Psychodynamic Treatment Research Articles

A constructive replication of client change during psychodynamic treatment in an outpatient setting

AbstractWe responded to the need for replication in psychotherapy research by extending a prior naturalistic study documenting the effectiveness of long‐term psychodynamic treatment. We employed three novel analytic strategies and evaluated their influence on substantive interpretations offered in the prior study. The sample consisted of clients (N = 387; Mage = 31.61; SD = 11.13; 58.9% female; 79.1% Caucasian/White) receiving outpatient treatment at a psychodynamic training clinic. Results replicated the original two‐class solutions for social functioning, depression and life satisfaction. Novel to the replication analyses, each trajectory for social functioning and depression exhibited nonlinear change and results advanced research on a theorised mechanism of effective psychodynamic treatment. Results showed that change in experiential avoidance was a possible mechanism between early‐treatment change in social functioning and later‐treatment changes in depression symptoms and life satisfaction. Clinical implications focus on the influence that initial levels of symptoms and well‐being may have on early and later phases of treatment, monitoring progress throughout treatment, and how to promote symptom and well‐being improvement.

The relationship of functional and symptomatic changes after multimodal psychodynamic treatment

Objectives: Personality organization or functioning describes biographically acquired characteristics for the regulation of psychological processes. Limitations correlate with symptom load. This study examines whether significant improvement in personality functioning can be achieved in the framework of a multimodal psychodynamic treatment and its influence on the psychological symptoms. Methods: In this naturalistic study design (N = 318) personality organization was measured with the OPD-SQS and the symptoms were obtained using PHQ-9, GAD-7, SCL-9 and mini- Spin. Changes in the functioning levels were calculated using a t-test. The associations between the functional and symptom improvements were calculated using hierarchical regressionmodels. ANOVAs for dependent samples were used to calculate the association of the personality organization changes on symptom reduction Results: Treatment resulted in significant improvement in personality structure.The greater the changes, the lower the symptom burden at the end of treatment. Patients with lower personality structure benefited equally well from treatment. Conclusions: Personality functioning improves with multimodal psychodynamic therapy and is accompanied by reduction of psychological symptoms. Structural changes proceed equally in high and low structured patients.

Psychodynamic Therapies for the Treatment of Substance Addictions: A PRISMA Meta-Analysis.

The aim of this meta-analysis was to compare psychodynamic with other treatments in studies of substance addiction. The literature search was conducted using the PubMed, Web of Science, Cohcrane library, SCOPUS, and Onesearch databases. All studies comparing psychodynamic therapy with other types of psychological interventions for Substance Use Disorder were eligible. Three outcomes were considered to compare intervention performance: substance use, participation in treatment and other symptomatic conditions (OSCs). Hedges' G was used to measure effect size. The Revised Cochrane Risk of Bias tool for randomized trials was used to assess quality of evidence and possible bias, Egger regression analyses for publication bias, and Q and I-square statistics were used to assess heterogeneity. The alcohol group showed no differences between treatments on the three outcomes. The cocaine group showed no significant differences in the two outcomes, while for OSCs, available data was insufficient. The opioids group showed small but significant differences regarding participation in favor of non-psychodynamic interventions and no significant results for other outcomes. Based on the three measures of recovery considered in this meta-analysis, psychodynamic interventions were shown to be as effective as other psychological treatments in treating substance dependence and proved to be an empirically-supported treatment for the above addictions.

Computerized linguistic analysis of counselors’ clinical notes in a university counseling center: Which associations correspond with students’ symptom reduction in a brief psychodynamic intervention?

Computerized linguistic analysis of counselors’ clinical notes in a university counseling center: Which associations correspond with students’ symptom reduction in a brief psychodynamic intervention?

