Psychodynamic therapy a guide to evidence-based practice pdf

Congratulations and kudos to Dr. Summers and Dr. Barber for their lucid and up to date text. They have swept away many cobwebs from outmoded notions of psychoanalytic psychotherapy. They present a contemporary, pluralistic, and humanistic vision, firmly rooted in a biopsychosocial model.

The authors integrate contemporary and traditional psychoanalytic models with cognitive behavioral, neuropsychological, and family systems paradigms. Sometimes attempting to integrate models results in muddy thinking. However, the authors establish and retain a clarity of vision.

This is a well researched book. Whenever possible, the authors use the best evidence currently available. When evidence is either not available or not possible to obtain due to the nature of the field, they use good common sense and clinical wisdom.

Their approach throughout I find to be highly respectful of patients as people with strengths and vulnerabilities. As such the writing models as well as espouses a therapeutic alliance based on mutuality, transparency, and a respect for autonomy.

The book is written clearly and simply, and not in the obfuscating prose sometimes used in this literature. Although it is written for the beginning clinician, there is much of value to the more experienced practitioner. I learned from reading this book. It helped me articulate more clearly some of my own thoughts regarding psychoanalytically based psychotherapies, and as such is useful in my own practice as well as in doing supervision.

resenting a pragmatic, evidence-based approach to conducting psychodynamic therapy, this engaging guide is firmly grounded in contemporary clinical practice and research. The book reflects an openness to new influences on dynamic technique, such as cognitive-behavioral therapy and positive psychology. It offers a fresh understanding of the most common problems for which patients seek help—depression, obsessionality, low self-esteem, fear of abandonment, panic, and trauma—and shows how to organize and deliver effective psychodynamic interventions. Special topics include ways to integrate individual treatment with psychopharmacology and with couple or family work.

See also , edited by Summers and Barber, which features 12 in-depth cases that explicitly illustrate the approach in this book.

Table of Contents

E-Book Overview

This is a wonderful book. It is a unique collaboration written by two authors both at the University of Pennsylvania, one a psychiatrist who is a practicing psychoanalyst and the other a psychologist who is a well known psychotherapy researcher. It is highly readable and practical in its approach. This is not your typical psychoanalytic book, filled with difficult and dense jargon. The writing is practical and hands on with plenty of clinical examples. The book uses evidenced based ideas from psychotherapy research in a way that is somewhat unusual: it integrates these findings into a sensible approach to dealing with patients. Positive psychology, family systems therapy, and behavioral and cognitive approaches are given respect and even integrated into their approach without feeling forced. I cannot think of another psychodynamic text that does this- the authors obviously have respect for other psychotherapies and are unashamedly practical in their approach to treating patients and seeing the limits of their approach. This is a good book for beginners who are learning “the ropes” of psychotherapy of any kind, or for experienced psychoanalysts or psychodynamically trained clinicians who want an evidence based contemporary approach to treating their patients in psychotherapy. Highly recommended.

E-Book Information

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Edition: 1
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Language: English
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Library: ebook3000.com
Identifier: 9781606234433,1606234439
Ddc: 616.89/14
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“This is the best book on psychotherapy that this former training director has ever read. It is rooted in both 21st-century science and the wisdom of psychiatry over the past two centuries. Students will value its lucidity, positivity, and common sense.”–George E. Vaillant, MD, Department of Psychiatry, Harvard Medical School

“At last, we have the definitive book on psychodynamic therapy. The authors weave together traditional psychodynamic strategies and techniques with up-to-date developments in the field. The chapters are extremely well written, containing clinical examples that illustrate the strategies and techniques. The volume integrates psychotherapy with couple and family therapy, positive psychology, and combined psychotherapy and psychopharmacology. I highly recommend this book to clinicians and students who want the latest on psychodynamic therapy.”–Aaron T. Beck, MD, University Professor Emeritus of Psychiatry, Perelman School of Medicine, University of Pennsylvania

“This important work combines the wisdom of experienced therapists with current empirical research. The book includes thoughtful discussions of alliance, transference, and interpretation, along with newer understandings of narrative and trauma. Summers and Barber share what they know, based on systematic research; what they believe, based on clinical experience; and, especially, what works–the specific clinical strategies they have found to be helpful and effective.”–Robert Michels, MD, Walsh McDermott University Professor of Medicine and Psychiatry, Cornell University

