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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

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Excerpt

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.

References

Alexander F: The voice of the intellect is soft. Psychoanal Rev 28:12–29, 1941
 
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000
 
Bender DS: The therapeutic alliance in the treatment of personality disorders. J Psychiatr Pract 11:73–87, 2005
[PubMed]
 
Blatt S, Shahar G: Psychoanalysis-with whom, for what and how? Comparisons with psychotherapy. J Am Psychoanal Assoc 52:393–447, 2004
[PubMed]
 
Blatt S, Quinlan D, Pilkonis P, et al: Impact of perfectionism and need for approval on the brief treatment of depression: the National Institute of Mental Health Treatment of Depression Collaborative Research Program revisited. J Consult Clin Psychol 63:125–132, 1995
[PubMed]
 
Bond M: Psychodynamic psychotherapy in the treatment of mood disorders. Curr Opin Psychiatry 19:40–43, 2006
[PubMed]
 
Bond M, Perry C: Long-term changes in defense styles with psychodynamic psychotherapy for depressive, anxiety and personality disorders. Am J Psychiatry 161:1665–1671, 2004
[PubMed]
 
Brenner C: Psychoanalytic Technique and Psychic Conflicts. New York, International Universities Press, 1976
 
Bruch H: Learning Psychotherapy: Rationale and Ground Rules. Cambridge, MA, Harvard University Press, 1974
 
Chessick RD: Psychoanalysis: clinical and theoretical. Am J Psychiatry 157:846–848, 2000
[PubMed]
 
Clarkin JF, Foelsch PA, Levy KN, et al: The development of psychodynamic treatment for patients with borderline personality disorder: a preliminary study of behavioral change. J Personality Disord 15:487–495, 2001
[PubMed]
 
Coleman JV: Aims and conduct of psychotherapy. Arch Gen Psychiatry 18:1–6, 1968
[PubMed]
 
Crits-Christoph P: The efficacy of brief dynamic psychotherapy: a meta-analysis. Am J Psychiatry 149:151–158, 1992
[PubMed]
 
Curtis HC: The concept of therapeutic alliance: implications for the "widening scope." J Am Psychoanal Assoc 27 (suppl):159–192, 1979
 
Dewald PA: The clinical importance of the termination phase. Psychoanal Inq 2:441–461, 1982
 
DiMascio A, Weissman M, Prusoff B, et al: Differential symptom reduction by drugs and psychotherapy in acute depression. Arch Gen Psychiatry 36:1450–1456, 1979
[PubMed]
 
Edelson M: Telling and enacting stories in psychoanalysis and psychodynamic psychotherapy. Psychoanal Study Child 48:293–325, 1993
[PubMed]
 
Etking A, Pittenger, C, Polan HJ, et al: Toward a neurobiology of psychotherapy: basic research and clinical applications. J Neuropsychiatry Clin Neurosci 17:145–158, 2005
 
Fawzy F, Kemeny M, Fawzy N, et al: A structured psychiatric intervention for cancer patients, II: changes over time in immunological measures. Arch Gen Psychiatry 47:729–735, 1990
[PubMed]
 
Fawzy F, Fawzy N, Hyun C, et al: Malignant melanoma. Arch Gen Psychiatry 50:681–689, 1993
[PubMed]
 
Fonagy P, Roth A, Higgitt A: Psychodynamic psychotherapies: evidence-based practice and clinical wisdom. Bull Menninger Clin 69:1–58, 2005
[PubMed]
 
Freud A: The Ego and the Mechanisms of Defense, Revised Edition. New York, International Universities Press, 1966
 
Freud S: The interpretation of dreams (1900), in The Standard Edition of the Complete Psychological Works of Sigmund Freud, Vols 4 and 5. Translated and edited by Strachey J. London, England, Hogarth, 1953
 
Freud S: The dynamics of transference (1912), in The Standard Edition of the Complete Psychological Works of Sigmund Freud, Vol 12. Translated and edited by Strachey J. London, England, Hogarth, 1958, pp 97–108
 
