Team psychodynamic [emoji6]

[LadyHalcyon]

Not to bash any other theoretical orientation, but I am glad to see the pendulum swinging a bit in the other direction. I'm tired of people equating "evidence-based" with only manualized treatments

Not Your Great-Grandfather’s Psychoanalysis

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[WisNeuro]

I've always felt that it was misguided to compare psychoanalysis with CBT (and other symptom-focused psychotherapies). The two schools have very different psychotherapeutic aims.

I wouldn't call CBT a symptom focused therapy. That is a fundamental misunderstanding of CBT.

 

[LadyHalcyon]

I've always felt that it was misguided to compare psychoanalysis with CBT. The two schools have very different psychotherapeutic aims.

I think research, among other things, demands we measure symptoms. Otherwise, how could we tell if people are improving? That being said, I think only measuring symptoms is too reductionistic

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[psych.meout]

Not to bash any other theoretical orientation, but I am glad to see the pendulum swinging a bit in the other direction. I'm tired of people equating "evidence-based" with only manualized treatments

Not Your Great-Grandfather’s Psychoanalysis

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Except if you look at the RCTs, metas, and other empirical research, you'll generally see two things.

1. Great heterogeneity as to how "psychoanalytic" and "psychodynamic" therapies are defined and practiced. You can even see this in the article you linked. This makes it difficult to compare the results of different studies of these therapies, at least compared to other more manualized therapies, e.g., ERP for OCD, DBT for BPD, etc. The way the artcile is citing research is simplistic, at best, obviously in service of structuring a narrative.

2. When "psychodynamic/psychoanalytic therapy" is efficacious, it is relatively manualized and time-limited, e.g., prescribed number of sessions with certain goals for each session or group of sessions. Even then, it's unclear whether the efficacy is due to unique aspects of psychodynamic or psychoanalytic therapy (e.g., free association, transference/countertransference) or other facets, e.g., stronger common factors like improved therapeutic alliance. Thus, it could be an EMDR situation.

I'm all for embracing whatever types and modalities of assessment and therapy that are supported by the research literature. I don't dogmatically hold to any given position. It would be nice to see more research on psychodynamic therapies and for their benefits, if any, to be incorporated into clinical training and practice. The issue is that the psychodynamic/psychoanalytic crowd needs to do some housecleaning if they expect to receive similar regard to CBT, ACT, DBT, and other well-regarded, mainstream therapies, but I'm skeptical that their community could come to any agreement. They need to rein in the kind of amorphous, unlimited, multi-year/decade therapy that can comprise some forms of psychoanalytic or psychodynamic interventions. These kinds of therapies eschew scientific methods in favor of concepts lacking in evidence. Clinical intuition is inherently inferior to actuarial methodology and evidence-based practice, but I'm unsure if their community as a whole understands and accepts this.

 

[LadyHalcyon]

Except if you look at the RCTs, metas, and other empirical research, you'll generally see two things.

1. Great heterogeneity as to how "psychoanalytic" and "psychodynamic" therapies are defined and practiced. You can even see this in the article you linked. This makes it difficult to compare the results of different studies of these therapies, at least compared to other more manualized therapies, e.g., ERP for OCD, DBT for BPD, etc. The way the artcile is citing research is simplistic, at best, obviously in service of structuring a narrative.

2. When "psychodynamic/psychoanalytic therapy" is efficacious, it is relatively manualized and time-limited, e.g., prescribed number of sessions with certain goals for each session or group of sessions. Even then, it's unclear whether the efficacy is due to unique aspects of psychodynamic or psychoanalytic therapy (e.g., free association, transference/countertransference) or other facets, e.g., stronger common factors like improved therapeutic alliance. Thus, it could be an EMDR situation.

