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The Psychodynamic Approach to Therapy

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    1. The Psychodynamic Approach to Therapy

    2. What does this mean? Psychodynamic therapies are often referred to as psychoanalysis. These therapies are long term and intensive, they also disrupt the patients lives and are expensive. To avoid disrupting the patients lives, psychodynamic therapists are returning to the idea of brief dynamic therapy, and this is now growing in popularity. By focusing a therapy on particular issues the patients are directed to introspect on specific events, and are educated about their interpersonal relationships, therefore the process of catharsis and insight into psychodynamic therapy is greatly speeded up.

    3. Classical Psychoanalysis This type of therapy is intensive and long term, taking place five times a week it typically lasts several years. The sessions last exactly 50 minutes, as they are very particular about having exact boundaries. The analytic technique usually uses free association and interpretation, and the patient will lie on a couch, instead of sitting facing the therapist.

    4. Psychoanalytic/Psychodynamic Psychotherapy This is a less strict form of classical psychoanalysis, whilst it is still a long term therapy, it is slightly less intensive. Sessions take place 1-3 times per week, and the therapy typically lasts 1-5 years. The analytical technique mirrors that of classical psychoanalysis, but occasionally includes humour and information giving.

    5. Evaluation of Psychoanalytic Psychotherapy Sandell (1999) studied 756 patients receiving classic psychoanalysis or psychoanalytic psychotherapy, he found strong evidence for the effectiveness of long term psychodynamic therapies and also strong evidence for the difference between the 2 therapies. Classical psychoanalysis was defined by having 4-5 sessions per week, in contrast to psychoanalytic psychotherapy which took place 1-2 times per week. The therapies continued for up to 3 years. At the end of treatment there were substantial improvements in the conditions of the patients, but no difference between the 2 groups of patients. At a 3 year follow up the Classical Psychoanalysis group were seen to have significantly fewer symptoms, and continued to improve after the end of treatment.

    6. Group Psychoanalytic Therapy This is where the principles of psychodynamic therapy are applied to working with groups, generally of around 6-12 patients. Most commonly there are 2 therapists, one male, one female, to enact maternal and paternal transference. In group analysis the insight is mainly from interaction with the other group members. However the Bion Model of Group Therapy says that the group adopt the behaviour of a single individual and is collectively interpreted by the therapists.

    7. Brief Dynamic Therapy There are a variety of subtly differing brief approaches to psychodynamic therapies. In long term therapies the emphasis is on the interpersonal functioning and effective state of the patient. In order to speed up the process, brief dynamic therapy is more confrontational and the patients are educated about their relationships as opposed to waiting for the development of a transference relationship.

    8. Evaluation of Brief Dynamic Therapy Because it is a short term treatment it means that most of the research done on it is based on the outcome of the treatment, and there is a large amount of evidence to support its effectiveness. Guthrie et al (2001) tested the effect of 4 sessions of BDT with 119 patients following attempted suicide by poisoning. A control group received standard treatment (i.e. a referral back to their GP). 6 Months later the BDT group had significantly lower suicidal thoughts than the control group, and were much less likely to have made suicide attempts again.

    9. The effectiveness of Psychodynamic Therapies FOR Recent studies have found much more positive results, showing that PDT are at least as affective as other Psychological Treatments. AGAINST Early studies found no evidence that psychodynamic treatments had any effect on patients.

    10. Conclusion Psychodynamic therapies include long term intensive treatment (Classical Psychoanalysis) and briefer and less intensive BDT. These all work on similar principles aiming to achieve catharsis and insight although the process by which this is achieved varies between the therapies. There is now substantial evidence to support the effectiveness of both these therapies in treating a variety of psychological problems.