Empirical examination of long-term and intensive psychodynamic psychotherapy for severely disturbed patients

Objectives This study examines the effectiveness and efficiency of intensive psychodynamic psychotherapy for severely impaired patients. Method: 104 patients in four public mental health centers underwent intensive psychodynamic psychotherapy. The number and duration of psychiatric hospitalizations were monitored for these patients from one year before therapy to eight years after. Several outcome variables were measured every six months, six times in total over two and a half years, using a longitudinal design. A multi-level analytic approach was applied to account for repeated measurements and missing data. Results: Significant improvement was found in all three symptomatic outcome measures (SCL-90, OQ-45, BDI) throughout treatment. The numbers of psychiatric hospitalizations and psychiatric hospitalization days decreased significantly from the level they were in the year before the start of psychodynamic treatment to three years after the start of treatment. These results were maintained for at least up to eight years. After capitalization, the overall cumulative 127.47-day decrease in hospitalization days equals savings of 115,850 NIS. The average cost of treatment after capitalization was 26,770 NIS. The insurer's estimated direct savings is 89,080 NIS (24,054 $). Conclusion: These findings support the hypothesis that psychodynamic psychotherapy is clinically effective and economically efficient for severely impaired patients.

Forensic Mental Health Evaluators' Unprocessed Emotions as an Often-Overlooked Form of Bias.

There has been robust interest in the influence of cognitive and implicit biases that can hamper a forensic mental health evaluator's ability to provide objective opinion evidence. By contrast, literature exploring the biasing effects of the examiner's unacknowledged and unprocessed emotions has been scanty. Borrowing from concepts originating from psychodynamic treatment literature, this article explores how a forensic mental health evaluator's emotional and transferential reactions can affect the assessment process and formulation of findings. We make the case that forensic mental health evaluators are not impervious to their own mental health concerns, including vicarious trauma. We ultimately argue for a cultural shift in forensic practice that acknowledges the unavoidable existence and influence of a forensic evaluator's human emotions, personal reactions, and conflicts, so that strategies can be developed for compassionate but careful management in training programs, supervision, and beyond. We suggest that self-reflection, sometimes with the aid of consultation and psychotherapeutic support, is not only important for clinical trainees but also could serve forensic practitioners throughout their careers, especially during challenging junctures in their personal and professional lives.

A systematic review of the association between interpretations and immediate, intermediate, and distal outcomes.

Interpretations are a hallmark of psychodynamic treatment and a method used in other theoretical orientations as well. Therapists use interpretations to increase patients' insight concerning unconscious and preconscious elements in their lives, with the ultimate aim to reduce mental pain and suffering and improve mental health. This systematic review focuses on the association between the therapists' use and accuracy of interpretation and immediate (within-session), intermediate (between-session), and distal (end-of-treatment) outcomes. This synthesis of the research literature is based on 18 independent samples of 1,011 total patients in individual psychotherapy. The results suggest that the use and accuracy of interpretations were associated, in half the studies, with patient disclosure of emotions and increased insight at the immediate, moment-to-moment enfolding of the session. At the intermediate postsession outcome, the use of interpretations was associated with a stronger alliance and greater depth, in half the studies. At the end of treatment, however, while there is some evidence for a positive effect of the use of interpretations on treatment success, there are also neutral effects and even evidence that interpretations have the potential to be harmful in some particular situations. The article concludes with training implications and therapeutic practices based on the integration of clinical experience and research evidence. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Shifting between Self-States and Narrative Change—Implicit and Explicit Change Processes in Psychotherapy

This study examined the relationship between implicit and explicit levels of change in psychotherapy—the ability to shift between self-states, measured by the Two Person APES (TPA), a relational extension of the Assimilation of Problematic Experiences Scale (APES), and the emergence of exceptions to the problematic self-narrative, measured by the Innovative Moments Coding System (IMCS). The contribution of each of these dimensions of change to session outcome was also examined. Eighty sessions of eight psychodynamic treatments (10 sessions each) were sampled and coded according to the TPA and the IMCS. Session outcome was measured by the Outcome Rating Scale (ORS). A repeated measures correlation approach was used, revealing a positive association between IMs and client TPA. Also, IMs showed stronger correlations with session outcome compared to TPA. These results indicate that a growing ability to shift between self-states in the implicit level is related to the client’s ability to construct new meanings in the explicit level, and that these explicit changes have stronger correlations with functioning improvement at the session level than implicit processes concerning the renewal of dialogue between self-states.

