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Intensive short-term dynamic psychotherapy: A review of the treatment method and empirical basis

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Abstract

Based on over forty years of videotaped case-based research, Habib Davanloo of McGill University, Canada, discovered some of the core ingredients that can enable direct and rapid access to the unconscious in resistant3 patients, patients with functional disorders, and patients with fragile character structure. We will describe here some of the main research findings that culminated in his description of a central therapeutic process involved in the intensive short-term dynamic psychotherapy (ISTDP) model. We will also describe the evolution of the technique over the past thirty years and summarize the empirical base for Davanloo's ISTDP. © 2013 Italian Area Group of the Society for Psychotherapy Research.

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... After the pioneering work of Davanloo (1980Davanloo ( , 1990) the ISTDP treatment model, in addition to the traditional way of learning psychotherapy founded on the oral or written transmission of the knowledge (Freud, 1905(Freud, , 1909a(Freud, , 1909b, uses a more technological training modality. Through the use of video technology in didactic teaching, case practice and supervision, it is possible not only to listen and read the therapy reports, but also to see and listen to the psychotherapy live through video review (Abbass, 2004;Abbass et al., 2013b). The advantages of this learning method are clear: the psychotherapy setting is open and other therapists can directly learn a way of doing psychotherapy live. ...
... This objective offers an implicit evaluation of the degree to which the ISTDP approach is transmissible while maintaining the effectiveness already recognized in the literature (Abbass et al., 2012;Abbass et al., 2013b;Rhamani et al., 2020b). ...
... All these data show that beneficial effects of ISTDP when provided by experienced clinicians are also achievable by novice psychotherapists during training. This appears true not only for changes at level of symptom remission (Rahmani, et al., 2020a;2020b), but also at the level of structural/personality change (Abbass et al., 2012;Abbass et al., 2013b;Lilliengren et al., 2020). Our findings provide information about role of limited clinical experience on clinical effectiveness and suggest that factors beyond clinical experience may contribute to outcomes. ...
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This study examines the effectiveness of psychotherapy provided by novice therapists, in an attempt to clarify the controversial relationship between treatment effectiveness and therapist experience. To achieve this, we examined the short- and long-term effec�tiveness of intensive short-term dynamic psychotherapy (ISTDP) in the treatment of patients with the Diagnostic and Statistical Manual of Mental Disorder, IV edition - Text Revision anxiety disorders, as provided by novice psychology trainees. Twenty-two patients with anxiety disorders were provided ISTDP. Patients improved significantly on all outcome indices, including the global assessment of functioning, the symptom checklist and the inventory of interpersonal problems, at the end of the treatment and at 6 and 12 month follow-up. In addition to these results, there was marked structural personality change as evidenced by ratings on the Shedler Westen assessment procedure (SWAP-200), at the same assessment moments; the SWAP-200 psychological health index score showed a meaningful increase in adaptive psychological resources and capacities, while the mean number of personality di�agnoses decreased from the beginning to the end of therapy, and all patients maintaining their gains in 6-12 month follow-up. We conclude that ISTDP provided by novice psychotherapists is efficacious in bringing broad and in-depth change to pathology that can perpetuate anxiety disorders and other psychiatric conditions.
... Davanloo conceptualised the Central Dynamic Sequence (discussed further below) as a systematic method for how, in an idealised therapeutic scenario, the therapist can help the patient overcome their defensive processes in order to contact their hidden attachment emotions (Tab. 7.3, adapted from Abbass, Town, & Driessen, 2013;Davanloo, 1990Davanloo, , 2001Davanloo, , 2005). Davanloo, 2001) 1 Inquiry ...
... The empirical base for ISTDP is still developing. Abbass, Town, and Driessen's (2013) review found 21 outcome studies pertaining to personality disorders, somatic disorders, depression and anxiety disorders, and mixed samples that reference Davanloo's method in their description of treatment. Of these studies, 13 (including 5 RCTs), met criteria for meta-analysis and used common outcome measurements. ...
... Spectra of Psychoneurosis and Fragility (Adapted fromAbbass, Town, & Driessen, 2013) ...
... Thus, in addition to the traditional way of learning psychotherapy founded on the oral or written transmission of the knowledge started with Freud (1905Freud ( , 1909aFreud ( , 1909b, these trainees experience a new and more technological modality starting with the pioneering work of Davanloo. Through this method, it is possible not only to listen and read the therapy reports, but also to see and listen to the psychotherapy live (Abbass, 2004;Abbass., Town, & Driessen, 2013). The advantages of this learning methodology are clear: the psychotherapy setting is open and the other therapists can learn a way of doing psychotherapy "live". ...
