Contemporary Psychodynamics and Humanistic Therapies

psychodynamic therapies

• originate from psychoanalysis

• focus on unconscious processes that impact client’s present behavior

examples of psychodynamic therapies

• short-term psychodynamic therapy

• mentalization-based therapy

• transference-focused psychotherapy

humanistic/experiential therapies

• Originate from client-centered therapy

• Based on premise that individuals are “self-actualizing”

examples of humanistic therapies

• gestalt therapy

• existential therapy

• emotion-focused therapy

• interpersonal therapy

differences btw therapies

1. focus on affect and the expression of patient emotions

2. explore patient’s attempts to avoid topics or engage in activities that hinder therapy progress to uncover unconscious meaning

3. Identification of patterns in patient’s actions, thoughts, feelings, experiences, relationships

4. emphasis on past experiences

5. focus on patient’s interpersonal experiences

6. emphasis on the therapeutic relationship

7. exploration of patients wishes, dreams or fantasies

focus on affect and the expression of patient emotions

• cognitive insight not sufficient

• emotional insight needed → encourage expression of emotions

• draw attention to feelings that are uncomfortable

explore patient’s attempts to avoid topics or engage in activities that hinder therapy progress to uncover unconscious meaning

• changing conversation topics

• not doing their homework

• missing sessions

• not paying bills

Identification of patterns in patient’s actions, thoughts, feelings, experiences, relationships

• identify patterns beyond those in thoughts

• how patterns in interpersonal functioning repeat over time, settings and people

• patterns are identifies through interpretations

emphasis on past experiences

• identify origin of patient difficulties and understand how they have manifested in lifetime

  • past and present

• emphasize both pre-adult and adult past

• recent trend for PI treatment to be more present-focused

focus on patient’s interpersonal experiences

• problematic relationships interfere with the ability to fulfill needs and wishes

• compare and contrast patient functioning with that of other

• impact patient has on other people

emphasis on the therapeutic relationship

• therapeutic relationship is a vehicle or medium of change

• transference = patient’s projections onto the therapist

• therapist elicits feedbacks about clients reactions to therapy

exploration of patients wishes, dreams or fantasies

clues to unconscious functioning

goal of short-term psychodynamic therapy

• symptom relief and limited, but significant, character change

• work on one area of foucs

structure of short-term psychodynamic therapy

• once per week for less than one year

  • around 16 sessions

• therapist must maintain therapeutic eye on chosen focus

candidates for short-term psychodynamic therapy

• patients should be psychologically minded, insightful, motivated

• capacity to engage readily and disengage easily

techniques of STPT

• supportive

• expressive

• monitoring countertransference

supportive

• Defining the therapeutic “frame”

• Demonstrating genuine interest and respect

• Noting gains

• Maintaining here-and-now perspective

expressive

• Offering empathic comments

• Confrontation

• Interpretation

efficacy of short-term psychodynamic psychotherapy (Steinert et al., 2017)

• Meta-analysis of 23 RCTs comparing psychodynamic therapy to an established treatment; both treatments using manuals

• Primary outcome: target symptoms

• Secondary outcome: general symptoms and functioning

• Tested for equivalence of two treatments

• No difference between psychodynamic and comparator treatments at post-treatment and follow-up except for

  • Difference favouring psychodynamic treatment for functioning at follow-up

emotion-focused therapy

• Originally called Process-Experiential therapy

• 16-20 sessions

• Emotion is a key determinant of self-organization

• Emotions are useful from an evolutionary standpoint, but how we make sense of our emotional experiences is influenced by culture

types of emotion in EFT

• Primary: direct initial reaction

  • instinctual

• Secondary: secondary emotion to primary emotions

  • guilt for still being sad

• Adaptive: primary emotions that communicate information

• Maladaptive: “old familiar feelings” that do not change with the situation

three principles targeted in EFT

• emotion awareness

• emotion regulation

• emotion transformation

emotion awareness

• Become aware of primary adaptive emotions

• Not thinking about feeling, but actually feeling the emotion

• Accept rather than avoid emotional experiences

• Express emotions, including what you feel in words

emotion regulation

• determine which emotions need to be regulated

• Teach emotion regulation sills, including tolerance and self-soothing

emotion transformation

• Process of changing emotion with emotion

  • undo a maladaptive emotional response with a more adaptive emotion

• Techniques used in emotion transformation

  • Shifting attention

  • Positive imagery

  • Remembering another emotion

research evidence for EFT

• major depression

  • Watson et al., 2004

    • similar outcomes in EFT and CBT

    • greater decrease in interpersonal problems in EFT than CBT

  • Goldberg et al., 2006

    • symptom remission greater in EFT compared to client-centered therapy

Interpersonal Psychotherapy

• Concerned with interpersonal context

  • Relational factors that predispose, precipitate, and perpetuate distress

• Structure: 12-16 sessions

• Suitability

  • Secure attachment

  • specific interpersonal focus of distress

  • good support system

IPT problem areas

• Role transitions (e.g., move, new job, divorce)

• Role disputes (e.g., infidelity, unmet expectations)

• Grief

• Interpersonal sensitivity: difficulty forming and maintaining relationships

IPT Structure

• Interpersonal inventory administered to choose problem area

• Work collaboratively to develop solutions to problem

• Patient implements solution(s) between sessions

IPT techniques

• Interpersonal incidents

• Communication analysis

• problem-solving and role-playing

• Encouragement of affect–content vs. process

IPT research evidence depression

• Cuijperset al., 2016

  • Meta-analysis of 62 RCTs of IPT for depression

  • d= .62 in favour of IPT compared to control treatments

  • d= .06 for IPT compared to other psychotherapies

IPT research evidence for bulimia nervosa and binge-eating disorder

• Agraset al., (2000)

  • CBT more rapidly improves BN symptoms, compared to IPT

  • but those treated with IPT continue to improve post-treatment

• Wilfley et al., (2000)

  • Group IPT comparable to group CBT for BE