The Psychodynamic Approach to Therapy

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The Psychodynamic Approach to Therapy
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What does this mean?

• Psychodynamic therapies are often referred to as
  psychoanalysis. These therapies are long term and
  intensive, they also disrupt the patients lives
  and are expensive.
• To avoid disrupting the patients lives,
  psychodynamic therapists are returning to the
  idea of brief dynamic therapy, and this is now
  growing in popularity.
• By focusing a therapy on particular issues the
  patients are directed to introspect on specific
  events, and are educated about their
  interpersonal relationships, therefore the
  process of catharsis and insight into
  psychodynamic therapy is greatly speeded up.

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Classical Psychoanalysis

• This type of therapy is intensive and long term,
  taking place five times a week it typically lasts
  several years.
• The sessions last exactly 50 minutes, as they
  are very particular about having exact
  boundaries.The analytic technique usually uses
  free association and interpretation, and the
  patient will lie on a couch, instead of sitting
  facing the therapist.

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Psychoanalytic/Psychodynamic Psychotherapy

• This is a less strict form of classical
  psychoanalysis, whilst it is still a long term
  therapy, it is slightly less intensive. Sessions
  take place 1-3 times per week, and the therapy
  typically lasts 1-5 years.
• The analytical technique mirrors that of
  classical psychoanalysis, but occasionally
  includes humour and information giving.

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Evaluation of Psychoanalytic Psychotherapy

• Sandell (1999) studied 756 patients receiving
  classic psychoanalysis or psychoanalytic
  psychotherapy, he found strong evidence for the
  effectiveness of long term psychodynamic
  therapies and also strong evidence for the
  difference between the 2 therapies.Classical
  psychoanalysis was defined by having 4-5 sessions
  per week, in contrast to psychoanalytic
  psychotherapy which took place 1-2 times per
  week. The therapies continued for up to 3 years.
  At the end of treatment there were substantial
  improvements in the conditions of the patients,
  but no difference between the 2 groups of
  patients.At a 3 year follow up the Classical
  Psychoanalysis group were seen to have
  significantly fewer symptoms, and continued to
  improve after the end of treatment.

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Group Psychoanalytic Therapy

• This is where the principles of psychodynamic
  therapy are applied to working with groups,
  generally of around 6-12 patients. Most commonly
  there are 2 therapists, one male, one female, to
  enact maternal and paternal transference.In
  group analysis the insight is mainly from
  interaction with the other group
  members.However the Bion Model of Group Therapy
  says that the group adopt the behaviour of a
  single individual and is collectively interpreted
  by the therapists.

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Brief Dynamic Therapy

• There are a variety of subtly differing brief
  approaches to psychodynamic therapies. In long
  term therapies the emphasis is on the
  interpersonal functioning and effective state of
  the patient. In order to speed up the process,
  brief dynamic therapy is more confrontational and
  the patients are educated about their
  relationships as opposed to waiting for the
  development of a transference relationship.

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Evaluation of Brief Dynamic Therapy

• Because it is a short term treatment it means
  that most of the research done on it is based on
  the outcome of the treatment, and there is a
  large amount of evidence to support its
  effectiveness.
• Guthrie et al (2001) tested the effect of 4
  sessions of BDT with 119 patients following
  attempted suicide by poisoning. A control group
  received standard treatment (i.e. a referral back
  to their GP). 6 Months later the BDT group had
  significantly lower suicidal thoughts than the
  control group, and were much less likely to have
  made suicide attempts again.

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The effectiveness of Psychodynamic Therapies

• FORRecent studies have found much more
  positive results, showing that PDT are at least
  as affective as other Psychological Treatments.

• AGAINSTEarly studies found no evidence that
  psychodynamic treatments had any effect on
  patients.

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Conclusion

• Psychodynamic therapies include long term
  intensive treatment (Classical Psychoanalysis)
  and briefer and less intensive BDT. These all
  work on similar principles aiming to achieve
  catharsis and insight although the process by
  which this is achieved varies between the
  therapies. There is now substantial evidence to
  support the effectiveness of both these therapies
  in treating a variety of psychological problems.