Psychotherapeut

, Volume 61, Issue 4, pp 327–338 | Cite as

Davanloos Intensive Psychodynamische Kurzzeittherapie

Wirksamkeit der Therapiemethode und Zusammenhang zwischen Erschließen des Unbewussten und Therapieergebnis
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Zusammenfassung

Hintergrund

Die Intensive Short-Term Dynamic Psychotherapy (IS-TDP, Intensive Psychodynamische Kurzzeittherapie), entwickelt von Habib Davanloo, ist eine intensive psychodynamische emotionsfokussierte Kurzzeittherapie. Der Behandlungsschwerpunkt liegt im Umgang mit Widerständen, die während einer Therapie auftreten. Eine Grundannahme der IS-TDP ist, dass die Wirkungen der Therapie abhängig sind von komplexen emotionalen Prozessen in der Therapie, die sich im Anstieg der komplexen Übertragungsgefühle zeigen, wenn die Widerstände herausgefordert werden. Neueste Forschungsergebnisse belegen, dass das Erschließen des Unbewussten während einer Sitzung, ausgelöst durch einen hohen Anstieg der komplexen Übertragungsgefühle, die Wirksamkeit der IS-TDP verbessert. Während viele Studien fortlaufend die Wirksamkeit der IS-TDP bestätigen, fehlt bei den vorangegangenen Untersuchungen eine ausreichend große Stichprobenmenge. Auch wurden Patienten ausschließlich von erfahrenen Experten therapiert. Ziel dieser Studie ist daher, die generelle Wirksamkeit der IS-TDP in einem klinischen Rahmen nachzuweisen sowie zu untersuchen, ob ein Erschließen des Unbewussten während der Therapie zu einer erhöhten Behandlungswirksamkeit führt.

Methode

Insgesamt 412 Patienten nahmen an der Studie teil. Die durchschnittliche Dauer der Behandlungen betrug 10,2 Sitzungen (SD = 13,3). Um die Wirksamkeit der Behandlungsmethode und den Zusammenhang zwischen Erschließen des Unbewussten und dem Therapieergebnis herauszufinden, wurde die Analyse mit Mehrebenenwachstumsmodellen durchgeführt. Eine Reihe möglicher Vorhersagevariablen, wie die Art des Widerstands, wurde aufgeführt und zum Kontrollvergleich in die Modelle einbezogen. Als Messinstrumente dienten der Brief Symptom Inventory (BSI) und der Inventory of Interpersonal Problems (IIP). Circa die Hälfte der Patienten wurde von Therapeuten in der Ausbildung und der Rest von erfahreneren Psychotherapeuten behandelt.

Ergebnisse

Es ergaben sich anhand von Wachstumskurvenanalysen der vollständigen „Intention-to-treat“-Population signifikante Zwischengruppeneffekte der IS-TDP, in den Vergleichen mit dem BSI und dem IIP. Die Effektstärken sind groß (> 0,80). Das Erschließen des Unbewussten während der Therapie wies einen Zusammenhang mit einer signifikanten Zunahme der Behandlungswirksamkeit auf. Letzteres Verhältnis ließ sich zudem nachweislich von der Art des Widerstands beeinflussen.

Schlussfolgerung

Diese Studie leistet einen weiteren Beitrag zur Konsolidierung empirischer Wirksamkeit für Davanloos IS-TDP-Methode. Die Ergebnisse bestätigen die Effektivität der IS-TDP-Behandlung, durchgeführt bei einer großen Stichprobe von Therapeuten mit unterschiedlicher Therapieerfahrung. Des Weiteren wurde der emotionale Prozess des Erschließens des Unbewussten als Prozessfaktor hervorgehoben und dessen Beitrag zur Verbesserung des Therapieergebnisses bestätigt.

Schlüsselwörter

Psychotherapie Psychodynamische Psychotherapie Wirksamkeit Affekt Emotion 

Davanloo’s intensive short-term dynamic psychotherapy

Effectiveness and association between unlocking the unconscious and outcome

Abstract

Background

Intensive short-term dynamic psychotherapy (ISTDP), as developed by Habib Davanloo, is an intensive emotion-focused psychodynamic therapy with an explicit focus on handling resistance in treatment. A core assumption in ISTDP is that psychotherapeutic effects are dependent on in-session emotional processing in the form of an increase in complex transference feelings that occur when treatment resistance is challenged. Recent research indicates that an unlocking of the unconscious, a powerful emotional breakthrough achieved by a rise in complex transference feelings, can potentially enhance the effectiveness of ISTDP. While ISTDP has a growing evidence base, most of the research conducted has used small samples and has tested therapy delivered by expert therapists. The aims of this study were to evaluate the overall effectiveness of ISTDP when delivered in a tertiary psychotherapy service and to investigate whether unlocking the unconscious during therapy promotes enhanced treatment effectiveness.

