Use Of Psychodynamic Techniques Research Articles

Examining Psychotherapeutic Processes with Depressed Adolescents: A Comparative Study of Two Psychodynamic Therapies

To understand processes associated with better or poorer psychotherapy outcomes is vital. This study examined and contrasted interaction patterns between one therapist and two depressed 17-year-old girls, Johanna (good outcome) and Sonja (poor outcome), in short-term psychoanalytic therapies selected from an RCT. Outcome data were collected regarding level of inter- and intra-personal functioning and symptoms of depression. Process data were obtained using the Adolescent Psychotherapy Q-Set on all available sessions. Analyses yielded five relational patterns or "interaction structures" in the two therapy processes; Three explained most of the variance in sessions with Johanna (i.e., 'positive working alliance', 'therapist's active use of psychodynamic techniques', and 'a receptive patient') and two explained more of the variance in sessions with Sonja (i.e., 'therapist using a more problem-solving and symptom-oriented approach' and 'patient displaying limited capacity for mentalization'). The processes in the two cases presented differences related to mentalization, psychological mindedness, and attachment style of the patients. The therapist used different therapeutic approaches, favouring more psychodynamic interventions in the good outcome case and a more problem-solving and symptom-oriented approach with the poor outcome case. In the latter case, the relationship seemed to be more of a struggle.

The Role of Common and Specific Factors in Child Psychodynamic Psychotherapy: A Grouped Cases Study

ABSTRACT There is a growing evidence-base that suggests the effectiveness of the psychodynamic therapies for children, but the mechanisms by which the results are achieved still demand clarification. This study aimed to analyze the role of specific and common factors in the process of psychodynamic psychotherapy for school-age children and their association with psychotherapies outcomes. A longitudinal, repeated-measures design, based on the systematic case-study method was adopted. 204 sessions from four child psychotherapies were analyzed in terms of the therapists’ techniques, the therapeutic alliance, the use of the reflective functioning approach and the role of the symbolic play in the sessions. The outcomes were assessed based on mothers’ reports about children’s symptomatic improvement. Correlational, discriminant and regression analyses were used to examine the associations and the role of each factor in those therapeutic processes. The results indicated that the use of psychodynamic techniques and a stronger therapeutic alliance impacted more significantly the symptomatic improvement. The factor that presented more changes over time was the therapeutic alliance, increasing in two cases and decreasing in one of them, which did not show clinically significant symptomatic improvement. Common and specific factors walked together in these treatments, and both were important to produce clinically significant improvements.

What interpersonal problems are related to different therapeutic techniques early in treatment?

The current study seeks to explore the relationship between patient-reported interpersonal problems and therapist interventions in early psychodynamic psychotherapy for 71 outpatients. Pretreatment ratings on the Inventory of Interpersonal Problems Circumplex Scales (IIP-C) total and subscale scores were examined in relation to early treatment process. Independent clinicians reliably rated therapist use of psychodynamic-interpersonal (PI) and cognitive-behavioural (CB) interventions using the Comparative Psychotherapy Process Scale (CPPS) over two early treatment sessions (third and ninth). Intraclass correlation (ICC) values were in the excellent range for CPPS-PI and CPPS-CB scale scores (CPPS-PI=0.86; CPPS-CB=0.78). A significant positive correlation was found between interpersonal problems and global PI therapist technique. A significant positive correlation was also found between interpersonal problems and specific PI interventions, most significantly experience and expression of feelings in session. In specific interpersonal problem subscales, most significant was that Cold/Distant and Socially Inhibited octants positively related to global PI and to specific PI techniques, including exploration of uncomfortable feelings. Multiple regression analyses revealed most significantly that CPPS Intervention 7 (discussion of patient-therapist relationship; positive) and CPPS Intervention 11 (therapist explanation of rationale behind treatment; negative) explained 15.6% of variance in interpersonal problem score. These findings demonstrate that the use of psychodynamic techniques tend to occur alongside patient-reported interpersonal problems early in psychotherapy treatment. Clinical implications are discussed for this area of research, and future directions are explored.

Testing a mediation model of psychotherapy process and outcome in psychodynamic psychotherapy: Previous client distress, psychodynamic techniques, dyadic working alliance, and current client distress

To test a sequential model of psychotherapy process and outcome, we included previous client distress, therapist psychodynamic techniques, dyadic working alliance, and current client distress. For 114 sets of eight-session segments in 40 cases of psychodynamic psychotherapy, clients completed the Outcome Questionnaire-45 and Inventory of Interpersonal Problems-32 after the first and final session, judges reliably coded one middle sessions on the Psychodynamic subscale of the Multitheoretical List of Therapeutic Interventions, and clients and therapists completed the Working Alliance Inventory after every session. Results indicated that higher use of psychodynamic techniques was associated with higher levels of the working alliance, which in turn was associated decreased client distress; and working alliance was higher later in psychotherapy. There was a significant indirect effect of psychodynamic techniques on decreases in distress mediated by the working alliance. Implications for theory, practice, and research are provided. Clinical or methodological significance of this article: Conducted a longitudinal, latent variable examination of the relationships of psychodynamic techniques and working alliance on client distress. Psychodynamic techniques have an indirect effect on decreases in client distress through the dyadic working alliance.

