Time-limited Psychodynamic Psychotherapy Research Articles

Improvement in Psychodynamic Psychotherapy for Depression: A Qualitative Study of the Patients' Perspective.

The patient’s perspective on improvement in psychotherapy is crucial for tailoring the therapy he or she is receiving. The present study aimed at exploring the factors aiding and the patients’ experiences of improvement in time-limited psychodynamic psychotherapy for depression. Semi-structured, in-depth interviews were conducted with ten adult patients who received up to 28 sessions of manualized psychodynamic psychotherapy in the Norwegian study “Mechanisms of change in psychotherapy” (the MOP study). The post-therapy interviews addressed the participants’ experiences from therapy. The data were analyzed with thematic content analysis and hermeneutic interpretation. The analysis identified four helpful dimensions: “Therapist activities” comprised supporting and acknowledging, advising and offering tips for everyday life, questioning and pressuring. “Patient activities” included opening up, caring for oneself and showing agency. “Facilitators” for improvement were learning from therapy, learning to receive therapy and agreed goals. “Achievements” comprised new perspectives and understandings, increased self-awareness and mastery and changed thinking and feeling. Improvements from psychodynamic therapy seemed reliant on the degree to which the therapy could activate and be relevant to the patients’ everyday life. Tailoring therapy for patients with depression should link the focus on symptoms and ways of thinking and feeling with their life circumstances.

Assessment of dynamic change in psychotherapy with adolescents

BackgroundDiagnostic interviews and questionnaires are commonly used in the assessment of adolescents referred to child and adolescent mental health services. Many of these rating scales are constructed for adults and focus on symptoms related to diagnosis. Psychodynamic Functioning Scales (PFS) focus on relational aspects and how the patients handle affects and solve problems, rather than manifest symptoms. As these aspects are considered important for mental health, the PFS were developed to assess change in adults, consistent with the relational and intrapsychic concepts of dynamic psychotherapy. The scales describe internal predispositions and psychological resources that can be mobilized to achieve adaptive functioning and life satisfaction. PFS consist of six subscales; the relational subscales Family, Friends and Romantic/Sexual relationships and the dynamic subscales Tolerance for Affects, Insight and Problem-solving Capacity. PFS has been used for the first time as a measure of change in adolescent psychotherapy. This study examines the reliability of PFS when used to assess adolescents’ level of relational functioning, affective tolerance, insight, and problem-solving capacities.MethodsOutpatient adolescents 16–18 years old with a major depressive disorder were included in the First Experimental Study of Transference work in Teenagers (FEST-IT). They were evaluated before and after time-limited psychodynamic psychotherapy with an audio-recorded semi-structured psychodynamic interview. Based on the audio-tapes, raters with different clinical background rated all the available interviews at pre-treatment (n = 66) and post-treatment (n = 30) using PFS. Interrater reliability, the reliability of change ratings and the discriminability from general symptoms were calculated in SPSS.ResultsThe interrater reliability was on average good on the relational subscales and fair to good on the dynamic subscales. All pre-post changes were significant, and the analyses indicated discriminability from general symptoms. The interrater reliability on PFS (mean) and Global Assessment of Functioning were good to excellent.ConclusionBased on the interrater reliability in our study, PFS could be recommended in psychotherapy with adolescents by experienced clinicians without extensive training. From the post-treatment evaluations available, the scales seem to capture statistically and clinically significant changes. However, the interrater reliability on dynamic subscales indicates that subscales of PFS might be considered revised or adjusted for adolescents.Trial registration First Experimental Study of Transference-Work-In Teenagers (2011/1424 FEST-IT). ClinicalTrials.gov Identifier: NCT01531101

Pragmatic Psychodynamic Psychotherapy for a Patient with Depression and Breast Cancer: Functional MRI Evaluation of Treatment Effects

Time-limited psychodynamic psychotherapy is garnering empirical support as an intervention for clinical depression. However, research is needed to examine the efficacy of psychodynamic approaches among patients presenting with diverse psychiatric and medical problems. This case study examined the efficacy of eight sessions of pragmatic psychodynamic psychotherapy (PPP) in treating a woman with major depression and breast cancer. Pre- to posttreatment assessment indicated significant reductions in depression and weekly assessment indicated increased environmental reward was associated with reduced depression. Secondary aims involved piloting a functional magnetic resonance imaging (fMRI) task as a neurobiological indicator of depression attenuation as a function of PPP. This assessment was conducted to explore alternative means of evaluating treatment responsiveness and addressing the problem of arbitrary metrics in measuring change. Clinical and assessment implications are discussed, with a focus on innovative approaches to evaluate treatment outcome and behavioral and neurobiological mechanisms of change associated with PPP.