Methods

A total of 412 patients were included in the analysis. The average length of treatment was 10.2 sessions (SD 13.3). Multilevel growth curve modeling was used to evaluate treatment effectiveness and the association between unlocking the unconscious and outcome. A number of control predictors including type of treatment resistance were selected and included in the analysis. Outcome was measured with the brief symptom inventory (BSI) and the inventory of interpersonal problems (IIP). Approximately half of the patients in the study were treated by therapists in training and the rest by more experienced therapists.

Results

Growth curve analyses using the full intention to treat sample revealed significant within-group effects of ISTDP on both the BSI and the IIP. Effect sizes were large (> 0.80). Unlocking the unconscious during therapy was associated with a significant improvement in treatment outcome. The relationship was further moderated by the type of treatment resistance.

Conclusion

This study adds to the empirical base of Davanloo’s ISTDP with confirmed treatment effectiveness in a large-scale patient sample when ISTDP was delivered by therapists with a wide range of experience. Furthermore, emotional mobilization in the form of unlocking the unconscious was confirmed as a process factor enhancing the effectiveness of ISTDP.

Keywords

Psychotherapy Psychodynamic psychotherapy Effectiveness Affect Emotion 

Literatur

  1. Abbass A (2002) Modified short-term dynamic psychotherapy in patients with bipolar disorder–preliminary report of a case series. Can Child Psychiatry 11:19–22Google Scholar
  2. Abbass A (2004) Small-group videotape training for psychotherapy skills development. Acad Psychiatry 28:151–155. doi:10.1176/appi.ap.28.2.151CrossRefPubMedGoogle Scholar
  3. Abbass A (2006) Intensive short-term dynamic psychotherapy of treatment-resistant depression: a pilot study. Depress Anxiety 23:449–452. doi:10.1002/da.20203CrossRefPubMedGoogle Scholar
  4. Abbass A, Bechard D (2007) Bringing character changes with Davanloo’s intensive short-term dynamic psychotherapy. Ad Hoc Bull Short Term Dyn Psychother 11:26–40Google Scholar
  5. Abbass A, Lovas D, Purdy A (2008a) Direct diagnosis and management of emotional factors inchronic headache patients. Cephalalgia 28:1305–1314. doi:10.1111/j.1468-2982.2008.01680.xCrossRefPubMedGoogle Scholar
  6. Abbass A, Joffres MR, Ogrodniczuk JS (2008b) A naturalistic study of intensive short-term dynamic psychotherapy trial therapy. Brief Treat Crisis Interv 8:164–170. doi:10.1093/brief-treatment/mhn001CrossRefGoogle Scholar
  7. Abbass A, Campbell S, Magee K, Tarzwell R (2009) Intensive short-term dynamic psychotherapy to reduce rates of emergency department return visits for patients with medically unexplained symptoms: preliminary evidence from a pre-post intervention study. CJEM 11:529–534PubMedGoogle Scholar
  8. Abbass A, Town JM, Driessen E (2012) Intensive short-term dynamic psychotherapy: a systematic review and meta-analysis of outcome research. Harv Rev Psychiatry 20:97–108. doi:10.3109/10673229.2012.677347CrossRefPubMedGoogle Scholar
  9. Abbass A, Kisely S, Rasic D, Katzman JW (2013) Residency training in intensive short-term dynamic psychotherapy: methods and cost-effectiveness. Psychiatr Ann 43:508–512. doi:10.3928/00485713-20131105-06CrossRefGoogle Scholar
  10. Anda RF, Felitti VJ, Bremner JD, Walker JD, Whitfield C, Perry BD, Dube SR, Giles WH (2006) The enduring effects of abuse and related adverse experiences in childhood. A convergence of evidence from neurobiology and epidemiology. Eur Arch Psychiatry Clin Neurosci 256:174–186. doi:10.1007/s00406-005-0624-4CrossRefPubMedGoogle Scholar
  11. Baldoni F, Baldaro B, Trombini G (1995) Psychotherapeutic perspectives in urethral syndrome. Stress Med 11:79–84. doi:10.1002/smi.2460110115CrossRefGoogle Scholar
  12. Borenstein M, Hedges LV, Higgins JP, Rothstein HR (2011) Introduction to meta-analysis. Wiley-Blackwell, OxfordGoogle Scholar
  13. Chartier MJ, Walker JR, Naimark B (2010) Separate and cumulative effects of adverse childhood experiences in predicting adult health and health care utilization. Child Abuse Negl 34:454–464. doi:10.1016/j.chiabu.2009.09.020CrossRefPubMedGoogle Scholar