“This gem of a book fills an important gap in the dynamic therapy literature, incorporating cutting-edge research and conceptual advances while using jargon-free, experience-near language. The result is a scholarly, nuanced, and innovative work that will be highly useful for beginning clinicians, supervisors, and even experienced clinicians across all major theoretical orientations. Summers and Barber debunk outdated and stereotyped ideas about dynamic psychotherapy by describing in a clear, pragmatic manner the core principles and the unique aspects of a dynamic approach. The clinical examples are vivid and resonant, illustrating the added value of dynamic principles for understanding and intervening with patients. A ‘must read’!”–Kenneth N. Levy, PhD, Department of Psychology, Pennsylvania State University

“This timely, up-to-date, and remarkably useful book will be accessible to readers from a broad range of professional backgrounds. It will be of particular interest to therapists-in-training who are relatively unfamiliar with psychoanalytic theory and seek a hands-on guide that incorporates the latest developments in clinical thinking and research. At a time when many psychiatry residencies and clinical psychology graduate programs neglect to provide adequate training in this pivotal approach, the book provides a much-needed corrective. Summers and Barber convey the wisdom, clinical sophistication, and vitality of psychodynamic therapy in a way that speaks to the sensibilities and needs of a new generation of therapists. A wonderful contribution!”–Jeremy D. Safran, PhD, Professor and Director of Clinical Psychology, New School for Social Research

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Presenting a pragmatic, evidence-based approach to conducting psychodynamic therapy, this engaging guide is firmly grounded in contemporary clinical practice and research. The book reflects an openness to new influences on dynamic technique, such as cognitive-behavioral therapy and positive psychology. It offers a fresh understanding of the most common problems for which patients seek help–depression, obsessionality, low self-esteem, fear of abandonment, panic, and trauma–and shows how to organize and deliver effective psychodynamic interventions. Extensive case material illustrates each stage of therapy, from engagement to termination. Special topics include ways to integrate individual treatment with psychopharmacology and with couple or family work.

See also Practicing Psychodynamic Therapy: A Casebook, edited by Summers and Barber, which features 12 in-depth cases that explicitly illustrate the approach in this book.

The push towards Evidence-Based Therapy is a movement in psychology that aims to track the efficacy of treatment plans, with the goal of providing clients with treatments that have solid evidence backing their effectiveness.

This article will cover what Evidence-Based Therapy is, how it relates to the idea of evidence-based practice, and why it is important.

Finally, some examples of Evidence-Based Therapy will be discussed, and recommendations will be provided for further reading on Evidence-Based Therapy.

Before you continue, we thought you might like to download our three Positive Psychology Exercises for free. These science-based exercises will explore fundamental aspects of positive psychology including strengths, values, and self-compassion, and will give you the tools to enhance the wellbeing of your clients, students, or employees.

What is Evidence-Based Therapy? A Definition

Evidence-Based Therapy (EBT), more broadly referred to as evidence-based practice (EBP), is any therapy that has shown to be effective in peer-reviewed scientific experiments. According to the Association for Behavioral and Cognitive Therapies, evidence-based practice is characterized by an:

“[a]dherence to psychological approaches and techniques that are based on scientific evidence”.

The American Psychiatric Association and the American Psychological Association both consider EBT/EBP to be:

“‘best practice’ and one of the ‘preferred’ approaches for the treatment of psychological symptoms”.

In relevant literature, evidence-based medicine has also been defined as the:

“conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients”

(Sackett et al., 1996).

Recently, this definition has expanded to include “consideration of patients’ preferences, actions, clinical state, and circumstances” (Cook et al., 2017). This expansion of the definition is particularly important in the context of psychotherapy where the effectiveness of the treatment is in large part determined by the patient’s investment and belief in the efficacy of the treatment.

To sum up these discussions, we can think of Evidence-Based Therapy or practice as referring to psychotherapy practices that have research that been proven effective rather than based solely on theory.

The Goals and Benefits of Evidence-Based Therapy

Two of the main goals behind evidence-based practice are:

increased quality of treatment, and
increased accountability.