Object representation quality, therapeutic alliance, and psychotherapy process.

This is the first study to demonstrate the existence of a relationship between patient pretreatment object relations functioning as measured by the Mutuality of Autonomy (MOA) Scale and patient-rated therapeutic alliance. Specifically, MOA scores were related to a patient-rated alliance Bond score (lower, more adaptive object-relations representations were associated with a stronger alliance). In addition, higher MOA scores indicating more malevolent object relations were related to a greater use of psychodynamic techniques. Specific psychodynamic techniques focused on the patient's relationships with the therapist as well as cyclical patterns in actions, feelings, and experiences. Implications for clinical practice and future research are discussed.

Psychodynamic techniques related to outcome for anxiety disorder patients at different points in treatment.

Although psychodynamic therapy has a well-articulated model of therapeutic change for anxiety, few empirical studies have examined specific treatment interventions related to symptom improvement. We examined the degree of adherence to a psychodynamic model of therapy (Blagys and Hilsenroth [Clin Psychol 7:167-188, 2000) related to changes in anxiety symptoms across early treatment process. Secondary analyses also examined the use of specific psychodynamic techniques across early treatment process in relation to symptom change. The current study sought to extend the findings of , who found a relationship between the use of psychodynamic techniques in the third session (independent clinical ratings) and reduction in anxiety symptoms at posttreatment (r = 0.46, p = 0.04). Using the same sample of anxiety disorder patients (N = 20), we found a significant relationship between psychodynamic technique and posttreatment change in anxiety symptoms at the ninth session (r = 0.49, p = 0.03) and the mean levels of psychodynamic technique across both third and ninth sessions (r = 0.53, p = 0.02). In addition, specific psychodynamic techniques demonstrated significant relationships or moderate to large effects with posttreatment changes in anxiety symptoms at the third and ninth sessions as well as mean ratings across early treatment (third and ninth sessions). These findings indicate that therapist focus on cyclical intrapersonal patterns in patient actions, feelings, or experience as well as suggestions of alternative ways to understand these experiences or events not previously recognized by the patient (i.e., interpretation) in the early treatment process were particularly helpful in reducing posttreatment anxiety symptoms. Clinical implications and areas for future research will be discussed.

Interaction Between Alliance and Technique in Predicting Patient Outcome During Psychodynamic Psychotherapy

The current study examined whether alliance interacted with psychodynamic interventions to predict patients' psychotherapy outcomes. A prospective study of psychodynamic psychotherapy with 68 outpatients who were treated by 23 therapists was used. The patients rated the alliance with their therapist early in treatment. Therapist use of psychodynamic techniques was reliably rated by independent clinicians for the same sessions. The therapy outcomes were measured at the end of treatment based on the patients' global symptomatology as well as estimate of improvement across a broad range of functioning. In all models, we controlled for the patients' pretherapy psychiatric severity. Analyses were conducted using multilevel modeling to account for therapist effects. Results revealed that patient rated alliance was significantly related to improvement on a measure of broad band functioning. In addition, alliance and psychodynamic interventions interacted to predict this scale of multidimensional therapy outcome. Further, results showed that several individual psychodynamic techniques interacted with alliance that were meaningfully related to this measure of broad band outcome including (1) linking current feelings or perceptions to the past; (2) focusing attention on similarities among patient's relationships repeated over time, settings, or people; and (3) identifying recurrent patterns in patient's actions, feelings, and experiences. In this sample of outpatient psychodynamic treatments, the dynamic techniques were most effective when provided in the context of strong alliances.

The Talking Cure Revisited: Content Analyses of a Two-Year Psychodynamic Psychotherapy

A 208-session treatment (previously investigated by Jones, Ghannam, Nigg, & Dyer, 1993) was studied using two computer-assisted content analytic strategies. The first measured the patient’s associative freedom by determining the Co-Occurrence Rate of commonly associated word pairs. The second measured the topics of each session by determining the proportion of topic-related words in each session. Results revealed that the patient’s associative freedom: (a) increased with time (replicating the results of Spence, Dahl, & Jones, 1993), (b) was influenced by the use of psychodynamic techniques, and (c) predicted symptom change. The analyses of the topic of discussion revealed that (a) the therapist displayed a nonneutral attitude (paradoxically shown to be helpful by Jones et al., 1993) while discussing certain key topics, and (b) the patient’s discussion of these topics was related to symptom improvement. Results are discussed in terms of their contribution to an understanding of the case as well as theory of psychotherapy process.