Freud S: Resistance and repression (1917), in The Standard Edition of the Complete Psychological Works of Sigmund Freud, Vol 16. Translated and edited by Strachey J. London, England, Hogarth, 1963, pp 286–302
 
Fromm-Reichmann F: Principles of Intensive Psychotherapy. Chicago, IL, University of Chicago Press, 1950
 
Gabbard GO: Countertransference: the emerging common ground. Int J Psychoanal 76:475–485, 1995
[PubMed]
 
Gabbard GO: Psychodynamic Psychiatry in Clinical Practice, 3rd Edition. Washington, DC, American Psychiatric Press, 2000
 
Gabbard GO: Psychodynamic Psychiatry in Clinical Practice, 4th Edition. Washington, DC, American Psychiatric Publishing, 2005
 
Gabbard GO, Wilkinson SM: Management of Countertransference With Borderline Patients. Washington, DC, American Psychiatric Publishing, 2001
 
Gabbard GO, Gunderson JG, Fonagy P: The place of psychoanalytic treatments within psychiatry. Arch Gen Psychiatry 59:505–510, 2002
[PubMed]
 
Goldstein WN, Goldberg ST: The Transference in Psychotherapy. Northvale, NJ, Jason Aronson, 2003
 
Greenson RR: The working alliance and the transference neurosis. Psychoanal Q 34:155–181, 1965
[PubMed]
 
Guthrie E, Moorey J, Margison F, et al: Cost effectiveness of brief psychodynamic-interpersonal therapy in high utilizers of psychiatric services Arch Gen Psychiatry 56:519–526, 1999
[PubMed]
 
Hall J, Caleo S, Stevenson J, et al: An economic analysis of psychotherapy for borderline personality disorder patients. J Ment Health Policy Econ 4:3–8, 2001
[PubMed]
 
Halpert E: Asclepius: magic in transference to physicians. Psychoanal Q 63:733–755, 1994
[PubMed]
 
Hofer MA: Relationships as regulators: psychobiological perspective on bereavement. Psychosom Med 46:183–197, 1984
[PubMed]
 
Horowitz MJ, Eells T, Singer J, et al: Role-relationship models for case formulation. Arch Gen Psychiatry 52:625–633, 1995
[PubMed]
 
House JS, Landis KR, Umberson D: Social relationships and health. Science 241:540–545, 1988
[PubMed]
 
Huttenlocher PR: Neural Plasticity. Cambridge, MA, Harvard University Press, 2002
 
Kandel ER: Biology and the future of psychoanalysis: a new framework for psychiatry revisited. Am J Psychiatry 156:505–524, 1999
[PubMed]
 
Kernberg OF: Borderline Conditions and Pathological Narcissism. New York, Jason Aronson, 1975
 
Kernberg OF: Transference and countertransference in the treatment of borderline patients, in Object-Relations Theory and Clinical Psychoanalysis. New York, Jason Aronson, 1976, pp 161–184
 
Klerman G, DiMascio A, Weissman M, et al: Treatment of depression by drugs and psychotherapy. Am J Psychiatry 131:186–191, 1974
[PubMed]
 
Lazar SG (ed): Extended dynamic psychotherapy: making the case in an era of managed care. Psychoanal Inq (special supplement):1–110, 1997
 
Lazare A, Eisenthal S: Clinician/patient relations, I: attending to the patient's perspective, in Outpatient Psychiatry. Edited by Lazare A. Baltimore, MD, Williams & Wilkins, 1989a, pp 125–136
 
Lazare A, Eisenthal S, Frank A: Clinician/Patient relations, II: conflict and negotiation, in Outpatient Psychiatry. Edited by Lazare A. Baltimore, MD, Williams & Wilkins, 1989b, pp 137–157
 
