Therapist effects in yearlong psychodynamic therapy: An exploratory study (original) (raw)
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This volume presents 12 highly instructive case studies grounded in the evidence-based psychodynamic therapy model developed by Richard F. Summers and Jacques P. Barber. Bringing clinical concepts vividly to life, each case describes the patient's history and presenting problems and takes the reader through psychodynamic formulation, treatment planning, and the entire course of therapy, including the challenges of termination. The cases address a variety of core psychodynamic problems, with outcomes ranging from very successful to equivocal. The emotional experience of the therapist is explored throughout. Commentary from Summers and Barber on every case highlights important points and key clinical dilemmas. See also the authored book Psychodynamic Therapy: A Guide to Evidence-Based Practice http://www.amazon.com/Practicing-Psychodynamic-Therapy-Richard-Summers/dp/1462517188/ref=sr\_1\_2?s=books&ie=UTF8&qid=1418591091&sr=1-2
Comparative Effects of Short-Term Psychodynamic Psychotherapy
1991
In a review of 19 clinically relevant comparative outcome studies published 1978-1988, short-term psychodynamic psychotherapy (STPP) was evaluated as to overall effects, differential effects, and moderating effects visa -vis no-treatment controls (NT) and alternative psychotherapies (AP), respectively Overall, STPP was superior to NT at posttreatment, inferior to AP at posttreatment, and even more so at 1-year follow-up. STPP was inferior to AP in treating depression and, in particular, to cognitive-behavioral therapy for major depression. STPP was equally successful with mixed neurotics. As research quality increased, STPP grew less superior to NT. Furthermore, STPP decreased its overall superiority over NT and increased its overall inferiority to AT on a series of clinically relevant variables. Improvement in research quality from 1978 to 1988 was noted. Evidence, although limited, supported the view that STPP approaches do seem to differ along a few major dimensions.
Sequential consequences of therapists' interventions
The Journal of Psychotherapy Practice and Research, 1999
Using sequential analysis, the authors examined how therapists' actions related to the verbal disclosure and defensive patterns that followed therapists' interventions within a single therapy hour for 20 patients. At the same time, a new measure, the Psychodynamic Intervention Rating Scale (PIRS), was tested for reliability and construct validity. Results indicated that therapists fit their styles of intervention to patients' levels of distress and functioning. Within the session, patient's emotional elaboration was followed by therapist's defense interpretation, followed by more patient emotional elaboration. Patient elaboration of significance was followed by more transference interpretation, followed by more patient elaboration of significance. Noninterpretive interventions were followed by patient's disclosure of facts, not emotion. Both interpretive intervention process sequences and therapist's use of support predicted posttreatment symptom reduction. The PIRS was shown to have satisfactory reliability and construct validity.
Journal of Clinical Psychology, 2006
This study examined data collected on over 5,000 clients seen by 71 therapists over a 6-year period in a University Counseling Center. Clients were given the Outcome Questionnaire-45 (OQ-45) on a session-bysession basis to track their treatment response. Data were also collected on therapists' theoretical orientation, years of experience, gender, and type of training. Data were analyzed using hierarchical linear modeling (HLM) to see if general therapist traits (i.e., theoretical orientation, type of training) accounted for differences in clients' rate of improvement. Data were then analyzed, again using HLM with therapists as a fixed effect, to compare individual therapists to see if there were significant differences in the efficiency of treatment. In addition, pre-minus posttest OQ-45 scores were examined to see if there were differences in the overall outcome of clients. There was a significant amount of variation among therapists' clients' rates of improvement. Therapist feedback reports were generated to summarize client outcome for individual providers in contrast to center averages and in an attempt to improve client outcome.
Publicly accessible Penn Dissertations, 2009
From the psychotherapy outcome literature, many have inferred that either theory-specific techniques or interventions common to all therapies are what produce symptom change. However, such conclusions are premature because (a) too few direct tests have been conducted of how variation in the levels of either specific or common factor interventions relate to outcome, (b) those prior investigations of specific and common factors and outcome have often been limited to examining linear relations between intervention use and outcome when curvilinear functions might better model their association, and (c) most studies of psychotherapy and outcome have failed to consider how interventions specific to theoretical orientations other than that being studied (i.e., interventions not intended to be in the specific treatment under investigation nor common to all therapies) might also contribute to outcome. In this thesis, I present two studies investigating the relation of interventions from a number of different therapy systems to subsequent symptom improvement in behavioral therapy for Obsessive-Compulsive Disorder (OCD) and psychodynamic therapy for Major Depressive Disorder (MDD). Theory-specific techniques were prominent in both therapies (e.g., behavioral techniques in behavioral therapy, psychodynamic techniques in dynamic therapy), and moderate levels of specific factors were related to better outcome than were higher or lower levels in each treatment. Common factor techniques were among the highest reported interventions in both treatments, but were not predictive of symptom improvement in either therapy. Interventions from other theoretical orientations were present in both therapies, but in such a way that individual techniques appeared to be selected for use based on their congruence with the theoretical orientation of the treatment. In behavioral therapy, no other types of interventions contributed to outcome more than behavioral interventions. In psychodynamic therapy, moderate levels of process-experiential techniques were associated with better outcome than were higher or lower levels. Further research needs to document how specific, common, and unintended factors occur in different psychotherapies and how such interventions might relate to outcome in complex ways before conclusions can be made about the mechanisms of therapy.
The Efficacy of Psychodynamic Psychotherapy
Empirical evidence supports the efficacy of psychodynamic therapy. Effect sizes for psychodynamic therapy are as large as those reported for other therapies that have been actively promoted as " empirically supported " and " evidence based. " In addition, patients who receive psychody-namic therapy maintain therapeutic gains and appear to continue to improve after treatment ends. Finally, nonpsy-chodynamic therapies may be effective in part because the more skilled practitioners utilize techniques that have long been central to psychodynamic theory and practice. The perception that psychodynamic approaches lack empirical support does not accord with available scientific evidence and may reflect selective dissemination of research findings .
Sequential consequences of therapist interventions
The Journal of psychotherapy practice and research
Using sequential analysis, the authors examined how therapists' actions related to the verbal disclosure and defensive patterns that followed therapists' interventions within a single therapy hour for 20 patients. At the same time, a new measure, the Psychodynamic Intervention Rating Scale (PIRS), was tested for reliability and construct validity. Results indicated that therapists fit their styles of intervention to patients' levels of distress and functioning. Within the session, patient's emotional elaboration was followed by therapist's defense interpretation, followed by more patient emotional elaboration. Patient elaboration of significance was followed by more transference interpretation, followed by more patient elaboration of significance. Noninterpretive interventions were followed by patient's disclosure of facts, not emotion. Both interpretive intervention process sequences and therapist's use of support predicted posttreatment symptom reductio...