Psychodynamic psychotherapy

Psychodynamic psychotherapy or psychoanalytic psychotherapy is a form of depth psychology, the primary focus of which is to reveal the unconscious content of a client's psyche in an effort to alleviate psychic tension. Psychodynamic psychotherapy or psychoanalytic psychotherapy is a form of depth psychology, the primary focus of which is to reveal the unconscious content of a client's psyche in an effort to alleviate psychic tension. Psychodynamic psychotherapy relies on the interpersonal relationship between client and therapist more than other forms of depth psychology. In terms of approach, this form of therapy uses psychoanalysis adapted to a less intensive style of working, usually at a frequency of once or twice per week. Principal theorists drawn upon are Freud, Klein, and theorists of the object relations movement, e.g., Winnicott, Guntrip, and Bion. Some psychodynamic therapists also draw on Jung or Lacan. It is a focus that has been used in individual psychotherapy, group psychotherapy, family therapy, and to understand and work with institutional and organizational contexts. In psychiatry, it is considered a treatment of choice for adjustment disorders, as well as posttraumatic stress disorder (PTSD) but more for personality-related disorders. The principles of psychodynamics were introduced in the 1874 publication Lectures on Physiology by German scientist Ernst Wilhelm von Brücke. Von Brücke, taking a cue from thermodynamics, suggested all living organisms are energy systems, governed by the principle of energy conservation. During the same year, von Brücke was supervisor to first-year medical student Sigmund Freud at the University of Vienna. Freud later adopted this new construct of “dynamic” physiology to aid in his own conceptualization of the human psyche. Later, both the concept and application of psychodynamics were further developed by the likes of Carl Jung, Alfred Adler, Otto Rank, and Melanie Klein. Most psychodynamic approaches are centered on the concept that some maladaptive functioning is in play, and that this maladaption is, at least in part, unconscious. The presumed maladaption develops early in life and eventually causes difficulties in day-to-day life. Psychodynamic therapies focus on revealing and resolving these unconscious conflicts that are driving their symptoms. Major techniques used by psychodynamic therapists include free association, dream interpretation, recognizing resistance and transference, working through painful memories and difficult issues, and building a strong therapeutic alliance. As in some psychoanalytic approaches, the therapeutic relationship is seen as a key means to understanding and working through the relational difficulties which the client has suffered in life. Although psychodynamic psychotherapy can take many forms, commonalities include: Psychodynamic psychotherapy, both short-term and long-term, is an effective psychotherapy. Psychodynamic psychotherapy is an evidence-based therapy (Schedler 2010) and it’s more intensive form, psychoanalysis has been proven to be evidence-based, too. (Meta-analyses in 2012 and 2013 come to the conclusion that there is little support or evidence for the efficacy of psychoanalytic therapy, thus further research is needed. Later meta-analyses showed psychoanalysis and psychodynamic therapy to be effective, with outcomes comparable or greater than other kinds of psychotherapy or antidepressant drugs, but these arguments have also been subjected to various criticisms. A system review of Long Term Psychodynamic Psychotherapy (LTPP) in 2009 found an overall effect size of .33. Others have found effect sizes of .44–.68. Meta-analyses of Short Term Psychodynamic Psychotherapy (STPP) have found effect sizes ranging from .34–.71 compared to no treatment and was found to be slightly better than other therapies in follow up. Other reviews have found an effect size of .78–.91 for somatic disorders compared to no treatment and .69 for treating depression. A 2012 meta-analysis by the Harvard Review of Psychiatry of Intensive Short-Term Dynamic Psychotherapy (ISTDP) found effect sizes ranging from .84 for interpersonal problems to 1.51 for depression. Overall ISTDP had an effect size of 1.18 compared to no treatment. In 2011, a study published in the American Journal of Psychiatry made 103 comparisons between psychodynamic treatment and a non-dynamic competitor and found that 6 were superior, 5 were inferior, 28 had no difference and 63 were adequate. The study found that this could be used as a basis 'to make psychodynamic psychotherapy an 'empirically validated' treatment.'