The Emergence of Psychodynamic Psychotherapy for Treatment Resistant Patients: Intensive Short-Term Dynamic Psychotherapy

Changes in clients' relational patterns with parents and therapist during psychodynamic psychotherapy: Their association and relation to treatment outcome

OBJECTIVE

The study aimed to explore how changes in clients' relational patterns during psychodynamic psychotherapy relate to treatment outcomes and therapy effectiveness.

METHOD

Seventy clients receiving psychodynamic psychotherapy in a university counseling center were interviewed three times and filled out the OQ-45 questionnaire five times during therapy. We used the Core Conflictual Relationship Theme (CCRT) to study clients' relational patterns. Mixed models were used to assess the interaction between clients' CCRT intensity toward their parents and toward their therapists, treatment effectiveness, and treatment outcome.

RESULTS

First, we found that clients' relational patterns with their parents correlated with relational patterns with their therapists across several time points in therapy. Then, we found significant interactions, indicating that treatment effectiveness moderates the relationship between clients' CCRT intensity and treatment outcomes.

CONCLUSIONS

The findings suggest that the transference phenomenon is related to therapy outcomes differently in effective and less-effective therapies, depending on the transference intensity. Further research is needed to expand knowledge about the intensity of transference and its possible impact on treatment choice and management.

Challenging the role of challenge in intensive short-term dynamic psychotherapy for social anxiety disorder: A randomized controlled trial

OBJECTIVES

Intensive short-term dynamic psychotherapy (ISTDP) requires the technique of challenge to defenses when treating resistant patients. As the technique of challenge is difficult for some therapists to practice, it leads us to question whether challenge can be replaced by clarification of defenses without losing treatment effectiveness. This study compared ISTDP with two different technical emphases while treating social anxiety disorder (SAD).

METHOD

Forty-two subjects with DSM-5 SAD were randomly assigned to either a waitlist control, 10 sessions of ISTDP with the use of challenge or 10 sessions of ISTDP without the use of challenge.

RESULTS

ISTDP led to significant, sustained symptom reduction on the Liebowitz Social Anxiety Scale (LSAS-SR) compared with the control group. There were no significant outcome differences between standard ISTDP and ISTDP where challenge was restricted.

CONCLUSION

ISTDP is efficacious for SAD. ISTDP may be effective for SAD without the use of challenge elements.

The Emergence of a Stereotypic Movement During Intensive Short-Term Dynamic Psychotherapy in a Patient with Obsessive Compulsive Disorder: A Case Report

No previous research has investigated the emergence of stereotypic movements in patients during psychotherapeutic sessions, nor have such movements been mentioned in the numerous articles on Habib Davanloo's technique of intensive short-term dynamic psychotherapy. In this article, we present two clinical vignettes from early intensive short-term dynamic psychotherapy sessions, using Davanloo's technique, with a patient who was observed to have an emerging stereotypic movement. These vignettes, extracted from the videotaped sessions using audiovisual technology, concern a young woman who is known to have treatment-resistant obsessive-compulsive disorder. By presenting this case report, we aim to highlight the possibility of the occurrence of such a movement in response to specific interventions, and propose its clinical significance. We interpret this movement as being a tension-releasing mechanism that manifests in response to the therapist's exploration of the patient's emotions. We propose that the purpose of this stereotypic movement is to defend against the patient's actual experience of her repressed feelings. Clinical outcome of this case suggests that psychodynamic psychotherapy could be an effective intervention for patients with treatment-resistant obsessive-compulsive disorder.

The Efficacy of Intensive Short-Term Dynamic Psychotherapy for Social Anxiety Disorder: Randomized Trial and Substudy of Emphasizing Feeling Versus Defense Work

This research examined the efficacy of intensive short-term dynamic psychotherapy (ISTDP) in the treatment of social anxiety disorder (SAD) and compared the therapeutic outcomes of ISTDP when feeling focus or defense work is emphasized. A three-group randomized design with 6-month follow-up was used. Forty-one subjects were selected among volunteer college students diagnosed with SAD. They were assigned randomly into three groups; 14 cases to feeling-focused ISTDP (FF-ISTDP) group, 14 cases to defense-focused ISTDP (DF-ISTDP) group, and 13 cases to a control group. All subjects were evaluated at pretest, posttest, and six-month follow-up through clinical interviewing using DSM-5 criteria for SAD along with the Liebowitz Social Anxiety Scale. Each experimental group had a course of 8 to 10 sessions of ISTDP treatment. Analysis of variance showed that ISTDP is an effective treatment for SAD compared with a control group. No outcome differences were found between FF-ISTDP and DF-ISTDP in treating SAD.