I'm all for embracing whatever types and modalities of assessment and therapy that are supported by the research literature. I don't dogmatically hold to any given position. It would be nice to see more research on psychodynamic therapies and for their benefits, if any, to be incorporated into clinical training and practice. The issue is that the psychodynamic/psychoanalytic crowd needs to do some housecleaning if they expect to receive similar regard to CBT, ACT, DBT, and other well-regarded, mainstream therapies, but I'm skeptical that their community could come to any agreement. They need to rein in the kind of amorphous, unlimited, multi-year/decade therapy that can comprise some forms of psychoanalytic or psychodynamic interventions. These kinds of therapies eschew scientific methods in favor of concepts lacking in evidence. Clinical intuition is inherently inferior to actuarial methodology and evidence-based practice, but I'm unsure if their community as a whole understands and accepts this.

I have five pages of citations of studies that show the efficacy of psychodynamic modalities. Of course it is more difficult to design strict RCTs for psychodynamic studies, but I also think the CBT crew is just as biased toward psychodynamic practice. In order to be truly scientific, one has to be open to evidence that disconfirms their beliefs. Undoubtedly there are weaknesses regarding psychodynamic studies, as there are weaknesses with CBT studies. Despite these limitations, one should not discount numerous studies based off of one argument.

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[psych.meout]

I have five pages of citations of studies that show the efficacy of psychodynamic modalities. Of course it is more difficult to design strict RCTs for psychodynamic studies, but I also think the CBT crew is just as biased toward psychodynamic practice. In order to be truly scientific, one has to be open to evidence that disconfirms their beliefs. Undoubtedly there are weaknesses regarding psychodynamic studies, as there are weaknesses with CBT studies. Despite these limitations, one should not discount numerous studies based off of one argument.

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Huh, it's almost like you didn't even read my comment....

 

[LadyHalcyon]

Huh, it's almost like you didn't even read my comment....

I read it

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[LadyHalcyon]

I guess I'm just tired of hearing all the excuses as to why one should discount CBT studies and why one should discount psychodynamic studies. Each side basically uses the same boring excuses

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[psych.meout]

I guess I'm just tired of hearing all the excuses as to why one should discount CBT studies and why one should discount psychodynamic studies. Each side basically uses the same boring excuses

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Ah, so you're giving us examples of these generic excuses that don't bother to address the substance of arguments?

Thanks. It was illuminating.

 

[LadyHalcyon]

Ah, so you're giving us examples of these generic excuses that don't bother to address the substance of arguments?

Thanks. It was illuminating.

Critical thinking is always an important skill to possess; it is truly the foundation of academia. No need to be snarky. Perhaps I have triggered your primitive defense mechanisms or maybe re-opened an old wound based on your relationships with your early childhood caregivers.

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[WisNeuro]

Behave, kids, or we'll have to close the thread.

 

[LadyHalcyon]

Behave, kids, or we'll have to close the thread.

Duly noted. I suppose I will return to acting like an adult now.

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[smalltownpsych]

Psychodynamic knowledge can be very helpful for conceptualizing cases and I believe that it can even guide effective CBT interventions. I include attachment and object relations in that more so than the construct of psychosexual stages which is deeply flawed partially due to Freud's backing off from his findings of frequent childhood sexual abuse in his patients with hysteria. I actually don’t think any of the major schools of thought in psychology should be ignored and have been a bit concerned about the dominance of CBT thought so am always going to vouch for the psychodynamic, family systems, and even humanistic/existential.

 

[Jake0006]

Psychodynamic knowledge can be very helpful for conceptualizing cases and I believe that it can even guide effective CBT interventions. I include attachment and object relations in that more so than the construct of psychosexual stages which is deeply flawed partially due to Freud's backing off from his findings of frequent childhood sexual abuse in his patients with hysteria. I actually don’t think any of the major schools of thought in psychology should be ignored and have been a bit concerned about the dominance of CBT thought so am always going to vouch for the psychodynamic, family systems, and even humanistic/existential.

I second all of that... adding a little common factors to the mix, the therapist who does needless therapy for decades is a shyster no matter the orientation.... and a crappy psychodynamic therapist always has his/her equal somewhere in a crappy CBT therapist.

Also, object relations, attachment theory, and also relational psychology and all the 2 person approaches (winnicott, kohut, Mitchell, etc) are what a modern psychodynamic worth a darn is probably into. They're probably not using the tripartite model or psychosocial stages if they're under 50 yrs old. I'm sure exceptions exist, just speaking of the general state of things in my experience.