Psychodynamic Supportive Psychotherapy Research Articles

Psychodynamic Psychotherapy for Persons in States of Psychosis: Some Research Perspectives

This paper describes some basic problems and assumptions in supportive psychodynamic psychotherapy with persons in states of psychosis. It starts out by addressing changes in the views of science – from the case study method to the evidence‐based medicine paradigm – and continues with a discussion of the necessity for psychotherapy integration and conceptual clarification in delineating psychodynamic psychotherapy in the field of psychosis. Over a period of decades a small number of comparative studies have been conducted in which psychodynamic psychotherapy of patients with schizophrenia has been compared with treatment as usual. The latest of these, a Danish prospective multicentre study, is described. Some basic arguments for calling this study ‘psychodynamic’ and ‘supportive’ are outlined, and a few overall aims are described, including the desired abilities of the therapists in this particular field. Even though the use of randomized controlled trials, scientifically, is a difficult paradigm for psychodynamic psychotherapy, studies like the Danish one support the use of psychodynamic treatment in the National Health Service.

Five-Year Follow-Up of Supportive Psychodynamic Psychotherapy in First-Episode Psychosis: Long-Term Outcome in Social Functioning

Objectives: The long-term outcomes of several approaches to intervention targeting social functioning in schizophrenia are not well documented. Contemporary supportive psychodynamic psychotherapy (SPP) aims to improve social functioning. The aim of the present study was to investigate the long-term outcome of SPP in a prospective, longitudinal, comparative, multicenter investigation of successively referred patients diagnosed with first-episode schizophrenia spectrum disorder.Method: Manualized SPP for up to 3 years as a supplement to standard treatment (ST) were compared to ST alone and followed up for 5 years (N = 269). The SPP targeted interpersonal relationships, emotion regulation, social cognition, and self-coherence.Results: Significant between-group effects in favor of SPP+ST on social functioning, overall symptoms, and positive psychotic symptoms were found during the period of active SPP intervention. These differential effects, however, were not sustained after end of additional SPP at 5-year follow-up.Conclusion: The findings are in line with results from other approaches targeting social functioning in schizophrenia and support SPP as a valuable treatment. Further research into the curative elements of SPP is needed.

CRITICAL REVIEW OF OUTCOME RESEARCH ON INTERPERSONAL PSYCHOTHERAPY FOR ANXIETY DISORDERS

Interpersonal psychotherapy (IPT) has demonstrated efficacy in treating mood and eating disorders. This article critically reviews outcome research testing IPT for anxiety disorders, a diagnostic area where cognitive behavioral therapy (CBT) has dominated research and treatment. A literature search identified six open and five controlled trials of IPT for social anxiety disorder (SAD), panic disorder, and posttraumatic stress disorder. Studies were generally small, underpowered, and sometimes methodologically compromised. Nonetheless, minimally adapted from its standard depression strategies, IPT for anxiety disorders yielded positive results in open trials for the three diagnoses. In controlled trials, IPT fared better than waiting list (N = 2), was equipotent to supportive psychodynamic psychotherapy (N = 1), but less efficacious than CBT for SAD (N = 1), and CBT for panic disorder (N = 1) in a methodologically complicated study. IPT equaled CBT in a group residential format (N = 1). IPT shows some promise for anxiety disorders but has thus far shown no advantages in controlled trials relative to other therapies. Methodological and ecological issues have complicated testing of IPT for anxiety disorders, clouding some findings. The authors discuss difficulties of conducting non-CBT research in a CBT-dominated area, investigator bias, and the probable need to further modify IPT for anxiety disorders. Untested therapies deserve the fairest possible testing.

Supportive psychodynamic psychotherapy for psychosis

SummaryThe UK National Institute for Health and Care Excellence guidance suggests that psychodynamic principles may be used to understand the experiences of people with psychosis. In this article we consider the application of psychodynamic principles in psychotherapy for psychosis, focusing on one particular model: supportive psychodynamic psychotherapy (SPP). We describe this approach with a detailed fictitious case example and discuss how SPP has developed through significant modifications of classical psychoanalytic therapy and the evidence base for it. We consider its overlap with cognitive–behavioural therapy, its advantages and disadvantages, and the arguments for making SPP available as a treatment option in services for psychosis.