The Role Of Closed-Circuit Training in Short-Term Dynamic Psychotherapy Teaching

Closed-circuit training is a unique setting developed by Habib Davanloo, the founder of intensive short-term dynamic psychotherapy. The purpose of this setting is to achieve therapeutic benefits for the patient while providing valuable educational opportunities to the trainee. In this article, the authors present an intensive short-term dynamic psychotherapy session that was conducted in a closed-circuit setting at McGill University Health Center. The primary goal of the article is to highlight several aspects of Davanloo's metapsychological principles and the application of their corresponding technical interventions. Another goal is to convey the trainee's reflection on his experience and perception of the closed-circuit training. The authors propose that closed-circuit training could be considered a potential alternative, or at least a complementary method, to the traditional settings of psychotherapy training and supervision.

Dynamic Psychotherapy: The Therapeutic Process in the Treatment of Obsessive-Compulsive Disorder

Dynamic Psychotherapy (DP) was developed to overcome the limitations of traditional psychoanalysis, responding to a broader demand of patients who seek help to cope with specific problems in the short term, such as Obsessive-Compulsive Disorder (OCD). OCD is a chronic disabling mental disorder that leads to substantial distress, functional disability and severe occupational and social impairments. Recognizing the literature gap in this field, and the improvements reported by dynamic therapists who have dealt with patients suffering from OCD, a study on the treatment of these patients was conducted in order to discuss the effects of this technique. The method involved a narrative literature review and the analysis of two clinical cases to discuss therapeutic processes, which include the specificities of OCD patients and the mechanisms adopted in the treatment through DP. The therapist’s active stance seemed to be essential to encourage the patient to face feared situations and identify the core conflict. Both patients who were treated through DP presented similarities, such as high anxiety, feelings of guilt and inhibition of aggressive and sexual impulses. Through emotional exploration, confrontation of defensive functioning and interpretative interventions of inner conflicts, patients had reached awareness of their hidden feelings and experiences, and their symptoms and feelings of guilt decreased. They also showed significant improvements in their interpersonal relationships. Although both treatments do not fit into short-term therapies, this technique has led to long-term results, providing evidence that DP may produce favorable outcomes in the treatment of OCD.

Pilot study: An inpatient drug rehabilitation program based on intensive short-term dynamic psychotherapy

Addiction programs are plagued with high dropout and relapse rates. A large proportion of patients suffering from addiction also suffer from personality disorders. A 30-day inpatient program based on intensive short-term dynamic psychotherapy was developed to address features of personality disorders such as anxiety regulation, emotion recognition, and handling of fear responses and projective processes. The hypothesis was that addressing comorbid symptoms of personality disorder might improve recovery from drug addiction. We used a pilot randomized controlled trial design with six-month follow-up of both cases and controls. Rates of remission, relapse and drop out were recorded at each time point. N-1 chi-squared (χ²) tests were conducted to examine the statistical significance of differences in outcomes in patients receiving the experimental treatment and controls. A control group of 20 patients and an experimental group of 42 patients were treated. Dropout: control group 40%; experimental group 23.8%. Sobriety at six months: control group 17.6%, experimental group 48.8%. Future study is warranted to examine intensive short-term dynamic psychotherapy's long-term effects, study moderators of effects, and study its efficacy using a randomized controlled design.

The relationship between defense mechanisms and religious coping using a new two-factor solution for the Defense Style Questionnaire-40

This study examined the factor structure of the Defense Style Questionnaire (DSQ-40) and explored the relationships between defense mechanisms and religious coping in a diverse sample of 380 college students. In contrast with the three-factor model of defenses proposed by the developers of the DSQ-40, principal axis factoring yielded two internally consistent components: adaptive and maladaptive defense styles. Endorsement of adaptive defenses was positively correlated with the use of positive religious coping strategies and negatively correlated with negative religious coping. Maladaptive defenses were associated with the endorsement of negative religious coping strategies. Clinical implications of these findings are discussed and recommendations are made for future use of the DSQ-40.

Mentalized affectivity: A new model and assessment of emotion regulation

Here we introduce a new assessment of emotion regulation called the Mentalized Affectivity Scale (MAS). A large online adult sample (N = 2,840) completed the 60-item MAS along with a battery of psychological measures. Results revealed a robust three-component structure underlying mentalized affectivity, which we labeled: Identifying emotions (the ability to identify emotions and to reflect on the factors that influence them); Processing emotions (the ability to modulate and distinguish complex emotions); and Expressing emotions (the tendency to express emotions outwardly or inwardly). Hierarchical modeling suggested that Processing emotions delineates from Identifying them, and Expressing emotions delineates from Processing them. We then showed how these components are associated with personality traits, well-being, trauma, and 18 different psychological disorders (including mood, neurological, and personality disorders). Notably, those with anxiety, mood, and personality disorders showed a profile of high Identifying and low Processing compared to controls. Further, results showed how mentalized affectivity scores varied across psychological treatment modalities and years spent in therapy. Taken together, the model of mentalized affectivity advances prior theory and research on emotion regulation and the MAS is a useful and reliable instrument that can be used in both clinical and non-clinical settings in psychology, psychiatry, and neuroscience.