In Brief
- Psychodynamic therapy is not the psychoanalysis of Freud’s day: patients sit on a chair instead of lying on a couch, have sessions once or twice—not four or five times—a week, and may finish in months as opposed to years.
- Though often dismissed as too open-ended to solve specific problems, psychodynamic therapy alleviates symptoms as effectively as newer, more targeted therapies.
- People who undergo psychodynamic therapy continue to make gains after the therapy ends, perhaps because it addresses underlying psychological patterns that affect many areas of life.
Jeffrey (not his real name) came to treatment complaining of depression, anxiety and trouble getting along with others. Colleagues in the engineering department where he worked complained he was “not a team player,” and his wife saw him as distant and hypercritical. Beyond this, he carried with him a constant feeling of dread, no matter how well things were going.
I agreed with Jeffrey that his dread seemed out of proportion to anything that was actually happening in his life and suggested it might be in proportion to something that was not immediately obvious to either of us. I asked him to tell me about himself. Among other things, I learned that his father had been an alcoholic who would attack without warning, driving Jeffrey to leave home at an early age.
This article was originally published with the title Getting to Know Me.
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4 Comments
Add CommentThe use of empirical evidence to examine the efficacy and effectiveness of psychodynamic therapy is a noble cause and I am glad that researchers out there are taking on this task. That being said, a number of the conclusions in this article and the American Psychologist article upon which much of it is based are not accurate reflections of the data. I have covered these points in greater detail in other forums, but as a quick summary:
Reply | Report Abuse | Link to this(1) The characterization of CBT in this article is grossly inaccurate. This is unfortunate, as it has the potential to steer individuals in need of help away from an evidence-based treatment. Ethically speaking, this is problematic.
(2) The description of the data supporting psychodynamic psychotherapy is highly problematic. The flaws in this data are outlined clearly in the following references:
Anestis, M.D., Anestis, J.C., & Lilienfeld, S.O. (in press). The devil is in the details: Are the conclusions of Shedler (2010) consistent with the evidence? American Psychologist.
Bahr, S.S., & Beck, A.T. (2009). Treatment integrity of studies that compare short-term psychodynamic psychotherapy with cognitive-behavior therapy. Clinical Psychology: Science & Practice, 16, 370-378.
Bahr, S.S., Thombs, B.D., Pignotti, M., Bassel, M., Jewett, L., Coyne, J.C., & Beck, A.T. (in press). Is longer term psychodynamic psychotherapy more efficacious than shorter term therapies? Review and critique of the evidence. Psychotherapy and Psychosomatics.
If you do not have access to these articles, you can read summaries at the following two links:
http://www.psychotherapybrownbag.com/psychotherapy_brown_bag_a/2010/01/what-do-we-know-about-psychodynamic-therapy-a-closer-look-at-shedlers-in-press-review.html
http://www.psychotherapybrownbag.com/psychotherapy_brown_bag_a/2010/01/abandoning-science-and-logic-in-the-pursuit-of-an-agenda.html
(3) The discussion of the role of therapeutic alliance overlooks a vast literature that contradicts the stated conclusions. The work of Robert DeReubis of the University of Pennsylvania and Tony Tang of Northwestern University summarize this well. If you do not have access to their original works, here are two summaries:
http://www.psychotherapybrownbag.com/psychotherapy_brown_bag_a/2009/10/its-all-in-the-therapeutic-allianceor-is-it.html
http://www.psychotherapybrownbag.com/psychotherapy_brown_bag_a/2009/12/sudden-gains-in-psychotherapy-for-depression-how-do-they-happen-and-how-important-are-they-in-the-lo.html
Mike Anestis
Just to let the readers know, the article by Bhar and his colleagues cited by Mike Anestis in the preceding comment, is now published and the full article is available online:
Reply | Report Abuse | Link to thishttp://www.swinburne.edu.au/chancellery/mediacentre/resources/Bhar.pdf
I fully agree with Mike Anestis that CBT has been grossly misrepresented in this article and the research cited in support of longterm psychodynamic psychotherapy contains, as demonstrated in the aforementioned critiques, contains serious flaws. This is not a "knee-jerk" reaction but a carefully done analysis of problems with the research and I have yet to see a substantive rebuttal to such criticism.
I must say that for an article that decries the "caricature" of Freud and psychoanalysis, the author does of fairly good job of presenting a straw-man version of cognitive-behavioral treatment: I do hope that this will be addressed within a full article in an upcoming issue of SA Mind.
Reply | Report Abuse | Link to thisThat being said, one of the weaknesses of presenting the evidence in favor of therapies that can broadly be described as "psychodynamic" and then criticizing those who present a "caricature" of psychoanalysis is that the depiction is often not a caricature at all, but a fairly accurate depiction of the writings and practices of the orthodox Freudians for the better part of the 20th century, replete with references to castration anxiety, penis envy, the psychosexual stages, etc. If we are to continue teaching Freud in the textbooks, we should present his ideas accurately or simply delete them and make a passing reference to his legacy being more about how he emphasized the complexity of mental life and less about any one particular idea that has survived scientific scrutiny and the passing of time. Very true, modern evidence-based psychodynamic therapies look almost nothing like the practices of the orthodox Freudians and share very little in the way of common theory with Freud. That being the case, perhaps we should stop mentioning Freud altogether in such evaluations of the various psychotherapies, making clinical psychology more a science of facts and theories and less about gurus and totems.
First, I suggest you read Bettelheim's "Freud and Man's Soul" (short book). He gives a thorough lecture regarding the ignorance Freud and Psychoanalysis has met in America. Especially with the extreme misunderstandings surrounding "penis envy" etc. He was writing a whole new language and he used his scholarly background to paint a picture using mythology, stories etc. He didn't think Americans lacking this basic education would read it like an Asperger reading Bordieu. He meant for the mythology and references to greek tragedies to enrichen the understanding of the reader. It confused many with a shallow classical background, and still does.
Reply | Report Abuse | Link to thisSecond, he is the father of psychotherapy - not only psychoanalysis. Being ignorant here is foolish. Saying that his teachings should be excluded is very destructive. CBT was founded on the belief that thoughts cause anxiety. There is very hard neuroscientific evidence that this is (penis-envy-like?) nonsense. Should we exclude Beck from the history books? Barlow evolved CBT thinking in this respect just like others have evolved Freud's thinking. When I read your ignorance I cannot but feel that Freud should be read MUCH MORE. If not, we risk getting another generation of history-less ignorants who are tapping old wine on new bottles with fashionable "scientificy" labels, selling the next quick (false) fix to hapiness, well being and a rich life.