Psychodynamic Therapy: Literature Review - Research Paper Example

?Running head: Review of Related Literature Psychodynamic Therapy: Literature Review (school) Psychodynamic Therapy: Literature Review Various studies have been carried out on psychological interventions for mental health patients, and many of them provide sufficient support for the use and application of these interventions. This study shall discuss and provide a critical analysis of the different studies related to psychodynamic therapy. In a study by Thyme, et.al., (2007) the authors carried out a randomized controlled clinical study comparing the outcome of two types of short-term psychodynamic psychotherapy, namely, art and verbal psychotherapy. Participants for the study included 39 women diagnoses with depression. Half of the participants underwent art psychotherapy and the other half received verbal psychotherapy. Data was gathered before and after the interventions were carried out, followed by a three-month follow-up; and assessment was made via self-rating scales and interviewer-based ratings. The study revealed that results for both therapies was comparable and the three-month follow-up led to less depressed and less stress-related symptoms. The study concluded that both types of time-related therapies were valuable interventions for depressed women. The problem chosen is very much relevant in the current mental health practice. The authors are experts in related fields of practice and the study has been peer-reviewed. The authors were able to indicate the application of ethical practices in relation to respondent's informed consent and confidentiality. Factors which potentially could confound the variables were evaluated and the variables did not affect the results of the study (Thyme, et.al., 2007). The authors were able to mention limits on the generalizability of the conclusions based on outcome of the studies to the general practice. This study however involves women only, and so the results of this study can only be considered valid for women. This study did not also consider inter-rater reliabilities for the HRSD, diagnoses, and PO judgments; moreover, the respondents were not evaluated after the interventions were applied which would have assisted in comparing psychotherapists’ and participants’ self-ratings. The efficacy of dynamic psychotherapy was also evaluated in a program evaluation study by Shedler (2010). This evaluation study was more comprehensive in its content as it covered more studies and evaluated them in terms of content and relevance. In formulating empirical evidence from this review, the study revealed that psychodynamic therapy is an effective therapy. The results indicate that support for psychodynamic therapy was as large as that seen in other studies seen to be empirically supported with treatment benefits even after the end of treatment. The evaluation study also revealed that the efficacy of the treatment is based on skilled practitioners using techniques crucial to psychodynamic theory and practice. It was noted that more RCTs involving CBTs were reviewed as compared to psychodynamic therapy. These studies were assessed thoroughly. The characteristics of samples, as well as the methods were not adequately indicated and monitored. Nevertheless, the results of the study are strong and constant in terms of establishing the benefits of psychodynamic therapy for lasting therapy, or efficacy beyond symptom remission. A quantitative pilot study by Lema, Target, and Fonagy (2011) sought to review the application of the dynamic interpersonal therapy (DIT) among depressed patients, reviewing its acceptability and compatibility with session-by-session monitoring as an overture to a possible randomized controlled study. Sixteen depressed patients were enrolled in the DIT and they were assessed before and after the sessions, per session using PHQ-9 and GAD-7 assessments. Based on feedback, the psychodynamic treatment could be taught and its essential competencies could be gained based on the clinical work evaluated. This therapy was very much related to a reduction of symptoms. A slight increase towards the end of treatment was however seen in the application of DIT, but all in all it shows much promise in efficacy and acceptability (Lema, Target, and Fonagy, 2011). The study established the relative efficacy of DIT for mild to moderate depression. An insufficient sample size is apparent in this study, but is more or less comparable to other larger studies. The various concerns involving data gathering of monitored data was resolved through outcome monitoring. All in all, even as no definite conclusion can be established for this study considering the limited sample size, this pilot study provides basis for future studies taken on a larger scale. Cuijpers, et.al. (2008) also assessed the efficacy of psychotherapies. This study was carried out because of the perceived limitations in the number of available studies reviewing the efficacy of psychotherapies. This study was carried out as a meta-analysis where 7 major kinds of psychological treatment for mild and moderate depression were directly evaluated in relation to psychological treatments. These treatments were assessed in atleast 5 comparative studies. All in all, all studies showed efficacy of treatment, except in interpersonal psychotherapy and nondirective supportive therapy. Drop-out rates were higher in CBT, as compared to other therapies, and it was much lower in problem-solving therapies. In effect, no significant differences were seen in terms of the efficacy between major psychotherapies for mild to moderate depression. The authors mentioned the fact that their results are complicated by studies reporting completers-only analyses without intention-to-treat analyses. The authors are also keen to mention that the number of studies was large, but still not large enough for an adequate meta-analysis. The quality of various included studies was also not optimal and the participants were chosen based on diagnosis not test scores. The interventions