Psychodynamic Therapists Research Articles

Treatment goals and strategies of cognitive-behavioral and psychodynamic therapists: A naturalistic investigation.

Treatment goals and strategies of cognitive-behavioral and psychodynamic therapists: A naturalistic investigation.

Therapists' attitudes about addressing the role of exercise in psychotherapy

A questionnaire was mailed to 250 psychotherapists selected from the National Register of Health Providers in Psychology to assess attitudes regarding the discussion of exercise in psychotherapy. Responses were received from 110 (44%) of this group. The study focused on (1) reasons therapists do or do not address exercise in therapy; (2) beliefs about the efficacy of exercise; (3) the relationship between theoretical orientation and the likelihood of discussing exercise; and (4) the relationship between gender and the likelihood of discussing exercise. We found that exercising therapists are more likely to raise the issue and discuss exercise with their clients. In addition, male therapists are more likely to discuss exercise with their male clients than with their female clients. Although cognitive-behavioral therapists are more likely than psychodynamic therapists to use a cognitive-behavioral approach, no relationship was found between exercise variables and primary orientation.

The use of personal therapy by clinical psychologists working in the NHS in the United Kingdom

AbstractThis study describes a survey of 496 NHS clinical psychologists (65% return rate obtained) looking at professional activities, job‐related stress, views on personal therapy, and details of personal therapy experiences. Forty‐one per cent reported having had experience of personal therapy, a figure lower than in any of the published American samples. Seventy‐eight per cent said they were moderately or very stressed by the job. Those with experience of personal therapy had higher scores on the GHQ‐28 and higher self‐reported scores for stress of the job and stress of doing psychotherapy. More psychologists with a psychodynamic orientation had experience of personal therapy than would have been expected by chance. Psychodynamic therapists chose psychodynamic or psychoanalytic therapists, but cognitive‐behavioural therapists chose therapists of orientations other than their own. Reasons for undertaking and ending therapy, the rated outcome of therapy, and means of finding a therapist are reported. Outcome of therapy was generally positive, with 17% of the sample reporting unsatisfactory results. The results are discussed in the light of published studies and in the context of work‐related stress among clinical psychologists.

Differences in the effectiveness of psychodynamic therapists: A process-outcome study.

Differences in the effectiveness of psychodynamic therapists: A process-outcome study.

Personal therapy in the training of psychologists.

AbstractClinical and counselling psychologists in B.C. were surveyed about their opinions on as a component of professional training, and about the circumstances under which had been provided to them while they were in graduate school. Respondents identified potential benefits and risks of therapy. The majority, 88%, saw at least one benefit for the experience, and 83% saw at least one risk. About half (41%) of them had undergone as part of their clinical training, and in many cases this experience was provided in a manner inconsistent with ethical guidelines. Of those receiving therapy, 46% reported that was required rather than optional, 62% were not able to choose their therapist, and 69% received from an academic colleague. Several ethical issues concerning therapeutic interventions in the of psychotherapists are discussed.When being trained to work in the helping professions, many future therapists undergo some type of psychotherapeutic treatment as part of their preparation. This personal therapy experience has been used in psychoanalysts (Caligor, 1985), other psychodynamic therapists (Battegay, 1983; Strupp, Butler, & Rosser, 1988), family therapists (Forman, 1984; Francis, 1988; Guldner, 1978), group therapists (Salvendy, 1985), behaviour therapists (McNamara, 1986) and clinical psychologists (Garfield & Kurtz, 1976; Guy, Stark, & Poelstra, 1988).Although psychoanalysis has traditionally asserted that therapy, the training analysis, is a necessary prerequisite for developing professional competence (Caligor, 1985), opinion varies concerning the importance of this experience for psychologists. In their survey of 87 APA - approved clinical programs, Wampler and Strupp (1976) found that 4% of the programs required therapy, 67% encouraged it, and the rest neither encouraged nor discouraged it. As a result, not all psychologists receive the same exposure to therapy. A recent survey of APA members working in the areas of clinical psychology, psychotherapy, and independent practice (Guy et al., 1988), showed that 70% had received before completing their degree.The presumed benefits of this experience include mastery of technique as a result of exposure to a role model, increased self - awareness, a sense of conviction aboutthe validity of the therapeutic model, and resolution of problems or baggage which could interfere with the therapist's effectiveness in the treatment situation (Nierenberg, 1972). Arguments against such experiences include the risk of limiting the trainees' openness to a variety of therapeutic models, emotional and financial stress on trainees, and the lack of conclusive evidence that is an effective method of professional helpers (Clark, 1986; Macaskill, 1988).A variety of ethical issues can also be raised if is mandatory for students, or if it is provided by faculty members who are also serving as instructors of those students. However, these issues are seldom addressed in the literature on therapy, and most of the published studies deal with the format and content of the experience (e.g., Francis, 1988; McNamara, 1986) rather than with the ethical implications (e.g., Newman, 1981). In contrast, the current study examines some of the potentially problematic ethical issues that can arise when is included in graduate programs.In response to concerns that a CPA member raised about the use of encounter sessions in a group process course, the Committee on Ethics of the Canadian Psychological Association (CECPA) considered the potentially serious ethical ramifications of providing therapeutic processes within the context of an educational setting. The Committee recommended several guidelines (CECPA, 1988) for the inclusion of experiences as part of any program, and its suggestions are congruent with a report from the Ethics Committee of the American Psychological Association (APA, 1987) on the ethical issues raised by required psychotherapy for trainees. …