  14. CONSORT Group, Schulz KF, Altman DG, Moher D (2010) CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. PLoS Med 7:e1000251 doi:10.1371/journal.pmed.1000251CrossRefGoogle Scholar
  15. Davanloo H (1990) Unlocking the unconscious: selected papers of Habib Davanloo, MD. Wiley, New YorkGoogle Scholar
  16. Davanloo H (2000) Intensive short-term dynamic psychotherapy: selected papers of Habib Davanloo. Wiley, ChichesterGoogle Scholar
  17. Davanloo H (2001) Intensive short-term dynamic psychotherapy: extended major direct access to the unconscious. Eur Psychother 2:25–70Google Scholar
  18. Davanloo H (2005) Intensive short-term dynamic psychotherapy. In: Kaplan and Sadock’s comprehensive textbook of psychiatry. Lippincot Williams & Wilkins, Philadelphia, S 2628–2652Google Scholar
  19. Derogatis LR, Melisaratos N (1983) The brief symptom inventory: an introductory report. Psychol Med 13:595–605. doi:10.1017/S0033291700048017CrossRefPubMedGoogle Scholar
  20. Diener MJ, Hilsenroth MJ (2009) Affect-focused techniques in psychodynamic psychotherapy. In: Handbook of evidence-based psychodynamic psychotherapy. Springer, New York, S 227–247CrossRefGoogle Scholar
  21. Diener MJ, Hilsenroth MJ, Weinberger J (2007) Therapist affect focus and patient outcomes in psychodynamic psychotherapy: a meta-analysis. Am J Psychiatry 164:936–941. doi:10.1176/appi.ajp.164.6.936CrossRefPubMedGoogle Scholar
  22. Driessen E, Van HL, Don FJ, Peen J, Kool S, Westra D, Hendriksen M, Schoevers RA, Cuijpers P, Twisk JWR, Dekker JJM (2013) The efficacy of cognitive-behavioral therapy and psychodynamic therapy in the outpatient treatment of major depression: a randomized clinical trial. Am J Psychiatry 170:1041–1050. doi:10.1176/appi.ajp.2013.12070899CrossRefPubMedGoogle Scholar
  23. Edwards VJ, Holden GW, Felitti VJ, Anda RF (2003) Relationship between multiple forms of childhood maltreatment and adult mental health in community respondents: results from the adverse childhood experiences study. Am J Psychiatry 160:1453–1460. doi:10.1176/appi.ajp.160.8.1453CrossRefPubMedGoogle Scholar
  24. Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS (1998) Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) study. Am J Prev Med 14:245–258. doi:10.1016/S0749-3797(98)00017-8CrossRefPubMedGoogle Scholar
  25. Hans E, Hiller W (2013) A meta-analysis of nonrandomized effectiveness studies on outpatient cognitive behavioral therapy for adult anxiety disorders. Clin Psychol Rev 33:954–964. doi:10.1016/j.cpr.2013.07.003CrossRefPubMedGoogle Scholar
  26. Hattie JA, Sharpley CF, Rogers HJ (1984) Comparative effectiveness of professional and paraprofessional helpers. Psychol Bull 95:534–541. doi:10.1037/0033-2909.95.3.534CrossRefPubMedGoogle Scholar
  27. Hedeker D, Gibbons RD (1997) Application of random-effects pattern-mixture models for missing data in longitudinal studies. Psychol Methods 2:64–78. doi:10.1037/1082-989X.2.1.64CrossRefGoogle Scholar
  28. Horowitz LM, Rosenberg SE, Baer BA, Ureño G, Villaseñor VS (1988) Inventory of interpersonal problems: psychometric properties and clinical applications. J Consult Clin Psychol 56:885–892. doi:10.1037/0022-006X.56.6.885CrossRefPubMedGoogle Scholar
  29. Kessler RC, Angermeyer M, Anthony JC, De Graaf R, Demyttenaere K, Gasquet I, De Girolamo G, Gluzman S, Gureje O, Haro JM, Kawakami N, Karam A, Levinson D, Medina-Mora ME, Oakley Browne MA, Posada-Villa J, Stein DJ, Adley Tsang CH, Aguilar-Gaxiola S, Alonso J, Lee S, Heeringa S, Pennell BE, Berglund P, Gruber MJ, Petukhova M, Chatterji S, Ustün TB (2007) Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization’s World Mental Health Survey Initiative. World Psychiatry 6:168–176PubMedPubMedCentralGoogle Scholar
  30. Little RJ, Rubin DB (2002) Statistical analysis with missing data. Wiley, HobokenCrossRefGoogle Scholar
  31. Little RJ, Wang Y (1996) Pattern-mixture models for multivariate incomplete data with covariates. Biometrics 52:98–111. doi:10.2307/2533148CrossRefPubMedGoogle Scholar
