PSYCHODYNAMIC THERAPY

Psychodynamic Therapy



Psychodynamic Therapy

Cognitive-behavioral therapy (CBT) represents a unique category of psychological interventions based on scientific models of human behavior, cognition, and emotion. It includes a wide range of treatment strategies that take the current knowledge about the etiology and maintenance of the different mental disorders into account (Roth 2005). Patients and therapists work together to identify and understand problems in terms of the relationship between thoughts, feelings, and behavior. The focus lies in the here and now. Individualized, usually time-limited therapy goals are formulated. CBT intends to directly target symptoms, reduce distress, re-evaluate thinking and promote helpful behavioral responses. The therapist supports the patient to tackle problems by harnessing his or her own resources. Specific psychological and practical skills are acquired (e.g., reflecting and reevaluating the meaning attributed to a situation with subsequent behavior changes) and the therapist actively promotes change with an emphasis on putting what has been learned into practice between sessions ("homework"). The patient learns to attribute improvement to his or her own efforts (self-efficacy). A trusting and safe therapeutic alliance is viewed as an essential ingredient, but not as the main vehicle of change.

Behavioral interventions are considered as clinical applications of learning theory(Frank 2005). The most frequently used methods are classical and operant conditioning, often combined with observational learning ("modeling")(Frank 2005). For example, patients learn to reward themselves systematically whenever they have been successful in showing new and adequate reactions to crucial situations. Behaviors such as avoidance or reduced activity are problematic because they can act to keep the problems going or worsen. If patients avoid situtations that trigger phobias (e.g., crowds, traveling in bus or train), therapists help them feel safe enough to face the feared situation as a means of reducing anxiety and learning new behavioral skills with which they may tackle problems.

CBT-trained therapists work with individuals, families, and groups. The approach can be used to help anyone irrespective of ability, culture, race, gender, or sexual preference. It can be applied with or without concurrent psychopharmacological medication, depending on the severity or nature of each patient's problem.

The duration of cognitive-behavioral therapy varies, although it typically is thought of as one of the briefer psychotherapeutic treatments. Especially in research settings, duration of CBT is usually short, between 10 and 20 sessions. In routine clinical practice, duration varies depending on patient comorbidity, defined treatment goals, and the specific conditions of the health care system. For example, in Germany the mean duration of CBT in clinical (outpatient) practice is between 40 and 60 sessions; up to 80 sessions of CBT will be paid by the statutory health insurance, but the treatment must be applied for and an independent expert must check the individual indication and prognosis. The findings of the national institute of mental health study on depression are consistent with this duration of CBT, indicating that 16 to 20 sessions of cognitive-behavioral (and interpersonal therapy or pharmacotherapy of a comparable duration) are insufficient for most patients to achieve lasting remission(Fonagy ...