Time-limited Dynamic Psychotherapy Research Articles

Integrating Intersectionality into Time-Limited Dynamic Psychotherapy

Integrating Intersectionality into Time-Limited Dynamic Psychotherapy

Psychotherapy program as an additional treatment method for patients with rheumatoid arthritis, multidisciplinary approach

IntroductionChronic diseases, with the development of medicine, the extension of life expectancy and the reduction of dying from infectious diseases, have become a leading public health problem. Rheumatoid arthritis (RA) is a chronic, progressive, multifactorial, autoimmune, systemic inflammatory disease of connective tissue, and sufferers are at greater risk of developing psychological disorders, depression and anxiety being the most common. Optimal treatment of RA should include periodic screening of somatic and psychological comorbid disorders and diseases with a multidisciplinary approach to treatment.ObjectivesPresenting a psychotherapy program as an additional method of treating patients with rheumatoid arthritis.MethodsIn University Hospital Dubrava, a psychotherapy program was organized for patients with rheumatoid arthritis, which took place once a week for 12 weeks, and consisted of autogenic training, education about the disease and group psychotherapy. The program would begin with autogenic training held by a clinical psychologist, and the main goal was to achieve psychophysical relaxation. This was followed by an education on rheumatoid arthritis, in which a clinical rheumatologist was involved, and the goal was to provide basic information about the disease, thereby achieving better cooperation with health care personnel and a more active role in their own treatment. In the end, there would be a time-limited dynamic group psychotherapy conducted by a psychiatrist/psychotherapist with the basic therapeutic effects of group therapy.Results As a result of a 12-week psychotherapy program for somatic patients, which was held in a clinical hospital, patients’ anxiety and depression decreased, the experience of pain decreased, and there were positive changes in the perception of the quality of life.ConclusionsA multidisciplinary approach is recommended in treating patients with rheumatoid arthritis and psychotherapy progam can be used as an additonal way of treatment.Disclosure of InterestNone Declared

Time-Limited Dynamic Psychotherapy in University Counseling Centers: A Survey of Clinicians

ABSTRACT Time-limited dynamic psychotherapy (TLDP) is a time-sensitive, interpersonal approach, emphasizing attachment, and affective-experiential components, which influence the process of change. TLDP outcome studies have demonstrated the importance of the clinician’s role in both therapeutic process and outcome. However, TLDP research has been limited to archival data, necessitating additional analyses of the clinician’s role in new populations. The current study addressed this gap by evaluating clinicians’ experiences utilizing TLDP in university counseling centers (UCCs) nationwide. An 18-question survey was completed by 96 clinicians, and 28% reported utilizing TLDP. The interpersonal aspect and the focus on the cyclical maladaptive pattern were the most important components of TLDP in UCCs. Moreover, all clinicians who were trained in TLDP are positively impacted by the training, or their already neutral or positive view remained the same. Findings suggest preliminary evidence that UCC clinicians implementing TLDP view the model as beneficial to the UCC population.

Enlivening Psychodynamic Brief Therapy with Emotion-Focused Interventions: An Integrative Therapist’s Approach

Focusing on affect and the expression of emotion has long been a key feature of psychodynamic psychotherapies. While psychodynamically-oriented therapists have always paid attention to the emotional life of their clients, they usually do not focus on accessing and processing emotions in the manner and to the degree that emotion-focused therapists do. By recognizing the power of emotion as a fundamental change mechanism, an increasing number of therapists who previously defined themselves a classically psychodynamic (e.g., fostering insight through interpretation) are now placing themselves in the “experiential camp.” Developed in the 1980′s, Time-Limited Dynamic Psychotherapy (TLDP) has undergone several changes. One of these is to emphasize experiential learning as a main therapeutic change agent. In this updated version of TLDP, there is a focus on accessing feelings in the here–and-now that are seen as altering and even transforming old dysfunctional patterns of relating to self and others. To provide examples of what such interventions might look like in an integrative psychodynamically-oriented therapy, excerpts from transcripts of actual TLDP sessions will be provided. In particular, vignettes will illustrate accessing and processing emotion relevant for understanding and shifting a client’s cyclical maladaptive pattern and “working through.”

An Integrative Approach to Psychotherapy: A Case Study of Ms. B

In the case of Ms. B, the integration of faith and psychology was a critical approach facilitating the achievement of several treatment gains. This article provides a glimpse into a therapeutic relationship that acknowledged and provided space for the faith life and experience of the client, which proved to be the gateway that led her to symptom relief. Utilizing time-limited dynamic psychotherapy, Ms. B was able to attain new knowledge and have new experiences that had implications for her perceptions of God and her perceptions of herself.

