Psychodynamic psychotherapy

In this context, the type of psychosocial interventions used in schizophrenia has changed radically in the last 15 years. In the 1950 s and 1960 s, the emphasis was on psychodynamic psychotherapy, and in particular long-term psychoanalysis was practiced in institutions such as Chestnut Lodge or the Menninger Clinic. 

The second assumption was that the drugs could help induce the powerful experiences of regression, abreaction, intense transference, and symbolic drama that were the process goals of psychodynamic psychotherapy. 

Although dream emotions are the same in men and women, they are associated with highly individual content. It is in this spirit that the interpretation of dreams - particular dreams of specific individuals - can still find a place in personal psychology and psychotherapy. In all likelihood, this is probably what has been going on in psychodynamic psychotherapy anyway. 

Michaels, R. 1992. Principles of psychodynamic psychotherapy. Glendale, Calif. Audio Digest Psychiatry 20 no. 13. 

Consider couples therapy if problems with her parmer are key. Counselling/psychodynamic psychotherapy have a weaker evidence base, but may be offered if Denise prefers them... 

Although it has received the most attention, CBT is not the only form of psychotherapy that is effective for depression. Other psychological treatments include interpersonal psychotherapy, short-term psychodynamic therapy and non-directive supportive therapy. Interpersonal psychotherapy focuses on problems that arise in interpersonal relationships, such as marital conflict, the loss of a loved one and social isolation.20 Short-term psychodynamic therapy focuses on acquiring insight and understanding of unresolved conflicts arising from the person s childhood. It is based on Freud s psychoanalytic theory, but requires only months, rather than the years it takes for a full psychoanalysis.21 Non-directive supportive therapy provides a warm, supportive atmosphere in which the depressed person can explore life issues... 

If physical exercise is as effective as psychotherapy, why bother with psychotherapy at all Why not just prescribe exercise It is true that exercise is as effective as psychotherapy when all forms of psychotherapy are lumped together, but when different types of psychotherapy are compared with exercise, a somewhat different picture emerges.48 Exercise is about as effective as psychodynamic... 

Psychotherapies for PTSD include anxiety management (e.g., stress-inoculation training, relaxation training, biofeedback, distraction techniques), CBT, group therapy, hypnosis, psychodynamic therapies, and psychoeducation. Psychotherapy may be used in patients with mild symptoms, those who prefer not to use medications, or in conjunction with drugs in those with severe symptoms to improve response. 

The first decision when beginning acute phase treatment is choosing the primary treatment modality psychotherapy, medication, or both. Several short-term therapies including CBT, IPT, brief psychodynamic therapy, and marital therapy are effective treatments in mild-to-moderate cases of depression without added antidepressant treatment. This is a viable alternative that many patients may prefer. 

Because this book focuses on psychopharmacotherapy, it is not intended to exhaustively review the role of psychotherapy. Nonetheless, some form of counseling is usually necessary during the treatment of major depressive disorder. Broadly defined, psychotherapy covers a wide range of modalities, from simple education and supportive counseling to cognitive-behavioral to insight-oriented psychodynamically based therapy. 

Case Example A 29-year-old woman presented for consultation on referral from a psychiatrist who had seen her in psychodynamically oriented psychotherapy for approximately 10 years. The primary difficulty was intermittent interpersonal strife with fellow workers and supervisors. Thus, although quite competent, she had switched positions frequently because of these difficulties. Her history indicated that she had never experienced a full depressive, hypomanic, or manic episode, but that these problems seemed to coincide with intermittent periods of irritability. As a result, she was placed on a trial of lithium, with therapeutic blood levels. Within several weeks of treatment initiation, her difficulties with fellow coworkers and supervisors ceased, and during 1 year of follow-up, she did not have a recurrence of these problems. 

Psychodynamic supportive psychotherapy (n = 107) has been compared with psychotherapy plus medication (n = 101) in patients with major depressive disorder (93). The medications included venlafaxine, selective serotonin reuptake inhibitors, nortriptyline, and nortriptyline plus lithium. Lithium was used as an augmentation strategy in the patients who took lithium and nortriptyline (number not given). There were no differences in outcomes between the two treatment groups. No adverse effects specific to lithium were reported. 

As mentioned in chapter 2, individuals particular personality style and unique psychodynamics will often dramatically influence how they respond to pharmacotherapy. Robert Michaels (1992) has commented that in general clinical practice two-thirds of patients with Axis I disorders appear to respond quite well either to medication treatment or to brief, targeted psychological interventions, such as cognitive-behavioral or interpersonal therapy. However, a significant minority of patients with clear-cut Axis I disorders don t respond well to such treatments, primarily due to serious co-morbid character pathology. In treating these people, at the very least the clinician must be alert to how personality factors influence treatment outcome often medication treatment must be accompanied by more intensive psychotherapy that addresses the personality disorder. 

Two forms of psychological treatment have been shown to be effective in the treatment of BN cognitive behavioural therapy and interpersonal psychotherapy. Both have been found to be superior to traditional psychodynamic based therapy (Hay and Bacaltchuk 2003). 

Counselling and supportive psychotherapy aren t evidence-based, but worth considering if they d help Alex, e.g. for engagement or feeling supported. Psychodynamic therapy isn t recommended. 

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