Psychodynamic Therapists Research Articles

The Impact of Traditional Filial Piety on Chinese People

ABSTRACT In this article, I will analyze patterns in the most important book on the subject of traditional filial piety in Chinese culture. Several patterns of Chinese parent-child interaction are identified, including the hierarchical ladder between parents and children, probation of the expression of aggression, and Chinese parents’ infantilism and oral needs. On this basis, this article further demonstrates how these parent-child interaction patterns created by traditional filial piety shape some aspects of personality of Chinese people, such as the difficulty in expression of aggression, challenges with separation-individualization, the development of narcissistic problems, and the splitting of self-representations. This could provide deeper understanding for psychodynamic therapists who help Chinese patients.

When Cancer Enters the Therapy Room: The Lived Experience of Psychodynamic Therapists Working with Clients with a Recent Diagnosis of Cancer

When Cancer Enters the Therapy Room: The Lived Experience of Psychodynamic Therapists Working with Clients with a Recent Diagnosis of Cancer

Psychodynamic therapists treating patients with eating disorders during COVID-19: perceptions of the therapeutic relationship, patient experiences and symptomatology, and therapeutic processes

Psychodynamic therapy is commonly used to treat patients with eating disorders. Patients with a diagnosed eating disorder have varying and complex treatment needs. Psychodynamic therapists transitioning their practices to telehealth during COVID-19 experienced the novelty of developing and sustaining a therapeutic connection with their patients without inhabiting a shared physical space. The aim of this qualitative phenomenological study was to gain insight into how psychodynamic therapists treating patients with eating disorders via telehealth during COVID-19 perceived their patients’ experiences and personally experienced the therapeutic relationship and therapeutic processes. Twelve respondents met inclusion criteria, consented to participate, provided demographic data, and participated in a 30–45 minute semi-structured interview. Results from the data analysis included four emergent themes: (1) depth of content; (2) manifestations of patient distress; (3) therapist-patient relationship; and (4) implementation of techniques. Participants spoke about the challenges and resilience experienced by themselves and their patients. They highlighted having to rapidly transition their therapy practice to serve patients with exacerbated symptoms. They shared the complexities of navigating a global pandemic and considered the delivery of relational and dynamic therapy via telehealth. Practical implications and considerations for future research are offered with an emphasis on the treatment of patients with eating disorders.

‘Meeting the Client Where They Are Rather Than Where I'm At’: A Qualitative Survey Exploring CBT and Psychodynamic Therapist Perceptions of Psychotherapy Integration

This qualitative study explored therapists' attitudes towards psychotherapy integration. Twenty‐nine psychoanalytic/psychodynamic and cognitive‐behavioural therapy (CBT) therapists completed an open‐ended survey that focused on their personal understanding of psychotherapy integration, examples from their own practice and reflections on improving integrative therapy. Participants were also encouraged to share attitudes and perceptions towards the other therapeutic paradigm (CBT towards psychoanalysis, and vice versa). Thematic analysis revealed three main themes: (1) Positive perceptions and benefits of psychotherapy integration, (2) Negative perceptions and challenges of psychotherapy integration and (3) Proposals for strengthening integration in clinical practice. While most participants had a strong allegiance to their modality, they recognised the need for flexibility and additional techniques from other paradigms to address individual client needs. However, participants raised concerns about the level of knowledge required for integrative work and the epistemological compatibility between CBT and psychoanalysis. Some responses reflected the ongoing ‘turf wars’ between the two paradigms, with some referring to ‘outdated’ psychoanalytic ideas and ‘dogmatic’ evidence‐based hierarchies. Suggestions were made for further development of psychotherapy integration during the training and post‐qualification. The study reflects a generally positive outlook towards integration while recognising the challenges as well as the continuing resistances between CBT and psychoanalytic paradigms.