Addressing Social Anxiety Concurrently With Prison-Based Sex Offender Treatment

Emotional regulation may be an underaddressed therapeutic target in sex offender treatment. This article presents a case report of "Adam," a Caucasian male referred to a prison-based sex offender treatment program. Adam's social anxiety was recognized as an antecendent to his sexual offending, and treatment of such, as a critical adjunct to sex offender treatment, is discussed herein. Adam's individualized treatment included aspects of rational emotive behavior therapy and time-limited dynamic psychotherapy. Adam showed an increased understanding of his anxiety and improvement in his social interactions, both in the context of treatment groups and with female staff, and was willing to continue follow-up care in the community. This case provides support for the individualized treatment of incarcerated offenders as opposed to exclusively utilizing manualized psychoeducational interventions.

On the Skillful Integration of Buddhist Psychology and Short-Term Dynamic Psychotherapy

In this article, I respond to commentaries by Morgan (2016) and Schacht (2016) regarding my presentation of the cases of Beth and Amy (Samlin, 2016). Addressing the dialectic raised between Morgan’s (2016) support for and Schacht’s (2016) skepticism towards the integration of Time-Limited Dynamic Psychotherapy (TLDP) and the Aversion/Attachment Model of Client Suffering (A/AMCS, I organize my response into three broad sections. First, I provide context as to the type of Buddhist tradition from which the A/AMCS draws. In this section, I also address the current debate in Mindfulness-Based Interventions literature regarding the use of explicit vs. implicit Buddhism in treatment. Second, I address issues related to the technical and conceptual integration of the A/AMCS into TLDP. Finally, I re-examine the outcomes of Beth’s and Amy’s cases from the pragmatic standpoint and offer additional thoughts regarding the differing outcomes of the two cases.

Integrating Time-Limited Dynamic Psychotherapy and a Buddhism-Inspired Aversion/Attachment Model of Client Suffering: The Cases of "Beth" and "Amy"

In recent times, Buddhist psychological concepts have become appealing to many psychotherapy theorists and practitioners. Included are such notions as mindfulness, the "acceptance" of experience, the nature and causes of suffering, and the use of "skillful means" behaviors and thoughts that are intentionally undertaken to reduce suffering both for oneself and others. While there are a number of cognitive-behavioral therapy treatments that incorporate such Buddhist psychological concepts, little research and practice has been done examining the integration of such concepts and short-term dynamic psychotherapy. As one effort to fill this gap in research, the purpose of this study was to develop and pilot test in two cases—"Beth" and "Amy"—a model (a) that was based on such Buddhist concepts and (b) that would assimilatively integrate with the "home theory" of an established form of modern, relational, short-term psychodynamic psychotherapy, namely, Levenson's (1995, 2010) Time-Limited Dynamic Psychotherapy (TLDP). The new model is called the "Aversion/Attachment Model of Client Suffering" (A/AMCS). The A/AMCS model was conceptually incorporated into Beth's and Amy's case formulations through an expansion of TLDP’s case formulation method. Also, the A/AMCS model was technically integrated into TLDP treatment in two ways. First, formal mindfulness meditation practices were implemented with each client by conducting eight half-hour practices before sessions 6-13, in the context of therapy that lasted 23 and 20 sessions, respectively. Second, the treatment sessions included the incorporation of acceptance practices and skillful means strategies. Following the Pragmatic Case Study Method (Fishman, 2005), Beth and Amy’s cases are examined both quantitatively and qualitatively. This study concludes with a discussion of the possible reasons for Beth's dramatically positive outcome compared with Amy's only moderately successful outcome, together with a broader discussion of how future research could further examine the integration of Buddhist psychological concepts and short-term psychodynamic psychotherapy.

A TLDP Therapist Meets the Buddha on a Road and No One Is Killed

Samlin’s (2016) case studies demonstrate the creative integration of Time-Limited Dynamic Psychotherapy (TLDP) and selected Buddhist psychological concepts. In this commentary I analyze epistemological, theoretical, cultural, and clinical complexities involved in this integration from the perspectives of patient recruitment and selection, therapeutic alliance, diagnostic and outcome assessment, and the nature of the Cyclic Maladaptive Pattern (CMP) concept.

Does the supervisor's teaching style influence the supervisee's learning prescribed techniques?

