CLINICAL QUALITY OF CARE – PRACTICE PARAMETERS 

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Psychodynamic Psychotherapy Techniques

Psych-1
 
Category: Psychotherapy 
Published Date: August 2021
  1. PARAMETER GOAL
    1. To provide guidance on the use of psychodynamic psychotherapy techniques.
       
  2. TERMINOLOGY
    1. Psychodynamic Psychotherapy:  A form of depth psychology, the primary focus of which is to reveal the unconscious content of a client's psyche to alleviate psychic tension. Principal theorists drawn upon are Freud, Klein, and theorists of the object relations movement. Psychodynamic psychotherapy encompasses a broad range of techniques, including:
      1. The use of the interpersonal relationship between the client and therapist as a window into problematic relationship patterns in the client’s life;
      2. The use of psychoanalysis adapted to a less intensive style of working, usually at a frequency of once or twice per week; and
      3. A focus on the psychological roots of emotional suffering.
    2. Transference: a phenomenon in which one seems to direct feelings or desires related to an important figure in one’s life—such as a parent—toward someone who is not that person. For example, a client is thought to demonstrate transference when expressing feelings toward the therapist that appear to be based on the client’s past feelings about someone else.
       
  3. MEASURES
    1. Psychodynamic techniques include the:
      1. Identification, interpretation, and (where adaptive) integration of drives, motivations, and affects;
      2. Identification, interpretation, and resolution of internal and external conflicts;
      3. Identification and interpretation of psychological defenses and resistance; and
      4. Expression and integration (where appropriate) of affect, impulses, conflicts, and defenses.
    2. Selection and use of dynamic techniques are informed by assessing the client's:
      1. Diagnosis,
      2. Symptoms,
      3. Functional level,
      4. Intellectual capacity,
      5. Social and environmental support,
      6. Spiritual beliefs,
      7. Motivation,
      8. Ego strength,
      9. Verbal ability, and
      10. Linguistic and cultural background.
    3. The use of dynamic techniques is contraindicated in:
      1. Unstable psychosis,
      2. Ongoing significant substance abuse,
      3. Severe cognitive disability,
      4. Significant antisocial features,
      5. Dementia, and
      6. Delirium.
         
  4. TREATMENT STRATEGY
    1. The precise content and nature of psychodynamic psychotherapy should be individualized for each client.
    2. Psychodynamic techniques may be usefully employed as a component of other therapies.
    3. Clinical judgment should be exercised in determining the capabilities and personal interests of a given client for the purpose of obtaining a mutually agreed-upon treatment course.
    4. Effective feedback, support, and education should be used to give the client knowledge of the level of functioning, the type of life changes that may be necessary, and the expected results of psychotherapy.
    5. The client’s support systems (family/culture) should be integrated into psychodynamic psychotherapeutic interventions with the client’s consent.
    6. The client’s meaning of the therapeutic relationship should be recognized and should inform treatment.
    7. Termination of therapy with a given therapist must be appropriately managed.
       
  5. PROVISION OF SERVICES
    1. Dynamic techniques must occur at sufficient frequency and for sufficient duration to ensure clinical results.
    2. Specific therapist behaviors include:
      1. Timely interpretations and clarifications,
      2. Therapeutic use of the transference relationship,
      3. Promoting the development of insight,
      4. Permitting clients to work through problematic behavior,
      5. Providing a corrective emotional experience,
      6. Promoting autonomy and effective coping, and
      7. Promoting the development of empathy, healthy attachment, and responsibility.
    3. The therapist focuses on feelings and past experiences relevant to psychodynamic theory.
    4. Environments should be conducive to providing a sense of privacy, comfort, and safety.
       
  6. OUTCOMES AND MONITORING
    1. The response of the client and the nature of the therapeutic alliance should be continuously assessed during treatment.
    2. Termination
       
  7. STAFF TRAINING
    1. Specialized training is required to develop the skills necessary to practice psychodynamic therapy.
    2. All therapists must have a working knowledge of psychodynamic techniques.
    3. Trained psychodynamic therapists must be available for consultation.
    4. Essential Use: Selected dynamic techniques are a part of psychotherapeutic intervention for clients with:
      1. Personality disorders.
      2. Dissociative Disorders.
         
  8. SUPERVISION AND CONSULTATION
    1. All clinicians providing psychodynamic psychotherapy must have access to ongoing clinical supervision/consultation.