PSYCHODYNAMIC EMOTION FOCUSED THERAPIES: THE NEXT PSYCHIATRIC FRONTIER
- Posted by Alan Eppel
- Posted in Review Articles
ALAN EPPEL MB, FRCPC
Due to the increasing recognition among psychiatrists of the constraints of
psychopharmacological treatment of psychiatric disorders, there has been
an intensified interest in psychotherapies.
Current research is focused on identifying which types of patients respond best to the various psychotherapeutic modalities.
New forms of psychotherapy have evolved to respond to therapeutic gaps. Well-established therapies include cognitive behavior therapy, emotion focused therapy, cognitive processing therapy, interpersonal psychotherapy, and psychodynamic psychotherapy.
Over the past five decades there have been considerable advances to the psychodynamic paradigm.
Freud’s intrapsychic conflict model has evolved through object relations theory to attachment-based and relational psychotherapies.
Bowlby’s attachment theory has had a profound influence within psychiatry and psychology and is one of the foundational components within the practice of psychiatry.
Discoveries in Affective Neuroscience, particularly the work of Jaak Panksepp, have provided a deeper understanding of the human affective systems and their application to psychotherapy.
Therapeutic interventions are now conceptualized much more in attachment and relational terms; the language of object relations has been translated into new formulations.
There have been major changes in technique leading to more rapid access to unconscious emotions. There is greater emphasis on using the therapeutic dyad as a major accelerator of change.
The previous emphasis on interpretation has been replaced by the uncovering of core emotions and the processing of these experientially within the therapeutic session.
The previous emphasis on interpretation has been replaced by the uncovering of core emotions and the processing of these experientially within the therapeutic session.
New forms of shorter term and accelerated psychodynamic psychotherapy have been developed building upon the work of Michael Balint and David Malan in the UK. Intensive Short-term Dynamic Psychotherapy was developed by Habib Davanloo in Montreal and represented a dramatic breakthrough in accelerating the process of therapy.
Two of Davanloo’s students Alan Abbass in Halifax and Diana Fosha in New York went on to further develop and apply these methods. Alan Abbass continues to practice and teach Davanloo’s approach. This involves vigorous confrontation of defenses and focus on the transference. He has made major contributions by publishing meta-analyses, systematic reviews and outcome studies.
Recently Abbass led a Cochrane review of 33 studies involving 2173 patients with a rangeof common psychiatric disorders. Primary outcomes were reductions in general, somatic, anxiety and depressive symptoms, as well as change in interpersonal problems and social adjustment. Except for somatic measures in the short-term, all outcome categories suggested significantly greater improvement in the treatment versus the control groups.
New York psychologist Diana Fosha has applied attachment theory and affective neuroscience in developing AEDP: Accelerated Experiential Dynamic Psychotherapy.
In her ground-breaking book “The Transforming Power of Affect” she describes techniques that rapidly bypass defenses to reach deep emotions of sadness, anger, grief, rage, and joy. Adopting the attachment paradigm Fosha provides a secure base for the patient by means of active engagement, attunement, and validation.
Tracking moment to moment affect is done by paying exquisite attention to minute signs of affective shift, body posture and facial expression.
The therapist makes empathy explicit by the expression of compassion, warmth and appreciation. Implicit empathy is conveyed by matching tone, non-linguistic verbalizations, eye gaze, pacing and rhythm.
Disclosure of the positive impact the patient has on the therapist is a powerful tool to foster attachment and provides a corrective emotional experience.
Fosha has concluded that Interpretation and insight do not lead to change rather it is the experience of previously “unbearable affect” in the present moment, within the securely attached dyadic therapeutic relationship that leads to healing and inner transformation.
References:
Abbass A, Kisely S, Town J, Leichsenring F et al. Short-term psychodynamic psychotherapies for common mental disorders. Cochrane Collaboration 2014.
Bowlby, J (1977) The Making and Breaking of Affectional Bonds British J.
Psychiatry 130,421-31
Davanloo, H (1990) Unlocking the unconscious: Selected papers of Habib
Davanloo. New York. Wiley
Fonagy, P (2001) Attachment Theory and Psychoanalysis. New York. Other Press
Fosha, D (2000) The Transforming Power of Affect. New York. Basic Books.
Panksepp, J (1998) Affective Neuroscience: the foundations of human and animal
emotions. Oxford University Press.
Panksepp, J (2003) Feeling the Pain of Social Loss. Science v.302 237-239