... A second objective following on the first is to verify whether ISTDP is effective even when applied by young clinicians, who obtained the title of psychotherapist less than two years previously. Therefore there will also be an implicit evaluation of the degree to which the ISTDP approach is transmissible while maintaining the efficacy already recognized in the literature (Abbass, Town, & Driessen, 2012, 2013. Finally, our last goal is to evaluate whether the obtained changes are limited to symptom remission or if there is also a significant change in personality structure in order to say that some degree of intrapsychic change has occurred. ...
... The flexibility of the approach, the rapid diagnosis conducted through the identification of both the anxiety discharge pathways and the major defenses utilized by the patient, together with the changes in technique of recent years, allow the application of ISTDP to almost 86% of psychotherapy patients (Abbass, 2002). Recent studies on ISTDP show that it is effective with depressive disorder, panic disorder (including obsessive compulsive disorder and phobia) as well as personality disorders (Abbass, Town, & Driessen, 2012, 2013. The metapsychological basis of ISTDP derived from detailed case study, links to both psychoanalytic psychotherapy and Bowlby's attachment model (1982). ...
Article
In the following paper we report on systematic outcomes of Davanloo’s Intensive Short-term Dynamic Psychotherapy as provided by psychology trainees. Eight patients with anxiety disorders were provided ISTDP. Broad ranging results found that both clinician and patient symptom ratings were improved significantly. Beyond this self-reported interpersonal problems were markedly reduced and there was evidence of marked structural personality change as evidenced by ratings on the SWAP-200 instrument. We conclude that ISTDP therapy provided by trainees is efficacious bringing broad and in depth change to pathology that can perpetuate anxiety disorders and other psychiatric conditions
... Patients on the spectrum of fragile character structures have experienced severe, early trauma (Abbass, Town, & Driessen, 2013) with research data demonstrating the presence of a very high degree of primitive murderous rage and guilt within the unconscious (Davanloo, 2000). As they have little capacity to isolate affect or intellectualize about feelings and become tense in the voluntary (striated) muscle, they instead use projection, projective identification, depression, and experience cognitive disruption (Abbass, 2001(Abbass, , 2015. ...
... Regarding the symptoms of hallucinations and delusions in psychosis combined with a loss of reality testing, the propositions are as follows. As projective defenses and splitting prevent the experience of contradicting emotional states, there may be no unconscious anxiety at all (Abbass, Town, & Driessen, 2013). If there is a strong stimulus that triggers mixed emotions and overwhelms these primitive defenses, unconscious anxiety in fragile psychotic people is manifested as cognitive perceptual disruption. ...
Article
In this article, we review Davanloo's metapsychology of the unconscious and how it can contribute to the current psychodynamic understanding and treatment of psychosis. In this framework, current attachment and emotions become connected with unconscious conflict-laden feelings about early attachment trauma at the core of the unconscious conflict. These conflict-laden feelings mobilize unconscious anxiety and defenses, which are alongside or, in and of themselves, constitute the entire picture of psychosis. Those patients with low emotional capacities are provided specific therapeutic techniques to bolster anxiety tolerance while those more defended patients are offered means to begin to accept and experience the feelings they have about present and past adverse experiences including those caused by psychosis itself. Case and case series research have shown this model to be clinically effective and cost effective as an adjunct to care. Case vignettes will describe the assessment of capacities and treatment frame for patients with a history of psychosis. Davanloo's metapsychology of the unconscious offers an important contribution to the current psychodynamic understanding of psychosis by considering the role of attachment, emotions and unconscious conflict and addressing these through specific psychodynamic interventions.
... Davanloo conceptualised the Central Dynamic Sequence (discussed further below) as a systematic method for how, in an idealised therapeutic scenario, the therapist can help the patient overcome their defensive processes in order to contact their hidden attachment emotions (Tab. 7.3, adapted from Abbass, Town, & Driessen, 2013;Davanloo, 1990Davanloo, , 2001Davanloo, , 2005). ...
... Spectra of Psychoneurosis and Fragility (Adapted fromAbbass, Town, & Driessen, 2013) ...
