Skip to main content

Recasting Psychodynamics into a Behavioral Framework: A Review of the Theory of Psychopathology, Treatment Efficacy, and Process of Change of the Affect Phobia Model

Abstract

The objective of this article is to review empirical evidence on the theory of psychopathology, treatment efficacy, and proposed process of change of the affect phobia model, a form of short-term dynamic psychotherapy reformulated into a behavioral framework developed by Leigh McCullough. A search of the literature was conducted using Medline and PsycINFO. Eighteen empirical studies respected the inclusion criteria. The results suggest that the assessment of affect phobias has been neglected. Affect phobias’ hypothesized origins in childhood and their disorder specificity have not been investigated empirically. Randomized controlled trials showed no significant differences between affect phobia therapy and cognitive therapy at posttreatment and two-year follow-up among Cluster C personality disorders, and a greater symptom decrease in affect phobia therapy than in a controlled condition among depression and anxiety disorders. A pilot study revealed that depressed pregnant women also improved after affect phobia therapy. There is some but limited evidence that the process of change during treatment is coherent with the model’s assumptions. Research on the theory of psychopathology, treatment efficacy, and proposed process of change of the affect phobia model is in its early stage. Nevertheless, the model is promising and deserves additional research.

This is a preview of subscription content, access via your institution.

Fig. 1

References

  • Abbas, A., Town, J., & Driessen, E. (2011). The efficacy of short-term psychodynamic psychotherapy for depressive disorders with comorbid personality disorder. Psychiatry, 74, 58–71.

    Article  Google Scholar 

  • Berggraf, L., Ulvenes, P. G., Hoffart, A., McCullough, L., & Wampold, B. E. (2014a). Growth in sense of self and sense of others predicts reduction in interpersonal problems in short-term dynamic but not in cognitive therapy. Psychotherapy Research, 24, 456–469. doi:10.1080/10503307.2013.840401.

    Article  PubMed  Google Scholar 

  • Berggraf, L., Ulvenes, P. G., Oktedalen, T., Hoffart, A., Stiles, T., McCullough, L., & Wampold, B. E. (2014b). Experience of affects predicting sense of self and others in short-term dynamic and cognitive therapy. Psychotherapy, 51, 246–257.

    Article  PubMed  Google Scholar 

  • Berggraf, L., Ulvenes, P. G., Wampold, B. E., Hoffart, A., & McCullough, L. (2012). Properties of the Achievement of Therapeutic Objectives Scale (ATOS): A generalizability theory study. Psychotherapy Research, 22, 327–347. doi:10.1080/10503307.2011.653997.

    Article  PubMed  Google Scholar 

  • Bhatia, M., Rodriguez, M. G., Fowler, D. M., Godin, J. E., Drapeau, M., & McCullough, L. (2009). Desensitization of conflicted feelings: Using the ATOS to measure early change in a single-case affect phobia therapy treatment. Archives of Psychiatry and Psychotherapy, 11, 31–38.

    Google Scholar 

  • Dornelas, E. A., Ferrand, J., Stepnowski, R., Barbagallo, J., & McCullough, L. (2010). A pilot study of affect-focused psychotherapy for antepartum depression. Journal of Psychotherapy Integration, 20, 364–382. doi:10.1037/a0022035.

    Article  Google Scholar 

  • Driessen, E., Cuijpers, P., de Maat, S. C. M., Abbass, A. A., de Jonghe, F., & Dekker, J. J. M. (2010). The efficacy of short-term psychodynamic psychotherapy for depression: A meta-analysis. Clinical Psychology Review, 30, 25–36. doi:10.1016/j.cpr.2009.08.010.

    Article  PubMed  Google Scholar 

  • Elliott, R., Watson, J. C., Goldman, R. N., & Greenberg, L. S. (2004). Learning emotion-focused therapy: The process-experiential approach to change. Washington, DC, US: American Psychological Association.

    Book  Google Scholar 

  • Ezriel, H. (1952). Notes on psychoanalytic group therapy: II. Interpretation. Research Psychiatry, 15, 119–126.

