Psychodynamic Stigma

[BSWdavid]

For those of you of practice primarily from a psychodynamic or psychoanalytic perspective, have you noticed a negative effect on your practice due to the negative stigma surrounding psychodynamic therapy? I ask because I am interested in dynamic/insight oriented therapy but have received mixed feedback on the current state of psychodynamic therapy, if I should go that route, and the future outlook for psychodynamic therapists.

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[erg923]

I think you're asking the wrong questions. It seems to me that the most appropriate question would be: Given the available intervention options, the current state of our understanding of maladaptive behaviors using the science of psychology, and the existing literature base on the efficacy of certain interventions, what is the reasons one would chose to practice in a primarily psychodynamic model?

I think the future outlook is that people who can afford it will continue to pay for services that they feel are helpful to them, whether or not they truly are. Think Tony Soprano and Dr. Melfi...

There is little doubt that insight oriented psychotherapy (understanding the dynamics of how early experience shape who we are and how we behave) is important and may be all that is necessary for some people. However, laying back and imploring" the fundamental" rule for a person with a debilitation phobia, chronic bipolar disorder, or an antisocial delinquent is pretty unacceptable in this day and age.

 

[clin2012orbust]

Psychodynamic/psychoanalytic theory has made many contributions to psychology and clinical psychology. It is my belief that it will continue to. If you want to do research or work in a psychology department, it's likely that you will need to incorporate psychodynamic work into models and research that are less blatantly psychodynamic or psychoanalytic. But, tons of people do this. Kenneth Levy, Les Morey, Linda Mayes----just some of the people in the field of psychology that are very successful and psychodynamic (to an extent). As far as a clinical practice, there are always people looking for insight oriented work. I think the popularity of specific orientations changes based on a variety of variables--psychodynamic work was probably more popular once, but as we have learned more about what works and what doesn't, many have moved in other directions. But, you can always find a home for yourself.

 

[Sendtrees]

I would say the OP is in the wrong place to get positive feedback about psychodynamic therapy. Most people here seem to carry old-fashioned notions about what it is and isn't. I've also seen a lot of non-reflective enthusiasm for "EBTs," which--no mystery--align perfectly with the financial interests of insurance companies.

 

[psychmama]

I would say the OP is in the wrong place to get positive feedback about psychodynamic therapy. Most people here seem to carry old-fashioned notions about what it is and isn't. I've also seen a lot of non-reflective enthusiasm for "EBTs," which--no mystery--align perfectly with the financial interests of insurance companies.

I agree to some extent with this. While many people on SDN are open to psychodynamic theory, it seems to be a minority that practice it (or hope to practice it) as their main orientation. Having said that, I personally know of dozens of practititioners who work psychodynamically and who have thriving practices. I also agree that, depending on where you work, you may need to speak the language of other orientations (CBT, behavioral, biomedical) and incorporate what you do in the room into these frameworks.

The more I've learned the more I realize that modern psychodynamic theory has come a long way from Freud. There is so much out there that is useful, and not all of it is geared to long-term treatment.

 

[Neuropsych2be]

I agree to some extent with this. While many people on SDN are open to psychodynamic theory, it seems to be a minority that practice it (or hope to practice it) as their main orientation. Having said that, I personally know of dozens of practititioners who work psychodynamically and who have thriving practices. I also agree that, depending on where you work, you may need to speak the language of other orientations (CBT, behavioral, biomedical) and incorporate what you do in the room into these frameworks.

The more I've learned the more I realize that modern psychodynamic theory has come a long way from Freud. There is so much out there that is useful, and not all of it is geared to long-term treatment.

I think to some degree the bias against psychodynamic therapy is a reaction to past psychodyamic arrogance and exclusiveness. For decades clinical psychologists were locked out of the official training institutes since until about 15 years ago only physicians could get that training. Its also true that the current enthusiasm for EBT's is based in large measure on the existing culture and momentum CBT has created for itself. Research funding, the publish or perish atmosphere in academe etc has given CBT a certain momentum. The 2000 pound elephant in the room is whether CBT or any therapy works due to the factors that its proponents presume as the causal factor

Funny thing is that you can read the CBT literature and read about the "implicit interpersonal schema's" which get activated in therapy. These are another name for tranference and countertransference! Whenever you read about anything in the cognitive literature that describes something as "implicit" remember that this is a codeword for "unconscious." Eventually, these distinctions will be worked out as the field progresses. I think more integrative approaches such Schema Focused therapy or ACT are the way the things will go in the future. I'd suggest some of the books or papers written by Paul Wachtel as a useful starting off place to look at integrating therapy approaches.

However, rather than getting all caught up in which brand of therapy works best, we should be looking at therapy processes used by effective therapists. I and my pet dodo bird would contend that you would be hard pressed to find that much difference between effective psychodynamic treatment and effective CBT treatment if you analyzed (pun intended) the content of the sessions themselves.

 

[psychmama]

oops - accidental post.

 

[Ollie123]

Going to try not to be the one to derail this (though I suspect its inevitable), so going to bite my tongue on a couple of comments.

That said, I will add I think you will find far more stigma amongst other psychologists than amongst clients - and even then it largely depends on what settings you want to work in with some settings being more accepting than others. I doubt you will have much trouble finding a place to practice unless you are aiming for an academic med center.

That said, I think it will be increasingly important to be able to defend why a treatment was given in the future. I think it has less to do with being in the pocket of insurance companies, and more to do with not being a scam artist who takes advantage of the mentally ill (sorry, can't help myself on that one...).

That doesn't mean there aren't many situations where psychodynamic treatments are completely appropriate. It just means I think practitioners are going to have to provide a reason why it was appropriate for that particular situation, beyond "That is what I believe and how I was trained". It will hold true for all modalities, as there are situations where traditional CBT may not be as effective as other options either (and I suspect this will become increasingly true as new techniques are developed are refined).

 

[erg923]

nt