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When people seek psychological support, formulation is the theory-driven methodology used by many practitioners to guide identification of the processes, mechanisms, and patterns of behaviour that appear to be contributing to the presenting difficulties. However, the process of formulating – or applying psychological theory to practice – can often seem unclear. In this volume, we present multiple demonstrations of formulation in action – written by applied psychologists embedded in clinical training, research, and practice. The volume covers a range of contemporary approaches to formulation and therapy that have not been considered in extant works, and includes unique sections offering critical counter-perspectives and commentaries on each approach (and its application) by authors working from alternative theoretical positions.
... 11 The interested reader can find a description of these studies in recently published reviews. 11,20 Several key points can be distilled from this literature: First, the RCTs, which were of adequate quality 3 to use as the basis for evidence-based recommendations, demonstrated efficacy of ISTDP for personality disorders. ISTDP was efficacious when compared to control, 22,22 and no significant differences were found compared to other formal psychotherapy treatment. ...
... These studies are thoroughly described in two recently published articles. 11,20 Several findings were evident across the literature. First, patients treated with IST-DP had significant improvements in target symptom ratings post-treatment, including measures of chronic back pain, psychogenic movement disorder, general somatic symptomology, and urinary symptoms or pelvic pain. ...
Article
CME EducationaL Objectives 1. Review the outcome evidence of prior meta-analytic reviews of intensive short-term dynamic psychotherapy (ISTDP). 2. Provide an additional meta-analysis of ISTDP for the treatment of personality and somatic disorders. 3. Suggest areas for future study in the use of psychodynamic psychotherapy for personality and somatic disorders. The literature reviewing studies of psychodynamic psychotherapy clearly demonstrates evidence for the efficacy of both short-term and long-term models. Meta-analytic reviews synthesizing effects across different psychodynamic psychotherapy formats have been conducted for common mental disorders, depression, depression in the setting of personality disorder, personality disorders, and somatic disorders. Psychodynamic psychotherapy demonstrates superiority to control condition, and no significant difference to other formal psychotherapies, including cognitive behavioral therapies. Building upon a recently published systematic review and meta-analysis,11 the aim of this article is to further examine the evidence for a contemporary psychodynamic psychotherapy treatment protocol, intensive short-term dynamic psychotherapy (ISTDP), in the treatment of personality and somatic disorders.
... 5 Although psychiatry residency training programs continue to underscore the importance of psychodynamic psychotherapy as a paradigm, faculty members are often unaware of the outcome data to support this. 6 ISTDP, in particular, is accumulating increased empirical support for the treatment of a wide array of diagnoses. 7,8 We are not aware of any studies in the literature that assess outcome measures and cost-effectiveness of psychodynamic psychotherapy delivered exclusively by psychiatry residents. ...
... This mirrors other studies in this field. 7,8,18 In our clinic, we serve a region spanning 8 hours by car, so it is great work for many patients to come to receive care. Thus, many treatment courses are brief with an average of approximately seven sessions. ...
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CME Educational Objectives 1. Understand the role of training in psychodynamic psychotherapy in psychiatry residency training programs. 2. Learn a potential model for training residents in a short-term model of psychodynamic psychotherapy. 3. Review the efficacy and cost-savings data in a study training residents in this model. Whereas psychiatry grows as a field through contributions from neuroscience, genetics, psychopharmacology, and diagnostic specificity, psychiatrists continue to value the importance of psychodynamic assessment and intervention. This is reflected in the current Royal College of Physicians and Surgeons of Canada and American College of Graduate Medical Education (ACGME) guidelines in psychiatry, requiring the demonstration of competency in psychodynamic psychotherapy. This has been further underscored through the roll out of the Next Accreditation System, requiring faculty in psychiatry training programs to delineate the achievement of resident milestones in the area of psychodynamic psychotherapy.
... Intensive short-term dynamic psychotherapy (ISTDP), delivered as a brief intervention, is effective across a broad range of psychiatric conditions [1]. Treatment starts with a comprehensive clinical interview called a trial therapy. ...
Article
Received: January 23, 2018 Accepted: February 11, 2018 Published online: April 10, 2018 Issue release date: August 2018
... A defining feature of PDT models is that symptoms and defenses are based on underlying internal conflicts (Leichsenring & Salzer, 2014). The assumed nature of the conflict may vary somewhat across models-for instance, between activating and inhibitory emotions in affect-phobia therapy (McCullough & Andrews, 2001) and between attachment wishes and rage over their frustration in short-term dynamic therapy (Abbass, Town, & Driessen, 2013). Anyhow, the symptoms are explained in terms of latent variables, leading to an inability to define the presumed cause independent of outcome and to represent within-person relationships. ...
