Limits of Psychodynamic work/The Wright Institute

[Elanala]

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Hello All,

I'm new here and first should say that I appreciate any and all points of view! I should also say a bit about myself: I majored in a different field as an undergrad and, several years out, became interested in psych. I've taken Intro, Stats, Abnormal, Developmental, and Personality Psychology, have read some Freud, Frankl and Fritz Perls, and am looking forward to reading much more....

So, I'd like to go ahead and apply to PsyD programs in the Bay Area this year--specifically PGSP and The Wright Institute--but I've been reading some comments that seem to suggest the Wright's too focused on psychodynamic therapy. Yet on the other hand, in this year's edition of the wonderful _Insider's Guide to Grad Programs in Clinical and Counseling Psychology_, it says that 30% of the faculty ascribe to CBT, 20% to family systems, amd 10% to humanistic. Which seems well-rounded to me.

(1) What's the deal with the Wright's rap? (2) What are the limits that you see in psychodynamic work like that the Wright espouses? Is it digging too deep for some clients? Is it outdated somehow in today's market? I'm far from an expert in the different therapeutic modalities....

I'll be attending the Wright's Open House next Friday, so I'll be able to get their perspective as well. But I'm interested in hearing from a range of students and practitioners. Many thanks!🙂

 

[BamaPsych]

Hello! Welcome to the forums.

I can't answer all of your questions but I can answer one of them...well...sorta 😛

(2) What are the limits that you see in psychodynamic work like that the Wright espouses? Is it digging too deep for some clients? Is it outdated somehow in today's market?

This is pretty accurate. You see, in clinical psychology a lot of practitioners have problems getting reimbursed from insurance companies for more than a minimal amount of sessions per year per patient. Psychodynamic therapy, by nature, tends to be longer-term than some other forms of therapy. (There are newer, shorter-term psychodynamic therapies available...so my previous point isn't true 100% of the time).

So, from a market perspective, NOT saying quality wise necessarily, therapies like CBT can seem more desirable because it's shorter term and easier for insurance to cover.

When you go to Wright, see if they are teaching some of the short-term psychodynamic therapies. I'd be curious to know.

Good luck!

 

[erg923]

Hello! Welcome to the forums.

I can't answer all of your questions but I can answer one of them...well...sorta 😛



This is pretty accurate. You see, in clinical psychology a lot of practitioners have problems getting reimbursed from insurance companies for more than a minimal amount of sessions per year per patient. Psychodynamic therapy, by nature, tends to be l,onger-term than some other forms of therapy. (There are newer, shorter-term psychodynamic therapies available...so my previous point isn't true 100% of the time).

So, from a market perspective, NOT saying quality wise necessarily, therapies like CBT can seem more desirable because it's shorter term and easier for insurance to cover.

When you go to Wright, see if they are teaching some of the short-term psychodynamic therapies. I'd be curious to know.

Good luck!

There are limits to all therapuetic modalities. The longer you do therapy, the more you relaize that the modality you chose has more to do with the client, than its does with you. The clients preferences and the clients own perception of what contributes to their problems. Hence, you need alot of tools for your "clinical toolbox." When all your professors and/supervisors subscribe to one view, you tend to fall into a default group-think mindset and wont neccearily experiment and/or get exposure to the other tools that can help you to help a client.

Kinda like psychiatrist prescribing meds, I always start out my first-line treatments. CBT. I start there and generally work problems from that frame of reference. There is experimetal evidence supporting many of its underlying assumtions and supositions about psychopathology (unlike anayltic theory) and it has good outcome studies in the literature (analytic does too, but CBT generally is more cost effective fo all involved). However, many times patients will find clever and subtle ways to express to you that this is not what they want and that this is not where the problems really are. They are deeper. Or sometimes they will just tell you. In this case, I move to my second line of treatments. More towards Rogerian and interpersonal approaches. The issues that come out here are priceless. I am not a skilled analyst or anything, so I do very little interpretation. Theme tracking can be useful though.

At the end of the day, you will realize that your main goal for every session is to simply make the client feel as if someone truely cares and has made a genuine effort to understand their emotional experience. Anything more than that during a session is just gravy, as Rogers used to say-so Ive heard anyway. That is often more powerful than any one formal method or excercise you will do with them. In other words, its alll about relationship, relationship, relationship. 70 percent of your outcome variance is right there!

 

[PsyDr]

imo the problem with psychodynamic therapy is that the patient comes to you suffering from something. you are then prescribing a course of treatment that lasts years. that insurance will not pay for. why they would not choose a CBT practicioner that can offer relief in 6-8 sessions that insurance will cover 80% of is beyond me.

you could justify this idea by stating that this therapy is more in depth and therefore longer lasting. but when they ask if you are a psychoanalyst your answer has to come back "no" as you are not board certified.

board certification to become a true analyst is another minimum 4 year process. and it is not a cheap process. one analyst i know states he spent well over 50k becoming an analyst. he also makes half of what i do. but he says he is happy.


then there is the finding of patients who can afford to pay for this out of pocket and have 3-4 hours a week free, and are interested in learning about themselves that much. your busy professionals are out. but rural areas are also generally out.

i will also share some advice my mentor gave me: "if you want to be an analyst, spend a lot of time with them and ask yourself if they seem happy and well adjusted.". following his advice i found that as a group, analysts were weird. but i think my mentor's advice can be applied to any group you are intending to become a part of.


not saying it cannot be done. there are clearly many analysts who do great work and make a great living. but it is a lengthy route.