Meeting these goals will make it more likely that patients will only pay for and undergo treatments that have shown to be effective (Spring, 2007). Research has shown that Evidence-Based Therapy is indeed cost-effective (Emmelkamp et al., 2014), likely due to the decrease in time spent receiving treatment compared to those undergoing treatment plans which may or may not be effective.

In fact, some commentators have even argued that, along with the push for Evidence-Based Therapy, subscribers to EBT should also promote therapy that has shown to be cost-effective as well as clinically effective (Castelnuovo et al., 2016).

These commentators have also stressed that caution must be taken to ensure that this does not result in treatment plans that are only cheap because they are ineffective (or of unknown effectiveness) in other words, there should be an emphasis on EBT being both clinically effective and cost-effective, not just one of the two.

Some recent literature has also argued that the therapist has more of an impact on treatment effectiveness than the therapy practices deployed, leading one paper to declare that “the time is overdue for the psychotherapy field as a whole to research and develop the idea of evidence-based therapists” rather than simply focusing on Evidence-Based Therapy (Blow & Karam, 2017).

Proponents argue that since certain therapists are more effective for certain clients than other therapists (Kraus et al., 2016), therapists should then be held accountable for their effectiveness just like treatment plans are.

If adopted, this approach would likely involve tracking a therapist’s success rate and ensuring that they continue to provide proof of their effectiveness, just as one would assess the effectiveness of a certain treatment plan. This idea is still in its infancy, but it may prove to be a popular one in the coming years.

Examples of Interventions Used in Evidence-Based Therapy

There are dozens, if not hundreds, of scenarios in which one or more therapies have been shown to effectively treat psychological symptoms.

Listing them all would make for an extremely long read; instead, consider these examples and continue looking for more in the areas that interest you.

1. Acceptance and Commitment Therapy

Acceptance and Commitment Therapy (ACT) has been shown to be effective in the treatment of anxiety disorders, depression, addiction, and certain physical health issues (A-Tjak et al., 2015).

A recent meta-analysis of 39 randomized controlled trials (RCT, often called the “gold standard” of determining clinical effectiveness) found that ACT was more effective than either placebo or what the researchers called “treatment as usual,” or the standard treatment for such issues; however, ACT was not found to outperform cognitive behavioral therapy.

2. Cognitive Behavioral Therapy

Cognitive Behavioral Therapy, or CBT, is perhaps the most well-known and widely accepted form of treatment for many psychological issues.

In recent years, several independent meta-analyses have found solid evidence for the effectiveness of CBT in treating anxiety (Carpenter et al., 2018), depression (in all treatment delivery formats; Cuijpers, Noma, Karyotaki, Cipriani, & Furukawa, 2019), psychosis (Hazell, Hayward, Cavanagh, & Strauss, 2016), Body Dysmorphic Disorder (BDD; Harrison, de la Cruz, Enander, Radua, & Mataix-Cols, 2016), and eating disorders (Linardon, Wade, de la Piedad Garcia, & Brennan, 2017), among other psychological issues.

Due to its wide-reaching effectiveness, CBT is a commonly used treatment for a variety of ailments.

Although CBT is a big commitment, requiring a large investment of both time and resources (not to mention effort and energy on behalf of both therapist and patient), it has been so effective for so many disorders, which has led some researchers to explore the possibilities in making CBT more accessible.

One such effort examined the feasibility of internet-delivered cognitive behavior therapy (IBCT), which found that ICBT can be effective in treating children and adolescents with anxiety and depressive symptoms (Vigerland et al., 2016). CBT is an effective, evidence-based treatment plan for a wide range of disorders, so making it accessible as possible should be a priority. ICBT is a crucial first step towards that goal.

3. Dialectical Behavior Therapy

Dialectical Behavior Therapy (DBT) is also an evidence-based treatment, as it has been shown to be effective for relieving the symptoms and improving outcomes for patients with both borderline personality disorder (BPD) and substance abuse (Linehan et al., 1999) as well as for patients with trichotillomania (Keuthen et al., 2011).