Supportive and Insight-Oriented Psychodynamic Psychotherapy for Posttraumatic Stress Disorder in an Adult Male Survivor of Sexual Assault

This is a single case study of a middle-aged man with posttraumatic stress disorder (PTSD) and Dissociative Disorder Not Otherwise Specified following sexual assault as an adult. Treatment consisted of supportive psychodynamic psychotherapy, focusing on reintegrating the patient into his community, followed by insight-oriented psychodynamic psychotherapy with an emphasis on processing trauma and decreasing PTSD and dissociative symptoms. Daily subjective, self-report measures were used to track his symptoms over a 29-month period. Simulation Modeling Analysis for time-series was utilized to assess the phase change from pretreatment baseline phase to total treatment phase and also between supportive psychotherapy phase and insight-oriented psychotherapy phase. Symptoms tracked included overall distress, preoccupation with the trauma, and dissociation. All symptoms significantly improved from the pretreatment baseline phase to the total treatment phase. Overall distress and preoccupation with the trauma significantly improved from the supportive to the insight-oriented psychotherapy phase.

Supportive Psychodynamic Psychotherapy versus Treatment as Usual for First-Episode Psychosis: Two-Year Outcome

During recent decades, the field of treatment of schizophrenia has lacked empirical, systematic outcome studies that support psychodynamic psychotherapy as an evidence-based intervention for patients with schizophrenia. The Danish schizophrenia project (DNS) compared psychodynamic psychotherapy for psychosis with standard treatment in patients with a first-episode schizophrenia spectrum disorder. The study was designed as a prospective, comparative, longitudinal multi-site investigation of consecutively referred patients who were included during two years. The patients were treated with either manualized individual supportive psychodynamic psychotherapy (SPP) in addition to treatment as usual or with treatment as usual alone (TaU). Symptoms and functional outcomes were measured using the Positive and Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning scale (GAF). The study included 269 consecutively admitted patients, age 18–35, of whom 79% remained in the study after two years. The intervention group improved significantly on measures of both PANSS and GAF scores, with large effect sizes at two years follow-up after inclusion. Further, improvement on GAFfunction (p = 0.000) and GAFsymptom (p = 0.010) significantly favored SPP in combination with TaU over TaU alone. In spite of limitations, this study speaks in favor of including supportive psychodynamic psychotherapy in the treatment for patients with schizophrenic first-episode psychoses.

Psychodynamic Supportive Psychotherapy Techniques in Clinical Social Work Practice with Parents

In this study, the author researched his clinical practice in a community mental health center with six parental couples whose latency-aged children suffered from prevalent separation anxiety disorder symptoms. Through thematic analysis of the anamnestic process recordings of 53 parent sessions, the author's speculation on the effectiveness of the supportive psychodynamic psychotherapy techniques to psychodynamic clinical social work practice with parents was confirmed. Nine of thirteen supportive psychodynamically grounded therapy techniques were highlighted, whereas the clinical practice produced three more. The techniques permeated and shaped the author's clinical social work intervention, and a follow-up confirmed the reduction in mental health symptoms for the children and also increased parental satisfaction in response to the interventions.

Assessing Changes in Psychoanalytic Psychodynamic Therapy with an Early Adolescent

This paper describes changes in personality functioning according to Exner’s Rorschach Comprehensive System (CS) in an early adolescent boy, Gabriele, referred for anxiety and obsessive compulsive symptoms. The DSM-IV diagnosis was General Anxiety Disorder (GAD). The therapy lasted about 2 years, and sessions were all audio-taped to create a more objective database. A total of 50 sessions were analyzed. The therapist employed a broadly defined, object-relations-focused, psychodynamic framework, with particular emphasis placed on balancing supportive versus insight-oriented modes of therapy ( Skean, 2005 ). After a brief introduction of Gabriele’s clinical history and anamnesis, the paper illustrates (a) changes in the symptoms from the beginning to the end of the supportive psychodynamic psychotherapy, which also included some cognitive-behavioral therapy (CBT) interventions; (b) changes in the CS administered at the beginning and at the end of the psychotherapy; and (c) the relevance of therapeutic alliance measured by the Collaborative Interactive Scale (CIS; Colli & Lingiardi, 2007 ) as a fundamental intervening variable in the psychotherapy process.