were also not adequately described in the studies and most of the studies covered the Caucasian population. The generalizability of this meta-analysis is therefore limited, and the results of this study have to be applied with caution. More research is required in order to establish better results. Nevertheless, these results provide few significant differences in terms of efficacy between the different types of treatment for mild to moderate depression. In a study by Cromer and Hilsenroth (2010), the authors sought to evaluate pretherapy patient personality characteristics which may be related to outcomes in short-term psychodynamic psychotherapy. The prognostic ability of the Capacity for Dynamic Process Scale (CPDS) was evaluated in a sample of 71 outpatient patients seeking treatment at a university-based community center. CPDS in relation to various outcome measures were evaluated in terms of patient and other perspectives. Factor analysis was used to establish important item clusters in relation to insight, affective, or relational capacities. The study revealed that the CPDS score was related to various outcome measures, but not in terms of significance. Some CPDS items and other items related to the insight subscale indicated improved relationships to the number of patient and clinician-rated outcome measures. This study is however limited in terms of its mild-moderate pathology patient pool which anchored it within a specific psychotherapy. Such considerations may control the generalizability of the study to different settings and treatments. The community-setting of this study nevertheless represents a real-world approach and application for this therapy. In this case, this study remains highly meaningful and applicable. This study includes appropriate methods which apply to the important elements of the research, more importantly its thesis and research questions. The authors are credible experts in the related field of practice, and the research is peer-reviewed by other authors and researchers in related field of practice and research. Improvements on generalizability of application to various settings and treatments need to be made in future researches. Van, et.al., (2008) set out to establish an overview of the consistency of findings on the association between socio-demographic factors and depression qualities, on the one hand and outcomes of pharmacotherapy, CBT, and interpersonal psychotherapy for depression on the other. The study did not reveal gender-related treatment outcomes for tricycle antidepressants. Some studies seemed to indicate that young adults did not respond well to tricyclics, and women had improved outcomes with modern antidepressants. Married patients seemed to respond better to antidepressants and CBT. Longer effect of depression was seen as having a negative impact on psychotherapy. This review only provided a global estimate in terms of positive and negative associations of outcomes. The strengths and correlations are not established in this study. No placebo controls were seen in some of these studies, making it difficult to distinguish between the natural course of depression and the impact of treatment. Not enough studies on psychotherapy were apparent; hence more studies seem to be needed to support this therapeutic process. This study can only provide a tentative conclusion on the predictive essence of easily qualified patient qualities in major depression. Once again, from this review, it can be deduced that more studies on the application of psychotherapeutic standards of care are needed in order to establish their efficacy in the mental health setting, especially among depressed clients. Smith’s (2009) study sought to establish the contribution and relevance of Winnicott’s thinking in the Brief Dynamic Therapy practice. In this study, Smith establishes that three transitions can be established in order to improve the therapeutic relationship with the patient and thereby improve efficacy. Such transitions include the acknowledgment of the let-down, facing the patient’s destructiveness and then assessing what has been good about the early experience. Play and spontaneity are important elements in the transitions of short therapy. The themes for Winnicott’s ideas are reviewed in two case studies. The author revealed after the case study that therapeutic practices can be enshrined in evidence-based practice; however, they can also lose their efficacy after a while and can limit the applications of creative processes or approaches to care. In the current practice setting, the focus which Winnicott gave to play and spontaneity in the therapeutic context on the part of the therapist and the patient was able to have an even greater significance among brief dynamic therapists and for applied psychoanalysis. The three transitions help improve the art form and support therapeutic change as illustrated in the two case studies. Gustafson’s support based on the importance of patterns in a patient’s life work to enhance the realities of the current world (through dreams); it also supports Winnicott’s artistry. This study provides a qualitative analysis of the Brief Dynamic Therapy practice. The processes of qualitative study have been specifically established in this study, with particular focus and emphasis on the application of thorough and effective interventions for mental health issues. The author is a credible and highly-regarded practitioner in mental health care and the journal has been peer-reviewed and published in a credible mental health journal. The case study specifies ethical processes which the authors undertook in order to establish a valid and reliable research. The proper informed consent and confidentiality measures were ensured by the authors. Due to its qualitative nature, the results in this study cannot be generalized to a larger population. In order therefore to improve its applicability, more thorough research and studies have to be undertaken, and a larger population needs to be considered in establishing a generalized application of these