    CAS  PubMed  Google Scholar 

  • Johansen, P.-O., Krebs, T. S., Svartberg, M., Stiles, T. C., & Holen, A. (2011). Change in defense mechanisms during short-term dynamic and cognitive therapy in patients with Cluster C personality disorders. Journal of Nervous and Mental Disease, 199, 712–715. doi:10.1097/NMD.0b013e318229d6a7.

    Article  PubMed  Google Scholar 

  • Johansson, R., Björklund, M., Hornborg, C., Karlsson, S., Hesser, H., Ljótsson, B., et al. (2013). Affect-focused psychodynamic psychotherapy for depression and anxiety through the Internet: A randomized controlled trial. PeerJ, 1, e102. doi:10.7717/peerj.102.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kallestad, H., Valen, J., McCullough, L., Svartberg, M., Hoglend, P., & Stiles, T. C. (2010). The relationship between insight gained during therapy and long-term outcome in short-term dynamic psychotherapy and cognitive therapy for Cluster C personality disorders. Psychotherapy Research, 20, 526–534. doi:10.1080/10503307.2010.492807.

    Article  PubMed  Google Scholar 

  • Koss, M. P., & Butcher, J. N. (1986). Research on brief psychotherapy. In S. L. Garfield & A. E. Bergin (Eds.), Handbook of psychotherapy and behavior change (pp. 624–670). New York: Wiley.

    Google Scholar 

  • Kuhn, N. S., & McCullough, L. (2002). Short-term dynamic psychotherapy: Resolving character pathology by treating affect phobias. In S. G. Hofmann & M. C. Tompson (Eds.), Treating chronic and severe mental disorders: A handbook of empirically supported interventions (pp. 403–418). New York: Guilford Press.

    Google Scholar 

  • Malan, D. H. (1979). Individual psychotherapy and the science of psychodynamics. London: Butterworth.

    Google Scholar 

  • McCullough, L. (1999). Short-term psychodynamic therapy as a form of desensitization: Treating affect phobias. In Session: Psychotherapy in Practice, 4, 35–53. doi:10.1002/(SICI)1520-6572(199924)4:4.

    Google Scholar 

  • McCullough, L. (2001). Desensitization of affect phobias in short-term dynamic psychotherapy. In M. F. Solomon, R. J. Neborsky, L. McCullough, M. Alpert, F. Shapiro, & D. Malan (Eds.), Short-term therapy for long-term change (pp. 54–82). New York: W. W. Norton & Co.

    Google Scholar 

  • McCullough, L., Kuhn, N., Andrews, S., Kaplan, A., Wolf, J., & Hurley, C. L. (2003a). Treating affect phobia: A manual for short-term dynamic psychotherapy. New York: Guilford Press.

    Google Scholar 

  • McCullough, L., Kuhn, N., Andrews, S., Valen, J., Hatch, D., & Osimo, F. (2003b). The reliability of the Achievement of Therapeutic Objectives Scale: A research and teaching tool for brief psychotherapy. Journal of Brief Therapy, 2, 75–90.

    Google Scholar 

  • McCullough, L., & Magill, M. (2009). Affect-focused short-term dynamic therapy. In R. A. Levy & J. S. Ablon (Eds.), Handbook of evidence-based psychodynamic psychotherapy: Bridging the gap between science and practice (pp. 249–277). Totowa: Humana Press.

    Chapter  Google Scholar 

  • McCullough-Vaillant, L. (1997). Changing character: Short-term anxiety-regulating psychotherapy for restructuring defenses, affets, and attachment. New York: Basic Books.

    Google Scholar 

  • Menninger, K. (1958). Theory of psychoanalytic technique. New York: Basic Books.

    Book  Google Scholar 

  • Messer, S. B. (2001). What makes brief psychodynamic therapy time efficient. Clinical Psychology: Science and Practice, 8, 5–22. doi:10.1093/clipsy.8.1.5.