Objectives: This study examined the directive and non-directive supervisors’ instructional styles, supervisees’ interactive communications within supervision sessions as well as the relative success of supervisees’ learning to apply specific techniques within psychotherapy. Method: The developers of Time-Limited Dynamic Psychotherapy (TLDP) provided the supervised training for 16 therapists as part of the “Vanderbilt II” psychotherapy project. Supervision sessions were rated for supervisors’ adherence to TLDP content. Both supervisors and supervisee were rated for classroom interactive behaviors of “initiation” speech (e.g., introducing ideas) and “responsive” speech (e.g., amplifying the other speaker's topic). The third therapy session was targeted for discussion within supervision. Therapy sessions immediately before and after supervision were rated on TLDP adherence. Results: One of the supervisors (Supervisor A) was found to use an instructional style of relatively more initiation-based speech, whereas the other (Supervisor B) used more response-based speech. Technical adherence for supervisees of Supervisor A was significantly higher than those assigned to Supervisor B. Supervisees’ initiation-based speech during supervision predicted less use of TLDP techniques in the therapy session after supervision. Supervisors’ interactive style was not associated with therapy adherence. Conclusions: Relatively more directive and structured supervision may influence the acquisition and use of manual-prescribed therapy techniques.

Training in time-limited dynamic psychotherapy: A systematic comparison of pre- and post-training cases treated by one therapist

Objective: This qualitative study systematically compared cases treated by the same therapist in order to understand the group comparison findings of a larger study on training of experienced therapists (the “Vanderbilt II” psychotherapy project). Method: The therapist, Dr C., was selected based on the therapist's overall treatment successes. His two patients were selected based on their outcomes and the relative training cohort from which they were drawn: a case with successful outcome from the pre-training cohort and a case of negligible improvement from the post-training cohort. Results: Dr C. demonstrated a variety of interpersonal skills throughout his pre-training case, though there was also poor interpersonal process throughout. However, in the second case he had considerable difficulty in adapting his typical therapeutic approach to the requirements of the time-limited dynamic psychotherapy (TLDP) manual, even while appearing to work hard to find ways to use the manual. Conclusions: Dr C.'s spontaneity, and his unique set of interpersonal skills may enhanced his initial rapport and alliance building with clients and yet may not have interfaced well with TLDP. His unique interpersonal skills also may have contributed to problems of interpersonal process. Future research may benefit from examining the interaction of between therapist interpersonal skills and the implementation of the treatment manual.

The Influence of Supervision on Manual Adherence and Therapeutic Processes

To identify the effectiveness of psychotherapy supervision on therapists' immediate (next session) and long-term (1 year) adherence to time-limited dynamic psychotherapy (TLDP). Sixteen therapists from the Vanderbilt II psychotherapy project were assigned new cases in pretraining, training, and booster/posttraining year-long cohorts. Technical adherence to the manual, as well as general therapeutic relational processes, were rated for clinical supervisory sessions in which the third therapy session was discussed. The therapy sessions immediately before and after the supervisory sessions were also rated for technical adherence and relational processes. Postsupervision adherence increased from the presupervision session during the training cohort. In supervision, therapists' discussion of techniques and strategies from the manual in supervision was significantly related to technical adherence in the session prior to (but not after) supervision. However, supervisors' discussion of specific techniques predicted therapists' total technical adherence in the therapy session after (but not before) supervision. In terms of the type of techniques, supervisors' influenced postsupervision therapy adherence on TLDP's unique approach to formulation, the cyclical maladaptive pattern, but did not influence technical adherence on the therapeutic relationship. In supervision, therapists tend to focus on how they adhered to techniques from the previous session, whereas supervisors' comments about specific techniques predicted how the therapist would adhere to techniques in the next therapy session. The findings provide support for the immediate effects of supervision in shaping therapist techniques as well as highlighting the challenges of altering common relational processes through technical training.

Time-Limited Dynamic Psychotherapy as a Model for Short-Term Inpatient Groups

The present article proposes a method, practiced by the author, to adapt time-limited dynamic psychotherapy (TLDP), a short-term individual psychodynamic therapy, for use with inpatient psychotherapy groups. Characteristics of TLDP which suggest the usefulness of such an adaptation, including short-term duration, specific treatment focus, rapid conceptualizations and broad selection of patients, and emphasis on the here-and-now in therapy, are discussed. The general approach to treatment, a supportive stance that involves an identification of maladaptive interpersonal issues, and then working on these issues without directly confronting the patients, is described. Specific therapeutic techniques for common inpatient group situations are also discussed.