Recovered memories in psychotherapy: a survey of practicing psychotherapists in Germany

ABSTRACT We report on a survey of 258 psychotherapists from Germany, focusing on their experiences with memory recovery in general, suggestive therapy procedures, evaluations of recovered memories, and memory recovery in training and guidelines. Most therapists (78%) reported instances of memory recovery encompassing negative and positive childhood experiences, but usually in a minority of patients. Also, most therapists (82%) reported to have held assumptions about unremembered trauma. Patients who held these beliefs were reported by 83% of the therapists. Both therapist and patient assumptions reportedly occurred in a minority of cases. Furthermore, 35% of participants had used therapeutic techniques at least once to recover presumed trauma memories. Only 10% reported assuming trauma in most patients and recovering purported memories in a majority of the attempts. A fifth believed memory recovery was a task of psychotherapy. This belief correlated with trauma assumptions, memory recovery attempts, and recovery frequency. Psychodynamic therapists more often reported to assume trauma behind symptoms and agreed more with problematic views on trauma and memory. No differences showed regarding suggestive behaviour in therapy. Most participants expressed interest in receiving support on dealing with memory recoveries. This interest should be taken up, ideally during therapist training.

A long but fruitful journey: From clinical psychoanalysis to public mental health in Chile

AbstractThe authors, both professors of psychiatry, trained as psychoanalysts according to the standards of the International Psychoanalytic Association (IPA), recount 30 years of conceptual and empirical research work for the construction of a model of brief and adaptive psychodynamic psychotherapy applicable at the Primary Health Care level. The many milestones of this journey are reviewed, starting with the difficulties and obstacles encountered when pursuing this task within IPA institutions. Once the authors decided to conduct the task outside the analytic institution, they created two training programs for psychodynamic therapists and a research group in psychotherapy, all of which have attained excellence. This effort gave birth to several institutions that are still in operation, such as the Chilean and Latin American chapters of the Society for Psychotherapy Research, the Chilean Congress of Psychotherapy, the PhD Program in Psychotherapy, and finally the Millennium Institute for Research and Personality (MIDAP). In its 8 years of existence, MIDAP has become a national and Latin American reference center for research in Mental Health, aimed at implementing preventive and psychotherapeutic interventions in vulnerable populations at the primary health care and community level. The article ends with a description of the main components and the final process of the construction of the Protocol of Psychotherapeutic Competences for the Treatment of Depression in Primary Health Care level.

Transference and Countertransference

Psychodynamic therapists use the interpersonal experience in therapeutic relations to understand the subconscious background of a clients disorder, use it for diagnosis, treatment plans, interventions and supervision. Transference and countertransference were defined and described in the article. In the presented article the five skills of the therapist were distinguished in the five stages of therapy, beginning with the perception of one’s own feelings in the transference.

Therapist reactions to patient personality: A pilot study of clinicians' emotional and neural responses using three clinical vignettes from in treatment series.

Therapists' responses to patients play a crucial role in psychotherapy and are considered a key component of the patient-clinician relationship, which promotes successful treatment outcomes. To date, no empirical research has ever investigated therapist response patterns to patients with different personality disorders from a neuroscience perspective. In the present study, psychodynamic therapists (N = 14) were asked to complete a battery of instruments (including the Therapist Response Questionnaire) after watching three videos showing clinical interactions between a therapist and three patients with narcissistic, histrionic/borderline, and depressive personality disorders, respectively. Subsequently, participants' high-density electroencephalography (hdEEG) was recorded as they passively viewed pictures of the patients' faces, which were selected from the still images of the previously shown videos. Supervised machine learning (ML) was used to evaluate whether: (1) therapists' responses predicted which patient they observed during the EEG task and whether specific clinician reactions were involved in distinguishing between patients with different personality disorders (using pairwise comparisons); and (2) therapists' event-related potentials (ERPs) predicted which patient they observed during the laboratory experiment and whether distinct ERP components allowed this forecast. The results indicated that therapists showed distinct patterns of criticized/devalued and sexualized reactions to visual depictions of patients with different personality disorders, at statistically systematic and clinically meaningful levels. Moreover, therapists' late positive potentials (LPPs) in the hippocampus were able to determine which patient they observed during the EEG task, with high accuracy. These results, albeit preliminary, shed light on the role played by therapists' memory processes in psychotherapy. Clinical and neuroscience implications of the empirical investigation of therapist responses are discussed.

