Experimental Psychodynamic Model

Psychodynamic Therapy and the Experimental Model Making psychodynamic therapy (PDT) fit the experimental model does not remove it from the evocative therapy category. This is because the fundamental roles involved with evocative therapies are still present in experimental PDT. There are, of course, a number of changes made to fit the experimental model, but PDT continues the patient-based evocative methods involved in a long-term evocative therapy. In general, psychotherapies tend to follow a set of guidelines as described by Persuasion and Healing by Jerome and Julia Frank. For instance, the Franks write, “We shall consider as psychotherapy only those types of influence characterized by: (1) A healing agent (2) A sufferer who seeks relief
from the healer (3) A healing relationship” (Frank, 2). PDT continues these components of psychotherapy by having a treatment, patient, and therapeutic relationship. The roles involved in PDT psychotherapy have not gone outside these bounds, but rather specified them in order to conduct experimental research. For example, in the case of PDT for anxiety disorders Leichsenring, et al. explicate that “UPP-ANXIETY encompasses the following 9 treatment principles (modules): (1) socializing the patient for psychotherapy, (2) motivating and setting treatment goals, (3) establishing a secure helping alliance…” (Leichsenring et al. 2014). Clearly, the UPP-ANXIETY plan includes similar roles as earlier psychotherapies, which includes a patient, healer, and healing agent. Because of this, it is apparent that PDT continues to incorporate the roles of older psychotherapies, and can be considered in the same category. Part of the problem of determining the effectiveness of PDT is the subjectivity involved with the results.
As written by Jerome and Julia Frank, “Scientific methods, however, deal poorly with the meanings of the therapeutic situation… Psychotherapy may be better understood by its similarities to rhetoric, including sources of influence, targets, and the methods of persuasion used.” (Frank, 73). Even though PDT seeks to create “unified protocols that integrate principles of empirically supported treatments [that] do not yet exist,” the treatments by themselves aren’t effectively evaluated by the scientific method (Leichsenring et. al 2014). This is because as a form of evocative therapy, the patient’s evocation is crucial to whether or not the treatment will be successful. Otherwise, there is no one method that can be applied to every single patient that comes in with a myriad of issues to deal with. Furthermore, Seligman believes “that the ‘effectiveness’ study of how patients fare under the actual conditions of treatment in the field, can yield useful and credible ‘empirical validation’ of psychotherapy and medication” (Seligman, 966). Without the patient’s input from psychotherapy treatment, there is no clear way of moving forward. PDT, then, seeks “By the modular format, both the course of treatment and individual differences between patients can be taken into account, for example, patient motivation or severity of pathology.” (Leichsenring et. al 2014). This modular
format hopes to adapt to each individual patient’s needs, while simultaneously creating a universal plan of treatment (Leichsenring et. al 2014). Though this is an idealistic view of psychotherapy having the capability to heal all wounds, it demonstrates the same subjectivity involved with evocative therapies that “combat demoralization by persuading patients to transform these pathogenic meanings to ones that rekindle hope, enhance mastery, heighten self-esteem, and reintegrate patients with their groups” (Frank, 52). Overall, subjectivity in patients is a universal trait of psychotherapies, as it becomes a centerpiece of the treatment to focus on the evocative feelings of the patient to solve the problem, rather than using medication. Additionally, the techniques and evidence for PDT are evocative in nature. When comparing psychotherapies, Seligman writes, “No specific modality of psychotherapy did any better than any other for any problem. These results confirm the ‘dodo bird’ hypothesis, that all forms of psychotherapies do about equally well” (Seligman, 969). Similarly, in Leichsenring’s study “a considerable proportion of patients did not sufficiently benefit from PDT or CBT. Thus improving psychodynamic treatment of anxiety disorders is required” (Leichsenring et. al 2014). With similar comparative results, PDT could be as effective as any other psychotherapy available. In the PDT techniques, Leichsenring describes “Taking an empathic position, the therapist confronts, clarifies, and interprets the patients’ ambivalent between changing and remaining, their avoidance behavior and resistance to change” (Leichsenring et. al 2014). This presents an evocative method to psychotherapy, as the therapist uses the healing relationship to begin the process of change in the patient’s behavior. Another method used is “… the therapist may say, for example: ‘If you avoid meeting other people, they cannot humiliate you… So by avoiding other people, you protect yourself. That’s helpful to you.” (Leichsenring et. al 2014). Part of the therapy involved is mixed in between evocative and directive methods. It is evocative when the patient undergoes free association, e.g. sitting on the couch and talking about their feelings, whereas the directive therapist is about “setting goals and addressing the patient’s ambivalence and doubts” (Leichsenring et. al 2014). Overall, the methods and evidence provided for PDT make it similar to evocative therapies, though that by itself doesn’t make it one. The focus on the healing relationship, treatment, and patients make PDT an evolving form of psychotherapy that remains mostly evocative in the face of evidence-based treatments. Though psychotherapies often differentiate themselves from one another—dividing between evocative and directive therapies—the underlying ideals of PDT demonstrate its commitment to the psychotherapy world. When dealing with the problem of improvement over time, Seligman writes, “Thus the benefits of long-term psychotherapy are inferred by comparing different individuals’ improvements cross-sectionally” (Seligman, 973). PDT also acknowledges the problems with providing evidence for long-term therapies, which are generally well-received by their patients (Leichsenring et. al 2014). For instance, Leichsenring explains the problem with the evidence for specific treatments in the following: “In many cases, this form of evidence is more indirect and should be cautiously taken into account… To put it short and simple: before we study how a treatment works we need to show that it works” (Leichsenring et. al 2014). Recognizing that not all the evidence backs the treatments demonstrates that while PDT is being pushed towards the goal of being more experimental, it is still very much based on the ideals in the treatments. For example, when describing the healing relationship, it’s explained that “in PDT a focus away from affect may improve the bond, but not the outcome. To benefit, the patients need to talk about and experience difficult feelings, even if that means that the bond is not as strong for periods” (Leichsenring et. al 2014). Clearly, this puts emphasis on the patient to work through their feelings rather than using a toolbox in directive therapies. While it could be psychologically explained, this component of the therapy is evocative in nature as well as presenting the ideals of psychotherapies from the past. In short, the effort to make PDT fit the strict experimental model does not necessarily remove it from the category of evocative therapy.
Of course, changes have been made to PDT by including directive therapy methods, which are used to deal with the treatment of anxiety disorders and depression (Leichsenring et. al 2014). Overall though, PDT continues to fit the ideals, techniques, and evidence-based processes that evocative therapies have in the past. PDT, like other psychotherapies, is adapting to an ever-changing field and will continue its best to pursue evocative methods so long as it remains effective in treating
patients.