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The purpose of this study was to examine the conceptualization of mental problems and disorders inherent in the therapeutic theories used in psychodynamic (PDT) and cognitive-behavioral therapy (CBT). Supportive-expressive (SET) and cognitive (CT) therapy for social anxiety disorder (SAD) were used as representative examples. Based on the typology proposed by Kendler, Zachar, and Craver, we found that PDT models accord with an essentialist model of mental disorders, while CBT models align with a mechanistic property cluster (MPC) model. Because the PDT explanatory concepts represent definitions of symptoms rather than causal explanations of them, PDT models cannot be examined with regard to mechanisms of change. Moreover, because these concepts are treated as latent constructs, they are not able to represent within-person causal/mechanistic relationships between observable phenomena. PDT models cannot while CBT models can lead to testable predictions and knowledge accumulation.
... Among the brief therapy methods, intensive short-term dynamic psychotherapy (ISTDP) (Abbass, 2015;Davanloo, 2000) is a broadly applied treatment of mixed psychiatric disorders with growing empirical support. This treatment model has been studied with case series research and randomized controlled trials and found to show large treatment effects for psychosomatic, depressed, anxious, personalitydisordered, and mixed populations, which are maintained in follow-up (Abbass et al., 2012Town and Driessen, 2013). ...
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This study examined the effects of trial therapy interviews using intensive short-term dynamic psychotherapy with 500 mixed sample, tertiary center patients. Furthermore, we investigated whether the effect of trial therapy was larger for patients who had a major unlocking of the unconscious during the interview compared with those who did not. Outcome measures were the Brief Symptom Inventory (BSI) and the Inventory of Interpersonal Problems (IIP), measured at baseline and at 1-month follow-up. Significant outcome effects were observed for both the BSI and the IIP with small to moderate preeffect/posteffect sizes, Cohen's d = 0.52 and 0.23, respectively. Treatment effects were greater in patients who had a major unlocking of the unconscious compared with those who did not. The trial therapy interview appears to be beneficial, and its effects may relate to certain therapeutic processes. Further controlled research is warranted.
... We are both concordant with the basic finding that psychodynamic therapy can be "uniquely effective" in these complex populations (Davanloo, 1990). Several of the aspects of this research have been corroborated by various groups of process researchers over the past 20 years (Abbass, Town, & Driessen, 2013). ...
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The objective is to study the effectiveness of Intensive Short-Term Dynamic Psychotherapy (ISTDP) trial therapies. In a tertiary psychotherapy service, Brief Symptom Inventory (BSI), Inventory of Interpersonal Problems (IIP) medication use, and need for further treatment were evaluated before versus 1-month post trial therapy in a sequential series of 30 clients. Trial therapies were interviews with active focus on emotions and how they are experienced. The interviews resulted in statistically significant improvements on all BSI subscales and one of the IIP subscales. One-third of clients required no further treatment, seven stopped medications, and two returned to work following trial therapy. The ISTDP trial therapy appeared tobe clinicallyeffectiveandcosteffective. Future researchdirections arediscussed. (Brief Treatment and Crisis Intervention 8:164-170 (2008))
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The present study investigated change in patient resistance in the transference relationship in Davanloo's (1990) STDP by assessing change in patient BECAs, from early to late therapy. A clinical sample (n=6) significantly differed between early and late therapy on anxiety, BECAs, and GAF ratings. Change, from early to late therapy, in GAF ratings (indexing therapeutic improvement) correlated marginally significantly with change, from early to late therapy, in BECAs (indexing reduction of resistance in the transference). Results are seen as consistent with Davanloo's (1990) theory that positive therapeutic outcomes are caused by positive changes in alliance, from early to late therapy, and by related negative change in resistance, from early to late therapy. Results also are seen as consistent with Westerman et al's (1995) model of linearly increasing alliance in successful STDP, and with other research implicating reduced resistance as a factor in STDP's efficacy.
