Psychoanalytisch-orientierte Fokaltherapie der Depression bei Krebskranken

Emotional distress connected to a cancer disease may result in comorbid mental and especially depressive disorders. Although psychodynamic therapy is one of the most frequently applied forms of psychotherapy of depression in cancer patients there is a lack of empirical studies which meet the criteria of evidence-based psychotherapy research. This is especially true with regard to randomized controlled trials of psychodynamic psychotherapy. As far as we know no manual for psychodynamic treatment of cancer patients has yet been published. In this article a manual for a 20-session short-term psychodynamic treatment is presented. The treatment is based on Luborsky’s supportive-expressive (SE) therapy. The SE treatment manual of depressions in cancer patients presented here is an adaptation of the general SET manual as well as the SE manual for depression. In the first part the general principles of SE therapy are presented. In the second part a manual specifically adapted to the treatment of depressive cancer patients is described. The treatment manual is presently being used in a large-scale randomized controlled multi-centered study comparing short-term psychodynamic psychotherapy and treatment as usual.     

Psychoanalytisch-orientierte Fokaltherapie der sozialen Phobie

Although psychodynamic therapy is one of the most frequently applied forms of psychotherapy to treat anxiety disorders in clinical practice, evidence for the efficacy of psychodynamic therapy in anxiety disorders is unsatisfactory. This is especially true with regard to randomized controlled trials of psychodynamic psychotherapy in anxiety disorders. Psychodynamically oriented treatment manuals for anxiety disorders presently exist for generalized anxiety disorder and panic disorder. For social phobia (or social anxiety disorder), however, no manual for psychodynamic treatment has yet been published. Social phobia is a very frequent mental disorder characterized by an early onset, a chronic course, severe psychosocial impairments and high socio-economic costs and at the same time in spite of these facts one of the mental disorders which are scarcely diagnosed and treated. In this article, a manual for a 30-session (5 exploratory and 25 therapy sessions) short-term psychodynamic treatment of social phobia is presented. The treatment is based on Luborsky’s supportive-expressive (SE) therapy. In the first part, the general principles of SE therapy are presented. In the second part, a manual specifically adapted to the treatment of social phobia is described. This manual includes specific additional treatment elements that have clinically proved to be useful in the therapy of social phobia. The treatment manual is presently used in a large-scale randomized controlled multi-center study comparing short-term psychodynamic psychotherapy and cognitive-behavioral therapy in the treatment of social phobia.     

Soziale Phobie

Social anxiety is characterised by overwhelming fears in social interactions or performance situations. Its life-time prevalence is high (about 13%) and relapses are quite common. Social anxiety disorder is a chronic disease with a high impairment for the persons afflicted. Cognitive-behavioural, psychodynamic and neurobiological models have promising implications for psychotherapy and pharmacological treatment. Neurobiological approaches have identified risk factors and possible somatic mechanisms. Cognitive-behavioural models explain the development of dysfunctional beliefs and the maintenance of social anxiety. Psychodynamic approaches refer to a disturbed self-concept and underline the importance of prior negative interpersonal relationships. Manualised treatments exist for the cognitive-behavioural approach and a manual for psychodynamic psychotherapy was recently developed. This paper presents the different approaches (neurobiological, cognitive-behavioural, psychodynamic) to social anxiety disorder and possible implications for therapy are discussed.     

Are psychodynamic and psychoanalytic therapies effective?: A review of empirical data