 

[BamaPsych]

Good post Erg,

I am kinda confused though. You quoted my response as in you were replying to what I said, but I feel like your response was talking about something different altogether from my response...though I could be wrong. I was just suggesting (in response to OP's original question) that psychdynamic therapy usually lasts longer and thus has more insurance hurdles. But, I did note that it has more insurance hurdles, not that it's the only therapy that has insurance hurdles.

If I understand correctly I think your response was about the efficacy of the psychodynamic treatments, which I wasn't addressing at all. Anywho, maybe I'm just reading too much into the fact that you quoted my response

 

[Therapist4Chnge]

board certification to become a true analyst is another minimum 4 year process. and it is not a cheap process. one analyst i know states he spent well over 50k becoming an analyst. he also makes half of what i do. but he says he is happy.

There are many different flavors of psychodynamic work, in addition to many different structures (weekly, 2-3x a week, etc). He didn't specify "analyst", which is one of the most traditional and rigid approaches. While being an analyst requires a great deal more study and supervision, not all dynamic approaches are like that.

imo the problem with psychodynamic therapy is that the patient comes to you suffering from something. you are then prescribing a course of treatment that lasts years. that insurance will not pay for. why they would not choose a CBT practicioner that can offer relief in 6-8 sessions that insurance will cover 80% of is beyond me.

This is incorrect.

As mentioned above, there are many flavors of dynamic work, one of which is time limited psychodynamic work, which can be much closer to the number of sessions for CBT work.

I do dynamic work (in addition to CBT), and it can be quite effective both in a short-term and long-term format...it all depends on patient needs, goals, time frame, etc.

--

As for doing dynamic work in private practice....there are still opportunities, but insurance is a consideration (as it would be with any therapy), so it is important to figure out if this is a viable route.

In regard to The Wright Institute, it did/does have a strong dynamic influence. I looked there 5-6 years ago, and they were very dynamic back then, though supposedly they have diversified. I thought it was a sound place for clinical training, though their research training leaves something to be desired. I wanted a more balanced program, so they weren't a good fit for me, but that isn't to say they aren't a good program.

 

[erg923]

No, that was my bad, I meant to quote the OP.

 

[PsyDr]

t4c,

fair enough on the time limit on time limited psychodynamic therapy. time limited psychodynamic therapy averages between 7 and 40 sessions, diagnosis dependent.

insurance does base their authorization on research though. for MDD, they will authorize 6-8 sessions. if you can honestly make your treatment modality work within those confines, then fine. if you honestly think it takes longer than that using your treatment of choice, then you are ethically bound to tell the patient. all of my patients are told from the outset what their financial responsibility will likley be. i also tend to eat the costs when i have quoted them the wrong number.

in my experience those seeking psychodynamic work have non-diagnosable chief complaints such as "i'm just not happy". insurance will not and does not authorize any sessions for such a dx. unless you are willing to commit insurance fraud and upcode to make the pt appear more pathological (e.g., making what is actually a v code go to a 299.10 or something). so then you are stuck convincing people to patients why they should pay for such a thing.


as for the board certification thing: i believe that i presented the board certifcation thing in an alright manner, especially to an undergraduate. i was simply trying to make the OP aware that they would not and cannot be an analyst right out of grad school and that analysts would likely look down upon them until he/she was board certified.


with all that in mind, i do absolutely no therapy whatsoever. although i do subcontract out a lot to several therapists.

 

[Elanala]

Thanks to all for the feedback. I feel like I'm going in well-armed with questions now. Have a good weekend!

 

[psychmama]

Hi. I'd just like to add to what T4C said. There are a number of shorter-term dynamic therapies, and many are evidence-based. Also, I don't think it's exactly accurate to state that most insurance companies will only reimburse a patient with a Dx of MDD for 6-8 sessions. Even a CBT practitioner would often need more time than this to see long-lasting symptom relief.

I think you are asking good questions about Wright -- it's important to know what you are signing on for when investing in graduate education. I just think it's useful to bear in mind that many practitioners (at the end of the day) use a blend of approaches -- interpersonal, CBT, dynamic -- in a rather pragmatic way. Few therapists are purists. That's why I think it's good to make sure you can get at least basic training in a range of theoretical approaches and modalities. If Wright can provide this, and if you incline towards dynamic work, they may be a good fit for you.

 

[Therapist4Chnge]

One thing to keep in mind is The Wright Institutes's poor internship match rate....which seems to be heavily influenced by students not wanting to leave CA. Make sure to ask about the success rate for students who actively apply outside CA.

