The Depression: Online Therapy Study (D:OTS)—A Pilot Study of an Internet-Based Psychodynamic Treatment for Adolescents with Low Mood in the UK, in the Context of the COVID-19 Pandemic

Introduction: Face-to-face therapy is unavailable to many young people with mental health difficulties in the UK. Internet-based treatments are a low-cost, flexible, and accessible option that may be acceptable to young people. This pilot study examined the feasibility, acceptability and effectiveness of an English-language adaptation of internet-based psychodynamic treatment (iPDT) for depressed adolescents, undertaken during the COVID-19 pandemic in the UK. Methods: A single-group, uncontrolled design was used. A total of 23 adolescents, 16–18 years old and experiencing depression, were recruited to this study. Assessments were made at baseline and end of treatment, with additional weekly assessments of depression and anxiety symptoms. Results: Findings showed that it was feasible to recruit to this study during the pandemic, and to deliver the iPDT model with a good level of treatment acceptability. A statistically significant reduction in depressive symptoms and emotion dysregulation was found, with large effect size, by the end of treatment. Whilst anxiety symptoms decreased, this did not reach statistical significance. Conclusions: The findings suggest that this English-language adaptation of iPDT, with some further revisions, is feasible to deliver and acceptable for adolescents with depression. Preliminary data indicate that iPDT appears to be effective in reducing depressive symptoms in adolescents.

An International Survey of the Concept of Effective Psychodynamic Treatment During the Pandemic

Introduction: Most psychotherapists had no choice during the COVID-19 pandemic but to offer teletherapy in order to provide needed treatment. Several psychoanalytic theorists wondered if the very concept of treatment would change without an embodied relationship in an office setting. Methods: To attempt to understand the current concept of effective psychodynamic treatment in the new norm of teletherapy, we surveyed practitioners from 56 countries and regions who remotely treated patients psychodynamically during the beginning months of the pandemic. We asked the practitioners to rank six factors felt to be important to psychodynamic treatment: use of the couch during sessions, session in-office or via teletherapy, cultural similarity between therapist and patient, number of sessions a week, patient factors (motivation, insightfulness, and high functioning) and therapist factors (empathy, warmth, wisdom, and skillfulness). Results: We received 1,490 survey responses. As predicted, we found that the therapist and patient variables were considered much more important (both tied as highest rankings) to effective treatment than any of the other variables, including if the therapy was in-office or by teletherapy. Discussion: Psychodynamic practitioners worldwide confirmed that the empathy, warmth, wisdom, and skillfulness of the therapist and the motivation, insightfulness, and level of functioning of the patient are most important to treatment effectiveness regardless if the treatment is remote or embodied.

Psychodynamic Treatment with the Addicted Person

Psychodynamically trained clinicians have much to offer patients with substance use disorders, but lack a coherent model of treatment for addictions. This paper proposes a bipartite model for approaching addictive illness, separating the addicted person from their illness. Within this framework, the psychodynamic treatment approach seeks to discover and cultivate each person's unique humanity through the therapeutic relationship. Addiction and recovery are conceptualized not as states but as opposing dynamic forces within the individual, each requiring its own therapeutic approach. The seeds of psychodynamic work are planted from the onset of treatment through a therapeutic position of curiosity, nonjudgmental acceptance, empathy, kindness, honesty, and evolving trust. Unlike other treatment approaches, the therapeutic relationship takes center stage in driving the healing process. Countertransference challenges signal crucial opportunities to “flip the script” from dynamics of addiction to those of recovery. The author draws upon several models to illuminate this work. Khantzian's ego-deficit model describes areas of self-regulation vulnerability associated with addiction and conversely pathways to growth in treatment. Winnicott's concept of false self is translatable to the addictive self, while psychotherapy allows true self to emerge. Krystal's description of psychic trauma relates directly to the fragmentation and dissociation of experience in addictive illness. Clinical vignettes illustrate the themes discussed. Psychodynamic therapy offers the opportunity for healing of the deep psychic wounds afflicting many who suffer from addictive illness.

Efficacy of Internet-Delivered Psychodynamic Therapy: Systematic Review and Meta-Analysis

Recent years have seen an increase of internet-delivered interventions based on psychodynamic treatment models. To test the efficacy of internet-delivered psychodynamic therapy (IPDT), we conducted a systematic review and meta-analysis of randomized controlled trials. Following literature searches, we identified seven studies meeting inclusion criteria. The total number of participants was 528 in the treatment group and 552 in the control conditions. We found small effects favoring IPDT compared to inactive control conditions for main outcomes (g = 0.44), depression (g = 0.46), anxiety (g = 0.20), and quality of life (g = 0.40). There was significant heterogeneity between studies for main outcomes and depression. Within-group effects ranged from Hedges's g = 0.32–0.99. The effects of IPDT were maintained or increased at follow-up. Study quality varied but was generally high. No indications of publication bias were found. In conclusion, IPDT is a promising treatment alternative, especially for depression, although the small number of studies limits the generalizability of the findings.

Psychoanalytic treatment of psychosis

This chapter focuses on psychoanalysis and long-term psychoanalytic psychotherapy. Early in the history of psychoanalysis, strong claims were made that psychosis could be treated psychoanalytically. This chapter shows that the idea of psychodynamic treatment for psychosis is alive and well. And, even people with serious disorders such as schizophrenia can have work and relationship issues, just like everyone else; and these can be addressed in therapy, just like with everyone else. Psychodynamic treatment can help people identify what quality of life is for them; and how best to achieve it. Psychosis can go hand-in-hand with psychodynamic treatment in addition to medication. those who struggle with mental illness want what Freud noted that everyone wants—to work and to love.

Intermittent Treatment with the Psychodynamic Psychiatrist: A Patient-Centered Approach

This study examines the experiences of patients in treatment with psychodynamic psychiatrists on an intermittent basis following an initial brief period of intensive psychotherapy and stabilization. Patients with non-psychotic disorders who received intermittent treatment answered a web-based questionnaire describing the usefulness of various supportive, cognitive-behavioral, and psychodynamic interventions. Forty-eight out of 58 patients invited to participate completed the survey (83% response rate). The majority (75%) of respondents welcomed the intermittent treatment frame. Therapeutic factors deemed to be most helpful included supportive interventions such as ability to relate to the clinician, ability of clinician to listen empathically, and feeling supported by a non-judgemental therapist when talking about private matters. The majority of respondents also endorsed as highly beneficial various cognitive-behavioral interventions such as understanding how thinking patterns impact behavior and feelings and discussing alternative coping skills. Also highly rated were psychodynamic interventions, including understanding how the present is modeled from past experiences and expression and regulation of affect. In the open-ended qualitative feedback, therapeutic factors including collaboration, forming an alliance, and empathic attunement emerged as important. Our preliminary findings suggest that the intermittent psychodynamic treatment frame is well received by patients. Patients welcome integration of different psychotherapeutic approaches to individualize treatment. The common factors in psychotherapy are important patient-reported therapeutic factors in the intermittent treatment approach.