There is a need for empirical outcome research in psychodynamic and psychoanalytic therapy. However, both the approach of empirically supported therapies (EST) and the procedures of evidence‐based medicine (EBM) have severe limitations making randomised controlled trials (RCTs) an absolute standard. After a critical discussion of this approach, the author reviews the empirical evidence for the efficacy of psychodynamic psychotherapy in specific psychiatric disorders. The review aims to identify for which psychiatric disorders RCTs of specific models of psychodynamic psychotherapy are available and for which they are lacking, thus providing a basis for planning further research. In addition, results of process research of psychodynamic psychotherapy are presented. As the methodology of RCTs is not appropriate for psychoanalytic therapy, effectiveness studies of psychoanalytic therapy are reviewed as well. Studies of psychodynamic psychotherapy published between 1960 and 2004 were identifed by a computerised search using Medline, PsycINFO and Current Contents. In addition, textbooks and journal articles were used. Twenty‐two RCTs were identifed of which 64% had not been included in the 1998 report by Chambless and Hollon. According to the results, for the following psychiatric disorders at least one RCT providing evidence for the efficacy of psychodynamic psychotherapy was identifed: depressive disorders (4 RCTs), anxiety disorders (1 RCT), post‐traumatic stress disorder (1 RCT), somatoform disorder (4 RCTs), bulimia nervosa (3 RCTs), anorexia nervosa (2 RCTs), borderline personality disorder (2 RCTs), Cluster C personality disorder (1 RCT), and substance‐related disorders (4 RCTs). According to results of process research, outcome in psychodynamic psychotherapy is related to the competent delivery of therapeutic techniques and to the development of a therapeutic alliance. With regard to psychoanalytic therapy, controlled quasi‐experimental effectiveness studies provide evidence that psychoanalytic therapy is (1) more effective than no treatment or treatment as usual, and (2) more effective than shorter forms of psychodynamic therapy. Conclusions are drawn for future research.     

Psychological aspects of anorexia nervosa

Research on anorexia nervosa (AN), its etiology and treatment, and the results of outcome studies are reviewed. Early studies focused on psychodynamic aspects of AN whereas recently the brain's neurotransmitters and hypothalamic area, particularly, having been investigated as contributing to symptoms of AN. No treatment is successful for all AN patients. Recovery is slow and is often resisted. Diet, psychotherapy, and drugs have sometimes alleviated symptoms for some AN patients but the root cause and the best treatment have eluded a century of research.     

Die DPG-Praxis-Studie

All psychotherapeutic methods must be scientifically evaluated. Empirical evaluation of evidence is a prerequisite for acceptance as scientific psychotherapy as well as for payment by health insurance. Currently the psychotherapy methods accepted within the German health system (behavioural therapy, psychodynamic psychotherapy, and analytic psychotherapy) are reviewed by a governmental evaluation committee concerning evidence, necessity and cost-effectiveness. The DPG practice study has basically two aims: 1) to conduct a large naturalistic study to investigate effectiveness, sustainability and economic aspects of psychodynamic and analytic psychotherapy and 2) to offer a framework for psychoanalytic institutes, members, candidates or groups to realize own research ideas by collecting additional data within the study. The present article describes the background, main research questions, structure and design of the DPG practice study with regard to the evaluation questions.     

Creative Group Living in a Children's Institution Edited by Susanne Schulze

Psychoanalytic psychotherapy is not well developed in Japan (Kotani, 1996). Until recently, group psychotherapy in particular has not been well received by patients or clinicians. Cultural difficulties in using group psychotherapy with Japanese patients have now been overcome and a theory of systematic intervention techniques has been developed. The basic dynamic factors of group psychotherapy such as culturally embedded aspects of social and personality structure are analyzed in this article. Culture-bound psychodynamic characteristics of Japanese patients as activated and worked through in the group process are first described with case illustrations. A systemic hypothesis linking cultural and psychodynamic structure is then delineated and the focal points of interventions are explained in terms of the field dynamics of social structure and boundary dynamics of personality structure.     

Methods and mechanisms in the efficacy of psychodynamic psychotherapy

Comments on the original article, "The efficacy of psychodynamic psychotherapy," by J. Shedler (see record 2010-02208-012). Shedler summarized a large body of research that shows psychodynamic therapy to have a substantial effect size, comparable to that for many empirically supported treatments. This is an important finding, in part refuting the concerns raised by Bornstein (2001, 2002) regarding the future of psychodynamic approaches had there been no substantial changes in how practitioners and researchers approached the science to demonstrate efficacy. Further, Shedler showed that the efficacy of psychoanalytic psychotherapy is due to therapeutic methods commonly employed in cognitive behavior therapy (CBT), one of the most frequently cited empirically supported approaches for a wide range of psychological conditions. From a methodological perspective, there are some important limitations to the claim of psychodynamic psychotherapy's comparable efficacy to other empirically supported approaches.     