The Evidence-Base for Psychodynamic Interventions with Children Under 5 Years of Age and Their Caregivers: A Systematic Review and Meta-Analysis

ABSTRACT Experiences in the first years of life can shape a range of outcomes throughout the lifespan. Effective early interventions have the potential to offset negative outcomes associated with early adversity. A broad range of psychodynamic interventions are available to children under five and their caregivers but there is a lack of research synthesizing the current evidence for their effectiveness. This paper presents a systematic review and meta-analysis of the evidence for the effectiveness of psychodynamic interventions for children under 5 years of age and their caregivers. Following a systematic search of 10 databases and screening for eligibility, 77 papers were included in the review. Most studies reported positive outcomes on a range of parent and infant domains. The meta-analyses of controlled studies found significant effects of psychodynamic interventions compared to control conditions on parental reflective functioning, maternal depression, infant behavior, and infant attachment. No significant differences between psychodynamic and control interventions were found for parental stress, and parent-infant interactions. Very few studies were rated as good quality and further high-quality research is needed.

Systematic review of machine learning utilization within outpatient psychodynamic psychotherapy research.

Although outpatient psychodynamic psychotherapy is effective, there has been no improvement in treatment success in recent years. One way to improve psychodynamic treatment could be the use of machine learning to design treatments tailored to the individual patient's needs. In the context of psychotherapy, machine learning refers mainly to various statistical methods, which aim to predict outcomes (e.g., drop-out) of future patients as accurately as possible. We therefore searched various literature for all studies using machine learning in outpatient psychodynamic psychotherapy research to identify current trends and objectives. For this systematic review, we applied the Preferred Reporting Items for systematic Reviews and Meta-Analyses Guidelines. In total, we found four studies that used machine learning in outpatient psychodynamic psychotherapy research. Three of these studies were published between 2019 and 2021. We conclude that machine learning has only recently made its way into outpatient psychodynamic psychotherapy research and researchers might not yet be aware of its possible uses. Therefore, we have listed a variety of perspectives on how machine learning could be used to increase treatment success of psychodynamic psychotherapies. In doing so, we hope to give new impetus to outpatient psychodynamic psychotherapy research on how to use machine learning to address previously unsolved problems.

How are psychodynamic conflicts associated with personality functioning? A network analysis.

Personality functioning and psychodynamic conflicts are central constructs in psychoanalytic theories of psychopathology as well as in many psychodynamic treatment models. Although there has been a longstanding conceptual discussion on how they relate to each other, empirical evidence on this question is still scarce. In this study, we explore the associations between psychodynamic conflicts and levels of structural integration (which can be used synonymously with personality functioning) by means of a partial correlation network analysis in a sample of N = 220 outpatients interviewed and rated according to Operationalized Psychodynamic Diagnosis (OPD-2). We examined network centrality, bridge centrality, clustering, and network stability. The network analysis resulted in separate clusters for levels of structural integration and conflicts, supporting the assumption of distinct psychodynamic constructs. The greatest association between the two clusters was found between the individuation vs. dependency conflict (C1) and the structural capacity to attach to internal objects. In general, C1 showed significantly greater connections with structural dimensions compared to the other five OPD conflicts included. C1 was also more central in the network compared to most other conflicts, whereas the structural dimensions did not differ in centrality. All structural dimensions were found to be strongly interconnected. C1 showed exclusively negative edges to the other conflicts, suggesting that a profound C1 decreases the probability of other psychodynamic conflicts. We discuss clinical as well as conceptual implications of our findings for psychodynamic diagnosis and treatment.

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.

Individual psychotherapy for cluster-C personality disorders: protocol of a pragmatic RCT comparing short-term psychodynamic supportive psychotherapy, affect phobia therapy and schema therapy (I-FORCE)

