November 2010  << Back  

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Psychodynamic Therapy: A Guide to Evidence-Based Practice

Eva Waineo, MD

Wayne State University, Detroit, MI, USA

By Richard F. Summers and Jacques P. Barber. New York: NY; Guilford Press; 2010; ISBN 978-1-60623-443-3; pp 355; $40 (hardcover).

Psychodynamic therapy has been criticized as being out-of-date, difficult to integrate within today’s practice, and lacking evidence-based research. For others, it remains an integral way to understand patients on a deeper level, help them improve their symptoms, and lead healthier lives. Drs. Summers and Barber address these differing opinions in Psychodynamic therapy and set out to “describe a contemporary psychodynamic therapy model that we believe is practical, effective, and easily integrated with other treatment modalities.”

The book is organized into 5 parts: context, opening phase, middle phase, combining treatments, and ending. This provides a unique chronological structure that beginning psychotherapists can use to organize their understanding of psychodynamic therapy. Clinical examples are woven into the writing beginning in the first chapter. These examples engage the reader, are useful illustrations of psychodynamic therapy in clinical practice, and provide a deeper understanding of its techniques, challenges, and goals. The authors emphasize active psychotherapist participation as opposed to the outdated “blank screen.” From the beginning, Drs. Summers and Barber describe psychodynamic therapy in the context of other treatment options. The authors also describe relevant research on psychodynamic therapy succinctly in each chapter and acknowledge the lack of and difficulties in performing research. However, I think it would have been informative to discuss these studies in greater detail.

The chapters on context concisely define psychodynamic therapy and explain different perspectives within the field. Interestingly, their discussion is not limited to approaches within psychodynamic therapy. For example, Drs. Summers and Barber coherently weave a clinical example into the writing and describe how a psychodynamic and cognitive-behavioral therapist would view and clinically approach different aspects of a patient’s presentation and treatment. It was refreshing to read a description of psychotherapy not presented within a vacuum but in the context of other treatments.

In the following chapters, the authors move on to the opening phase in treatment, during which skills the therapist needs for a good therapeutic alliance, the patient’s and the therapist’s role, formulation, and treatment goals are discussed. Most valuable were the specific, practical tips for a beginning psychotherapist, such as how to introduce and explain psychodynamic therapy to a patient and how to appropriately phrase and time interpretations.

In the chapters on core psychodynamic problems, the authors write about 6 problems—depression, obsessionality, fear of abandonment, low self-esteem, panic anxiety, and trauma—which they believe are the majority of problems that are appropriate to treat with psychodynamic therapy. They discuss in detail patient presentation, psychodynamic conceptualization, therapy techniques, transference, and countertransference. Unfortunately, the amount of evidence for effective treatment of some problems, especially obsessionality and low self-esteem, is limited. It would be beneficial to spend more time describing the available research or reasons why the problems were included if little research was available. Without this, it remains unclear why the authors thought these particular problems, and not others, would be appropriate for psychodynamic therapy.

In the discussion of the middle phase, I found that the chapter on change included a thoughtful discussion of this process within therapy. The section on difficult decisions, which the authors describe as “particular moments when there is a sense that the patient is at a fork in the road, with an important decision to make,” could be expanded to include specific examples, possibly brief process notes from sessions, and further discussion on how to approach these important issues.

The section on combining treatments includes a chapter on combining psychopharmacology with psychotherapy. Particularly useful are the practical ways to treat patients with medications and psychotherapy, the complex role a psychiatrist must take, and how to understand patient reactions to medications using psychodynamic thinking.

The last section, entitled “Ending,” consists of 1 chapter about termination. The description of ways to distinguish premature from appropriate termination and how termination affects the therapist were particularly informative. Drs. Summers and Barber even address the often encountered forced termination when trainees complete their training. The authors only briefly touch upon the topic of supervision. It would be interesting to include psychodynamic meanings of supervision and its affect on the therapist-patient relationship because supervised psychotherapy is a key component of training curricula.

Overall, the book provides a structure in which a psychotherapist can organize a patient’s presenting symptoms, diagnosis, psychodynamic presentation, and treatment approach. The organization lends itself less to a reference text, but may be applicable to a beginning psychotherapist who already has some understanding of and interest in psychodynamic therapy. Such a reader would appreciate a guide that explains psychodynamic therapy and provides practical advice. Although the flowing style is interesting and easy to read, it may be less applicable to experienced clinicians. Those particularly interested in a thorough discussion of the available research may be disappointed with the brief descriptions of most of the included studies. However, the authors have formulated an excellent guide to starting psychodynamic therapy. The text engagingly and concisely offers useful information about how to understand and apply psychodynamic theory to clinical practice.