The Talking Cure Revisited: Content Analyses of a Two-Year Psychodynamic Psychotherapy

A 208-session treatment (previously investigated by Jones, Ghannam, Nigg, & Dyer, 1993) was studied using two computer-assisted content analytic strategies. The first measured the patient's associative freedom by determining the Co-Occurrence Rate of commonly associated word pairs. The second measured the topics of each session by determining the proportion of topic-related words in each session. Results revealed that the patient's associative freedom: (a) increased with time (replicating the results of Spence, Dahl, & Jones, 1993), (b) was influenced by the use of psycho-dynamic techniques, and (c) predicted symptom change. The analyses of the topic of discussion revealed that (a) the therapist displayed a non-neutral attitude (paradoxically shown to be helpful by Jones et al., 1993) while discussing certain key topics, and (b) the patient's discussion of these topics was related to symptom improvement. Results are discussed in terms of their contribution to an understanding of the case as well as theory of psychotherapy process. Eine 208 Sitzungen umfassende Behandlung (die bereits von Jones et al., 1993, untersucht wurde) wurde unter Verwendung zweier computerunterstützter inhaltsanalytischer Methoden analysiert. Die erste Methode misst die assoziative Freiheit eines Patienten durch die Bestimmung der Héufigkeit, mit der üblicherweise assoziierte Wortpaare vorkommen. die zweite Methode bestimmt die Inhalte einer jeden Sitzung durch die Feststellung des Anteils von gegenstandsbezogenen Worten in einer jeden Therapiestunde. Die Ergebnisse zeigen, dass die assoziative Freiheit der untersuchten Patientin (a) mit der Zeit zunahm (was eine Replikation der Ergebnisse von Spence et al., 1993, darstellt), (b) beeinflusst war duch den Einsatz psychodynamischer Techniken und (c) die Sympomveränderung vorhersagte. Die Analysen des Gegenstandes des therapeutischen Dialogs legen nahe, dass (a) die Therapeutin eine nicht neutrale Haltung einnahm (was paradoxerweise als hilfreich nachgewiesen wurde; Jones et al., 1993), wenn sie bestimmte wesentliche Inhalte ansprach, (b) dass die Tatache, dass die Patientin diese Gegenstände ansprach, mit der Symptombesserung in Bziehung stand. Die Ergebnisse werden im Hinblick auf ihren Beitrag zu einem Verständnis des Falles diskutiert, aber auch im Hinblick auf eine Theorie des psychotherapeutischen Prozesses. Une thérapie de 208 séances, déjà investiguée par E. E. Jones et al. (1993), a été étudiée à l'aide de deux stratégies d'analyse de contenu informatisées. La premiées. la première mesure la liberté associative de la patiente en déterminant le taux d'apparition simulatanée de cuples de mots fréquemment associés. La seconde mesure les thémes de chaque séance en déterminant la proportion par séance de mots évoquant un thème. Les résultats montrent que la liberté associative de la patiente a) augmente avec le temps, b) est influencée par des techniques psychodynamiques, c) peut prédire le changement symptomatique. L'analyse des thèmes de discussion révèle que a) la thérapeute n'est pas neutre en discutant de certains sujects-clés (ce qui, paradoxalement, avait été démontré par Jones et al., 1993, comme utile), b) l'élaboration de ces thèmes par la patiente est en rapport avec l'amélioration des symptômes. a discussion des résultats porte sur l'éclaircissement du cas invergué comme su la thérie du processus psychothérapeutique.Se estudió un tratmiento de 208 sesiones (investigado previamente por E. E. Jones et al, 1993) utilizando dos estrategias de analisis de contenido asistidas por computadora. la primera midió la libertad asociativa de la paciente utilizando la Escala de Co-ocurrencia de pares de palabras comúnmente asociados. La segunda analizó los tópicos de cada sesion según la proporción de palabras vinculadas al tópico de cada sesión. Los resultados mostraron que la libertad asociativa de la paciente: a) aumentaba con el tiempo (replicando los resultados de D. P. Spence et al, 1993, b) se veía influida por el uso de técnicas psicodinémicas, y c) predecía el cambio de síntomas. El anélisis del tópico d discusión reveló que: a) la terapeuta desplegaba una actitud no neutral en la discusión de ciertos tópicos por la paciente se relacionaba con una mejoría de los síntomas. Se discuten los resultados en términos de su contribución a la comprensión del caso así también como a teoría del proceso psicoterapéutico.