents' perspectives.

A child's emotional and social development depends on the parents' provision of optimal support. Many parents with perinatal distress experience difficulties in mastering parenthood and seek help from professionals within primary healthcare. A clinical project was launched in Stockholm, where psychodynamic psychotherapists provided short-term consultations at Child Health Centers. This study qualitatively explored parents' experiences of perinatal distress and of receiving help by nurses and therapists in the project. Thirteen parents were interviewed, and their responses were analyzed with a hermeneutical method. Three main themes crystallized; accessibility of psychological help and detection of emotional problems; experiences of therapy at the Child Health Center; and the therapists' technique. Parents were also clustered into three so-called ideal types: the insecure; parents in crisis; and parents with lifelong psychological problems. Parents experienced obstacles in accessing psychological care within primary healthcare. Psychotherapists with a holistic family perspective and who managed to oscillate between insight-promoting and supportive interventions were especially appreciated. Patient categories who benefitted from insight promotion and support, respectively, were identified.