Dynamic Psychotherapy

A study has compared the effectiveness of short-term cognitive therapy vs dynamic psychotherapy in a community mental health setting. This study challenges the notion that cognitive therapy is superior to dynamic psychotherapy, and states that its results indicated they were equally effective.

According to CAMH, about 2.5 million adults will experience a major depression or will be diagnosed with depression in their lifetime. This astounding number means that you, yourself, have probably experienced depression in some capacity, or you likely know someone who has. Depression severely impacts all aspects of a person’s life, and even gaining access to treatment can be a very real struggle. But once there, what kind of treatment works best? The pseudo “gold standard” for treatment is currently considered to be Cognitive Training (CT), primarily because it has had various clinical trials providing evidence of its success. The Journal of the American Medical Association Psychiatry published an article in August 2016 that set out to provide evidence to support the effectiveness of Dynamic Psychotherapy (DT).

There is much debate about whether or not DT is an appropriate or effective treatment intervention for Major Depressive Disorder (MDD), and whether or not its effectiveness has been established. This study strived to contribute to the obvious gap in research. Dynamic Psychotherapy targets a person’s conscious and unconscious relationships with themselves, others, and their environment. Cognitive Therapy focuses more on developing skills and tools to test and modify beliefs, recognize and change distorted thinking, and other tools to assist a person with their disorder. The authors hypothesized that DT would not be inferior to CT for treating MDD, and would not be inferior to CT when assessing changes and improvements in symptoms, functioning, and quality of life. They were not attempting to establish that DT was superior to CT.

The methods utilized were a randomized noninferiority trial of 237 adult patients (aged 18-65) from a private, non-profit, community outpatient mental health centre. They had baseline assessments and structured clinical interviews throughout the process. Patients with co-morbidities such as psychosis, bipolar disorder, schizophrenia, or substance abuse were not included to ensure reliable results for MDD treatment. The DT treatment included techniques “to help patients gain self-understanding of their repetitive maladaptive relationship patterns. The treatment actively explores current relationship conflicts and includes socialization to treatment and focus on interpersonal goals.” The CT arm of the trial consisted of “structured sessions focusing on behavioural activation of depressogenic beliefs… Interventions included activity scheduling, evaluating automatic thoughts, and behavioural experiments.” Assessments were conducted at months 1, 2, 4, & 5. No statistically significant differences between treatment groups based on demographics such as age, gender, or ethnic background were found. The authors also determined that the number of sessions attended did not impact the study results.

The trial results showed that short-term dynamic psychotherapy was not less effective than short-term cognitive therapy in terms of decreasing symptoms and increasing functionality within a community out-patient clinical setting. Academically, this trial is important to help fill in the obvious research gaps regarding efficacy concerns. Practically, this trial demonstrated that DT can be useful in the out-patient setting. Many community mental health services are always quite busy, and wait lists are often long. If CT is currently what’s being primarily utilized, there could be limitations on which therapists or psychologists can work in those facilities. Aside from the potential to have extra staff (funding permitting), not all therapies work for everyone. If a person feels that DT will help them more than CT based on their personal concerns, history, and diagnosis, then that person should have the ability to decide what treatment route is best for them. An article like this reminds us that we should never simply accept what is currently being offered as treatment as the only option for ourselves or loved ones, but rather as one of the options out there. It is important to advocate for the type of care you feel you or your loved one needs.


Written By: Tori Cuthbertson, BSc AEMCA

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