Residency Training in Intensive Short-Term Dynamic Psychotherapy: Methods and Cost-Effectiveness

Abbass, Allan; Kisely, Steve; Rasic, Daniel; Katzman, Jeffrey

doi:10.3928/00485713-20131105-06

Cited by 8 publications

(6 citation statements)

References 13 publications

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“…This is in line with our findings that the group of professional therapists (vs. trainees) with far more training hours did not seem to conduct more effective treatments. It also parallels previous research on the effectiveness of ISTDP when carried out by psychiatry residents that indicated reductions in both symptoms and health care costs ( Abbass, 2004 ; Abbass et al, 2013 ). However, we found that a single therapist, considered an expert in ISTDP, had better outcomes than the other therapists, on one of the outcome measures.…”

Section: Discussionsupporting

confidence: 84%

Davanloo’s Intensive Short-Term Dynamic Psychotherapy in a tertiary psychotherapy service: overall effectiveness and association between unlocking the unconscious and outcome

Town

Abbass

2014

PeerJ

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Background. Intensive Short-Term Dynamic Psychotherapy (ISTDP), as developed by Habib Davanloo, is an intensive emotion-focused psychodynamic therapy with an explicit focus on handling resistance in treatment. A core assumption in ISTDP is that psychotherapeutic effects are dependent on in-session emotional processing in the form of rise in complex transference feelings that occurs when treatment resistance is challenged. Recent research indicates that an unlocking of the unconscious, a powerful emotional breakthrough achieved at a high rise in complex transference feelings, can potentially enhance ISTDP’s effectiveness. While ISTDP has a growing evidence base, most of the research conducted has used small samples and has tested therapy delivered by expert therapists. The aims of this study were to evaluate the overall effectiveness of ISTDP when delivered in a tertiary psychotherapy service, and to investigate if having an unlocking of the unconscious during therapy predicted enhanced treatment effectiveness.Methods. A total of 412 patients were included in the analyses. The average length of treatment was 10.2 sessions (SD 13.3). Multilevel growth curve modeling was used to evaluate treatment effectiveness and the association between unlocking the unconscious and outcome. A number of control predictors including type of treatment resistance were selected and included in the analyses. Outcome measures were the Brief Symptom Inventory (BSI) and the Inventory of Interpersonal Problems (IIP). About half of the patients in the study were treated by therapists in training and the other half by more experienced therapists.Results. Growth curve analyses using the full intention-to-treat sample revealed significant within-group effects of ISTDP on both the BSI and the IIP. Effect sizes were large (>0.80). Unlocking the unconscious during therapy was associated with significantly larger treatment outcome. The relationship was further moderated by type of treatment resistance.Conclusion. This study adds to the empirical base of Davanloo’s ISTDP with confirmed treatment effectiveness in a large-scale patient sample when ISTDP was delivered by therapists with a range of experience. Furthermore, emotional mobilization in the form of unlocking the unconscious was confirmed as a process factor enhancing the effectiveness of ISTDP.

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Section: Discussionsupporting

confidence: 84%

Davanloo’s Intensive Short-Term Dynamic Psychotherapy in a tertiary psychotherapy service: overall effectiveness and association between unlocking the unconscious and outcome

Town

Abbass

2014

PeerJ

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“…The notable exception to this was the case series treated by psychiatry residents. 19 Second, all cost-bearing figures were not available in all studies, and it is unclear in most studies which cost measures were determined a priori. This raises the likelihood of reporting bias; thus, greater weight should be given to those studies with more complete reporting.…”

Section: Discussionmentioning

confidence: 99%

“…11 Three studies included inpatients in an acute care hospital 12 or residential treatment facility, 9,10 whereas the remainder involved outpatient samples. [13][14][15][16][17][18][19] In all, the studies included two randomized, controlled trials 13,15 and three non-randomized, controlled trials. 8,12,17 The remainder were case series.…”

Section: Overall Cost-effectivenessmentioning

confidence: 99%

The Cost-Effectiveness of Intensive Short-Term Dynamic Psychotherapy

Abbass¹,

Katzman²

2013

Psychiatric Annals

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CME Educational Objectives 1. Expose the reader to various sources of health care costs and diagnoses responsible for these. 2. Review the evidence for multiple categories of cost reduction for intensive short-term dynamic psychotherapy (ISTDP). 3. Review the return-to-work rates for patients receiving ISTDP treatment. The health care burden of chronic disability, with mental illness and somatic symptom disorders leading the way, is crippling to global economies. 1 In the recent JAMA report by the U.S. Burden of Disease Collaborators, the top diseases with the largest number of years lived with disability in 2010 were low back pain, major depressive disorder, other musculoskeletal disorders, neck pain, and anxiety disorders. Migraine, drug use, alcohol use and dysthymia were also in the top 20. The authors noted that half of the health system cost is due to disability and morbidity. 1

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“…According to this method, the path to establishing therapeutic alliance is through overcoming resistances. The main therapeutic interventions, which aim to unlock the unconscious, include confrontation, clarification, challenge to resistance, head on collision, facilitation of emotional experiences and recapitulation [10,[15][16][17][18][19][20]. The basis of ISTDP is resistance, transference and unconscious therapeutic alliance [10,[19][20][21][22][23], allowing this technique to be considered as an effective psychodynamic therapy, mainly by studies that cover follow-up interviews and post-treatment assessment measures [18,24,25].…”

Section: Dynamic Psychotherapymentioning

confidence: 99%

Dynamic Psychotherapy: The Therapeutic Process in the Treatment of Obsessive-Compulsive Disorder

Becker

Paixão

Silva

et al. 2019

Behavioral Sciences

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Dynamic Psychotherapy (DP) was developed to overcome the limitations of traditional psychoanalysis, responding to a broader demand of patients who seek help to cope with specific problems in the short term, such as Obsessive-Compulsive Disorder (OCD). OCD is a chronic disabling mental disorder that leads to substantial distress, functional disability and severe occupational and social impairments. Recognizing the literature gap in this field, and the improvements reported by dynamic therapists who have dealt with patients suffering from OCD, a study on the treatment of these patients was conducted in order to discuss the effects of this technique. The method involved a narrative literature review and the analysis of two clinical cases to discuss therapeutic processes, which include the specificities of OCD patients and the mechanisms adopted in the treatment through DP. The therapist’s active stance seemed to be essential to encourage the patient to face feared situations and identify the core conflict. Both patients who were treated through DP presented similarities, such as high anxiety, feelings of guilt and inhibition of aggressive and sexual impulses. Through emotional exploration, confrontation of defensive functioning and interpretative interventions of inner conflicts, patients had reached awareness of their hidden feelings and experiences, and their symptoms and feelings of guilt decreased. They also showed significant improvements in their interpersonal relationships. Although both treatments do not fit into short-term therapies, this technique has led to long-term results, providing evidence that DP may produce favorable outcomes in the treatment of OCD.

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Residency Training in Intensive Short-Term Dynamic Psychotherapy: Methods and Cost-Effectiveness

Cited by 8 publications

References 13 publications

Davanloo’s Intensive Short-Term Dynamic Psychotherapy in a tertiary psychotherapy service: overall effectiveness and association between unlocking the unconscious and outcome

Davanloo’s Intensive Short-Term Dynamic Psychotherapy in a tertiary psychotherapy service: overall effectiveness and association between unlocking the unconscious and outcome

The Cost-Effectiveness of Intensive Short-Term Dynamic Psychotherapy

Dynamic Psychotherapy: The Therapeutic Process in the Treatment of Obsessive-Compulsive Disorder

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