Prejudice and Homosexuality

SUMMARY. The recent psychodynamic literature on homosexuality is reviewed and a negative view is shown to remain prevalent. It is suggested that this may be the result of prejudice as opposed to simple error or to justified belief. In order to support this suggestion a theory of the origins and operation of prejudice is outlined. Next it is shown to be a consequence of this theory that prejudice should be especially likely in the domain of sexuality. Then an understanding of the psychic mechanisms which maintain prejudice is applied to a close reading of three papers concerned with homosexuality, which are shown to retain the marks of prejudice despite their compassionate and thoughtful stance. The way in which the logical distortions which mark prejudice are discernible in all three papers and operate to perpetuate some prejudices about AIDS, HIV infection, homosexuality and perversion is also shown. The prevalence of prejudices about homosexuality is noted to be especially great amongst psychodynamic therapists. It is argued that some reasons for this lie in the nature of psychoanalytic theory particularly in the way that homosexuality challenges some choices implicit within psychoanalytic theory. The parallels between this situation and that of the prejudiced individual are noted and suggestions are made for steps that might reduce prejudice in this area. Finally it is argued that the ill effects of prejudice on theory in this area are detrimental to psychoanalysis as well as to homosexuals. Prejudice and its effects are argued to be major barriers to the construction of good theory about homosexuality and, more optimistically, the work of some analysts who have questioned the prevailing attitude to homosexuality is reviewed.

The Development of the Psychodynamic Psychotherapist in Supervision

Supervision is a fundamental component of every clinical training program that teaches psychodynamic psychotherapy. However, the development of the psychodynamic therapist in supervision has been a relatively unexplored area. This article identifies nine areas of development of the psychodynamic psychotherapist in supervision, with an emphasis on the beginning trainee. The areas explored include aspects of the therapist's understanding of the patient and aspects of the therapist's use of himself or herself in the psychotherapy. Consideration of the trainee in each of these areas helps the supervisor better understand the specific strengths and weaknesses that the trainee brings to their work together and enables the supervisor to be more skillful in the difficult business of psychotherapy supervision.

Perceptions of General and Specific Therapist Behaviors

In the process of developing a two-part therapist rating scale, we obtained questionnaire responses from a large sample of subjects who had undergone one of a variety of psychotherapies. Our data support the importance of perceived therapist care as a strong correlate of patient satisfaction, and patients seemed able to discriminate clearly between psychodynamic and cognitive-behavioral therapies. In the first (nonspecific) questionnaire, we derived five dimensions (Care-Concern, Directive-Control, Critical-Confronting, Understanding, and Charisma) from principal-components analyses, with the first two dimensions being relatively independent of each other. A multiple-regression analysis revealed that combined scale scores accounted for 50% of the variance of patient satisfaction ratings, with the Care dimension accounting for most of this effect. In the second questionnaire, data were analyzed from respondents who had undergone therapy with known cognitive-behavioral or psychodynamic therapists; but, in a minority of subjects who were recruited through the media, we depended on detailed descriptive vignettes to allocate them to one or another of these "specific" types of psychotherapy. Six scales emerged, three characterizing cognitive-behavioral therapies (Behavioral Task Orientation, Organization, and Cognitive Focus) and three representing psychodynamic therapies (Transference, Inner Conflict, and Relationship). Subjects' ratings on all scales strongly discriminated between the two broad modalities of therapy, suggesting that patient reports may provide valid measures of therapist styles. We conclude that questionnaires such as the one we are developing may provide economical measures for assessing therapist consistency when comparing different modalities of psychotherapy.