Comparing Bion's Container–Contained Relationship with Aspects of Containment in the Collective Unconscious

The psychodynamic therapist is both aware of and open to phenomena arising in their relationship with the patient. This paper compares two different phenomena and expands on how processing these phenomena aids the therapeutic pair: Bion's container–contained relationship and Jung's concept of the collective unconscious, which could be thought of as containing the therapeutic relationship. The two concepts will be described and elucidated using a clinical example of a therapist's dream from the collective unconscious following sudden termination in therapy. This supports a synthesis of the two concepts in a developmental context and within the wider scholarship of both thinkers. Finally, their relationships to embodied processes will be explored.

Work involvement and work satisfaction of psychotherapists-A nationwide online survey among psychotherapeutic practitioners in Germany.

The aim of this study was to explore psychotherapist characteristics associated with work involvement and work satisfaction among psychotherapists in Germany. In total N = 1358 psychotherapeutic practitioners with different levels of training participated in our nationwide online survey, we assessed work involvement and its sub-concepts of healing involvement (HI), stressful involvement (SI) and work satisfaction (WS) using the Therapist Work Involvement Scale (TWIS) and combined HI and SI into practice patterns. In our study, the levels of HI and WS were high, whereas SI was low. The percentage of effective practice patterns was higher than in previous studies, whereas challenging practice patterns were lower. HI, SI and WS were associated with gender and age, indicating that male and younger participants showed more SI but less HI and WS. Psychodynamic therapists reported more SI and WS. The number of weekly therapy sessions was related to HI, SI and WS. Furthermore, HI was positively related to WS and negatively to SI, while SI and WS were negatively correlated. Our results indicated that therapist characteristics influenced their work involvement and work satisfaction. Therefore, therapist training and interventions should consider individualized approaches based on the relevant therapist characteristics to foster HI and WS while reducing SI. One could speculate whether the changes in psychotherapeutic training may have already contributed to improved practice patterns over the last decades.

Opinion: Grasping the Unconscious Dynamism: A Prerequisite in Insight- Oriented Training

Insight-oriented psychotherapies, like psychoanalysis, as the most systematic method, and short-term dynamic psychotherapies, as the related compressed techniques, have a shared goal, which includes restoration of insight in patient by the help of a psychoanalyst or other associated psychotherapists. While there are many psychotherapists, who introduce themselves as psychodynamic therapists, a lot of criticizers believe in futility of analytic methods. Though there is no absolute guarantee of the effectiveness of any therapeutic method, whether pharmaceutical or psychological, it seems that based on physiognomies of systematic methods, some positive consequences can be reasonably expectable, which can be quantifiable by available evidence and records, too.

Developmental changes and their impact on psychoanalytic technique with emerging adults

ABSTRACT By integrating psychodynamic and developmental perspectives, this contribution reflects on psychotherapy in emerging adults, who are ‘in between’ adolescent and adult patients regarding therapeutic technique. The high mobility of this patient group makes adjustments in the frame and in the indication necessary, and psychodynamic therapists need to reflect on the flexibility and stability of the therapeutic setting. Identity problems occur frequently, but a distinction must be made between intrapsychic identity conflicts that may hamper development, and structural deficits such as identity diffusion. Since autonomy from parents is another central topic, guilt of autonomy and conflicts of loyalty must also be dealt with, potentially including accompanying work with parents in case of parental separation anxiety. Too much support from the therapist may continue or repeatt a parental pattern. New media also play a role in therapy, and the processing of narcissistic phenomena including mourning that not everything is possible, is useful.

A Case Report of a Man with Melancholy 60 Years Old Following Psychoanalytical Psychotherapy for Four Years

Age is often overlooked in discussions of diversity in clinical practice. In recent years, the interest of psychodynamic therapists has been extended to later stages of life. Psychodynamic psychotherapy with older individuals views them as continuing to face developmental challenges and navigating major experiences and various life transitions.

