What Works?
By Kathleen Lawrence, LMFT
By Kathleen Lawrence, LMFT
There has been a lot of focus on shorter term therapies in recent years. Shorter term therapies are narrowly focused therapies that deal with the immediate problem without regard or necessity of looking at the underlying cause. Studies have shown these shorter term solution focused therapies as extremely effective at solving simple as well as complex problems in everyday life. The theory is that many of us do not need a deep delve into the psyche about our childhood issues, but rather effective solutions to the dysfunction of the moment.
I have found several aspects of short term therapies useful as tools in my therapy practice. However, I do not regard them as effective resolutions of the underlying issues that served to create the dysfunction of the moment. I am a psychodynamic therapist that believes that most of us could benefit greatly from a deep delve into the psyche with the intent that we can resolve our childhood wounds or complete stages of development that were interrupted in childhood for one reason or another. Psychodynamic types of therapy are not short term. It takes time for the relationship between therapist and client to develop. It takes time for you to get to know me and understand the therapy process in which you participate and heal. The relationship we develop is an integral part of the therapy process. Relationships do not develop overnight. Relationships take time to develop. There are many other reasons why psychodynamic therapy takes longer, but I will not go into those reasons now.
What I do want to highlight here are the results of a recent analysis of 23 studies published in the Journal of the American Medical Association that determined that people with complex mental issues or disorders did far better in a long term psychodynamic therapy than those who received shorter term therapies. By ‘far better’ I mean that they did better than 96% of those who received shorter term therapies.
Among the studies analyzed were the results of a 2007 study by the European Journal of Psychotherapy, which “demonstrated how adults retain feelings and inferences from their early bond with their parents, and that these ghostly transferences affect the nature and quality of their adult lives” (Therapy Networker, January/February 2009). In other words, some of the fighting in your relationship with your partner could easily be embedded in your psychological relationship with your parents or caregivers in childhood. Your belief system is based in what you experienced early in life. The lens through which you see the world is strongly influenced by those early relationships. To unravel those influences and their meaning takes time. It cannot be accomplished in six visits.
Evidence of the inferences and transferences described above was reinforced in neuroimaging where it appeared that the brain sort of overlayed new experiences and relationships over older ones. Long term psychodynamic forms of therapy with an experiential component help to overlay or reimprint new healthy experiences over old trauma.
Evidence of the inferences and transferences described above was reinforced in neuroimaging where it appeared that the brain sort of overlayed new experiences and relationships over older ones. Long term psychodynamic forms of therapy with an experiential component help to overlay or reimprint new healthy experiences over old trauma.
Here is what the JAMA analysis found regarding long term psychodynamic therapies that lasted at least one year or 50 sessions:
· Larger improvement in personality functioning for such disorders such as borderline personality disorder, eating disorders, and other chronic or multiple disorders.
· Especially effective for people with anxiety or depression.
· Effectiveness was reduced when combined with psychotropic medications, but still more effective than short term therapies.
· Clients continued to improve after therapy ended.
(Psychotherapy Networker, January/February 2009).
We live in a culture of immediacy. We want a cure and we want it now. We want the pill that makes us feel better—makes the problems go away. Anyone who has taken psychotropic medication knows that the problems don’t go away. They may, for a time be easier to manage, but they simply do not vanish. Additionally, there is a new set of problems dealing with the side effects of the medications. Short term therapies may work to solve the immediate problem, but we are still left to deal with the ‘side effects’ of our unresolved childhood issues.
Please understand that I am not saying that medication and short term therapy does not have its purpose and value. There are certain conditions where psychotropic medications are essential. There are others where they may be necessary for some people to gain a stable base from which to do their therapy work. Likewise, short term therapies can serve a beneficial purpose in resolving an immediate situation that prevents us from doing the long term work of healing. I believe that the value in the JAMA analysis is that it supports what some of us already knew: There is no overnight ‘cure.’ The healing comes in the willingness to develop a relationship with the therapist so that the client is able to confront their problems in a safe and supportive environment. And that takes time.
Resources:
Psychotherapy Networker, January/February 2009
Long-Term Psychotherapy: Journal of the American Medical Association, 300, No. 13 (October 1, 2008: 1551-65)