BackgroundCluster-C personality disorders (PDs) are highly prevalent in clinical practice and are associated with unfavourable outcome and chronicity of all common mental health disorders (e.g. depression and anxiety disorders). Although several forms of individual psychotherapy are commonly offered in clinical practice for this population, evidence for differential effectiveness of different forms of psychotherapy is lacking. Also, very little is known about the underlying working mechanisms of these psychotherapies. Finding evidence on the differential (cost)-effectiveness for this group of patients and the working mechanisms of change is important to improve the quality of care for this vulnerable group of patients.ObjectiveIn this study, we will compare the differential (cost)-effectiveness of three individual psychotherapies: short-term psychodynamic supportive psychotherapy (SPSP), affect phobia therapy (APT) and schema therapy (ST). Although these psychotherapies are commonly used in clinical practice, evidence for the Cluster-C PDs is limited. Additionally, we will investigate predictive factors, non-specific and therapy-specific mediators.MethodsThis is a mono-centre randomized clinical trial with three parallel groups: (1) SPSP, (2) APT, (3) ST. Randomization on patient level will be pre-stratified according to type of PD. The total study population to be included consists of 264 patients with Cluster-C PDs or other specified PD with mainly Cluster-C traits, aged 18–65 years, seeking treatment at NPI, a Dutch mental health care institute specialized in PDs. SPSP, APT and ST (50 sessions per treatment) are offered twice a week in sessions of 50 min for the first 4 to 5 months. After that, session frequency decreases to once a week. All treatments have a maximum duration of 1 year. Change in the severity of the PD (ADP-IV) will be the primary outcome measure. Secondary outcome measures are personality functioning, psychiatric symptoms and quality of life. Several potential mediators, predictors and moderators of outcome are also assessed. The effectiveness study is complemented with a cost-effectiveness/utility study, using both clinical effects and quality-adjusted life-years, and primarily based on a societal approach. Assessments will take place at baseline, start of treatment and at 1, 3, 6, 9, 12, 18, 24 and 36 months.DiscussionThis is the first study comparing psychodynamic treatment to schema therapy for Cluster-C PDs. The naturalistic design enhances the clinical validity of the outcome. A limitation is the lack of a control group for ethical reasons.Trial registrationNL72823.029.20 [Registry ID: CCMO]. Registered on 31 August 2020. First participant included on 23 October 2020.

A Developmental Line for Affects: The Relevance of Contextualization of Affects for the Psychodynamic Treatment of Early Developmental Psychopathology

ABSTRACT In this paper we present perspectives from clinical work, neuroscience, and evolutionary anthropology that together provide a useful framework to think about and work clinically with patients with early developmental psychopathology, in particular certain aspects of borderline personality structure. Our argument is that conceptualizing a line of affective development starting with basic, primary affects, and progressing to nuanced, contextualized, tertiary affects helps locate the origin of the affective instability and dysregulation of some patients. When this line of affective development is interrupted, a limited, inflexible self develops. When the development of tertiary affects is facilitated, it allows for a richer, more flexible self. We also argue that, separate from splitting as a defense, a black and white form of cognition often accompanies the early experience of primary and secondary affects. When development of more sophisticated, contextualized affects is interrupted, this binary form of cognition tends to persist, but when that development is facilitated, richer, more nuanced forms of cognition also contribute to a more robust self.

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.

The development of narrative identity in the psychodynamic treatment of avoidant personality disorder: A case study.

Avoidant personality disorder (AvPD) is characterized by feelings of shyness, inadequacy, and restraint in intimate relationships and has been associated with a disturbance in narrative identity, which is the internalized and evolving story of past, present, and future experiences. Study findings have indicated that an improvement in overall mental health through psychotherapy may increase narrative identity. However, there is a lack of studies incorporating not only the examination of narrative identity development before and after psychotherapy but also within psychotherapy sessions. This case study examined the development of narrative identity in short-term psychodynamic psychotherapy treatment of a patient with AvPD, using therapy transcripts and life narrative interviews before, after, and 6 months following treatment termination. Narrative identity development was assessed in terms of agency, communion fulfillment, and coherence. Results showed that the patient's agency and coherence increased over the course of therapy, whereas communion fulfillment decreased. At the six-month follow-up, agency and communion fulfillment increased, whereas coherence remained stable. The results of this case study suggest that the patient's sense of narrative agency and ability to narrate coherently improved after undergoing short-term psychodynamic therapy. The decrease of communion fulfillment during psychotherapy and later increase after termination suggests that the patient became more aware of conflictual patterns in their relationships, therefore realizing that their wishes and desires were not being fulfilled in their current relationships. This case study displays the possible impact short-term psychodynamic therapy may have by helping patients with AvPD develop a narrative identity.

