Psychodynamic Psychotherapy: Approach to Treatment
I offer help in better approaching your issues of depression, loss, anxiety, event and complex trauma, relationships, and self-esteem with personal development and greater self capacity. The psychotherapy model that I practice in is psychodynamic Object Relations which focuses on uncovering previously unknown or inaccessible sources of frustration and distress.
Such states of feeling are often the result of experience which developed into conflicting internal motivations and expectation. Without remaking these through a working relationship with a psychotherapist, these experiences get repeated throughout our lives.
The work of psychotherapy is done through understanding the ways in which feelings, events and meaning create behavior. The benefit of this approach is in treating the various aspects of a person as more than just a collection of problems.
In the interest of learning about psychodynamic psychotherapy in contrast with other approaches often referred to as evidence-based practice, I offer this reading:
Research and Evidence Summaries on Psychodynamic Psychotherapy
Milrod, B., et al (2007) investigated the effects of psychodynamic psychotherapy in panic disorder. The researchers compared the effect on patients of panic-focused psychodynamic therapy versus relaxation training. There were 49 adults in the study and they were all diagnosed with panic disorder. Many were also suffering from agoraphobia and/or depression. The participants who received psychodynamic treatment showed a significantly greater reduction of panic symptoms than those receiving relaxation training, as well as greater improvement in psychosocial functioning, the term ‘psychosocial’ referring to an individual’s psychological state in relation to social factors.
Taylor (2008) focused on depression with researchers producing an overview of the effectiveness of psychoanalytic and psychodynamic therapies. The paper examined available evidence, and concluded that the benefits for patients of short-term psychodynamic therapies are equivalent to those produced by antidepressants and CBT. This finding was replicated by Shedler (2010) who summarized the evidence for the general effectiveness of psychodynamic psychotherapy and concluded that psychodynamic therapy has as positive an impact on patients as other therapies that have been more readily promoted in modern healthcare. However, patients who had psychodynamic therapy additionally saw an improvement in their psychological difficulties during treatment and that this improvement continued after treatment had ended.
Fonagy et al (2015) reported on the Tavistock Adult Depression Study (TADS) which was the first randomized controlled trial in the NHS to establish if long term psychoanalytic psychotherapy provided relief for patients living with chronic depression not helped by the treatments currently provided: antidepressants, short-term courses of counseling or cognitive behavioral therapy. It was a rare long-term study beginning in 2002 and the follow up period ending in December 2013.
The treatment provided comprised weekly sessions over 18 months, as a treatment for persistent, chronic or treatment resistant depression and compared with ‘treatment as usual condition’. The results indicated that 44% of the patients in the treatment condition no longer had major depressive disorder when followed up two years after therapy had ended. For those receiving the NHS treatments currently provided the figure was only 10%. Additionally, 14% of those receiving the psychoanalytic psychotherapy had recovered completely, full recovery occurred in only 4% of those receiving the treatments currently employed.
In every 6-months period of the trial’s exceptional 3 1/2 years of observation of participants, the chances of going into partial remission for those receiving psychoanalytic psychotherapy were 40% higher than for those who were receiving the usual treatments. After two years of follow-up, depressive symptoms had partially remitted in 30% of those receiving the psychoanalytic therapy whilst in the control condition this figure was again only 4%. Those receiving the psychoanalytic psychotherapy also saw significantly more benefits to their quality of life, general wellbeing and social and personal functioning. The paper was published in the open access journal World Psychiatry and is available here.
Town, J.M., Abbass, A., Hardy, G. (2011) conducted a review of trials into the effect of short-term psychodynamic psychotherapy in patients with personality disorder. Looking at the results of eight studies, the researchers concluded that psychodynamic psychotherapy may be considered an effective treatment option for a range of personality disorders, producing significant and medium- to long-term improvements for a large percentage of patients.
In what is known as a meta-analysis, in which the results of different but sufficiently similar studies are combined, Leichsenring & Rabung (2008) reviewed Long-Term Psychodynamic Psychotherapy (LTPP, here meaning at least a year or 50 sessions) across 23 studies, involving a total of 1,053 patients. They concluded that LTPP had a significantly higher rate of effectiveness in targeting problems and general personality functioning than shorter forms of psychotherapy. In a further study Leichsenring & Rabung (2011) examined the effectiveness of LTPP in complex mental disorders meaning those suffering from depression/anxiety and personality/relational problems, and found that LTPP appears to be more effective than less intensive forms of psychotherapy in treating such disorders. Evidencing the commitment that research requires in itself, Leichsenring et al (2023) reported a comprehensive review of over 320 randomized clinical trials concluding that there was high quality evidence showing that psychodynamic therapy was superior in reducing target symptoms when compared to (inactive and active) control conditions. This was particularly true for depressive and somatic symptom disorders and slightly less so but still significant for anxiety and personality disorders.