Empirical Support and General Methodology

Empirical Support and General Methodology

A recent article by Shedler (February-March 2010, American Psychologist) compiles a great number of empirical studies showing not only the therapeutic efficacy of psychoanalytically oriented treatments, but also that therapeutic gains increase after the end of the treatment.

In this same article, Shedler, basing himself on Blagys and Hilsenroth's (2000) revision, describes the following seven distinctive features of psychoanalytic psychotherapy, also applicable to psychoanalysis, that were used as defining elements in the empirical studies he compiles.

Seven Distinctive Features

Focus on affect and expression of emotions.

Psychodynamic therapy encourages exploration and discussion of the full range of a patient's emotions. The therapist helps the patient describe and put words to feelings, including contradictory feeling, feelings that are troubling or threatening, and feelings that the patient may not initially be able to recognize and acknowledge. There is also recognition that intellectual insight is not the same as emotional insight, which resonates at a deep level and leads to change (this is one reason why intelligent and psychologically minded people can explain the reasons for their difficulties, yet their understanding does not help them overcome those difficulties).

Exploration of attempts to avoid distressing thoughts and feelings.

People do a great many things, knowingly and unknowingly, to avoid aspects of experience that are troubling. This avoidance may take subtle forms that are difficult to recognize in ordinary social discourse, such as subtle shifts of topic when certain ideas arise, focusing on incidental aspects of an experience rather than what is psychologically meaningful, attending to facts and events to the exclusion of affect, focusing on external circumstances rather than one's own role in shaping events and so on. Psychodynamic therapists actively focus on and explore avoidances.

Identification of recurring themes and patterns.

Psychodynamic therapists work to identify and explore recurring themes and patterns in patient's thoughts, feelings, self-concept, relationships, and life experiences. In some cases, a patient may be acutely aware of recurring patterns that are painful and self-defeating but feel unable to escape them (e.g., a man who repeatedly finds himself drawn to romantic partners who are emotionally unavailable; a woman who regularly sabotages herself when success is at hand). In other cases, the patient may be unaware of the patterns until the therapist helps him or her to recognize and understand them.

Discussion of past experience (developmental focus).

Related to the identification of recurring themes and patterns is the recognition that past experience, especially early experience of attachment figures, affects our relationship to, and experience of, the present. Psychodynamic therapists explore early experiences, the relation between past and present, and the ways in which the past tends to "live on" in the present. The focus is not on the past for its own sake, but rather on how the past sheds light on current psychological difficulties. The goal is to help patients free themselves from the bonds of past experience in order to live more fully in the present.

Focus on interpersonal relations.

Psychodynamic therapy places heavy emphasis on patients' relationships and interpersonal experience. Both adaptive and nonadaptive aspects of personality and self-concept are forged in the context of attachment relationships, and psychological difficulties often arise when problematic interpersonal patterns interfere with a person's ability to meet emotional needs.

Focus on the therapy relationship.

The relationship between therapist and patient is itself an important interpersonal relationship, one that can become deeply meaningful and emotionally charged. To the extent that there are repetitive themes in a person's relationships and manner of interacting, these themes tend to emerge in some form in the therapy relationship.

For example, a person prone to distrust others may view the therapist with suspicion; a person who fears disapproval, rejection, or abandonment may fear rejection by the therapist, whether knowingly or unknowingly; a person who struggles with anger and hostility may struggle with anger towards the therapist and so on (these are relatively crude examples; the repetition of interpersonal themes in the therapy relationship is often more complex and subtle than these examples suggest). The recurrence of interpersonal themes in the therapy relationship provides a unique opportunity to explore and rework then in vivo. The goal is greater flexibility in interpersonal relationships.

Exploration of fantasy life.

In contrast to other therapies in which the therapist may actively structure sessions or follow a predetermined agenda, psychodynamic therapy encourages patients to speak freely about whatever is on their minds. When patients do this, their thoughts naturally range over many areas of mental life, including desires, fears, fantasies, dreams, and daydreams. All this material is a rich source of information about how a person views self and others, interprets and makes sense of experience, or interferes with a potential capacity to find greater enjoyment and meaning in life.

Read Shedler's article; know more about psychoanalytic psychotherapy; any questions?