Core Processes in Brief Psychodynamic Psychotherapy Advancing Effective Practice PDF
1.71 MB PDF
All psychotherapy educators aspire to teach evidence-based psychotherapy. They encounter problems, not the least of which is reaching agreement about the meaning of the phrase “evidence based” (Slade & Priebe, 2001). Other problems result from the fact that to advocate one particular evidenced-based treatment over others is to ignore the reality that treatments need to be tailored to the population one is treating. The university where I teach is located in a socially and economically deprived outer metropolitan area. Our clinic patients are mainly from lower socioeconomic circumstances, often from chaotic, disorganized families and with histories of abuse and deprivation. Our clinical trainees rarely get the option of working on prescribed homogeneous disorders or with circumscribed problem behaviors.
This patient group is similar to the one that I worked with in the field prior to becoming an academic. Early in my career I had been known as a neurpsychologist and even as a behavioral psychologist. However, when I accepted a position as a child and family clinical psychologist in a community health service, I quickly found that the skills I had acquired were not sufficient and sought a theoretical framework that could adequately encompass the intergenerational and systemic issues within which I could describe the maladaptive patterns in relating that I observed in many of my patients. To improve my effectiveness, I sought further training in psychodynamic psychotherapy and family therapy, both of which provide systemic and developmental perspectives and means for conceptualizing the complex in a wide range of patients and presenting problems.
When I joined the Department of Psychology at Victoria University, the then Head of Department, Associate Professor Ross Williams, seemingly moving against the tide promoting only evidenced-based cognitive-behavioral therapies, had a vision of instruction in psychodynamic psychotherapy. I was given the task of teaching it, among other things, and was determined to do so from an evidence base. I found that this task was difficult because although the evidence appeared to be there, it was not easily accessible to staff or students. The books that were readily available included ones devoted to specific treatments for specific disorders requiring students to purchase too many texts; conceptual bases for psychotherapies too far removed from actual practice skills; manuals for practitioners written by practitioners with little evidence that their clinical wisdom was in fact wise; descriptions of different dynamic therapies that were difficult for students to translate into practice and evaluate for effectiveness; specific curative factors providing too much detail and not enough integration with practice; and techniques of psychotherapy outside any theoretical framework. These books did not satisfy my criteria for a good textbook: They were not based on a task analysis, not evidence based, or not theoretically integrated.
For teaching purposes, I had to cobble together my reports of research into a book of readings for easy access by students. This book of readings eventually developed into Core Processes in Brief Psychodynamic Psychotherapy: Advancing Effective Practice. This book is designed to meet the needs of those teaching, learning, and practicing psychodynamic therapy and who know that it is evidence based but find it hard to argue the case to those who are adamant that it is not. I hope as a result of this book, one of the outcomes will be that the argument for one form of therapy (as against another) will be more evenhanded.
Core Processes in Brief Psychodynamic Psychotherapy: Advancing Effective Practice emphasizes therapy as process rather than product (Charman, 2003). Yet the question remains about which “processes”? Because many students enter graduate programs with little or no psychodynamic psychotherapy experience, my view is that training needs to take a task analysis approach. In this approach, the task of therapy is divided into its various, usually sequential components or significant events, each event analyzed, taught separately, and then put together as an entire sequence. A task analysis approach is consistent with the delineation of “curative factors,” that is, significant clinical events that are crucial for therapeutic change to be effective (Luborsky, Barber, & Beutler, 1993). These factors have been extensively researched.
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