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At least 19 recordsLinked to original sources
PubMed2000

Individual psychodynamic psychotherapy and psychoanalysis for schizophrenia and severe mental illness.

BACKGROUND: People with schizophrenia and severe mental illness may need much support from health care professionals, in most cases over a long period of time. Research on the effects of psychotherapy for schizophrenia shows mixed results. Although pharmacological interventions remain the treatment of choice for schizophrenia patients, it is also of interest to look at the effects of treatment methods focusing on psychosocial factors affecting schizophrenia. OBJECTIVES: To review the effects of individual psychodynamic psychotherapy and/or psychoanalysis for people with schizophrenia or severe mental illness. SEARCH STRATEGY: Electronic searches of Biological Abstracts (1985-1999), CINAHL (1982-1999), The Cochrane Library CENTRAL (Issue 1, 1999), The Cochrane Schizophrenia Group's Register (1999), Dissertation Abstracts On disc (1866-1999), EMBASE (1980-1999), MEDLINE (1966-1999), PsycLIT (1974-1999), and Sociofile (1974-1998) were made. Authors of included trials were contacted for information on further trials. SELECTION CRITERIA: All randomised trials of individual psychodynamic psychotherapy or psychoanalysis for people with schizophrenia or severe mental illness (however defined) were selected. DATA COLLECTION AND ANALYSIS: Data were independently extracted by at least two reviewers. For dichotomous data relative risks (RR) were calculated and for continuous data weighted mean differences (WMD) between groups were calculated. MAIN RESULTS: No trials of a psychoanalytic approach were identified. Data are sparse for all comparisons involving a psychodynamic approach. There is no evidence of any positive effect of psychodynamic therapy and the possibility of adverse effects seems never to have been considered. The psychodynamic approach may be more acceptable to people than a more cognitive reality-adaptive therapy. REVIEWER'S CONCLUSIONS: Current data do not support the use of psychodynamic psychotherapy techniques for hospitalised people with schizophrenia. If psychoanalytic therapy is being used for people with schizophrenia there is an urgent need for trials.

Humans↗
PubMed1981

Measuring outcome in psychodynamic psychotherapy: Psychodynamic vs symptomatic assessment.

Malan has argued forcefully that meaningful measurement of outcome in psychoanalytically oriented psychotherapy requires a complex clinical-judgment process by an expert clinician that is based on a psychodynamic hypothesis. Information pertaining only to symptom status before and after treatment was abstracted from each of 18 case summaries published by Malan. Each of these abstracted "cases" was related by a nonprofessional judge for global improvement and by me for symptomatic improvement. Correlations among these simple outcome ratings, "dynamic assessments" of treatment outcome made by the Tavistock group, and several theoretically important variables measuring transference manifestations during treatment were examined. Simple symptomatic improvement was an important component of the complex Tavistock outcome rating. The results raised questions as to the importance of the expert clinician and the psychodynamic hypothesis in the assessment of treatment outcome.

Adult↗
PubMed1996

Perceptions of the significant other of the effects of psychodynamic psychotherapy. Implications for thinking about psychodynamic and systemic approaches.

BACKGROUND: Clinical suggests that partners of psychotherapy patients often have powerful feelings about the therapy and therapist. The repercussions of psychotherapy on those close to the patient are rarely considered. A small exploratory study was therefore conducted. METHOD: All patients who had completed at least two months of weekly psychodynamic psychotherapy in 1990 at an out-patient unit of a psychiatric hospital (n = 35) and had a partner with whom they were living at the time of starting therapy (n = 23) were contacted. Eight gave permission for their partner to be contacted directly. All eight partners agreed to participate in a semi-structured interview exploring their perceptions of the effects of the therapy on a number of family relationships. The impact of the process of the study was also investigated by means of a questionnaire sent to all partners some weeks after the interview. RESULTS: Considerable changes were perceived to have taken place in association with therapy affecting not only the relationship between the couple but also their parenting relationship, the children, and at time members of the extended family. Partner's views about the direction of such changes seemed to influence other perceptions about the therapy. CONCLUSION: The repercussions of individual psychotherapy may well spread extensively within a family. This further blurs the boundary between individual and family therapy, both theoretically and clinically. Research procedures are themselves a major intervention and may have a considerable emotional impact on participants.

Adult↗
PubMed1990

[Psychodynamic aspects of behavioral disorders in the senescent patient and their psychodynamic approach].

Melanie Klein's therapy is comprised of elements likely to be transposed to senescence for a better understanding of certain disorders in pathological aging. To this day, several clinical states that appear for the first time at an advanced stage in life, such as certain forms of depression, deliria or intellectual deficiency, have not been satisfactorily explained psychodynamically. The author attempts to create a new approach with a Kleinien perspective.

Aged↗
PubMed1981

Brief psychodynamic psychotherapy: interrater agreement and reliability of individually specified outcomes.