Leichsenring F: Are psychodynamic and psychoanalytic therapies effective? A review of empirical data. Int J Psychoanal 86:841–868, 2005
[PubMed]
 
Leichsenring F, Leibing E: The effectiveness of psychodynamic therapy and cognitive behavior therapy in the treatment of personality disorders: a meta analysis. Am J Psychiatry 160:1223–1232, 2003
[PubMed]
 
Leichsenring F, Rabung S, Leibing E: The efficacy of short-term psychodynamic psychotherapy in specific psychiatric disorders: a meta analysis. Arch Gen Psychiatry 61:1208–1216, 2004
[PubMed]
 
Levinson D, Merrifield J, Berg K: Becoming a patient. Arch Gen Psychiatry 17:385–406, 1967
[PubMed]
 
Loewald HW: On the therapeutic action of psycho-analysis. Int J Psychoanal 41:16–33, 1960
[PubMed]
 
Luborsky L, Crits-Christoph P: Understanding Transference: The CCRT Method, 2nd Edition. Washington, DC, American Psychological Association Press, 1998
 
MacKinnon RA, Michels R, Buckley PJ (eds): The Psychiatric Interview in Clinical Practice, 2nd Edition. Washington, DC, American Psychiatric Publishing, 2006
 
Malan DH: Toward the Validation of Dynamic Psychotherapy. New York, Plenum, 1980
 
Malan DH, Heath ES, Baral HA, et al: Psychodynamic changes in untreated neurotic patients, II: apparently genuine improvement. Arch Gen Psychiatry 32:110–126, 1973
 
McEwen BS: Plasticity of the hippocampus: adaptation to chronic stress and allostatic load. Ann NY Acad Sci 933:265–277, 2001
[PubMed]
 
McLaughlin JT: Transference, psychic reality, and countertransference. Psychoanal Q 50:639–664, 1981
[PubMed]
 
McNeilly CL, Howard KI: The effects of psychotherapy: a reevaluation based on dosage. Psychother Res 1:74–78, 1991
 
Meany MK: Maternal care, gene expression and the transmission of individual differences in stress reactivity across generations Annu Rev Neurosci 24:1161–1192, 2001
 
Milrod B, Busch F, Leon AC, et al: Open trial of psychodynamic psychotherapy for panic disorder: a pilot study. Am J Psychiatry 157:1878–1880, 2000
[PubMed]
 
Mitchell S, Aron L (eds): Relational Psychoanalysis the Emergence of a Tradition. Hillsdale, NJ, Analytic Press, 1999
 
Mohl PC: Listening to the patient, in Psychiatry, 2nd Edition. Edited by Tasman A, Kaye J, Lieberman J. New York, Wiley, 2003, pp 3–18
 
Moran G, Fonagy P, Kurt A, et al: A controlled study of the psychoanalytic treatment of brittle diabetes. J Am Acad Child Adolesc Psychiatry 30:926–935, 1991
[PubMed]
 
Nemiah JC: Foundations of Psychopathology. New York, Oxford University Press, 1961
 
Ogden TH: Analysing forms of aliveness and deadness of the transference-countertransference. Int J Psychoanal 76:695–709, 1995
[PubMed]
 
Olfson M, Marcus SC, Druss B, et al: National trends in the use of outpatient psychotherapy. Am J Psychiatry 159:1914–1920, 2002
[PubMed]
 
Perry S, Cooper AM, Michels R: The psychodynamic formulation: its purpose, structure and clinical application. Am J Psychiatry 144:543–550, 1987
[PubMed]
 
Pine F: The four psychologies of psychoanalysis and their place in clinical work. J Am Psychoanal Assoc 36:571–596, 1988
[PubMed]
 
Poland WS: On the analyst's neutrality. J Am Psychoanal Assoc 32:283–299, 1984
[PubMed]
 
Racker H: Transference and Countertransference. New York, International Universities Press, 1968
 
Reiser MF: Memory in Mind and Brain: What Dream Imagery Reveals. New Haven, CT, Yale University Press, 1994
 