results. In a paper by Nilsson, et.al., (2007) the authors set out to evaluate whether the quantitative equivalence may hide differences in patient’s experiences on the quality of change. Thirty two patients who finished CBT or psychodynamic therapy were evaluated based on their experiences in psychotherapy. The various cases were grouped into four based on the type of therapy and based on outcome of treatment. Outcome narratives were established for each kind of therapy. Differences in the two types of treatment were not satisfactory; nevertheless, there were obvious differences in the types of outcomes reported, including the experiences for both groups of patients. Therefore, the qualitative perspective may support the quantitative evaluations in establishing that the usual amount of change may have various elements. Based on a quantitative analysis, the two treatments established equal results in relation to patient satisfaction; however, the quality of the results was very much different. The CBT treatment showed more satisfaction in terms of specific coping techniques with problems; and the PDT patient manifested more self-reflection and a huge range of personality-related improvements. The CBT showed more focus and structure; and the PDT was more open-ended and presented a difficult self-exploration with the therapist. The authors concluded that the CBT is more highly specific and more concrete than the PDT. Since this is a retrospective study, it is not possible to determine if there are differences between the groups based on variables relating to diagnosis, motivation, and personality before and after therapy. Such differences may explain the experiences in the two groups. The authors were not able to realize their sampling plans and as such the patient sample was heterogeneous in terms of duration and interval of treatment. Due to confidentiality measures, information on the individual therapists was not available to the authors. However, this did not affect the study results significantly. Based on the results of the study, the authors recommended that therapists must use sensitivity in dealing with their patient. In effect, it is important for the therapist to ask the patient why he is feeling the way he is feeling and for the therapist to try other kinds of psychotherapies which would meet the patient’s demands and complaints. This study establishes clear and comprehensive research process. As such, this type of research is advisable inasmuch as the researchers are not able to establish clear results using one research type. Otherwise, either method of research can assist in establishing adequate and valid research results. Higginson and Mansell (2008) sought to evaluate how and why psychological changes occur, whether this occurs as a result of psychotherapeutic intervention or during natural recovery. The study was carried out as an account of six individuals who went through psychological changes and recovery after a significant event in their lives; the interpretative phenomenological analysis (IPA) was used in this study. A semi-structured interview covered various aspects of their experiences, considering how the problem impacted on their lives, and how they overcame their problem. Four themes were seen in the study, including hopelessness and issues of control, change process, new self versus old self, and putting the problem into perspective. Results are seen in relation to current literature on hopelessness and locus of control, experiential avoidance, acceptance, as well as mindfulness. Since this is a qualitative study, the number of respondents was limited. As such, the results cannot be generalized to a larger population. Further research on psychological change based on a qualitative aspect can be carried out in order to address these limitations and in order to establish transdiagnostic findings for research. In effect, the study established that the nature of psychological change cannot fully be established and this can be seen in the research which demonstrates the efficacy (or lack thereof) of the various therapeutic tools and the rates of natural recovery. Nevertheless, qualitative processes can be used to establish how psychological changes occur. A paper by Elliott, et.al. (2009), sought to demonstrate the application of the adjudicated form of hermeneutic single-case efficacy design, which is a critical reflective method for inferring change and therapeutic influence among single therapy cases. This is a case study of a 61-year old European-American male with panic and bridge phobia. He underwent 23 sessions of individual process/experiential/emotion-focused therapy. The authors established that the results of labor-intensive research methods can be increased when the following conditions are seen. First, the therapy’s efficacy is questionable and there is a need for a well-documented single case to establish claims for efficacy. In this case, the PE-EFT was effective in a client where CBT used to be applied. In effect, the study established the PE-EFT was effective in treating phobia/panic. Secondly, the adjudicated HSCED is more likely to be useful with data collected being contradictory as seen in this case where the quantitative and the qualitative data established different conclusions. This study however is on the impact of the therapist, who was also the teacher of the two teams of graduate students, friends of judges, chief investigator and auditor. His impact cannot even be adequately reduced with the application of systematic and rigorous methods. The authors were able to recommend sound improvements for future research, mostly on the use of multiple research teams and expert panel judges which can be reserved for high-profile or complicated cases. In effect, the same goals can be reached even without the application of complicated and time-consuming research methods. In the analysis by Bradshaw and colleagues (2009), the authors sought to evaluate the efficacy of psychodynamic psychotherapy in the outpatient community mental health institution. This study