We tested Malan's method of constructing outcome criteria in brief dynamic psychotherapy by positing a core neurotic problem, psychodynamic outcome criteria, and psychodynamically oriented target criteria for 41 neurotic outpatients receiving either psychotherapy or behavioral therapy. We found that trained raters could assess psychodynamic problems and outcomes with high interrater reliability and agreement. Using these measures with behavioral therapy as well as psychodynamic therapy patients, we found that the psychodynamic ratings could be extended to patients not treated psychodynamically. Thus, we feel individualized psychodynamic ratings can be used to assess treatment effects on a reliable psychodynamic basis, and that individualized ratings can be extended to studies which contrast specific psychodynamic outcomes to those of other treatments.

Adult↗
PubMed2002

[The effectiveness of psychodynamic therapy. A review using criteria of evidence-based medicine].

The existing studies on the effectiveness of psychodynamic therapy are reviewed. All studies published between 1960 and 2001 were collected. In the first part of this survey, the focus is on short-term psychodynamic therapy, the second part focuses on longer-term psychoanalytic and psychodynamic therapy. The studies are reviewed with regard to forms of disorders. The methodological quality of the studies is judged according to criteria of evidence-based medicine. These criteria themselves are also critically discussed. Although they vary concerning their methodological quality, the studies reveal evidence of the effectiveness of both short-term and long-term psychodynamic therapy. In a meta-analytic evaluation performed by the author, substantial effects were found for psychodynamic therapy of personality disorders, i.e. 1.13 (self-report measures) and 1.57 (observer-rated measures) for short-term psychodynamic therapy and 1.05 (self-report measures) and 2.11 (observer-rated measures) for longer term psychodynamic therapy. Although there is evidence of the effectiveness of psychodynamic therapy, further research of specific forms of psychodynamic therapy in specific disorders is necessary.

Evidence-Based Medicine↗
PubMed1989

Assessing psychodynamic conflicts: I. Reliability of the idiographic conflict formulation method.

Recent years have seen increasing interest in devising methods of studying psychodynamic phenomena. These efforts have had confront difficulties, first, in specifying the data, the observation language, and rules of inference for psychodynamic propositions, and second, in determining the reliability and validity of the measures used. Given how "fuzzy" traditional psychodynamic concepts are, it is no wonder that psychodynamic clinicians from Freud onward have achieved more success in generating new hypotheses than in testing their validity. As Reichenbach (1938) has observed, science requires that discovery be followed by systematic validation of all new propositions, regardless of their degree of popular acceptance. At the core of efforts to study psychodynamics have been methods to study ego functioning (Bellak and Goldsmith 1984), defense mechanisms (Perry and Copper 1988), and psychodynamic conflicts. This paper reports on the reliability of the Idiographic Conflict Formulation (ICF), a guided method for formulating an individual's psychodynamic conflicts.

Antisocial Personality Disorder↗
PubMed2003

The effectiveness of psychodynamic therapy and cognitive behavior therapy in the treatment of personality disorders: a meta-analysis.

OBJECTIVE: The authors conducted a meta-analysis to address the effectiveness of psychodynamic therapy and cognitive behavior therapy in the treatment of personality disorders. METHOD: Studies of psychodynamic therapy and cognitive behavior therapy that were published between 1974 and 2001 were collected. Only studies that 1) used standardized methods to diagnose personality disorders, 2) applied reliable and valid instruments for the assessment of outcome, and 3) reported data that allowed calculation of within-group effect sizes or assessment of personality disorder recovery rates were included. Fourteen studies of psychodynamic therapy and 11 studies of cognitive behavior therapy were included. RESULTS: Psychodynamic therapy yielded a large overall effect size (1.46), with effect sizes of 1.08 found for self-report measures and 1.79 for observer-rated measures. For cognitive behavior therapy, the corresponding values were 1.00, 1.20, and 0.87. For more specific measures of personality disorder pathology, a large overall effect size (1.56) was seen for psychodynamic therapy. Two cognitive behavior therapy studies reported significant effects for more specific measures of personality disorder pathology. For psychodynamic therapy, the effect sizes indicate long-term rather than short-term change in personality disorders. CONCLUSIONS: There is evidence that both psychodynamic therapy and cognitive behavior therapy are effective treatments of personality disorders. Since 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 are necessary that examine specific forms of psychotherapy for specific types of personality disorders and that use measures of core psychopathology. Both longer treatments and follow-up studies should be included.

Cognitive Behavioral Therapy↗
PubMed1985

Psychodynamic study of male potency disorders. An overview.