The Effectiveness of Brief Versus Intermediate Duration Psychodynamic Psychotherapy in the Treatment of Adjustment Disorder

Treatment studies and particularly psychotherapeutic treatment studies of patients suffering from an adjustment disorder are very scarce, leading to insufficient evidence regarding the efficacy of treatment in this population. Whereas timely psychotherapy is known to be of benefit in the treatment of adjustment disorders, the ideal duration of psychotherapeutic interventions is not known. This study examined whether a brief 12-session focused psychodynamic psychotherapy may be as efficient as a longer intermediate-term (1?year) psychodynamic psychotherapy in treating patients suffering from an adjustment disorder. Subjects (n?=?66) were randomly assigned to either brief or intermediate psychotherapy. They were assessed by self-report measures and clinician’s evaluation at baseline, end of therapy, and 9?months after therapy was terminated. The results showed a good overall improvement in the whole group. Furthermore, brief psychotherapy was found to be as good as intermediate psychotherapy both at the end of treatment and at follow-up. Although our study was not designed to confirm the efficacy of dynamic psychotherapy in the treatment of adjustment disorders, our results suggest that brief interventions may be good enough in adjustment disorder, thus allowing treatment of a greater number of patients without compromising for the quality and suitability of treatment.     

Störungsorientierte psychodynamische Therapie der Bulimie

The concept of a disorder-oriented psychodynamic therapy of bulimia nervosa is described which combines the modification of the eating behaviour with a focal treatment of psychodynamic conflicts. Especially during the first phases behaviour-oriented and psychoeducative elements are integrated. The therapy comprises four steps: 1. disorder-oriented assessment and introduction to the treatment, 2. stabilisation of the eating behaviour, 3. working through the psychodynamic factors and 4. termination. These phases are illustrated by a case study of a psychodynamic treatment.     

Diagnostik in der Psychotherapie

Diagnostic approaches in psychotherapy are accompanied by a continuous and unchanged discussion concerning fundamental questions. Because of its many functions diagnostics in psychotherapy has to take psychiatric, psychological, orientation-specific models and methods of assessment into consideration. Following the publication of the fifth edition of the diagnostic and statistical manual of mental disorders (DSM-5) the increasing danger of a further increase in the number of psychiatric disorders is evident. In this article the principles of current psychiatric diagnostics and psychodynamic psychotherapy are presented and discussed. Furthermore, the dangers associated with the increased medicalization and over-diagnosis are highlighted. Against this background consideration is given to the risks for patients and societal aspects.     

Ist psychodynamische Kurztherapie eine wirksame Behandlungsform bei psychischen Störungen?

To test the efficacy of short-term psychodynamic psychotherapy (STPP) in specific psychiatric disorders, a meta-analysis of more recent studies was performed. Its importance is grounded on the inconsistent results of previous meta-analyses regarding short-term psychodynamic psychotherapy (STPP) and the controversial discussion regarding the efficacy of psychodynamic therapy in general. In a computer-based search, studies of STPP published between 1970 and 2004 were identified. Studies of interpersonal therapy were excluded and rigorous inclusion criteria were applied. Seventeen studies fulfilled these criteria. Effect sizes were calculated for target problems, general psychiatric symptoms, and social functioning. In order to examine the stability of outcome, effect sizes were assessed separately for end of therapy and for follow-up assessment. The effect sizes of STPP were compared to those of waiting list control patients, treatments as usual, and of other forms of psychotherapy. STPP yielded significant and large pre-post effect sizes, which were not only stable, but tended to increase at follow-up. The effect sizes of STPP significantly exceeded those of waiting list and treatments as usual, but no differences were found between STPP and other forms of psychotherapy. STPP proved to be an effective treatment in different psychiatric disorders. However, further research of STPP in specific psychiatric disorders is needed, including a study of the active ingredients of STPP. Effectiveness studies should be included.     