Rosenthal R: How are we doing in soft psychology? Am Psychol 45:775–777, 1990
 
Rosenthal R, Rubin DB: A simple, general-purpose display of magnitude of experimental effect. J Educ Psychol 74:166–169, 1982
 
Sandler J, Dare C, Holder A: The Patient and the Analyst: The Basis of the Psychoanalytic Process. New York, International Universities Press, 1973
 
Schafer R: The atmosphere of safety: Freud's "Papers on Technique" (1911–1915), in The Analytic Attitude. New York, Basic Books, 1983, pp 14–33
 
Searles HF: Countertransference and Related Subjects. New York, International Universities Press, 1979
 
Shapiro D: Neurotic Styles. New York, Basic Books, 1965
 
Sharpe EF: Dream Analysis. London, England, Hogarth Press, 1961
 
Silberman EK, Certa K: The psychiatric interview: settings and techniques, in Psychiatry, 2nd Edition. Edited by Tasman A, Kaye J, Lieberman J. New York, Wiley, 2003, pp 30–51
 
Smith ML, Glass GV, Miller TI: The Benefits of Psychotherapy. Baltimore, MD, Johns Hopkins University Press, 1980
 
Sonnenberg SM: Analytic listening and the analyst's self-analysis. Int J Psychoanal 76:335–342, 1995
[PubMed]
 
Sonnenberg SM, Sutton L, Ursano RJ: Physician–patient relationship, in Psychiatry. Edited by Tasman A, Kaye J, Lieberman J. Philadelphia, PA, WB Saunders, 1996, pp 41–49
 
Sonnenberg SM, Ursano AM, Ursano RJ: Physician–patient relationship, in Psychiatry, 2nd Edition. Edited by Tasman A, Kay J, Lieberman JA. New York, Wiley, 2003, pp 52–63
 
Spiegel D, Bloom J, Kraemer H, et al: Effect of psychosocial treatment on survival of patients with metastatic breast cancer. Lancet 2:888–891, 1989
[PubMed]
 
Stone L: Notes on the noninterpretive elements in the psychoanalytic situation and process. J Am Psychoanal Assoc 29:89–118, 1981
[PubMed]
 
Sullivan HS: The Psychiatric Interview. New York, WW Norton, 1954
 
Ticho E: Termination of psychoanalysis: treatment goals, life goals. Psychoanal Q 41:315–333, 1972
[PubMed]
 
Ursano RJ, Fullerton CS: Psychotherapy: medical intervention and the concept of normality, in Normality: Context and Theory. Edited by Offer D, Sabshin M. New York, Basic Books, 1991, pp 39–59
 
Ursano RJ, Silberman EK: Individual psychotherapies, in The American Psychiatric Press Textbook of Psychiatry. Edited by Talbott JA, Hales RE, Yudofsky SC. Washington, DC, American Psychiatric Press, 1988, pp 855–889
 
Ursano RJ, Silberman EK, Diaz A Jr: The psychotherapies: basic theoretical principles, techniques and indications, in Clinical Psychiatry for Medical Students. Edited by Stoudemire A. Philadelphia, PA, JB Lippincott, 1990, pp 855–890
 
Weissman MM, Verdell H, Gameroff JM, et al: National survey of psychotherapy training psychiatry, psychology and social work. Arch Gen Psychiatry 63:925–934, 2006
[PubMed]
 
Winkley K, Ismail K, Landau S, et al: Psychological interventions to improve glycaemic control in patients with type 1 diabetes: systematic review and meta-analysis of randomized controlled trials. BMJ 333:55–56, 2006
 
Zetzel ER: Current concepts of transference. Int J Psychoanal 37:369–376, 1956
[PubMed]
 
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Sample questions:
1.
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?
2.
Which of the following statements regarding use of psychotropic medication in the context of psychodynamic psychotherapy is true?
3.
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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