Chapter 29. Psychodynamic Psychotherapy

Robert J. Ursano, M.D.; Stephen M. Sonnenberg, M.D.; Susan G. Lazar, M.D.
DOI: 10.1176/appi.books.9781585623402.301305



The beginning therapist often does not have an extensive psychoanalytic background as was the case in previous years. There may be limited opportunity during training to learn a particular psychotherapy in detail. Yet, as a clinician, he or she may want to understand and use psychodynamic psychotherapy as a part of the therapeutic armamentarium and also use psychodynamic techniques in the evaluation and treatment of patients for whom a full psychotherapy may not be appropriate or may not be possible.

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TABLE 29–1. Psychodynamic psychotherapy
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TABLE 29–2. Psychodynamic listening
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TABLE 29–3. Psychodynamic perspectives
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TABLE 29–4. Guidelines for psychodynamic assessment
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TABLE 29–5. The evaluation
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TABLE 29–6. Helpful hints for the evaluation
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TABLE 29–7. First session
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TABLE 29–8. Transference
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TABLE 29–9. Defense mechanisms
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TABLE 29–10. Definitions of common mechanisms of defense
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TABLE 29–11. Countertransference
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TABLE 29–12. Criteria for termination
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TABLE 29–13. Tasks of the termination phase
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Transference occurs in all interpersonal relationships.

Defense mechanisms are cognitive mechanisms to decrease anxiety and other distressing feelings.

Early childhood development structures brain development and leaves patterns of feelings, thoughts, behaviors, and interpersonal relating.

Psychotherapy is an effective form of treatment, as effective as many other medical interventions.

The working, reality-based relationship with the patient is called the therapeutic alliance.

Psychodynamic psychotherapy may be brief, intermittent, or longer term.

The principles of psychodynamic psychotherapy are used in many doctor–patient interactions other than psychodynamic psychotherapy.


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Sample questions:
The theoretical constructs of psychodynamic therapy involve the understanding of the unconscious. Specifically, the classification of wishes into the libidinal and aggressive group may reflect in the patient's contemporary experiences. Which of the following would be a manifestation of aggressive, as opposed to libidinal, wishes?
Which of the following statements regarding use of psychotropic medication in the context of psychodynamic psychotherapy is true?
The clinical indications for psychodynamic psychotherapy generally include patients with "neurotic-level disorders." These disorders may span both Axis I and Axis II disorders. Which of the following would not be considered a "neurotic-level disorder" and thus would be inappropriate for psychodynamic psychotherapy as a primary intervention?
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