  32. Mallinckrodt CH, Clark WS, David SR (2001) Accounting for dropout bias using mixed-effects models. J Biopharm Stat 11:9–21. doi:10.1081/BIP-100104194CrossRefPubMedGoogle Scholar
  33. Minami T, Wampold BE, Serlin RC, Hamilton EG, Brown GSJ, Kircher JC (2008) Benchmarking the effectiveness of psychotherapy treatment for adult depression in a managed care environment: a preliminary study. J Consult Clin Psychol 76:116–124. doi:10.1037/0022-006X.76.1.116CrossRefPubMedGoogle Scholar
  34. Nanni V, Uher R, Danese A (2012) Childhood maltreatment predicts unfavorable course of illness and treatment outcome in depression: a meta-analysis. Am J Psychiatry 169:141–151CrossRefPubMedGoogle Scholar
  35. Salvadori A (2010) Is the experiencing of affect therapeutic? An investigation into the relationship between affect experiencing, degree of inhibition and distress in Intensive Short-Term Dynamic Psychotherapy. DClinPsy thesis, University of SheffieldGoogle Scholar
  36. Schore AN (2001) The effects of early relational trauma on right brain development, affect regulation, and infant mental health. Infant Ment Health J 22:201–269. doi:10.1002/1097-0355(200101/04)22:13.0.CO;2-9CrossRefGoogle Scholar
  37. Schore AN (2002) Dysregulation of the right brain: a fundamental mechanism of traumatic attachment and the psychopathogenesis of posttraumatic stress disorder. Aust N Z J Psychiatry 36:9–30. doi:10.1046/j.1440-1614.2002.00996.xCrossRefPubMedGoogle Scholar
  38. Singer JD, Willett JB (2003) Applied longitudinal data analysis: modeling change and event occurrence. Oxford University Press, New YorkCrossRefGoogle Scholar
  39. Town JM, Driessen E (2013) Emerging evidence for Intensive Short-Term Dynamic Psychotherapy with personality disorders and somatic disorders. Psychiatr Ann 43:502–507. doi:10.3928/00485713-20131105-05CrossRefGoogle Scholar
  40. Town JM, Diener MJ, Abbass A, Leichsenring F, Driessen E, Rabung S (2012a) A meta-analysis of psychodynamic psychotherapy outcomes: evaluating the effects of research-specific procedures. Psychotherapy 49:276–290. doi:10.1037/a0029564CrossRefPubMedGoogle Scholar
  41. Town JM, Hardy GE, Mc Cullough L, Stride C (2012b) Patient affect experiencing following therapist interventions in short-term dynamic psychotherapy. Psychother Res 22:208–219. doi:10.1080/10503307.2011.637243CrossRefPubMedGoogle Scholar
  42. Town JM, Abbass A, Bernier D (2013) Effectiveness and cost effectiveness of Davanloo’s intensive short-term dynamic psychotherapy: Does unlocking the unconscious make a difference? Am J Psychother 67:89–108PubMedGoogle Scholar
  43. Tracey TJG, Wampold BE, Lichtenberg JW, Goodyear RK (2014) Expertise in psychotherapy: an elusive goal? Am Psychol 69:218–229. doi:10.1037/a0035099CrossRefPubMedGoogle Scholar
  44. Ustün TB (1999) The global burden of mental disorders. Am J Public Health 89:1315–1318. doi:10.2105/AJPH.89.9.1315CrossRefPubMedPubMedCentralGoogle Scholar
  45. Wampold BE, Brown GSJ (2005) Estimating variability in outcomes attributable to therapists: a naturalistic study of outcomes in managed care. J Consult Clin Psychol 73:914–923. doi:10.1037/0022-006X.73.5.914CrossRefPubMedGoogle Scholar
  46. Whelton WJ (2004) Emotional processes in psychotherapy: evidence across therapeutic modalities. Clin Psychol Psychother 11:58–71. doi:10.1002/cpp.392CrossRefGoogle Scholar
  47. Whittemore JW (1996) Paving the royal road: an overview of conceptual and technical features in the graded format of Davanloo’s intensive short-term dynamic psychotherapy. Int J Short Term Psychother 11:21–39. doi:10.1002/(SICI)1522-7170(199603)11:13.0.CO;2-QCrossRefGoogle Scholar
  48. Wierzbicki M, Pekarik G (1993) A meta-analysis of psychotherapy dropout. Prof Psychol Res Pr 24:190–195. doi:10.1037/0735-7028.24.2.190CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Robert Johansson
    • 1
    • 2
  • Joel M. Town
    • 1
  • Allan Abbass
    • 1
  1. 1.Centre for Emotions and HealthDalhousie UniversityHalifaxCanada
  2. 2.Department of Behavioural Sciences and LearningLinköping UniversityLinköpingSweden

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