The information on the psychodynamics of monosymptomatic functional sexual disorders in men obtained so far from individual psychoanalytical investigations were tested on a large body of patients. In 74 men with psychogenic monosymptomatic primary or secondary potency disorders, several psychoanalytical interviews and pair interviews as well as, in some cases, a short psychotherapy were carried out. Investigations showed that in men with primary or secondary disorders of libido, erection and ejaculation, monosymptomatic neuroses were present in psychodynamic terms with particular repercussions for partner relationships. A correlation of symptomatology, age and psychodynamics was shown. Specific age-dependent conflict constellations could be discerned psychodynamically. In sexual phobias, primary disorders of erection and ejaculatio praecox, oedipal conflicts were found especially in young adults. In ejaculatio deficiens, the specific psychodynamics lay in an anal-retentive defense against pre-oedipal fears of anal-sadistic impulses and fear of ego-loss. In secondary (rarely primary) disorders of libido, erection and ejaculation, character neuroses, neurotic partnership conflicts on a pre-oedipal level as well as narcissistic crises in middle age were found. The results are discussed with regard to earlier views on the psychodynamics of functional sexual disorders in men.

Adult↗
PubMed2000

The value of a psychodynamic approach in the managed care setting.

The managed care setting presents significant challenges to all psychotherapists. Psychodynamic therapists, however, experience specific difficulties in this environment. Despite managed care's general hostility toward psychodynamic theory and practice, psychodynamic therapists provide unique and significant opportunities for patients. Psychodynamic training, with its emphasis on careful evaluation, exploration of unconscious conflict, transference and countertransference, and other therapeutic phenomena, enables clinicians to provide an invaluable service to managed care organizations. The case of K., a 45-year-old man, is used to illustrate the ways in which psychodynamic elements of a brief treatment contributed to a successful outcome. The importance of including psychodynamic treatment in managed care settings is discussed.

Health Maintenance Organizations↗
PubMed1986

[Differentiation and specificity of the psychodynamics of functional sexual disorders in males].

The information on the psychodynamics of monosymptomatic function sexual disorders in men obtained so far from individual psychoanalytical investigations were tested on a large body of patients. In 74 men with psychogenic monosymptomatic primary or secondary potency disorders, several psychoanalytical interviews and pair interviews as well as in some cases a short psychotherapy were carried out. Investigations showed that in men with primary or secondary disorders of libido, erection and ejaculation, monosymptomatic neuroses were present in psychodynamic terms with particular repercussions for partner relationships. A correlation of symptomatology, age and psychodynamics was shown. Specific age-dependent conflict constellations could be discerned psychodynamically. In sexual phobias, primary disorders of erection and ejaculation praecox, oedipal conflicts were found especially in young adults. In ejaculation deficiens, the specific psychodynamics lay in an anal-retentive defense against pre-oedipal fears of anal-sadistic impulses and fear of ego-loss. In secondary (rarely primary) disorders of libido, erection and ejaculation, character neuroses, neurotic partnership conflicts on a pre-oedipal level as well as narcissistic crises in middle age were found. The results are discussed with regard to earlier views on the psychodynamics of functional sexual disorders in men.

Adult↗
PubMed1999

Psychodynamic issues in the emergency department.

A psychodynamically informed approach to interviewing in the PES can greatly enhance clinicians' ability to appropriately assess and manage patients. Although psychoanalysis and psychodynamic psychotherapy as treatments are not appropriate to the emergency setting, the theory and technique that inform them are broadly applicable to all patients. In an age of rapidly proliferating psychopharmacologic approaches, recent major developments in psychodynamic conceptualization and technique are easily overlooked. When coupled with other advances in psychiatry, however, psychodynamic approaches can widen the scope of therapeutic abilities. The psychodynamic perspective can facilitate data gathering, enhance therapeutic alliances and personal safety, aid in treatment, and contribute to psychiatrists' continuing efforts to serve the biopsychosocial needs of all patients.

Emergency Services, Psychiatric↗
PubMed1999

Physiologic and psychodynamic responses to the administration of therapeutic touch in critical care.

Recent publications have questioned the efficacy of therapeutic touch (TT). The focus of attention has been on substantiating the existence of the recipient's energy field rather than on the physiologic and psychodynamic responses to TT. In this article the physiologic and psychodynamic responses during and following the administration of TT is described. The project involved the implementation of a time series design in which the physiologic and psychodynamic responses were measured. It is acknowledged that critical care environments are stressful for patients in terms of invasive medical and nursing procedures. Continuous bright lighting, and excessive noise prohibits the potential for relaxation and sleep. Within this context, the control of confounding variables was not possible, and therefore not an object of concern in the study. Rather the responses to TT in the natural setting were of importance to discern. Statistical repeated measures analysis of variance (one way) indicated there was no significant difference between pre-, during and post-physiologic variables in response to TT. However psychodynamic responses demonstrated significant correlation's in terms of relaxation and sleep. The non significance of physiologic change in variables pre-, during and post-administration of TT indicates critically ill patients remained physiologically stable. Significant correlations of psychodynamic responses demonstrated it is possible for critically ill patients to experience periods of relaxation and sleep in an otherwise stressful environment. TT was found to be a useful therapy to enhance relaxation and sleep in critically ill patients.