As a side note, DBT may benefit more than just patients with BPD; there is also evidence that DBT may be an effective treatment for other psychological issues, including patients struggling with intellectual disabilities, but more research is needed to determine its effectiveness (McNair et al., 2017).

4. Mindfulness-Based Cognitive Therapy

Mindfulness-Based Cognitive Therapy (MBCT) has been found to be effective in reducing relapse rates of Major Depressive Disorder (MDD) (Lilja et al., 2016).

As noted earlier, CBT research has proven it as effective for the treatment of both MDD and generalized anxiety disorder (GAD), along with several other disorders (Gratzer & Goldbloom, 2016); however, the addition of mindfulness to cognitive therapy may boost its effectiveness in some situations.

The Five Best Books on Evidence-Based Therapy

If you want to explore the more in-depth discussions of Evidence-Based Therapy and how to incorporate it into your own practice, consider picking up these five books on EBT.

1. Psychodynamic Therapy: A Guide To Evidence-Based Practice – Richard Summers and Jacques Barber

This is a good book for therapists who wish to practice evidence-based psychodynamic therapy.

While psychodynamic therapy has been around for a long time, this book aims to incorporate new movements in psychology, including positive psychology, to provide an up-to-date picture of what Evidence-Based Therapy looks like when it comes to psychodynamic therapy.

This makes it an especially good option for psychodynamic therapists who believe in the positive psychology movement.

Find the book on Amazon.

2. Clinician’s Guide to Research Methods in Family Therapy: Foundations of Evidence-Based Practice, First Edition – Lee Williams, JoEllen Patterson, and Todd Edwards

This book is all about Evidence-Based Therapy for marriage and family therapists.

It also focuses on applying the teachings of the book into one’s practice, so it can be an actionable book. Any marriage and family therapist who wants to incorporate Evidence-Based Therapy into their practice can start with this book.

Find the book on Amazon.

3. Evidence-Based Practice of Cognitive-Behavioral Therapy, Second Edition – Deborah Dobson and Keith Dobson

Since cognitive-behavioral therapy (CBT) is one of the strongest evidence-based therapies out there, it is important to include a book that discusses CBT specifically.

This book discusses the literature surrounding CBT and also how to incorporate these findings into a clinical practice. Any therapist who uses or wishes to use CBT will get a lot out of this book.

Find the book on Amazon.

4. Casebook of Evidence-Based Therapy for Eating Disorders, First Edition – Heather Thompson-Brenner

As the title suggests, this book focuses on Evidence-Based Therapy dealing with eating disorders.

It accomplishes this by focusing on a few case studies so that one can see what it looks like to deploy these evidence-based treatment plans in practice.

This is an excellent option for anyone who deals with eating disorders and wants to learn through example.

Find the book on Amazon.

5. The Evidence-Based Practitioner: Applying Research to Meet Client Needs, First Edition – Catana Brown

Finally, this book doesn’t focus on any particular disorder and doesn’t even focus on therapy itself.

This is a guide to incorporating evidence-based practices for all sorts of medicinal fields, including doctors as well as therapists.

While it is not written specifically for therapists, it does teach the reader step-by-step how they can incorporate evidence-based techniques into their own practice.

This is an excellent option for anyone interest in Evidence-Based Therapy since it is not specific to a disorder and discusses the entire process of evaluating the literature to incorporating it into one’s practice.

Find the book on Amazon.

A Take-Home Message

When it comes to any treatment plan for any sort of problem, your major concern is probably about the effectiveness of the treatment. Although questions about cost-effectiveness, ease of compliance with the treatment, and the treatment’s impact on your lifestyle may be high on your list, the most important question to ask is probably “But does it actually work?”

The field of therapy can only become stronger from this push for evidence-based techniques and practices. The more this movement is embraced, the better off patients and clients will be.

What are your thoughts on this topic? Would you engage in a form of treatment that was not backed by scientific evidence? Have you benefited from non-EBT treatments? How much evidence do you think is required for something to be officially “EBT?” Let us know in the comments.

We hope you enjoyed reading this article. Don’t forget to download our three Positive Psychology Exercises for free.