Effects of Time-Limited Dynamic Psychotherapy on Distress Among HIV-Seropositive Men Who Have Sex with Men

The current study seeks to examine changes in distress associated with receiving time-limited dynamic psychotherapy (TLDP) among men who have sex with men (MSM) who are also living with HIV and AIDS. Participants included 79 HIV-seropositive MSM who were seeking psychotherapy at a community mental health clinic between January 2000 and June 2005. Participants' had a mean age of 42 and were predominantly European American (77%), although Latinos (13%), African Americans (5%), and Asian Americans (4%) were also included. Each participant completed a pretest on a self-report measure of subjective distress, the Outcome Questionnaire 45.2 (OQ-45.2), received 20 sessions of TLDP over the course of 20 weeks, and then completed a posttest on the OQ-45.2 to examine changes associated with TLDP. Participants' self-reported distress showed statistically significant decreases after 20 sessions of TLDP. Furthermore, the overall effects were strong, suggesting that decreases in distress were clinically meaningful as well as statistically significant. These results are particularly significant in light of the AIDS Health Project's (AHP's) policy of assigning higher functioning clients to TLDP therapists at intake, indicating that the participants in this study began treatment with lower pretest scores than mental health clients in the general population. These results suggest that HIV-seropositive MSM who receive TLDP may experience significantly decreased distress. Future research using a randomized study design is needed to compare such benefits to those of more standard psychological interventions for this population. Strengths and limitations of the study are discussed in detail.

Kicking the Patient: Immediacy in the Consulting Room

A case is presented of an adolescent with a history of substance abuse. The case is discussed from the perspective of Time Limited Dynamic Psychotherapy (TLDP). The patient's Cyclical Maladaptive Pattern (CMP) involved remaining attached to significant others by avoiding all conflict and seeking to please them as much as possible out of a fear of abandonment. The therapist became “hooked” into counter-transference enactment–kicking the patient–thus playing the role of the rejecting adult figure that fails her. The patient and therapist were then able to break out of this cyclical pattern and forge a new kind of relationship. This experience led to the patient developing a healthier relational pattern in her life and, hopefully, may lead to her experience of God being able to break free from her expectations as well.

Chapter 5. Time-Limited Dynamic Psychotherapy and God Image

SUMMARY Time-Limited Dynamic Psychotherapy (TLDP) is an empirically supported treatment that can be used to conceptualize and address God image difficulties. This article provides an introduction to TLDP and outlines how the God image develops and can be modified through this method of psychotherapy. A case study is also provided to practically illustrate the TLDP process, treatment plan, and technique.

Chapter 12. God Image Psychotherapy

SUMMARY This chapter compares the seven different God image therapy approaches outlined in Part II of this book. These approaches include: attachment therapy, existential-integrative psychotherapy, neuroscientific therapy, rational emotive behavior therapy, time-limited dynamic psychotherapy, liberal protestant pastoral psychotherapy and theistic psychotherapy. First, similarities and differences are explored. Next, God image psychotherapy integration is discussed. General psychotherapy integration models are reviewed and applied to the different God image approaches. Finally, the chapter closes with a table that compares each orientation across the following categories: background and assumptions, God image development, God image difficulties, God image change, strengths and weaknesses.

Time-Limited Dynamic Psychotherapy and God Image

Time-Limited Dynamic Psychotherapy (TLDP) is an empirically supported treatment that can be used to conceptualize and address God image difficulties. This article provides an introduction to TLDP and outlines how the God image develops and can be modified through this method of psychotherapy. A case study is also provided to practically illustrate the TLDP process, treatment plan, and technique.

The Therapeutic Process As a Predictor of Change in Patients' Important Relationships During Time-Limited Dynamic Psychotherapy.

Components of the therapeutic process have been shown to be moderately strong predictors of change in patients’ global interpersonal functioning during therapy. The authors sought to extend this research by examining how the therapeutic process in time-limited dynamic psychotherapy related to change in patients’ perceptions of a specific relationship as rated by the Structural Analysis of Social Behavior. Results showed that ratings of therapist warmth at Session 3 predicted increased warmth and decreased hostility in patient behavior at posttreatment. Therapist warmth at Session 16 was predictive of a decrease in submissive behavior by patients toward their significant other. The importance of the association between the therapeutic process and patients’ important interpersonal relationships is discussed.

Therapist affirmation and the process and outcome of psychotherapy: Two sequential analytic studies

Therapist affirmation was examined in two studies, the first with cognitive-behavioral therapy (CBT, N = 22) and the second with time-limited dynamic psychotherapy (TLDP, N = 20). Affirmation was identified using Structural Analysis of Social Behavior (SASB), and sequential analysis used to gauge its impact on therapy process and outcome. It was hypothesized that affirmation would correspond with patients' continuation of the current topic of conversation, but relate negatively to outcome if generally offered after maladaptive statements. Patients in Study 1 (CBT) were more likely to continue a topic after it was affirmed, and affirmation of maladaptive statements reliably differentiated patients who evidenced clinically significant change from those who did not at termination and at 12-months posttreatment. Affirmation of maladaptive statements in Study 2 (TLDP) corresponded with poorer outcome in relationships with significant others, but unexpectedly with improvements in self-concept.