Adult↗
PubMed2001

[Psychodynamic therapy in chronic pain patients: a systematic review].

Psychoanalysis has made fundamental contributions to our understanding of somatoform pain disorder; however, psychodynamic therapy procedures have not been accorded their due recognition in the treatment of chronic pain. This is due to the inadequate differential indication for the employment of psychodynamic treatment methods, on the one hand, and to the refusal of most of the psychoanalysts to modify the standard psychoanalytic procedures in accordance with the requirements of pain treatment. This article reviews evidence of the modification of psychodynamic therapy procedures and their outcome in chronic pain patients in the context of past research. We conducted a systematic computer-based literature research employing MEDLINE, EVIDENCE BASED MEDICINE, and PSYNDEX data-bases between 1980 and 2000. Psychodynamic therapy procedures are indicated in the first instance for patients with psychic co-morbidity and those with somatoform pain disorder. A modification of the psychotherapeutic technique, involving an approach that is more structured and is also rather supportive at least at the beginning, is necessary. While employing psychodynamic methods in the treatment of pain patients, greater importance should be attached to the physical level and to the 'holding function' of the therapist than is usually the case with the conventional psychoanalytic therapy procedures.

Chronic Disease↗
PubMed1986

[Psychodynamics of neurotically-induced kleptomania].

With a detailed case report of a patient suffering from kleptomania with neurotic causes, we are trying to obtain more detailed information about such patients' psychodynamics. The case history is preceded by a discussion of the concept of kleptomania. We give a list of the descriptive-empirical papers which prove that one cannot speak of an independent clinical picture, but rather that the kleptomaniac actions may be a symptom of multiple causes. Following the case history, the psychodynamics of this patient is discussed and compared with the existing interpretations, based on depth psychology, of other patients. We confirm the opinion expressed by other authors that kleptomania with neurotic causes is to be classified amongst the impulse neuroses. We criticize the fact that in the presently existing psychodynamic interpretation the sexual symbolism of the theft actions and of the stolen goods themselves has been overvalued. In an ego-psychological consideration, we then draw the attention to these patients' desperate and greedy search for an object which helps them to maintain control over their own destructive aggressiveness and at the same time preserves the object. Subsequently, we suggest distinguishing between two groups of kleptomaniac patients who can be differentiated with regard to their symptoms and psychodynamics. Some kleptomaniacs seem to be "fixed" on special objects when stealing. Others give the impression of being "de-differentiated" by the way they steal. In the latter group the structural ego weakness is the most important feature. These psychodynamic considerations are included in the forensicpsychiatric discussion of kleptomania at the end of this paper. Several criteria are presented, e.g., the symptomatic character of the patients' behaviour, the compulsion to repeat, the progredience of the symptoms, the de-differentiation of personality, which are to contribute to the evaluation of the independence and the automatism of the action with regard to the possibility of a patients' ego control.

Adult↗
PubMed1997

Symptoms and character traits in patients selected for long-term psychodynamic psychotherapy.

In this naturalistic study of 55 outpatients selected for long-term psychodynamic psychotherapy, two Swedish assessment instruments are presented (the Karolinska Psychodynamic Profile and the Karolinska Scales of Personality), and the significance of psychodynamic criteria for the selection of patients is discussed. Thirty patients (55%) fulfilled criteria for a DSM-III-R diagnosis. The most prominent psychodynamically defined character pathology was found in the areas of coping with aggressive affects; dependency and separation; frustration tolerance; and impulse control. Some psychodynamically defined character traits, particularly poor frustration tolerance, were related to symptomatic suffering.

Adult↗
PubMedDate not supplied

[Operationalized psychodynamic diagnosis in childhood and adolescence--a contribution to quality assurance].

Adopting a therapeutic view on diagnosis in child and adolescent psychiatry a psychodynamic diagnostic manual seems to be necessary, that may provide reliability in the assessment of intrapsychic processes. Multiaxial diagnosis of children's and adolescent's psychiatric disturbances may thus be completed with additional psychodynamic assessment procedures. In adults an operationalized procedure of psychodynamic assessment (OPD) already exists. In child and adolescent psychiatry a working group for psychodynamic diagnostic (OPD-KJ) has been founded. In 4 areas (subjective experiences of disturbances, relationships, intrapsychic conflicts and psychic structure) diagnostic manuals are being worked out. Fundamental questions of developmental psychopathology and diagnostic procedures have to be addressed. The basic proposition takes into account that children should not be psychodynamically compared with adults, but normally have a basic capacity to adapt to environment on a high level of psychic organisation in all developmental stages. Reports of the ongoing work are being given.

Adolescent↗