The Danish National Schizophrenia project (DNS): Interpersonal self-image as predictor for outcome in first-episode psychosis (FEP)

BackgroundSeveral studies have indicated that a person's self-image is of central importance for psychological well being and mental health. A negative self-image has been associated with many mental health problems, but knowledge about self-image in psychosis is sparse. The present study examined self-image in psychosis and its importance for recovery from psychosis (Harder, 2006).MethodThe sample (N=97) was a subsample from the DNS-sample. The patients recieved supportive psychodynamic psychotherapy in combination with standard treatment. Self-image was measured by SASB-Intrex questionnaire (Benjamin, 1989) and outcome measures were PANNS Positive and Negative Symptom Scale) and GAF (Global Assessment of Functioning).ResultsSelf-image at baseline was found to be a strong predictor for outcome in positive psychotic symptoms, negative psychotic symptoms and social functioning both one and two years later. Patients with presence of grandiosity and reduced acknowledment of actual illness had a more positive self-image at their percieved worst state, which was associated with better outcome.ConclusionThis finding of a strong relationship between self-image and outcome has important implications for treatment, because preserving and enhancing self-image during treatment might help improve recovery from psychosis. Grandiosity and reduced acknowledment of actual illness might serve to protect the self-image, and reduce stress related to very negative aspects of self-image.

Supportive Psychotherapy

Supportive Psychotherapy

The Danish National Schizophrenia Project: prospective, comparative longitudinal treatment study of first-episode psychosis

First-episode psychosis intervention may improve the course and outcome of schizophrenic disorders. To describe the Danish National Schizophrenia Project and to measure the outcome of two different forms of intervention after 1 year, compared with standard treatment. A prospective, prospective, longitudinal, multicentre investigation included 562 patients, consecutively referred over a 2-year period, with a first episode of psychosis. Patients were allocated to supportive psychodynamic psychotherapy as a supplement to treatment as usual, an integrated, assertive, psychosocial and educational treatment programme or treatment as usual. There was a non-significant tendency towards greater improvement in social functioning in the integrated treatment group and the supportive psychodynamic psychotherapy group compared with the treatment as usual group. Significance was reached for some measures when the confounding effect of drug and alcohol misuse was included. Integrated treatment and supportive psychodynamic psychotherapy in addition to treatment as usual may improve outcome after 1 year of treatment for people with first-episode psychosis, compared with treatment as usual alone.

A Person-Centred Approach to Counselling, Psychotherapy and Rehabilitation of People Diagnosed with Dementia in the Early Stages

This article considers a person-orientated approach to counselling, psychotherapy and rehabilitation for people with a diagnosis of dementia. It draws on the concepts developed by Tom Kitwood (1995) for describing the factors –neuropathology, health, personality, biography, social psychology – that affect the manifestation of dementia, but places more emphasis on personality and biography for the person in the early stages. The social context – or psychology – is the home in these early stages, and the family system is critical. It provides a supportive or negative environment in which the person expresses an experience of cognitive decline. The behaviours seen in dementia are regarded as adaptive responses to the experience of cognitive decline, rather than directly the result of brain pathology. Given this view of the syndrome of dementia being a reactive response to cognitive decline, and to stresses such as giving up driving, the types of interventions that might be offered are discussed. These are grief counselling, non-directive counselling, long-term supportive psychodynamic psychotherapy, cognitive-behavioural therapy and rehabilitation. The human brain has developed over a lifetime of experience, in a variety of psychosocial environments, and so exhibits its own unique coping mechanisms in the face of internal devastation. It is this aspect of dementia – its individual uniqueness and its reflection of a person’s past and present psychosocial context – that this article uses as the basis for suggesting effective treatment strategies.

The utility of individual supportive psychodynamic psychotherapy for substance abusers in a therapeutic community.

*Medical and Health Research Association of New York City, Inc., and National Development and Research Institutes, Inc. New York. I would like to thank Allen Wilkes, Nick Haslam, Tina Tan, Terry Rosenberg, and the members of the Behavioral Sciences Training program for their constructive feedback on earlier drafts of this article. In addition, this research was conducted in part while the author was a postdoctoral fellow in the Behavioral Sciences Training in Drug Abuse Research Program sponsored by Medical and Health Research Association of New York City, Inc., and National Development and Research Institutes, Inc., with funding from the National Institute on Drug Abuse (5 T32 DA07233-09). It should also be noted that points of view and opinions in this paper do not necessarily represent the official positions of the United States Government, Medical and Health Research Association of New York City, Inc., and National Development and Research Institutes, Inc.