Therapeutic encounters at the onset of the COVID-19 pandemic: psychodynamic therapists’ experiences of transition to remote psychotherapy

The COVID-19 pandemic crippled many parts of society as it spread throughout the world beginning in early 2020. Overnight, whole societies were forced to change their way of life, because of social distancing and lockdowns. For therapists, the pandemic meant that in-person sessions were no longer possible and many switched to different forms of synchronous remote communication by telephone, online audio or video link. The aim of this study was to explore psychodynamic therapists’ experiences over time of forced transitions to telepsychotherapy. Five therapists were interviewed at the beginning of the pandemic and at a one-year follow-up. The data were analysed by applying thematic analysis with a phenomenological approach. Initially, the therapists struggled with technical and safety issues. The loss of the therapy room and of access to non-verbal nuances contributed to impaired contact with the patients and more superficial conversations. The therapists experienced that the very nature of psychodynamic psychotherapy was affected, even if telepsychotherapy could give some new opportunities. One year later many of the difficulties remained, but the therapists developed better coping strategies and were back to the therapy focus. One implication of this study is that telepsychotherapy needs to be integrated into psychotherapy training and supervision.

A Qualitative Exploration of CBT and Psychodynamic Therapists’ Views, Experiences and Perceptions of Integrating Different Therapeutic Modalities into their Private Practice with Adult Clients: Study Protocol.

A Qualitative Exploration of CBT and Psychodynamic Therapists’ Views, Experiences and Perceptions of Integrating Different Therapeutic Modalities into their Private Practice with Adult Clients: Study Protocol.

Psychodynamic Therapist's Subjective Experiences With Remote Psychotherapy During the COVID-19-Pandemic-A Qualitative Study With Therapists Practicing Guided Affective Imagery, Hypnosis and Autogenous Relaxation.

The COVID-19-pandemic brought massive changes in the provision of psychotherapy. To contain the pandemic, many therapists switched from face-to-face sessions in personal contact to remote settings. This study focused on psychodynamic therapists practicing Guided Affective Imagery, Hypnosis and Autogenous Relaxation and their subjective experiences with psychotherapy via telephone and videoconferencing during the first COVID-19 related lockdown period in March 2020 in Austria. An online survey completed by 161 therapists produced both quantitative and qualitative data with the latter being subject to a qualitative content analysis. Our research suggests that telephone and videoconferencing are considered valuable treatment formats to deliver psychodynamic psychotherapy. However, therapists’ experiences with remote psychotherapy are multifaceted and ambiguous. In particular, the findings raise questions concerning the maintenance of the therapeutic alliance, the development of the analytic process, the sensitivity to unconscious communication, and the indication for certain types of patients that still need further investigation. Our research indicates that the long-standing reticence toward remote treatments offers among psychodynamic therapists is becoming more differentiated and partially dissolves as therapists gain experiences in their use. Attitudes are becoming more open. At the same time, the way is being prepared to take a closer look at the specific processes and dynamics of remote psychotherapy and to examine them critically in future studies.

Working alliance, therapist expressive skills, and client outcome in psychodynamic therapy.

Bordin's (1979) theory suggests that therapist techniques that call for client introspection and self-observation will be more effective when the working alliance (WA) is stronger. Psychodynamic therapists use expressive techniques to elicit this introspection and self-observation. We examined whether therapists' use of expressive skills (e.g., encouraging expression of thoughts and feelings; helping clients understand the reasons behind their thoughts, feelings, and behaviors) when the WA is high, versus low, was related to client outcome in open-ended, psychodynamic treatment. Ten therapists rated the WA with their 47 clients, who rated their perceptions of helping skills, after 2,284 counseling sessions. Clients also completed the Outcome Rating Scale (ORS) in reference to the week following each session. We examined time-ordered relationships by creating lagged variables for WA (T-2) and therapist expressive skills (TES; T-1) and used these scores to predict ORS ratings (T) in a three-level Hierarchical Linear Modeling (HLM) analysis (sessions nested within clients, nested within therapists). Lagged WA (T-2) and expressive skills (T-1) were decomposed into between-therapist, within-therapist, and within-clients components. We found a 3-way interaction for within-therapist working alliance, within-client WA at T-2, and expressive skills at T-1 predicting ORS at T. When clients who had a weaker WA with their therapist than the therapists' other clients, had a session with a stronger WA than the client's usual WA, then more expressive skills in the next session was related to better psychological well-being in the subsequent session. Implications and future directions are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