    Google Scholar 

  • Norcross, J. C., Gold, J. R., Fensterheim, H., Greenberg, L., & McCullough, L. (2000). Clinical exchange: The architectural failure. Journal of Psychotherapy Integration, 10, 1–35.

    Article  Google Scholar 

  • Ryum, T., Stiles, T. C., Svartberg, M., & McCullough, L. (2010). The role of transference work, the therapeutic alliance, and their interaction in reducing interpersonal problems among psychotherapy patients with Cluster C personality disorders. Psychotherapy: Theory, Research, Practice, Training, 47, 442–453. doi:10.1037/a0021183.

    Article  Google Scholar 

  • Ryum, T., Store-Valen, J., Svartberg, M., Stiles, T. C., & McCullough, L. (2014). Factor analysis of the Achievement of Therapeutic Objectives Scale (ATOS) in short-term dynamic psychotherapy and cognitive therapy. Psychological Assessment, 26, 925–934. doi:10.1037/a0036570.

    Article  PubMed  Google Scholar 

  • Schanche, E., Nielsen, G. H., McCullough, L., Valen, J., & Mykletun, A. (2010). Training graduate students as raters in psychotherapy process research: Reliability of ratings with the Achievement of Therapeutic Objectives Scale (ATOS). Nordic Psychology, 62, 4–20. doi:10.1027/1901-2276/a000013.

    Article  Google Scholar 

  • Schanche, E., Stiles, T. C., McCullough, L., Svartberg, M., & Nielsen, G. H. (2011). The relationship between activating affects, inhibitory affects, and self-compassion in patients with Cluster C personality disorders. Psychotherapy, 48, 293–303. doi:10.1037/a0022012.

    Article  PubMed  Google Scholar 

  • Svartberg, M., Stiles, T. C., & Seltzer, M. H. (2004). Randomized, controlled trial of the effectiveness of short-term dynamic psychotherapy and cognitive therapy for Cluster C personality disorders. The American Journal of Psychiatry, 161, 810–817. doi:10.1176/appi.ajp.161.5.810.

    Article  PubMed  Google Scholar 

  • Ulvenes, P. G., Berggraf, L., Hoffart, A., Levy, R. A., Ablon, J., McCullough, L., & Wampold, B. E. (2012). Can two psychotherapy process measures be dependably rated simultaneously? A generalizability study. Journal of Counseling Psychology, 59, 638–644.

    Article  PubMed  Google Scholar 

  • Ulvenes, P. G., Berggraf, L., Wampold, B. E., Hoffart, A., Stiles, T., & McCullough, L. (2014). Orienting patient to affect, sense of self, and the activation of affect over the course of psychotherapy with Cluster C patients. Journal of Counseling Psychology, 61, 315–324. doi:10.1037/cou0000028.

    Article  PubMed  Google Scholar 

  • Valen, J., Ryum, T., Svartberg, M., Stiles, T. C., & McCullough, L. (2011). The Achievement of Therapeutic Objectives Scale: Interrater reliability and sensitivity to change in short-term dynamic psychotherapy and cognitive therapy. Psychological Assessment, 23, 848–855. doi:10.1037/a0023649.

    Article  PubMed  Google Scholar 

  • Winston, A., Laikin, M., Pollack, J., Wallner Samstag, L., McCullough, L., & Muran, J. C. (1994). Short-term psychotherapy of personality disorders. American Journal of Psychiatry, 151, 190–194.

    CAS  Article  PubMed  Google Scholar 

  • Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema therapy: A practitioner’s guide. New York: The Guilford Press.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Dominic Julien.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Julien, D., O’Connor, K.P. Recasting Psychodynamics into a Behavioral Framework: A Review of the Theory of Psychopathology, Treatment Efficacy, and Process of Change of the Affect Phobia Model. J Contemp Psychother 47, 1–10 (2017). https://doi.org/10.1007/s10879-016-9324-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10879-016-9324-9

Keywords

  • Affect phobia
  • Psychodynamics
  • Psychotherapy, psychodynamic
  • Review
  • Treatment outcome