Qualitative content analysis in art psychotherapy research: Concepts, procedures, and measures to reveal the latent meaning in pictures and the words attached to the pictures

The aim of this methodological paper is to describe and apply qualitative content analysis to a psychodynamic art psychotherapy context, and to give an example of the procedures used to analyse pictures and words in one time-limited psychodynamic art psychotherapy session, here named PDT/Scribbling. The art method was used with a female patient. Qualitative content analysis was used to analyse one scribble with its amplification together with the patient's own clarifying words explaining the pictures. In addition, the words spoken before and after scribbling were analysed in order to capture the whole psychotherapeutic process. In the application we coded and categorised colours and elements of the scribbles and amplifications, which together with categories of the patient's own words before and after scribbling resulted in three sub-themes and an overarching theme: permitting herself to leave a victim position and take charge of her life. The conclusion of this methodological paper is that qualitative content analysis is a meaningful method for analysing pictures and words from psychodynamic art psychotherapy sessions, keeping the manifest messages and the latent meanings in the pictures intact.

A developmentally focused time-limited psychodynamic psychotherapy for adolescents and young adults (TPP-A): Model and application

A developmentally focused time-limited psychodynamic psychotherapy for adolescents and young adults (TPP-A): Model and application

The power of subtle interpersonal hostility in psychodynamic psychotherapy: A speech acts analysis

This study compared participants' speech acts in low-hostile versus moderate-hostile interpersonal episodes in time-limited psychodynamic psychotherapy. Sixty-two cases from the Vanderbilt II psychotherapy project were categorized as low or moderate in interpersonal hostility based on ratings of interpersonal process using Structural Analysis of Social Behavior (Benjamin, 1996). Representative episodes were coded using a taxonomy of speech acts (Stiles, 1992), and speech acts were compared across low- and moderate-hostile episodes. Therapists in moderate-hostility episodes used more interpretations and edifications, and fewer questions and reflections. Patients in moderate-hostility episodes used more disclosures and fewer edifications. Content coding showed that therapist interpretations with a self/intrapsychic self focus were more characteristic of moderate-hostility than low-hostility episodes, whereas the two types of episodes contained similar levels of interpretations focused on the patient's interpersonal relationships and the therapeutic relationship.

A developmentally focussed time-limited psychodynamic psychotherapy for adolescents and young adults : origins and application

Résumé Cet article traite des processus qui sont en jeu dans l’articulation et l’évaluation d’un modèle de psychothérapie psychodynamique limitée dans le temps auprès des jeunes (TPP-A). À partir d’une thérapie centrée sur un aspect important de difficulté ou de perturbation développementale, et dans une période déterminée, TPP-A vise à aider le jeune à retrouver sa capacité d’affronter des défis développementaux, et/ou voir cette capacité renforcée. L’article élabore des aspects clés du modèle et présente un cas de figure.

Time-limited psychodynamic psychotherapy for adolescents and young adults

This article discusses the development of a model of time-limited psychodynamic psychotherapy for adolescents and young adults developed in the context of a multidisciplinary team within the UK's National Health Service working with young people with mental health difficulties. The therapeutic focus in this model is on a significant area of developmental difficulty and/or disturbance, to facilitate the capacity of the young person to meet developmental challenges and/or have this capacity strengthened. The developmental focus is rooted in a psychoanalytic approach to adolescent development, and connects internal, interpersonal and social worlds of young people. Thus this approach understands as psychosocial the mental health difficulties of young people in contemporary contexts. Young people are engaged in therapy through containing anxieties within a clear structure provided by the time frame and the core features of the model. Two case examples are presented and discussed of young people of different ages, both of whom were able to make therapeutic use of this therapeutic modality.