The Frequency and Effect on Outcome of Different Types of Interpretation in Psychodynamic and Cognitive–Behavioral Group Psychotherapy

The therapeutic effects of interpretations by both therapists and other clients were recorded by observers in three cognitive-behavioral and three psychodynamic groups over a period of thirty one-and-one-half-hour group therapy sessions. There was no significant difference in the overall frequency of interpretations made in the two different therapy modalities; however, there was the expected difference in the types of interpretations made. Cognitive-behavior therapists and group members tended to interpret patterns of behavior or impact on others more frequently than did psychodynamic therapists and group members; while psychodynamic therapists and group members made more historical cause interpretations. However, contrary to expectations, both therapy modalities made more interpretations of patterns of present behavior than any other type. When these interpretations were converted into problem statements that were sent to outside raters after the termination of the groups, the outside raters judged that clients improved most when interpretations of a pattern of behavior were made; next most when interpretations of impact on others were made; and did not improve when interpretations of motive were employed in either modality.

To be or not to be a real object: Monitoring the therapeutic relationship

Psychoanalytic theorists have lately come to acknowledge what practicing clinicians have long recognized: the importance of flexibility in psychotherapeutic technique. Adjusting the transference-countertransference expectations to the developmental level of each particular patient has become increasingly necessary as psychodynamic therapists work in depth with a wider range of “difficult” patients.

Three viewpoints on the therapeutic alliance. Similarities, differences, and associations with psychotherapy outcome.

This study tested three systems for measuring patient and therapist contributions to the therapeutic relationship. Scales with parallel dimensions were used by patients, therapists, and clinician judges to rate the same therapy hours. The sample consisted of 42 patients selected on specific criteria for their suitability for brief psychotherapy (20 sessions). They were treated by experienced psychodynamic therapists and therapeutic change was assessed by six outcome measures. Similarities and differences between the three perspectives of the alliance and their association with outcome were examined. There were significant correlations between patients', therapists', and nonparticipant judges' ratings of the patients' positive and negative contributions and the therapists' positive contributions, but no agreement between the three perspectives in their estimates of therapists' negative contributions. Within each measurement system, patients' and therapists' positive contributions to the relationship were the best predictors of outcome. In conclusion, the results suggest that the patients' and therapists' ratings of the treatment relationship, although influenced by subjective bias, agree to some extent with the nonparticipant judges' ratings and are more powerful in predicting the outcome of psychotherapy.

THE INTERPERSONAL CONTEXT OF OBJECT RELATIONS: IMPLICATIONS FOR FAMILY THERAPY*

Psychodynamic theory and family systems theories have come to represent competing orientations in the understanding of human behavior. This paper extends the quest for an integration of these perspectives. This is done by mapping ideas from one orientation onto constructs from the other. Case examples illustrate the ideas and demonstrate how inner dynamics and interactional behavior dovetail to create systemic and personal crises. Clinical implications highlight the need (a) for psychodynamic therapists to recognize the contextual forces that activate personality structures and (b) for systems therapists to recognize the idiosyncratic meanings of interactional behaviors.

Behaviour therapy for the neuroses: some conceptual and practical problems.

Some problems in reconciling behaviourism as pure science with clinical behaviour therapy for complex neurotic and personality disorders are examined. A major problem is the inability of scientific behaviourism to permit motivation, will and choice to be considered from an intrapsychic perspective. Cognitive behaviour therapy and its derivatives have been developed in an attempt to overcome this problem. Although such therapies have retained a paradigmatic attachment to behaviourism, they have more in common with psychodynamic psychotherapy. Conflict among contemporary behaviourists about the relevance of cognitive theory to behaviourism has obscured more fundamental issues such as the role of the patients-therapist relationship. Both classical and cognitive behaviour therapists view a direct examination of the patient-therapist relationship as therapeutically irrelevant, although there is evidence that such a viewpoint may be anti-therapeutic in some severe neurotic disorders. Behaviourists must acknowledge the central importance of examining the patient-therapist relationship in such disorders if they are to continue their successful dialectic with psychodynamic therapists.

Psychodynamic and behavior modification approaches to the treatment of infantile autism

In the treatment of infantile autism, behaviorists emphasize directed behavioral change while psychodynamic therapists tend to focus attention on the worker-child relationship. A review of the literature suggests that both of these aspects of intervention are important, and that both play a role in virtually all therapeutic efforts. The similarities in methods of intervention found in the work of investigators of very different theoretical persuasion raise the possibility that most treatment methods owe more to empirical clinical experience than to their presumed derivation from a theoretical model. This thesis is further examined with respect to a 50-year-old case history by Lightmer Witmer, and the work of the present writer with an 11-year-old autistic boy.

Differential effects of psychotherapy and behavioural techniques in a case of acute obsessive compulsive disorder.

The current status of the psychotherapy of obsessive-compulsive conditions is somewhat confusing. For many years the condition has been regarded as resistant to psychotherapeutic intervention, but recently some success has been claimed by both behaviour therapists (for example Boulougouris et al., 1971; Rackensperger and Feinberg, 1972) and psychodynamic therapists (for example Barnett, 1972; Suess, 1972). The confusion arises because despite the plethora of published work we seem little closer to an understanding of why the techniques have worked.