Psychodynamic Therapy for PTSD: Effectiveness, Strengths, and Limitations

Use of Psychodynamic therapy in the Treatment of Post-Traumatic Stress Disorder

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Use of Psychodynamic therapy in the Treatment of 

Post-Traumatic Stress Disorder

This paper herein takes a closer look at the various theoretical and practical aspects of psychodynamic therapy in the treatment of Posttraumatic Stress Disorder (PTSD). Through this paper, the relation between theory and practical aspects of psychotherapy including its strengths and weaknesses in treating PTSD will be reviewed.

An Introduction to Psychodynamic Psychotherapy

Psychodynamic psychotherapy is a range of treatments that facilitates exploring those aspects of self that are still not completely known, especially those that are manifested and influenced by therapy relationships (Shedler, 2015). Originated by Sigmond Freud, psychodynamic theory focuses around the idea that all human feelings and behavior are deeply influenced by psychological processes occurring deep within the unconscious mind.  The tenets of psychodynamic theory consist of the Unconscious Mind, Collective Unconscious, Psyche, Defense Mechanisms, Psychosexual Development, Psychosocial Development (Mcleod,2021). 

Features of Psychodynamic Psychotherapy

There are seven features that are practiced and reliably distinguish psychodynamic psychotherapy from other therapies such as Cognitive Behavior Therapy (CBT) (Shedler, 2015). These include, psychodynamic therapy focusing on the affect and expression of patient’s emotions, avoiding distressing thoughts and feelings, identifying recurring themes and patterns, discussing past experience, focusing on interpersonal relations, focusing on therapy relationships and exploring of fantasy life (Shedler, 2015). 

Use of Psychodynamic Theory as an Intervention for treating PTSD

Psychodynamic Psychotherapy is a neurobiologically informed and phased treatment approach that takes into account ego-function impairment and broad comorbidity found in the patients diagnosed with PTSD (Woller et al., 2012). 

The technique of psychodynamic therapy integrates imaginative and trauma-sensitive techniques that are result-oriented. This approach majorly emphasizes on the prevention of displaced traumatization (Woller et al., 2012). Although psychodynamic is understudied, the approaches of psychodynamic theory have been widely used in the treatment of PTSD among practitioners (Woller et al., 2012). There are several reasons for which psychodynamic theory is being used to treat PTSD. For instance, an understanding of psychic trauma right from the beginning is important for a psychoanalytic thinking which is done in the psychodynamic therapy (Woller et al., 2012). Besides this, the object-relations tools are being used along with the techniques to handle complicated transference as well as counter-transference phenomena are well handled in psychodynamic psychotherapy. Additionally, the treatment for attachment disorder and mentalization deficits related to PTSD are well handled by this therapy (Woller et al., 2012). The other issues such as deficient ego-functions and poor self-care and impaired self-esteem are being handled with the psychodynamic psychotherapy (Woller et al., 2012). Thus, psychodynamic therapy is a highly recommended therapy for the treatment of PTSD.  

Psychodynamic theory to Psychodynamic Psychotherapy - From theory to Practice

Strengths

There are some aspects that indicate strength of psychodynamic therapy over other treatment techniques such as both the theory and practice contribute to the understanding as well as treatment of complex traumatic disorders (Spermon et al., 2010). The therapists work to identify intense negative-affects, intrapsychic conflicts and various defense mechanisms and intervene on the basis of a psychodynamic framework (Busch & Milrod, 2018). 

Limitations

Some of the limitations pertaining to psychodynamic treatments include lesser number of controlled trails as compared to the other forms of psychotherapies such as CBT (Shedler, 2015). In many of the studies concerning psychodynamic therapy, the patient samples used were loosely specified and the control conditions have been suboptimal owing to which the empirical support has been lacking in most of them (Shedler, 2015). Another limitation to psychodynamic therapy is that even many psychodynamic psychotherapists are ill-prepared when it comes to practically applying the knowledge of psychotherapy to practice (Shedler, 2015). For instance, despite the availability of evidence-based research supporting the concepts in regards to psychodynamic treatments, the policymakers, psychodynamic practitioners are not ready to respond to the challenges faced while practicing psychodynamic therapy (Shedler, 2015). Thus, with these limitations, the brighter side of psychodynamic psychotherapy are yet to be explored to benefit people at large. 

The Effectiveness of Psychodynamic Therapy 

There are some challenges facing the evaluation of the effectiveness of Psychodynamic psychotherapy (Cherry, 2021). One of the reasons why the full efficacy of psychodynamic psychotherapy remains questioned is that many of the changes that this therapy produces are tough to measure and so is the evaluation of their effectiveness. However, researches indicate that it is useful in the treatment of a wide range of psychological problems. 