utilized a single pre-test post-test design covering 78 clients. Outcomes included psychological functioning, quality of life, level of subjective distress, interpersonal functioning, and role functioning. After study, the patients were able to indicate improvements from pretest to completion of treatment in functioning, as well as quality of life and other outcome measures. About 85% of clients were able to manifest significant clinical change. The study showed various interventions which therapists can use to integrate evaluation methods in their clinical services in order to reach improved mental health conditions of clients. Various limitations were seen in this research with the uncontrolled nature of the research not allowing for causal inferences on treatment effects. Lack of follow-up measures also prevents an improved understanding of treatments over time. More rigorous research methods are required in order to avoid the limitations seen in this current study. Ethical and practical issues must also be dealt with in order to increase reliability of results. Wright (2009) set out to evaluate the impact of time-limits on psychotherapy from the point of view of psychologists. Practicing psychologists were the respondents in this mixed methods study. Twenty seven all in all took answered the semi-structured interview and about 85 completed the mailed questionnaire. The results were reviewed thematically and the qualitative as well as statistical analysis was applied to the questionnaires. Both interview and questionnaire results were similar and they both indicated that time limit during psychotherapy has a significant impact to psychologists. They are less satisfied with the time-limit during psychotherapy. However, they see the benefits in terms of improved client access to psychologists as well as improvement in the efficacy of intervention. In effect, the study established that time-limits impact on psychologists in significant ways in relation to the process and results of psychotherapy. This study however had some limitations, mostly seen in the scope of the study, where no scope was seen. The extent of these findings also needs to be reduced in terms of generalizations, as they do not represent the views of all psychologists in Australia. In general, the methods of this research are rigorous enough with some minor improvements needed. However, the need for more studies on time-limits from the point of view of clients has to be carried out in order to complete the perspectives of time-limited psychotherapy. Conclusion Based on the above cited studies, psychotherapy is an effective therapeutic intervention for mental health patients, including those with depression, phobia, and related disorders. The studies cite general empirical evidence which establishes support for psychotherapy as a means of managing a patient’s symptoms and mental health issues. Gaps in the researches mostly relate to sampling size for most of the qualitative studies, for which reason their generalizability is limited. Nevertheless, their results are significant and follow patterns in quantitative studies which manifest support for psychotherapy. The recommendations of the study indicate adequate support for use by counselors and psychologists in the actual clinical setting. Based on the above studies, recommended future researches have to be carried out which must include higher sample sizes, covering both men and women, for all age-groups, and for various mental health diseases, including depression and anxiety disorders. Works Cited Bradshaw, W., Roseborough, D., Pahwa, R., Jordan, J. (2009). Evaluation of psychodynamic psychotherapy in a community mental health center. Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry, vol. 37(4), pp. 665-681. Castonguay, L. (2009). An adjudicated hermeneutic single-case efficacy design study of experiential therapy for panic/phobia. Psychotherapy Research, vol. 19(4-5): pp. 543-557. Cromer, T. & Hilsenroth, M. (2010). Patient Personality and Outcome in Short-Term Psychodynamic Psychotherapy. J Nerv Ment Dis, vol. 198: pp. 59–66. Cuijpers, P., van Straten, A., Andersson, G., & van Oppen, P. (2008). Psychotherapy for Depression in Adults: A Meta-Analysis of Comparative Outcome Studies. Journal of Consulting and Clinical Psychology, vol. 76(6), pp. 909–922. Elliott, R., Partyka, R., Alperin, R., Dobrenski, R., Wagner, J., Messer, S., Watson, J., & Wright, T. (2009). Providing Therapy in the Context of Third Party Determined Time Limits: A Mixed Methods Study of Psychologists' Experiences of Working in Pre-set Timeframes. The University of Sydney Higginson, S. & Mansell, W. (2008). What is the mechanism of psychological change? A qualitative analysis of six individuals who experienced personal change and recovery. Psychology and Psychotherapy: Theory, Research and Practice, volume 81, pp. 309–328. Lemma, A., Target, M., & Fonagy, P. (2011). The Development of a Brief Psychodynamic Intervention (Dynamic Interpersonal Therapy) and Its Application to Depression: A Pilot Study. Psychiatry, vol. 74(1), pp. 41-48. Nilsson, T., Svensson, M., Sandell, R., & Clinton, D. (2007). Patients’ experiences of change in cognitive-behavioral therapy and psychodynamic therapy: a qualitative comparative study. Psychotherapy Research, volume 17(5): pp. 553-566. Shedler, J. (2010). The Efficacy of Psychodynamic Psychotherapy. American Psychological Association, vol. 65(2), pp. 98–109. Smith, J. (2009). Steering through storms to safe havens: Playing and reality in Brief Dynamic Therapy. Psychodynamic Practice, vol. 15(2), pp. 129–146. Thyme, K., Sundin, E., Stahlberg, G., Lindstrom, B., Eklof, H., & Wiberg, B. (2007). The outcome of short-term psychodynamic art therapy compared to short-term psychodynamic verbal therapy for depressed women. Psychoanalytic Psychotherapy, vol. 21(3), pp. 250–264. Van, H., Schoevers, R., & Dekker, J. (2008). Predicting the Outcome of Antidepressants and Psychotherapy for Depression: A Qualitative, Systematic Review. Harv Rev Psychiatry, volume 16: pp. 225–234. Read More