When and for whom do psychodynamic therapists use guided imagery? Explicating practitioners' tacit knowledge.

Guided imagery psychotherapy (GIP) is an established therapeutic method using creative mental imagery within a psychodynamic frame of reference. Although there is evidence for the method’s general effectiveness, it is yet unclear under which conditions and for which patients it should be used. The aim of this study was therefore to empirically identify indication criteria for the use of guided affective imagery (GAI) as part of psychodynamic therapies. We conducted semi-structured interviews with N=15 psychodynamic therapists also qualified as GAI training therapists. We asked them to recollect cases in which they had decided either for or against the use of imagery. The therapists described a complex interplay of different factors. Using grounded theory coding supplemented by elements of Consensual Qualitative Research we reconstructed from their accounts a sequential model of their indicative decisions. First, there is a consideration of clear contraindications related to reality testing and destructiveness. Second, there are aspects requiring a modified application of GAI such as emotional instability and post-traumatic stress disorder symptoms. In a final step, there are a number of characteristics of the patient, the therapist, the therapeutic relationship, the patients’ initial imagery and different therapeutic goals and foci which are weighed relatively to each other in order for therapists to reach an indication decision. We end by discussing ways in which the indicative decision model may be used to improve GAI training as well as the method’s differential efficacy and effectiveness.

Supportive-Expressive Psychodynamic Psychotherapy for the Treatment of Opioid Use Disorder.

The United States is in the midst of an opioid epidemic with over 200,000 deaths per year due to opioid overdoses. There are numerous psychotherapeutic and medication-assisted approaches to treating opioid use disorder, but psychodynamic approaches remain underappreciated and underused. The self-medication hypothesis of substance use disorders is a psychodynamic model, which argues that all substance use disorders serve to defend against intolerable affects. In the case of opioid use disorders, opioids are thought to help defend against intense intolerable feelings of rage and depression associated with trauma. Supportive-expressive psychodynamic psychotherapy is an empirically supported psychodynamic treatment for a wide range of psychological problems, including opioid use disorders. Supportive-expressive psychodynamic psychotherapy focuses on transference analysis using an operationalized conceptualization of transference called the core conflictual relational theme method. This article describes supportive-expressive psychodynamic psychotherapy for opioid use disorders and provides clinical examples of its use in practice. The article describes and illustrates the three phases of supportive-expressive psychodynamic psychotherapy, the formulation of the core conflictual relationship theme, how it is applied when treating people with an opioid use disorder, and how supportive-expressive psychodynamic psychotherapy can be used with other therapies, such as medication-assisted treatments and 12-step programs. Last, this article encourages psychodynamic therapists who are not involved in treating people with an opioid use disorder to engage in treating people with one using supportive-expressive psychodynamic psychotherapy.

A palimpsest narrative of becoming a therapist

Written by an experienced psychodynamic therapist, this paper likens one’s narrative of becoming a therapist to an ancient palimpsest manuscript, where layer is built upon layer, yet traces of earlier texts keep coming through. Dipping into his personal archive of writings on this theme, the author revisits earlier constructions of his narrative, appraising them from his current perspective. Moving between past and present, personal experience and theory, clinical practice and research, this paper builds a rich, densely woven narrative account of becoming a therapist, while interrogating the process through which such a narrative is constructed and the purposes it serves. It concludes with reflections on the insights gained through the process of this inquiry, acknowledging the significant ontological and epistemological shifts that have occurred in the author’s approach to both asking and answering the question ‘What brings me here?’