References

About Psychological Treatment. (u.d.). Association for Behavioral and Cognitive Therapies. Retrieved from http://www.abct.org/Help/?m=mFindHelp&fa=WhatIsEBPpublic.
Blow, A.J., Karam, E.A. (2017). The Therapist’s Role in Effective Marriage and Family Therapy Practice: The Case for Evidence Based Therapists. Administration and Policy in Mental Health and Mental Health Services Research, 44(5), 716-723.
Castelnuovo, G., Pietrabissa, G., Cattivelli, R., Manzoni, G.M., Molinari, E. (2016). Frontiers in Psychology, 7(1), 563.
Cook, S.C., Schwartz, A.C., Kaslow, N.J. (2017). Evidence-Based Psychotherapy: Advantages and Challenges. Neurotherapeutics, 14(3), 537-545.
Emmelkamp, P.M.G., David, D., Beckers, T., Muris, P., Cuijpers, P., Lutz, W., Andersson, G., Araya, R., Rivera, R.M.B., Barkham, M., Berking, M., Berger, T., Botella, C., Carlbring, P., Colom, F., Essau, C., Hermans, D., Hofmann, S.G., Knappe, S., Ollendick, T.H., Raes, F., Rief, W., Riper, F., Van der Oord, S., Vervliet, B. (2014). Advancing psychotherapy and evidence-based psychological interventions. International Journal of Methods in Psychiatric Research, 23(S1), 58-91. doi:10.1002/mpr.1411
Gratzer, D., Goldbloom, D. (2016). Making Evidence-Based Psychotherapy More Accessible in Canada. Canadian Journal of Psychiatry, 61(10), 618-623.
Keuthen, N.J., Rothbaum, B.O., Falkenstein, M.J., Meunier, S., Timpano, K.R., Jenike, M.A., Welch, S.S. (2011). DBT-Enhanced Habit Reversal Treatment for Trichotillomania: 3-and 6-Month Follow-Up Results. Depression and Anxiety, 28(4), 310-313.
Kraus, D.R., Bentley, J.H., Alexander, P.C., Boswell, J.F., Constantino, M.J., Baxter, E.E., Castonguay, L.G. (2016). Predicting Therapist Effectiveness From Their Own Practice-Based Evidence. Journal of Consulting and Clinical Psychology, 84(6), 473-483.
Lilja, J.L., Zelleroth, C., Axberg, U., Norlander, T. (2016). Mindfulness-based cognitive therapy is effective as relapse prevention for patients with recurrent depression in Scandinavian primary health care. Scandinavian Journal of Psychology, 57(5), 464-472.
Linehan, M.M., Schmidt, H., Dimeff, L.A., Craft, J.C., Kanter, J., Comtois, K.A. (1999). Dialectical Behavior Therapy for patients with borderline personality disorder and drug-dependence. American Journal on Addictions, 8(4), 279-292.
McNair, L., Woodrow, C., Hare, D. (2017). Dialectical Behaviour Therapy [DBT] with People with Intellectual Disabilities: A Systematic Review and Narrative Analysis. Journal of Applied Research in Intellectual DIsabilities, 30(5), 787-804.
Sackett, D.L., Rosenberg, W.M.C., Gray, J.A.M., Haynes. R.B., Richardson, W.S. (1996). Evidence based medicine: what it is and what it isn’t. BMJ, 312(1), 71-72.
Spring, B. (2007). Evidence-based practice in clinical psychology: What it is, why it matters; What you need to know. Journal of Clinical Psychology, 63(7), 611-631.
Van Lith, T., Stallings, J.W., Harris, C.E. (2017). Discovering good practice for art therapy with children who have Autism Spectrum Disorder: The results of a small scale survey. Arts in Psychotherapy, 54(1), 78-84.
Vigerland, S., Lenhard, F., Bonnert, M., Lalouni, M., Hedman, E., Ahlen, J., Olen, O., Serlachius, E., Ljotsson, B. (2016). Internet-delivered cognitive behavior therapy for children and adolescents: A systematic review and meta-analysis. Clinical Psychology Review, 50(1), 1-10.
Withers, R., Tsang, Y.Y., Zwicker, J.G. (2017). Intervention and management of developmental coordination disorder: Are we providing evidence-based services? Canadian Journal of Occupational Therapy-Revue Canadienne D Ergotherapie, 84(3), 158-167.