Early change in defence mechanisms and coping in short‐term dynamic psychotherapy: Relations with symptoms and alliance

Several patient-related variables have already been investigated as predictors of change in psychodynamic psychotherapy. Defensive functioning is one of them. However, few studies have investigated adaptational processes, encompassing defence mechanisms and coping, from an integrative or comparative viewpoint. This study includes 32 patients, mainly diagnosed with adjustment disorder and undergoing time-limited psychodynamic psychotherapy lasting up to 40 sessions, and will focus on early change in defence and coping. Observer-rater methodology was applied to the transcripts of two sessions of the first part of the psychotherapeutic process. It is assumed that the contextual-relational variable of therapeutic alliance intervenes as moderator on change in adaptational processes. Results corroborated the hypothesis, but only for coping, whereas for defences, overall functioning remained stable over the first 20 sessions of psychotherapy. These results are discussed within the framework of disentangling processes underlying adaptation, i.e., related to issues on trait and state aspects, as well as the role of the therapeutic alliance.

Time-limited psychodynamic psychotherapy and venlaxafine among acutely suicidal bordeline patients

Time-limited psychodynamic psychotherapy and venlaxafine among acutely suicidal bordeline patients

Psicoterapias breves psicodinâmicas: características da produção científica nacional e estrangeira (1980/2003)

Apresenta o levantamento de algumas características formais da produção científica para saber quem, onde e o que tem sido indexado nas bases de dados eletrônicas, sob os verbetes: "psicoterapias breves psicodinâmicas" e "psicoterapias psicodinâmicas de tempo limitado". As produções estrangeira e nacional foram cotejadas e críticas apresentadas. A amostra de 534 resumos (1980 a 2003), publicados em bases nacionais e internacionais, indicou que a produção estrangeira foi quantitativamente superior quanto ao número de referências, periódicos científicos e autores. No entanto, a nacional equipara-se em aspectos tais como: média de referência por autor, predomínio de autoria única e adoção de psicoterapias integrativas, em que influências de outras abordagens, que não a psicodinâmica, são identificadas. Nas duas realidades predominaram, ainda, publicações sobre psicoterapias individuais de adultos, veiculadas por periódicos psiquiátricos. Espera-se que com a expansão das bases de dados da psicologia, esta última característica venha a se reverter, ao menos no Brasil.

A Two-Year Follow-up of Psychodynamic Psychotherapy for Internalizing Disorders in Children

To evaluate short- and long-term effects of time-limited psychodynamic psychotherapy (PP) for children with internalizing disorders. Fifty-eight outpatient children (6.3-10.9 years old), seen in a process of routine care and meeting criteria for depressive or anxiety disorder, were assigned to either active treatment or community services. Subjects were measured at baseline, after 6 months, and at a 2-year follow-up, by Children's Global Assessment Scale (C-GAS) and Child Behavior Checklist (CBCL). Major improvements in the experimental group were found in C-GAS and CBCL. These differences are noted at different times, with the C-GAS findings seen at 6 months and the CBCL findings at 2-year follow-up. Significant differences were found also for externalizing syndrome scales. PP is effective in treating internalizing disorders in routine outpatient care. The benefits of treatment are manifest both immediately and with delayed onset (sleeper effect). The finding that PP patients sought mental health services at a significantly lower rate than comparison conditions represents an important economic impact of PP.

Issues in teaching and learning time-limited psychodynamic psychotherapy

Psychodynamic psychotherapy training is briefly reviewed, with particular attention to short-term forms of treatment and to empirical investigations of therapy training. There have been relatively few investigations of actual psychotherapy training, and the prospect is for even fewer in the future. The traditional pedagogic strategy for conceptualizing and developing psychodynamic training programs has been to adapt psychoanalytic clinical theory for instructional purposes. It is proposed that concepts, principles, and instructional strategies from the area of the cognitive sciences concerned with the development of generic expertise offers a potentially more fruitful theoretical/empirical framework for understanding therapeutic expertise and can be applied to developing improved psychotherapy teaching methods. The mental processes of therapists are discussed from this perspective. A teaching format based on multimedia computer technology and designed to fill a gap between didactic course work and actual therapy supervision is briefly described. In addition, recommendations are offered for improving psychotherapy training using existing methods.