Announcements

1. Psychodynamic Therapies(Chapter 11)PSYC 4500: Introduction to Clinical PsychologyBrett Deacon, Ph.D.November 5, 2011

2. Announcements • Class is canceled on Tuesday, November 19th (as well as Thursday, November 21st)

3. From Last Class • What does science-based psychotherapy look like? • What form does it take? • ESTs vs. EBP • Biomedical approach to psychotherapy research • RCT became NIMH-mandated method • Emphasis on disorder-specific treatment packages: pros and cons

4. Questions for Deacon (2013) article; Response paper due next Tuesday 11/5 • Describe what you believe to be the three most significant effects (good or bad) of clinical psychology’s adoption of the biomedical model of psychotherapy research.

5. Remaining Topics • Psychodynamic therapy • Client-centered therapy • Cognitive-behavioral therapy • EMDR • Prescription privileges for psychologists • Meeting with psychiatric survivor Laura Delano

6. Psychoanalysis • Predominant model in first half of 20th century • Still a dominant psychological model in psychiatry • Influenced almost every other model • Freud’s early experiences • Studies on hysteria (cured by hypnosis) • Problems caused by hidden memories • Catharsis and abreaction – recalling a repressed memory, realizing its effect on emotion, and expressing the emotion

7. Psychoanalysis • Background and basic principles • Transference – intense emotional relationship between patient and analyst • Caused by patient re-experiencing an emotionally charged relationship from their childhood • Works both ways: countertransference (therapist feelings toward client)

8. Psychoanalysis • Background and basic principles • Repression and resistance • Free association • The interpretation of dreams • Seduction theory of hysteria

9. Technique of Classical Psychoanalysis • The psychoanalytic situation • Endogenous determination of material • Appointments and fees • Selection of patients • Training analyses

10. Evolution of Psychoanalysis • Importance of unconscious and early childhood development but de-emphasis on sex and aggression

11. Psychodynamic Therapies • Focus on interpersonal relationships, not intrapsychic conflicts • Emphasis on the present, not the past • Warm, collaborative relationship, not distant “blank slate” • More brief duration of therapy • Identifying problems and setting goals

12. Psychodynamic Therapy In Practice • Introduction: http://www.youtube.com/watch?v=P1447rpEcKc • Hanna Levenson: Time-limited, dynamic psychotherapy: http://www.youtube.com/watch?v=yTHM2o3dvao • Analysis?

13. Psychodynamic Therapies: Popularity (Weissman et al., 2006)

14. Psychodynamic Therapies: Popularity • Survey of Wyoming therapists (N = 51) • % using psychodynamic therapy for… • OCD = 57.6% • Social phobia = 50.0% • Panic disorder: 50.0% • PTSD = 51.1%

15. Psychodynamic Therapies: Popularity • Psychosocial Treatment Prescriptions for Generalized Anxiety Disorder, Panic Disorder, and Social Phobia, 1991–1996 (Goisman et al., 1999) • Abstract “OBJECTIVE: Pharmacologic prescriptions for anxiety disorders have changed significantly in the last decade. This article investigates whether psychosocial treatments, as reported by 362 subjects in the Harvard/Brown Anxiety Disorders Research Program from 1991 to 1996, changed as well. METHOD: Subjects were interviewed in 1991 and 1995–1996 to determine which psychosocial treatments (behavioral, cognitive, dynamic, or relaxation or meditation) they had received. RESULTS: The percentage of subjects who received each type of psychosocial treatment either declined or remained the same from 1991 to 1995–1996. Dynamic psychotherapy remained the most frequently used method of these four. The percentage of subjects receiving any such method declined. CONCLUSIONS: Behavioral and cognitive treatment, two empirically validated forms of psychotherapy, were less frequently used than dynamic psychotherapy, which lacks such validation. All use of verbal treatment methods declined from 1991 to 1995–1996.”

16. Psychodynamic Therapies • Not particularly “psychological” • Interesting and popular • Not much evidence of their efficacy • Not listed among empirically supported treatments • Exception is Interpersonal Psychotherapy for depression • Short-term psychodynamic therapies also have moderate empirical support for depression

17. Evaluation of Psychodynamic Therapies from Your Textbook • Traditional psychoanalysis – not economically feasible for most patients • Lack of emphasis upon behavior change – can be frustrating to consumers • Brief forms of psychodynamic therapy are the future • Increasing pressure to empirically test psychodynamic therapies

18. Psychodynamic Therapy for Panic Disorder (Milrod et al., 2007) • 24-session, twice-weekly psychodynamic treatment vs. applied relaxation

19. Psychodynamic Therapy for Panic Disorder (Milrod et al., 2007)

20. Psychodynamic Therapy for Panic Disorder (Milrod et al., 2007)

21. Psychodynamic Theory of Panic Disorder • Does the efficacy of psychodynamic therapy provide support for the validity of psychodynamic theory of panic disorder upon which the treatment is based? • How seriously should proponents of science-based psychotherapy take this treatment?

22. Psychodynamic Theory of Panic Disorder • Psychodynamic theory of panic disorder (Milrod, Busch, Cooper, & Shapiro, 1997, pp. 9-10) • Theory derived from a single study using “psychodynamic interviews” with 9 patients

23. Psychodynamic Theory of Panic Disorder • Milrod, Busch, Cooper, & Shapiro (1997, pp. 9-10): • Due either to early childhood trauma or a biologically-caused behavioral inhibition, the child becomes angry with his/her parents rejecting or frightening behavior. “As a result, the child becomes fearful of loss and frightened that his or her angry fantasies will destroy the parent on whom he or she depends. In this vicious cycle, rage threatens the all-important tie to the parent and increases the child’s fearful dependence. This process leads to further frustration and rage at the parent, whom the child views as the source of his or her inadequacies…Immaturity or failure of the ego’s signal anxiety function leads to the uncontrollable onset of panic levels of anxiety.”

24. Psychodynamic Therapy for Panic Disorder • Is this theory falsifiable? • Does manualized, structured, 24-session protocol resemble the way clinicians deliver psychodynamic therapy in the real world? • What should we think about treatments that appear to work, but lack theoretical plausibility?