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This paper describes the profile of verbal response modes utilised in the expert application of Short-Term Dynamic Psychotherapy (STDP). One hundred and fifteen randomly selected segments from six treatments of STDP were analysed. Trained raters used a verbal response mode coding system to examine the individual speaking turns of an expert therapist. Based on the profile of therapist interventions reported, it was concluded that the actual conduct of this treatment in routine practice illustrates the empirically informed modifications to STDP technique integrated alongside the common characteristics of STDP based on the therapist (i) adopting an active stance, (ii) maintaining treatment focus using frequent confrontations and the ‘Triangle of Conflict’, and (iii) tailoring treatment to participant functioning using a combination of supportive and expressive interventions. Furthermore, specific differences in therapist activity were observed across treatment phases as well as between participants.
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Studied patient defensive behavior and therapist addressing defense (TAD) in short-term dynamic psychotherapy and brief adaptive psychotherapy in 28 adult patients with personality disorders. Three levels of patient defense (immature, intermediate, and mature) were coded. Only intermediate defensive behavior such as intellectualization and rationalization decreased. The greater the frequency of Ss' intermediate and immature defenses early in treatment, the better the outcome. Ss' defensive behavior was significantly correlated with the therapist addressing this behavior and with a decrease in immature and intermediate defenses. The frequency of TAD was significantly correlated with patient outcome. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This paper attempts to provide an overview of a variation of Davanloo's Intensive Short-Term Dynamic Psychotherapy known as the Graded Format. This format is the appropriate choice for therapists who wish to treat particular diagnostic groups such as depressive disorders, functional disorders, panic disorder, certain psychosomatic conditions, syntonic character pathology, patients with low capacity to tolerate anxiety and those with mild to moderate degrees of fragility. A summary of key conceptual and technical aspects of the Graded Technique is provided along with some clinical vignettes, followed by a brief overview of why some therapists fail to apply this method, the consequences of such failure and the method's overall advantages.
Article
The current study examined changes in the ratio of patients' affective and defensive behaviors during the course of brief psychodynamic psychotherapy. Treatments of 16 patients were videotaped. For each patient, four sessions were evaluated with a minute-by-minute coding system of process variables. When patients were grouped according to outcome scores, significant differences between the high outcome and the average-to-low outcome groups emerged. During the early phase of treatment, patients in both groups showed an average of one affective response per five defensive responses. By the late phase of treatment, the high outcome patients showed a marked shift to one affective response per two defensive responses, while the low outcome patients remained the same. An incidental finding was a negative correlation between good outcome and the ratio of defensive behavior to total patient activity.
Article
Habib Davanloo has spent his career developing and teaching methods to accelerate dynamic psychotherapy, including his technique of intensive short-term dynamic psychotherapy (ISTDP). Over the past 20 years, outcome studies using this treatment have been conducted and published. We performed a systematic review of the literature to obtain studies presenting ISTDP outcome data. We found 21 studies (10 controlled, and 11 uncontrolled) reporting the effects of ISTDP in patients with mood, anxiety, personality, and somatic disorders. Using the random-effects model, we performed meta-analyses including 13 of these studies and found pre- to post-treatment effect sizes (Cohen's d) ranging from 0.84 (interpersonal problems) to 1.51 (depression). Post-treatment to follow-up effect sizes suggested that these gains were maintained at follow-up. Based on post-treatment effect sizes, ISTDP was significantly more efficacious than control conditions (d = 1.18; general psychopathology measures). Study quality was highly variable, and there was significant heterogeneity in some analyses. Eight studies using various measures suggested ISTDP was cost-effective. Within limitations of study methodologies, this evidence supports the application of ISTDP across a broad range of populations. Further rigorous and targeted research into this method is warranted.
Article
Somatization of emotions accounts for excess emergency department (ED) visits in the form of medically unexplained symptoms (MUS). Intensive short-term dynamic psychotherapy (ISTDP) has been used to diagnose and manage somatization. We examined the effectiveness of this procedure for ED patients with MUS. We implemented a service that included staff education, timely access to consultation and gathering of outcome data. Patients were assessed and treated shortly after referral. There was a mean reduction of 3.2 (69.0%) ED visits per patient (standard deviation [SD] 6.4) the year afterward (95% confidence interval [CI] 1.3-5.0, p< 0.001). In comparison revisit rates during the same time interval for 3 available ED populations (i.e., those matched by visit rates, those with matching complaints and all patients referred to the service but never seen) showed either smaller reductions or higher ED use (ranging from a 15% reduction to a 43% increase). Treatments averaged 3.8 sessions per patient (SD 5.3). Self reported symptoms improved significantly with the Brief Symptom Inventory global rating, which changed from a mean of 1.21 (SD 0.58) before assessment to 0.86 (SD 0.63) ( p< 0.01) at the end of contact with the service. The service appeared acceptable to both emergency physicians and patients. This emotion-focused assessment and treatment method appeared to be feasible and may be effective in reducing both symptoms and repeat ED use.
