Question 3: Shedler Efficacy of Psychodynamic Treatment

Question 1

Main premise

Answer 1

Empirical evidence supports the efficacy of psychodynamic psychotherapy

Pts. Who receive psychodynamic psychotherapy maintain therapeutic gains and appear to continue to improve after tx

Nonpsychodynamic therapies may be effective in part bc the more skilled practitioners utilize techniques that have long been central to the psychodynamic theory and practice

The goals of psychodynamic therapy include, but extend beyond, symptom remission. Successful tx should not only relieve symptoms but also foster the positive presence of psychological capacities and resources

Such ends are pursued through a process of self-reflection, self-exploration, and self-discovery that takes place in the context of a safe and deeply authentic relationship btw therapist and pt

The essence of psychodynamic therapy is exploring those aspects of the self that are not fully known, especially as they are manifested and potentially influenced in the therapy relationship

Question 2

7 Fundamental Principles of modern psychodynamic psychotherapy

Answer 2

1. Focus on affect and expression of emotion
2. Exploration of attempts to avoid distressing thoughts and feelings
3. Identification of recurring themes and patterns
4. Discussion of past experiences (developmental focus)
   * focus is not on the past for its own sake but rather on how the past sheds light on current psychological difficulties
5. Focus on the interpersonal relations
6. Focus on the therapy relationship
7. Exploration of fantasy life
   *In contrast to other therapies where the therapist may actively structure sessions or follow a predetermined agenda, psychodynamic therapy encourages pts to speak freely about whatever is on their mind
   This provides a rich source of info about how the pt views self and others, interprets and makes sense of experience, avoids aspects of experience or interferes with a potential capacity to find greater enjoyment in the meaning of life

Question 3

Empirical Claims

Answer 3

Studies supporting the efficacy of psychodynamic therapy span a range of conditions and populations:
• Depression, anxiety, panic, somatoform disprders, eating disorders, substance-related disorders, and personality disorders

Tx showed changes in underlying psychological mechanisms (intrapsychic processes) believed to mediate symptom change in BPD pts
• Such intrapsychic changes may account for long-term txt benefits
• No other tx for personality pathology has shown such enduring benefits

Question 4

Questioning Efficacy Studies

Answer 4

o A concern often raised about psychodynamic psychotherapy efficacy studies is that they use highly selected and unrepresentative pt. samples (range of symptoms rather than focusing on a diagnostic category) and consequently that their findings do not generalize to real-world clinical practice

Question 5

Shedler’s response to concerns over findings

Answer 5

DSM doesn’t define discrete homogenous pt groups Comorbidity always a factor
Diagnosable complaints are often embedded in personality symptoms

An increasing # of studies of psychodynamic txts are focusing on specific diagnoses

Question 6

“A rose by any other name” Psychodynamic Process in Other Therapies

Answer 6

The “active ingredients” of therapy are not necessarily those presumed by the theory or tx model.

Therefore, randomized controlled trials that evaluate a therapy as a ”package” do not necessarily provide support for its theoretical premises or the specific interventions that derive from them

Therapists act differently no matter what the tx

Unique patterns of interaction develop between them even in tx that are systematized

Studies of therapy “brand names” can be highly misleading
• In reality these therapies have active ingredients of psychodynamic elements (most likely unacknowledged)
• Therapeutic alliance is now considered a part of many therapies (but originally was a psychodynamic feature)

Question 7

The Dodo says: “everybody has won, and all must have prizes”

Answer 7

…Outcomes for different therapies were surprisingly equivalent and no form of psychotherapy proved superior to any other

Investigator allegiance effect:
When differences between tx are found, results always favored the preferred tx of the investigators

There are many reasons why outcome studies may fail to show differences between tx even if important differences do exist →

Mismatch between what psychodynamic therapy aims to accomplish and what outcome studies typically measure

SWAP (clinician report) assesses the inner capabilities and resources that psychotherapy may develop