Manualisierte psycho- dynamisch-interaktionelle Gruppentherapie

20–40% of the patients in general practices, as well as in different departments in hospitals, suffer from somatoform diseases. 70% of these patients have pain as their main complaint. The present treatment manual is the first disease-specific, psychodynamically oriented group-treatment for these patients. Compared to other psychodynamic treatment settings this therapy is a short and cost-effective approach to treat these patients. It is based on a so-called psychodynamic-interactional group psychotherapy and focuses on disease-specific parts of the problem, as well as on psychic and interpersonal problems resulting from adverse childhood experiences. Over a period of six months 7 to 9 patients are treated in 40 group therapy sessions. Two weekly meetings are held during the first four months and one weekly session is held during the last two months. The concept contains psycho-educational elements, the discussion and formulation of individual treatment goals as well as work with a psychodynamic and relationship- oriented treatment focus. The efficacy of this concept is planned to be evaluated in a randomised, controlled clinical trial, including two treatment conditions and one control condition. One of the two treatment conditions is, beneath the concept already discussed, a cognitive behavioural group therapy.     

Psychoanalytische Psychotherapie mit niedriger Sitzungsfrequenz

Compared to Freud??s use of six sessions a week, the frequency of therapy has now decreased to a maximum of three or four sessions. The current field of applied psychoanalysis using only one or two sessions a week is of much higher relevance for the worldwide supply of the population with psychotherapy. Not only frequency and duration have decreased over the years but also the sum of applied sessions per patient. This is especially the case in psychodynamic short term psychotherapy. With the change in frequency a change in therapy technique took place resulting in a more active and attentive therapist, an interactive pattern with more dialogue and an avoidance of regressive movements of the patient. The crucial role concerning the work with transference and resistance was maintained in tendency but the specific techniques also underwent modifications. The empirical state of psychodynamic psychotherapy is better than it used to be but further studies are urgently needed.     

THE OUTCOME OF SHORT‐TERM PSYCHODYNAMIC ART THERAPY COMPARED TO SHORT‐TERM PSYCHODYNAMIC VERBAL THERAPY FOR DEPRESSED WOMEN

The primary aim of this randomized controlled clinical trial was to compare the outcome from two types of short‐term psychodynamic psychotherapy. The participants were thirty‐nine women with depression. Half of the participants (n = 18) received art psychotherapy and the other half received verbal psychotherapy (n = 21). Data was collected before and after psychotherapy, and at a 3‐month follow‐up using self‐rating scales and interviewer‐based ratings. Results showed that art and verbal psychotherapies were comparable, and at follow‐up, the average participant in both groups had few depressive symptoms and stress‐related symptoms. The conclusion was that short‐term psychodynamic art therapy could be a valuable treatment for depressed women.     

A systematic review of the effectiveness of psychoanalysis,psychoanalytic and psychodynamic psychotherapy with adults with intellectual and developmental disabilities: progress and challenges

Objectives: This systematic review aimed to critically appraise the literature on the efficacy and effectiveness of psychoanalysis, psychoanalytic and psychodynamic psychotherapy in adults with intellectual and developmental disabilities (IDD). Method: A systematic search of electronic databases was carried out. The methodological quality of the studies was assessed using a quality assessment tool and comparisons were made with a review of the quality of research on the effectiveness of cognitive behavioural therapy (CBT) for people with IDD. Results: The search yielded 13 papers which provided evidence for the effectiveness but not efficacy of psychoanalytic and psychodynamic psychotherapy; but none were found for psychoanalysis. The quality of the research was generally poor compared to the current research on the effectiveness of CBT. Conclusions: Positive outcomes have been indicated for psychoanalytic and psychodynamic psychotherapy with people with IDD. Larger scale, more controlled research is necessary to advance the evidence base.     

Wie wirksam sind psychoanalytisch orientierte Therapie und Verhaltenstherapie bei Persönlichkeitsstörungen?

This meta-analysis adresses the effectiveness of psychodynamic therapy and cognitive-behavioral therapy in personality disorders. Included were 14 studies of psychodynamic therapy and 11 studies of cognitive-behavioral therapy from 1974 to 2001. There is evidence that both psychodynamic therapy and cognitive-behavioral therapy are effective treatments of personality disorders. As the number of studies that could be included in this meta-analysis was limited, the conclusions that can be drawn are only preliminary. Further studies which examine specific forms of psychotherapy in specific types of personality disorders using criteria of core psychopathology are necessary. Both longer periods of treatment and follow-up studies should be included.