Article
Typescript (photocopy). "Graduate Program in Psychology." Vita. Thesis (Ph. D.)--Rutgers University, 1988. Includes bibliographical references.
Article
Typescript. Thesis (Ph. D.)--New York University, School of Education, 2003. Includes bibliographical references (leaves 152-172).
Article
Thesis (Ph. D.)--Columbia University, 1987. Includes bibliographical references (leaves 115-126). Microfiche (positive).
Article
Somatization, anxiety, depression and personality disorders are common features of many patients with chronic headaches. Intensive short-term dynamic psychotherapy (ISTDP) is a brief therapy method developed specifically to treat patients with this cluster of somatic problems, symptoms and maladaptive behaviours through focusing on how the patient handles emotional experiences. It also contains a direct method of assessing the somatic discharge pathways of both emotions and anxiety, thus allowing direct observation of somatization in the case of many chronic headache sufferers. In this review, we summarize the extant literature on emotional factors in headache, review the evidence for short-term dynamic therapies in somatic problems and describe the assessment and treatment method of ISTDP we use routinely with chronic headache sufferers.
Article
Although panic disorder can be effectively alleviated by drug treatment, the relapse rate is high. By adding brief dynamic psychotherapy focused on the psychosocial vulnerability of patients with panic disorder to an established drug treatment regimen, we hypothesized that this would result in a lower relapse rate after pharmacotherapy. Patients with panic disorder (defined by DSM-III-R) were randomized to treatment with either clomipramine for 9 months (n = 20), or clomipramine for 9 months combined with 15 weekly sessions of brief dynamic psychotherapy (n = 20). Measures of anxiety and depression were collected at intake and at regular intervals. The patients had blind follow-up interviews at 6, 12, and 18 months after beginning treatment. All patients in both groups became free of panic attacks within 26 weeks of the start of treatment. On termination of pharmacotherapy, the relapse rate was significantly higher in the clomipramine-only group during the follow-up period. There were significantly lower scores for most anxiety measures in the clomipramine plus psychotherapy group at the 9-month follow-up. The addition of brief dynamic psychotherapy to treatment with clomipramine significantly reduces the relapse rate of panic disorder compared with clomipramine treatment alone.
Article
PMD are disabling, but lack any generally accepted treatment strategies. Ten patients with PMD received treatment with Psychodynamic Psychotherapy. Patients were assessed with psychiatric rating scales and the movement disorder was rated by a blinded rater with the Psychogenic Movement Disorder Rating Scale (PMDRS). Total mean PMDRS (p = 0.0195), total PMDRS function scores (p = 0.0142), Hamilton depression scores (p = 0.009), Beck anxiety scores (p = 0.002), and GAF (p = 0.0083) all improved with psychotherapeutic intervention. Psychotherapy and appropriate use of adjunct psychiatric medication can be a successful intervention for PMD.
Article
The authors systematically examined the relationship between therapist facilitation of patient emotional experience/expression and outcome in psychodynamic psychotherapy. Computer and manual searches were conducted for relevant publications, and 10 independent samples of short-term dynamic psychotherapy were included in a meta-analysis. Data analysis included calculation of an overall effect size of the relationship between therapist affect focus and outcome, statistical significance, and test for homogeneity. In addition, moderator analyses were conducted to examine the potential impact of type of outcome construct used and the methodological quality of individual studies. The overall average weighted effect size across all outcome types was statistically significant (r=0.30), and the homogeneity statistic was nonsignificant. Moderator analyses indicated a statistically significant relationship between therapist facilitation of patient emotional experience/expression and outcome when more than one outcome construct was included but not when either a single or an unclear outcome construct was used. There were no significant relationships between methodological quality and the size of the effects, although use of audio- or videotaping for supervision demonstrated a moderate effect. These data indicate that therapist facilitation of patient affective experience/expression is associated with patient improvement over the course of psychodynamic psychotherapy. Although the size of this relationship was not significantly related to methodological quality, results suggest the importance of close supervision of actual techniques through the use of audio- or videotapes. Additionally, results highlight the importance of defining outcome in a multidimensional way to properly assess theoretically relevant effects.
Intensive short-term dynamic psychotherapy: Correlates with clinical effectiveness
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