Long Term and Other Types of Psychotherapy
Natalie Reiss, PhD, wrote an excellent article reviewing recently published findings that long term psychotherapy is effective in treating complex emotional disorders. Her review can be found at:
The purpose of the following posting is to clarify some of the types of psychotherapy available to people and to throw more light on just what is meant by "long term psychotherapy."
Evidence Based Psychotherapies:
Among the types of psychotherapy we frequently discuss at Mental Help Net are what Dr. Reiss correctly refers to as EBT's or Evidence Based Psychotherapies. Examples of EBT's are Cognitive Behavioral Therapy(CBT, Dialectical Behavior Therapy(DBT), and Interpersonal Psychotherapy(IP). Each of these treatments is relatively short term in nature and the results of treatment are measurable. In fact, therapist and client begin treatment with specific short and long term goals that are clearly listed and measured to determine if they have been achieved and to what extent.
Therefore, most of the shorter term therapies involve client and therapist recording specific cognitions (thoughts) correcting distorted themes and experimenting with new non distorted ways of thinking. Each week the client has specific homework assignments. The role of the therapist is to be an educator, shaper of new thinking and new behaviors and maintainer of a positive relationship between therapist and client. The spouse and family of the client can be and are used as reporters of positive changes in the client. While helping maintain a positive relationship during the therapeutic work, the therapist is an active participant during session.
Interpersonal therapy is based on the premise that the client is symptomatic because of problematic relationships with others. Therefore, therapeutic works centers around finding solutions to current interpersonal problems. As a result, a lot of family work is done so as to improve communication skills at home. Here, too, the emphasis is on maintaining a positive therapeutic relationship while the therapist plays an active role. In fact, the therapist serves as a source of information, uses social skills building training, and advocates for the client.
Psychodynamic therapy is different from these forms of treatment. The client is most often referred to as a patient. Patient symptoms are viewed as psychodynamic in nature. Psychodynamics refers to one of several ways of viewing patients and their problems. The oldest form of psychodynamic therapy is psychoanalysis and is based on Sigmund Freud's work. However, as psychoanalysis evolved, newer ways of viewing patients became prevalent. Basically, patients are viewed as suffering from conflicts within their personalities. These conflicts could be viewed as between Id, ego and superego or between the conscious and the unconscious mind (Freud).
The purpose of psychodynamic therapy is to reduce these conflicts and basically change the personality of the individual.
The role of the therapist is to remain fairly quiet, allowing the patient to uncover ever increasing amounts of their unconscious minds and ever greater amounts of the conflicts they experience between id, ego and superego. Patient dreams are considered an important part of treatment and patient and therapist collaborate to find the correct interpretation of the dream.
Psychodynamic treatment takes a long time, especially in comparison to the other treatments mentioned. Patients attend therapy sessions three to five times per week. There are some psychodynamic therapist who keep sessions to twice a week. The length of treatment can range from a minimum of one year to as many as fifteen and more years. Freud himself saw patients five times per week and his treatment lasted for one year.
It would be a mistake to call psychodynamic therapies non evidence based. The definition of "evidence" varies from that used by those using CBT, etc., to that used by Psychodynamic therapists.
The EBT therapists would tell you that they have scientifically measurable goals and standards to determine whether or not a client has made progress, how much progress and what specifically needs to be done. Their research has been scientifically tested with control and experimental groups and pre and post test documentation.
By contrast, the psychodynamic therapies have almost always relied upon case studies written by therapists. Freud's case studies still make for good reading a century later. While there have been attempts to use the scientific method on psychodynamic therapies, terms tend to be vague and difficult to quantify. Therefore, research on psychodynamic therapy continues to rely on case studies of which there are plentiful numbers.
I was trained in and used psychoanalysis for many years. What I found coincides with this recent finding about the usefulness of psychodynamic therapy for complex conditions. For example, people with very long standing and chronic dysthymia, certain types of personality disorders, attachment difficulties and certain types of paranoia, did quite well. These patients were able to start excellent careers, marry and settle into their lives in states greatly improved over when they first sought treatment.
It is my opinion that it is the relationship with the therapist that helps "cure" the patient. By that I mean that patients learn, perhaps for the first time in their lives, that they can safely express their anger at me, as well as their love and fondness and without risking rejection in the form of termination of treatment. They then are able to continue and discuss the most intimate of secrets and issues that they harbored for their entire lives.
It seems logical to me that the practitioners, in conjunction with patients or clients, choose the type of psychotherapy best suited to their diagnosis and situation.
Your comments and questions are welcome and encouraged.
Allan N. Schwartz, PhD
Long Term and Other Types of Psychotherapy - Gary Graye - Jul 23rd 2009
Hi Dr. Schwartz,
I read your article on “Long term and other types of psychotherapy” and wanted to add to your discussion;
I thought you explained the different schools of thought very well, I also agree with your statement;
“It is my opinion that it is the relationship with the therapist that helps "cure" the patient…”
One size does not fit all and what works for one does not necessarily work for another. We are all individual and unique human beings.
I come from an integrative solution focused approach which is evidently very effective majority of the time when delivered within a 6 session process; I offer open door policies in order to offer a kind of safety net in case of relapse.