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Problem-Focused Psychodynamic Psychotherapy
For many years, the general rule of thumb in psychoanalysis and psychodynamic psychotherapy has been to refrain from focusing too much on specific symptoms or problems so as to not interfere with free association or the effectiveness of the psychoanalytic approach.
When Fredric Busch, M.D., and colleagues developed panic-focused psychodynamic therapy in the 1990's and subsequently psychodynamic approaches to depression, they emphasized the value of more active interventions, a focus on symptoms and associated dynamics, and occasional psychoeducation.
In this new volume, he expands the scope of that work, articulating how a focused psychodynamic psychotherapeutic approach can be adapted for patients in general. Rather than one specific aspect of patients' difficulties, Problem Focused Psychodynamic Psychotherapy (PrFPP) focuses on the set of problems (e.g., symptoms, relationship issues, behavioral difficulties) a particular patient brings into the consulting room.
Through numerous tables and a wealth of case vignettes, this guide provides novice and experienced clinicians alike with a general template for working with patients to identify and address the overlapping and unique dynamics of various problems.
It describes how to use psychodynamic exploratory techniques to make problem lists and examine the context and emotions surrounding each issue. It also discusses how to develop a psychodynamic formulation to provide a framework for identifying and addressing the dynamic contributors to the various problems.
Therapist and patient can then undertake the \"working through\" process to identify how specific dynamics emerge in different contexts and overlap in contributing to problems.
All of these approaches help spur patients' self-reflective capacities and the identification of their own dynamics—making it possible to more rapidly address core difficulties. The work also enables the continued use of these modes of managing problems after the treatment is completed.
And because PrFPP is suitable for short- and longer-term interventions, it is valuable for patients who either cannot commit to long-term treatment or only have access to brief interventions.
eBook
Understanding therapy : how different approaches solve real-world problems
\"This accessibly written book explores many types of psychotherapy, discussing the history, tenets, advantages, and shortcomings of each. It also compares and contrasts how different approaches address real-world mental health concerns\"-- Provided by publisher.
Book
Dosage effects of psychodynamic and schema therapy in people with comorbid depression and personality disorder: four-arm pragmatic randomised controlled trial
Higher intensity of psychotherapy might improve treatment outcome in depression, especially in those with comorbid personality disorder.
To compare the effects of 25 individual sessions (weekly) of two forms of psychotherapy - short-term psychoanalytic supportive psychotherapy (SPSP) and schema therapy - with the same treatments given for 50 sessions (twice weekly) in people with depression and personality disorder. Trial registration: NTR5941.
We conducted a pragmatic, double-randomised clinical trial and, over 37 months, recruited 246 adult out-patients with comorbid depression/dysthymia and personality disorder. A 2 × 2 factorial design randomised participants to 25 or 50 sessions of SPSP or schema therapy. The primary outcome was change in depression severity over 1 year on the Beck Depression Inventory II (BDI-II). Secondary outcomes were remission both of depression and personality disorder.
Compared with 25 sessions, participants who received 50 sessions showed a significantly greater decrease in depressive symptoms over time (time × session dosage,
< 0.001), with a mean difference of 5.6 BDI points after 1 year (
-0.53, 95% CI -0.18 to 0.882,
= 0.003). Remission from depression was also greater in the 50-session group (74%
58%,
= 0.025), as was remission of personality disorder (74%
56%,
0.010).
Greater intensity of psychotherapy leads to better outcomes of both depression and personality status in people with comorbid depression and personality disorder.
