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Beyond the Oedipus: Modern Psychodynamic Therapy’s Effectiveness in Treating Mental Illness

 

Abstract

Ever since its inception, the school of psychoanalysis has been controversial to other psychologists. The therapy arm of psychoanalysis, psychodynamic therapy, continues to be used two hundred years after the development of the school. After generations of evolution in the study and years of developmental pruning, it still remains as the most practiced form of talk psychotherapy. Its methods has moved vastly from Freud’s original work, though it remains as controversial as ever. With all of its controversy, is psychodynamic therapy an effect method for treating patients?

Keywords: psychotherapy, CBT, psychodynamic therapy

Beyond the Oedipus: Modern Psychodynamic Therapy’s Effectiveness in Treating Mental Illness

The methodology behind psychodynamic therapy has always been the subject of controversy with other psychologists. Keith Stanovich describes the “Freud problem” (p. 1) as being “a spur to the literary imagination [more] than as a theory in contemporary psychology.” (Stanovich, 2013, p. 2) It is a fair statement to say that it remains as the most widely controversial school of psychology that is still being used in modern-day clinical psychology. Psychoanalysis, in its former times focused on aspects of the human subconscious and reasons behind behavior people are unaware of, offering what can be described as an “invisible why” to human thought and behavior. To them, this subconscious was especially driven by sexual urges of the libido and childhood experience, coining popular phrases such as “Oedipus complex” and dream interpretation. In more modern times psychodynamic therapy, the therapy arm of psychoanalysis, has immensely evolved from Freudian theory and continues to be the most practiced form of modern talk therapy. (Norcross, Hedges, & Castle, 2002). (This excludes the eclectic approaches mentioned in the article).

Modern Psychodynamic Therapy

One benefit that comes with psychodynamic therapy’s amount of controversy it that it is able to more steadily and scientifically filter out  the aspects that are no longer in line with scientific findings. For example, patients now sit face to face with their therapists rather than lying on a couch. Also gone is the intense amount of time spent with a subject, in the past therapists met with patients three to four times a week over the span of several years. Modern psychodynamic sessions meet once or twice a week on an average span of two years (Leichsenring & Leibing, 2003).

One of the the main selling points on psychodynamic therapy’s effectiveness has remained since the days of psychoanalysis, however. Free association, defined by Zvi Lothane as, “bring[ing] out the basic congruence between the dynamics of unconscious cause of disorder and the dynamic causal cure of disorder” (Lothane, 2010). The key to free association’s therapeutic effects is that the subject is in a situation where they are explaining mental anguish uncensored and unpressured. This aspect becomes one methodological approach to modern psychodynamic therapy.

Vastly more changed over the years yet still remaining as key to the therapeutic process is the relationship between patient and therapist. Modern psychodynamics have moved from the idea of  “transference” but still focus greatly on how the patient perceives the therapist. “Both adaptive and nonadaptive aspects of personality and self-concept are forged in the context of attachment relationships” (Shedler, 2010 p. 3). Combining a close therapist/client relationship with the aspects of opening up feelings by free association are the main aspects of modern psychodynamic therapy. These aspects may factor into psychodynamic therapy’s effectiveness.

Assessments and Comparison

Critics to psychodynamic therapy argue that psychodynamic therapy is vastly outdated and unscientific. In the same work, Stanovich accuses psychoanalysis as lacking any scientific use. He states, “after-the-fact explanation robs it of any scientific utility” (Stanovich, 2013 p. 2). They have also criticized the amount time spent on therapy, stating it as basically overkill. At an average of two years length of therapy compared to mere months of Cognitive-Behavioral Therapy (Smith & Glass, 1977), it can be noted that there are quicker ways of performing patient therapy. Looking at several meta-analyses, however, shows trends backing the effectiveness of psychodynamic therapy’s time-orientation (Shedler, 2011). Though it is true that not every aspect of its approach can be explained and thereby are unscientific, Psychodynamic therapy’s lengthy span of therapy may be helping it be an effective treatment for treating the abnormal.