Psychodynamic psychotherapy for schizophrenia spectrum disoders: a case presentation and systematic review

IntroductionPsychodynamic psychotherapy emphasizes the unique history, subjectivity, and psychological complexity of each individual. The core principles in the psychodynamic treatment of schizophrenia spectrum disorders (SSD) includes a stable (yet flexible) frame; attention to countertransference; and clarification of experiences, emotions, and relationships including giving psychotic symptoms context in internal and external object relationships.ObjectivesThis study has two aims. First, to present the progress of a patient with chronic schizophrenia treated with psychodynamic psychotherapy. Second, to provide a systematic review of comparative trials that have included psychodynamic psychotherapy as treatment for SSD.MethodsThe case presentation includes information from the therapist’s notes, video footage, and the electronic health record. The systematic review will be conducted in November and December, 2022, and in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. The databases of MEDLINE, EMBASE, and PsycInfo will be searched for literature.ResultsL, a 25-year-old woman, was diagnosed with paranoid schizophrenia five years prior to starting psychodynamic psychotherapy at an outpatient unit for SSD. L grew up with a close relationship with her mother, father, and sister. She was bullied in school and clearly remembered being told by her classmates that she was “just L”. When therapy began L had been living with her boyfriend for six months. Voice hallucinations were one of the most interfering symptoms. The most present voice, M, was both her best friend and worst enemy. During psychotic breakdowns M could take control of L’s body. L was incapable of making her own decisions. Small and big decisions were consulted with a family member or the hallucinatory voices. L attended 33 psychotherapy sessions from October, 2020 to November, 2021. In the first six months, sessions were weekly and afterwards biweekly due to L feeling significantly better and she wanted to have more time to study. L benefitted from the structure and clarifying questions from the therapist. Most notably, she broke up with her boyfriend. She started dating and found a new boyfriend. At this point the voice hallucinations and psychotic breakdowns were reduced considerably. In the termination phase the themes were feeling insecure, relationships, and how having been bullied affected her as an adult.Results from the systematic review are not available at the time of submission.ConclusionsIn the present case, psychodynamic psychotherapy was an effective treatment of psychotic symptoms as well as childhood trauma and interpersonal conflicts for an individual with paranoid schizophrenia. It speaks for a broad application of psychodynamic psychotherapy in the treatment of SSD as the therapy both assesses and treats psychotic and non-psychotic symptoms.Disclosure of InterestNone Declared

A multimodal case study utilizing physiological synchrony as indicator of context in which motion synchrony is associated with the working alliance.

Interest in the association between patient and therapist's motion synchrony and the working alliance has been growing in recent years. This interest is part of a larger effort in psychotherapy research to study how the working alliance, being central to the therapeutic process, develops over the course of therapy. However, while previous studies suggest that such an association between motion synchrony and the working alliance exists, there are mixed results regarding the direction of it. The present single-case study seeks to shed light on these mixed results with a multimodal perspective of nonverbal synchrony. That is, through an exploration of a single case, the present study explores physiological synchrony as an indicator of context in which motion synchrony is associated with the working alliance. For this aim, a single case was chosen from a randomized control trial investigating short-term psychodynamic treatment for major depressive disorder. Statistical analysis identified an interaction between physiological synchrony and motion synchrony in predicting working alliance levels. Findings show that in the context of an antiphase pattern of physiological synchrony (negative association between physiological measures of the two participants), there was a positive association between motion synchrony and the working alliance. This study emphasizes the potential of a multimodal approach, while suggesting a possible explanation for mixed results in current literature that focuses on the association between motion synchrony and the working alliance. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Psychodynamic intervention in the early period—An explorative case analysis

Psychodynamic intervention in the early period—An explorative case analysis

Dynamic Interpersonal Therapy for U.S. Veterans in a Primary Care Setting.

Brief dynamic interpersonal therapy (DIT) is an evidence-based psychodynamic intervention for depression offered by the U.K. National Health Service and previously studied in the context of a U.S. Department of Veterans Affairs medical center. This study assessed the clinical value of DIT in primary care for veterans with general medical conditions. The authors examined outcome data of veterans (N=30; all but one had ≥1 comorbid general medical conditions) referred to DIT from primary care. Veterans who began treatment with clinically elevated depression or anxiety experienced a 42% reduction in symptom severity, as measured by the nine-item Patient Health Questionnaire or by the seven-item Generalized Anxiety Disorder questionnaire, respectively, representing large effect sizes. Significant decreases in depression and anxiety symptoms suggest the utility of DIT for veterans with comorbid general medical conditions. DIT's dynamically informed framework may improve patients' help seeking, which is relevant for patients experiencing comorbid medical conditions.