 

[ProspectivePsyD]

I would love to get your reactions/understandings about Wright and its psychodynamic leanings after you attended the open night. I was supposed to begin at the Wright fall 2008 and had to defer to fall 2009 for various reasons. I was always concerned that they were too psychodynamic (i am primarily interested in CBT) and was assured that this focus was a thing of the past and they are currently working on becoming more integrated. Was this what you came away with as well ? What did you think of the school? I loved it, my only concern was the psychodynamic issue, hopefully this will not be an issue because i have decided to attend there. Good luck.

 

[Eruca]

Just to add another recent impression.. I had dinner with a Wright graduate last weekend. She informed me that her class alone had 70 students (!) Coming from a program that graduates about 4-5 a year, it's hard to imagine. More importantly, she didn't want to leave the area and ended up having to take a non-paid internship at Kaiser - note, right along side PAID interns. So she spent a year watching others get paid for the same work she was doing. While this may happen to folks not coming from professional schools, I have the impression it happens much more with those from prof schools. (Mind you, this is not counting the tuition forked out to attend)

 

[psybee]

I would love to get your reactions/understandings about Wright and its psychodynamic leanings after you attended the open night. I was supposed to begin at the Wright fall 2008 and had to defer to fall 2009 for various reasons. I was always concerned that they were too psychodynamic (i am primarily interested in CBT) and was assured that this focus was a thing of the past and they are currently working on becoming more integrated. Was this what you came away with as well ? What did you think of the school? I loved it, my only concern was the psychodynamic issue, hopefully this will not be an issue because i have decided to attend there. Good luck.

i know the NYC one has become open to some more integrative Watchtel-y practice and shorter term practice, but it is still all psychodynamic, and that kind of training is really what they are renowned for (it's not a grad school though-post grad training).

 

[Therapist4Chnge]

Just to add another recent impression.. I had dinner with a Wright graduate last weekend. She informed me that her class alone had 70 students (!) Coming from a program that graduates about 4-5 a year, it's hard to imagine. More importantly, she didn't want to leave the area and ended up having to take a non-paid internship at Kaiser - note, right along side PAID interns. So she spent a year watching others get paid for the same work she was doing. While this may happen to folks not coming from professional schools, I have the impression it happens much more with those from prof schools. (Mind you, this is not counting the tuition forked out to attend)

That is a HUGE barrier to getting an APA-accredited internship spot. CA most likely has the most applicants, compared to all of the other states, and many people want to stay local/in CA....so it is not surprising to hear stories about taking unfunded/unaccredited internship placements. I can't imagine a scenario for me that I'd do that considering the time/effort invested to get to that point, but YMMV.

 

[Rapunzel]

Personally, I'm glad that there are still people around who continue to practice, and teach, psychodynamic therapy. Like others said, the modality often does need to correspond with what the client needs. I don't do straight psychodynamic therapy myself - I draw from a number of things, depending on client needs. But for myself, in my therapy, CBT didn't cut it. Long-term psychodynamic therapy (with other stuff mixed in as appropriate) with a lot of focus on relationships and attachment, seems to be the answer for me.

And thank heaven I had insurance available that covers it. Not all do, but obviously some do, As long as you don't say "personality disorder" or "adjustment disorder." And it isn't necessary to make something up. People who are actually suffering from personality disorders usually meet criteria for depression and/or anxiety (otherwise the personality disorder would more likely only be bothering others who interact with the patient). Adjustment disorders are more short-term, and if they become long-term, another disorder has developed. People who want psychodynamic therapy for minor concerns or because their life isn't perfect yet might be more able to pay out of pocket, if you even take cases like that. I would expect that the people who really benefit most from psychodynamic therapy would be those with deeper, long-standing patterns that have a significant effect on their lives.

One of my textbooks, which I am too lazy and too cold to go look up right now, quoted a study that found that when therapists go to therapy, regardless of the modality that they practice, the majority choose psychodynamic for themselves. Including (or especially) CBT therapists. Interesting, isn't it?

I know very little about the Wright Institute, but I think that psychodynamic work definitely has a place. I'm glad that it is still around.

 

[Therapist4Chnge]

....I think that psychodynamic work definitely has a place. I'm glad that it is still around.

As do I. I think it informs my conceptualization, and can offer a client the opportunity to explore more about their challenges that CBT and some other orientations may not as effectively address (my own bias).

 

[Pterion]

As do I. I think it informs my conceptualization, and can offer a client the opportunity to explore more about their challenges that CBT and some other orientations may not as effectively address (my own bias).

I'll not start a debate of the merits of one versus the other. I think the greatest strength any program can have is what I call a "therapeutically multilingual" preparation for practice. One should learn and execute that modality in which he/she is most effective (or at least is most effective for the patient). Then, you fill out your notes/billing forms/etc in the language that is reimbursed. For those new to either, I encourage Beck's cognitive therapy of personality disorders. It is a thinly veiled translation of psychoanalytic constructs to CBT terminology. Agree or not, it is a great introduction to how one may explain or formulate one's work in CBT language despite a different framework.

I am very sorry that I cannot answer any questions about Wright except anecdotally. Their grads that I pesonally know are quite competent and "multilingual".