Journal Article
A New Way of Analysing Dreams on Its Profoundest Level: The Development of Motif Analysis and Phase Model
Dream research today assumes that there is a connection between dreams and waking life. However, the structural alteration of dream motifs in connection with the psychotherapeutic process and waking life has not yet been researched extensively. This study depicts the development of the new Motif Analysis and Phase Model (MAP), a dynamic method which allows research on the previous aspects. The following question was investigated as an accompanying key issue: can a connection be established between the course of the dream patterns and the agency of the dream ego as well as the dream contents and the course of the psychotherapies of the dreaming person as a whole? Four hypotheses were formulated and tested. The data material consists of 217 dreams of a male test subject. The motifs were analysed using Structural Dream Analysis (SDA) at first. Thereafter, the content was linked to the test subject’s waking life in a guided interview. The findings show a strong connection between the dream content and the psychotherapies as well as the test subject’s waking life. Five motifs with structural changes were found, through which the Phase Model with four phases was developed. At turning points, the transformative child motif also appears in the dreams. The course of the dream patterns and agency of the dream ego, however, has not changed. The results, the method and the generalisability were critically discussed and recommendations for future research were formulated.
Journal Article
Complex dilemmas in group therapy : pathways to resolution
\"Group work presents the therapist with many situations, considerations, and, ultimately, decisions that are unique to the practice of group psychotherapy. Complex Dilemmas in Group Therapy includes advice and insights from more than fifty of the most eminent group therapists in the world and is edited by two leading thinkers and practitioners in the field. In its pages clinicians will find expert guidance on some of the most difficult situations group therapists face, and they'll come away from the book with a host of practical strategies for facilitating their work as well as deeper and broader understanding of the overarching ideas that underpin the practice of successful group therapy\"-- Provided by publisher.
Book
An introduction to marriage and family therapy
\"Now in its second edition, this text introduces readers to the rich history and practice of Marriage and Family Therapy, with 32 professionals from across the US presenting their knowledge in their areas of expertise. This blend of approaches and styles gives this text a unique voice and makes it a comprehensive resource for graduate students taking their first course in Marriage and Family Therapy. The book is divided into three sections: Part 1 focuses on the components on which 21st century family therapy is based and summarizes the most recent changes made to not only therapeutic interventions, but to the very concept of \"family.\" Part 2 presents an overview of the 7 major theoretical models of the field: structural, strategic, Milan, social constructionist, experiential, transgenerational, and cognitive-behavioral family therapy. Each chapter in this section - Focuses on the founder of the theory, its theoretical tenants, and its key techniques - Shows how the model focuses on diversity - Presents the research that supports the approach Part 3 addresses specific treatment areas that are common to marriage and family therapists, such as sex therapy, pre-marital therapy, research, and ethics and legal issues\"-- Provided by publisher.
Book
Is reflective functioning associated with clinical symptoms and long-term course in patients with personality disorders?
Mentalization is the capacity to understand behavior as the expression of various mental states and is assumed to be important in a range of psychopathologies, especially personality disorders (PDs). The first aim of the present study was to investigate the relationship between mentalization capacity, operationalized as reflective functioning (RF), and clinical manifestations before entering study treatment. The second aim was to investigate the relationship between baseline RF and long-term clinical outcome both independent of treatment (predictor analyses) and dependent on treatment (moderator analyses).
Seventy-nine patients from a randomized clinical trial (Ullevål Personality Project) who had borderline and/or avoidant PD were randomly assigned to either a step-down treatment program, comprising short-term day-hospital treatment followed by outpatient combined group and individual psychotherapy, or to outpatient individual psychotherapy. Patients were evaluated on variables including symptomatic distress, psychosocial functioning, personality functioning, and self-esteem at baseline, 8 and 18months, and 3 and 6years.
RF was significantly associated with a wide range of variables at baseline. In longitudinal analyses RF was not found to be a predictor of long-term clinical outcome. However, when considering treatment type, there were significant moderator effects of RF. Patients with low RF had better outcomes in outpatient individual therapy compared to the step-down program. In contrast, patients in the medium RF group achieved better results in the step-down program.
These findings indicate that RF is associated with core aspects of personality pathology and capture clinically relevant phenomena in adult patients with PDs. Moreover, patients with different capacities for mentalization may need different kinds of therapeutic approaches.
Journal Article