As per American Psychological Association (2010), psychodynamic psychotherapy works on the root-cause of the emotional sufferings. The hallmarks of emotional sufferings are self-reflection and self-examination and the purpose of this therapy is not just alleviation of symptoms but help people lead a healthy life (American Psychological Association, 2010). The study by Levi et al. (2015) on the comparative effectiveness of Cognitive-Behavior Therapy with Psychodynamic theory on PYSD patients indicates that both the treatments resulted in significant decrease in the symptoms of PTSD patients. They also found that improved functioning from pre-treatment to post-treatment that was maintained during follow-up. The study showed that no significant differences could be found between the efficacy of the two treatments on PTSD patients’ symptoms (Levi et al., 2015). The study indicates the same pattern of change in symptoms of the patients suffering from PTSD from both the therapies. This indicates that if not superior, Psychodynamic psychotherapy is as effective as other therapies such as CBT.  

Strengths and Limitations of Psychodynamic Psychotherapy concerning PTSD treatment

Strengths

Psychodynamic theory is evident to have many strengths when working with clients diagnosed with PTSD including the trauma informed approaches that are incorporated when using this theory with clients. As Alessi & Kahn (2019), discuss psychodynamic theory supports the focus of building therapeutic relationships and a safe environment where treatment can unfold. As Shedler (2010), explores the studies that have been completed demonstrate individuals who suffer from PTSD and take part in therapy based on the psychodynamic theory they have an increased likelihood of improving their interpersonal relationships, fewer feelings of inadequacy and a reduction of PTSD and depression symptoms. Additionally, social workers specifically benefit from using psychodynamic theory with clients who experience PTSD. As Bliss& Rasmussen (2013), discuss how there have been more complex cases including clients with PTSD and there being limitations to symptom focused therapy such as cognitive behavioral therapy along with other biological treatments. 

Limitations

One of the limitations to psychodynamic theory and PTSD is there has been a limited number of studies done to explore the limitations this theory has when working with clients who have PTSD. As Paintain & Cassidy (2018), discuss psychodynamic theory not being studied as much as much as other theories have in relation to PTSD which has created difficulty in measuring its effectiveness. Bliss & Rasmussen (2013), further emphasize this when they discuss psychodynamic theories and therapy not being empirically validated which is a limitation in measuring the outcomes (i.e., cause and effect) in relation to clients who are diagnosed with PTSD. 

Conclusion

This paper critically analyzed the use of psychodynamic therapy as an intervention for the treatment of Post-Traumatic Stress Disorder. It assessed the theoretical part of psychodynamic therapy along with its use in the real-life practice in treating various psychological problems in general and PTSD in specific. Although, psychodynamic psychotherapy is as effective as other psychotherapies such as Cognitive-Behavior therapy for which it has been found to be if not superior but on par with other therapies. However, further researches need to be done to evaluate and measure the effectiveness of psychodynamic psychotherapy in light of treatment of psychological problems including PTSD. Concluding, psychodynamic therapy can be a potential treatment for trauma-based psychological problems and to assess the measurable outcomes of psychodynamic therapy, more and more researches should be done to explore the brighter aspect of psychodynamic psychotherapy.

References

American Psychological Association (2010) Psychodynamic Psychotherapy Brings Lasting 

Benefits through Self-Knowledge. APA.org. Available at  https://www.apa.org/news/press/releases/2010/01/psychodynamic-therapy 

Busch, F.N. & Milrod, B.L. (2018) Trauma-Focused Psychodynamic Psychotherapy. Psychiatr Clin North Am. 2018 Jun;41(2):277-287. doi: 10.1016/j.psc.2018.01.005. Available at

https://pubmed.ncbi.nlm.nih.gov/29739526/ 

Cherry, K. (2021) What Is Psychodynamic Therapy? Verywellmind.com. Available at

https://www.verywellmind.com/psychodynamic-therapy-definition-uses-effectiveness- 5094933 

Levi, O. Bar-Haim, Y. Kreiss, Y., Fruchter, E. (2015) Cognitive–Behavioural Therapy and Psychodynamic Psychotherapy in the Treatment of Combat-Related Post-Traumatic Stress Disorder: A Comparative Effectiveness Study. Clinical Psychology and Psychotherapy. Available at https://people.socsci.tau.ac.il/mu/anxietytrauma/files/2014/04/Levy-et-al-in-press-Clinical-Psychology-and-Psychotherapy.pdf 

Shedler, J. (2010). The Efficacy of Psychodynamic Psychotherapy. APA.org, 65(2), 98–109.

Available at https://www.apa.org/pubs/journals/releases/amp-65-2-98.pdf   

Spermon, D., Darlington, Y., & Gibney, P. (2010). Psychodynamic psychotherapy for complex trauma: targets, focus, applications, and outcomes. Psychology research and behavior management, 3, 119–127. https://doi.org/10.2147/PRBM.S10215 

Woller et al. (2012) Psychodynamic psychotherapy for posttraumatic stress disorder related to 

childhood abuse-Principles for a treatment manual. Bulletin of the Menninger Clinic.  76(1):69-93. DOI:10.1521/bumc.2012.76.1.69. Available at  https://www.researchgate.net/publication/221695090_Psychodynamic_psychotherapy_fo r_posttraumatic_stress_disorder_related_to_childhood_abuse- Principles_for_a_treatment_manual