Psychodynamic Psychotherapy Research Articles

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>

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.

A Primer on Human Birth Theory.

In the 1970s Massimo Fagioli (1931-2017) proposed a new theory of mind that he called the Human Birth Theory, based on a healthy conception of the baby and of the nonconscious mind. Fagioli made significant contributions to the understanding of mental dynamics at birth, the pathophysiology of mental illness, and the nonconscious identity of psychiatrists and psychotherapists. His original contributions to psychodynamic psychotherapy included variations on the setting and understanding of transference and dream interpretations that deviated from classical psychoanalytic techniques. This article introduces the basic tenets of Human Birth Theory, its neuropsychiatric correlates, and clinical applications.

Clinical Case of Trauma-Focused Psychodynamic Psychotherapy for a Veteran With PTSD and Race-Based Trauma.

Clinical Case of Trauma-Focused Psychodynamic Psychotherapy for a Veteran With PTSD and Race-Based Trauma.

Should we feel the same? Mutual recognition and congruence between therapist and client regarding ruptures and repairs.

The pattern of rupture and repair within therapeutic alliances has been associated with improved outcome. The present study adds to this body of research by examining rupture and repair from a dyadic perspective. First, we examined the relationship between mutual recognition of ruptures, rupture intensity, and client ratings of session helpfulness. We then examined client-therapist congruence regarding rupture and repair characteristics and their relation to client ratings of session helpfulness. Data were collected from 90 client-therapist dyads (providing two subsamples of 61 and 45 dyads) during 16 sessions of short-term psychodynamic therapy. Clients and therapists rated the occurrence of ruptures, rupture characteristics, and rupture repair following each session. Clients also rated session helpfulness following each session. We found a significant negative interaction effect, indicating that when clients rated ruptures as more intense, therapist rupture recognition was related to lower client ratings of session helpfulness. Client-therapist congruence in the perception of rupture intensity was positively related to client perceptions of the extent to which ruptures were discussed. Finally, we found a significant positive relationship between client-therapist congruence in their perception of rupture repair and client ratings of session helpfulness. This study demonstrates the significance of the dyadic view of the rupture/repair process. Therapist recognition of ruptures may not be enough to facilitate repair, specifically in ruptures with a high level of intensity. Nevertheless, congruence in intensity is valuable for addressing the rupture within the session, and congruence in repair is valuable for session helpfulness. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Lexicon of Pain: Highlighting the Advantages of Applied Theater in Pediatrics through the Lens of Psychodynamic Therapy

The Lexicon of Pain: Highlighting the Advantages of Applied Theater in Pediatrics through the Lens of Psychodynamic Therapy

Randomised controlled trial of a psychotherapeutic intervention to improve quality of life and other outcomes in people who repeatedly self-harm: FReSH START study protocol

BackgroundSelf-harm is a major public health challenge, and repeated self-harm is common in those attending hospital following an episode. Evidence suggests psychological interventions could help people who self-harm, but few definitive studies have assessed their clinical and cost-effectiveness. Repeated self-harm is associated with poor quality of life, depression, suicide and increased health service costs which justify the development of psychotherapeutic interventions tailored for people with repeated self-harm.MethodsFReSH START is a multicentre individually 1:1 randomised controlled trial evaluating the clinical and cost-effectiveness of standard care plus psychological therapy or standard care alone for adults (≥ 18 years) presenting at an emergency department (ED) with repeated self-harm. Recruiting 630 participants, it includes an internal pilot, economic evaluation and process evaluation. The intervention will be delivered by mental health staff working in acute settings, with experience of assessing and managing risk in people presenting to emergency services with self-harm. Staff will be trained and supervised to deliver one of three specially adapted therapies: psychodynamic interpersonal therapy, cognitive behavioural therapy or acceptance and commitment therapy. Participants allocated to the intervention will receive one of the adapted therapies according to therapist allocation for up to 6 months via 12 weekly, one to one, 45–50-min sessions. The primary outcome is quality of life measured by the Clinical Outcomes in Routine Evaluation Outcome Measure at 12 months post-randomisation. Secondary outcomes include suicidal intent, depression and cost-effectiveness. Data are collected using hospital attendance records and online/postal/telephone questionnaires at 6 and 12 months post-randomisation, with resource use additionally collected at 3 and 9 months.DiscussionThis protocol outlines a randomised controlled trial to investigate whether modified therapies are cost-effective and improve quality of life for people who repeatedly self-harm. Few interventions are proven to be deliverable in the NHS for this population. This study is strengthened by the involvement of qualified mental health workers experienced in managing risk as therapists.Trial registrationRegistered on August 03, 2021.IRAS number: 297939.ISRCTN: https://doi.org/10.1186/ISRCTN73357210.REC reference: 21/EE/0145.Sponsor: University of Leeds.

Halifax somatic symptom disorder trial: A pilot randomized controlled trial of intensive short-term dynamic psychotherapy in the emergency department

BackgroundPatients commonly present at hospital Emergency Departments (ED) with distress that meet criteria for a Somatic Symptom and Related Disorder (SSRD). Without access to effective treatment, risk of ongoing patient disability and further ED visits is high. MethodThis pilot trial used a randomized parallel group design to test the efficacy of Intensive Short-Term Dynamic Psychotherapy (ISTDP). ED patients who met criteria for SSRD were recruited. The effects of ISTDP plus medical care as usual (MCAU) were judged through comparison against 8 weeks of MCAU plus wait-list symptom monitoring (WL-SM). The primary outcome was somatic symptom at 8 weeks. Patients allocated to WL-SM could cross-over to receive ISTDP and 6-month follow-up data was collected. Baseline measures of patient attachment style and alexithymia were collected to examine vulnerabilities to somatic symptoms. ClinicalTrials.gov: NCT02076867. ResultsThirty-seven patients were randomized to 2 groups (ISTDP = 19 and WL-SM = 18). Multi-level modelling showed that change over time on somatic symptoms was significantly greater in the ISTDP group. Between-group differences were large at 8 weeks (Cohen's d = 0.94) and increased by end of treatment (Cohen's d = 1.54). Observed differences in symptoms of depression and illness anxiety were also large, favoring ISTDP, and effects were maintained at follow-up. Patients receiving ISTDP had reduced ED service utilization at 2-year follow-up. ConclusionsISTDP appears an efficacious treatment for SSRD and a larger randomized trial is justified.