Looking at more severe personality disorders, a meta-analysis by Leichsenring & Leibing shows  that patients suffering from personality disorders who maintained the full length of the therapy (2.2 years) had a 75% recovery rate (not including the 15% percent reported dropout rate) as opposed to CBT’s (as a control) 47% over an average therapy time of  eight months (this number does not include the 17% dropout rate).

Fonagy & Lemma note psychodynamic’s evidence, “there are increasingly strong indications that adult mental health problems are developmental in nature; three quarters can be traced back to mental health difficulties in childhood, and 50% arise before age 14 years”  (Fonagy & Lemma, 2012 p. 4). These developmental discrepancies are what allows psychodynamic therapy the time to shine. The approach modern psychodynamic takes to treating mental illness lies in a patient’s upbringing, which is also an explanation for why psychodynamic therapy was the leading therapy for posttraumatic stress related neurosis (Nemeroff, Heim, Thase, Klein, Rush, Schatzberg, Keller, 2005). Fonagy & Lemma continue to note, however, that there are relatively few sufficient studies done on more modern types of psychodynamic therapy, but that evidence is now starting to emerge, showing it very well may be an effective treatment for treating mental illness. (Fonagy & Lemma, 2012).

Discussion

Meta-analyses emerging are starting to confirm that psychodynamic therapy may be an effective approach to psychotherapy. Its historical controversy seems to have pushed it to become more evidence based, pruning many of Freud’s original theories into a more modern, scientific approach to fight mental illness. As in all other forms of psychotherapy, perhaps the greatest change psychodynamic therapy has had in recent years is the addition of mental pharmaceuticals, allowing more bases to be covered and a clear aid to help in the fight against mental illness.

If studies come in to disprove psychodynamic therapy, we should be willing to discontinue it. It seems as a science, psychoanalysis exists in modern psychology almost as a tradition. We should not hold to that tradition if better forms of therapy come into play.

Limitations of this study include a lack longitudinal meta-analyses. More time oriented studies can allow us to more accurately find out if it is effective as currently used studies show. Also there were no studies on how pharmaceuticals have changed the approach for psychodynamic therapy or its effects. Further studies should include pharmaceuticals in their methods. Also, there still remains few studies attempting to explain why aspects of psychodynamic therapy work. Studies should continue and refine what we know so as to best find what we need to change and/or replicate.

References

Fonagy, P., & Lemma, A. (2012). Does psychoanalysis have a valuable place in modern mental health services? Yes. The Bmj, 344. doi:10.1136/bmj.e1211

Leichsenring, F., & Leibing, E. (2003). The effectiveness of psychodynamic therapy and cognitive behavior therapy in the treatment of personality disorders: A meta-analysis. American Journal of Psychiatry, 160(7), 1223-1232. doi:10.1176/appi.ajp.160.7.1223

Lothane, Z. (2010). The analysand and analyst team practicing reciprocal free association:     Defenders and deniers. International Forum Of Psychoanalysis, 19(3), 155-164.

Nemeroff, C. B., Heim, C. M., Thase, M. E., Klein, D. N., Rush, A. J., Schatzberg, A. F., . . . Keller, M. B. (2005). Differential responses to psychotherapy versus pharmacotherapy in patients with chronic forms of major depression and childhood trauma. Focus, 3(1), 1

Norcross, J.C., Hedges, M., & Castle, P. H. (2002). Psychologists conducting psychotherapy in 2001: A study of the division 29 membership. Psychotherapy: Theory/Research/Practice/Training, 39, 97-102

Shedler, J. (2011). The Efficacy of Psychodynamic Psychotherapy. Psychodynamic Psychotherapy Research, 9-25. doi:10.1007/978-1-60761-792-1_2

Smith, M. L., & Glass, G. V. (1977). Meta-analysis of psychotherapy outcome studies. American Psychologist, 32(9), 752-760. Doi:10.1037//0003-066x.32.9.752

Stanovich, K. E. (2014). How to think straight about psychology. Harlow, Essex: Pearson.

 

 

 

 

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