case study of psychodynamic therapy

Practicing Psychodynamic Therapy

Edited by richard f. summers and jacques p. barber.

• description T his volume presents 12 highly instructive case studies grounded in the evidence-based psychodynamic therapy model developed by Richard F. Summers and Jacques P. Barber. Bringing clinical concepts vividly to life, each case describes the patient's history and presenting problems and takes the reader through psychodynamic formulation, treatment planning, and the entire course of therapy, including the challenges of termination. The cases address a variety of core psychodynamic problems, with outcomes ranging from very successful to equivocal. The emotional experience of the therapist is explored throughout. Commentary from Summers and Barber on every case highlights important points and key clinical dilemmas. See also the authored book Psychodynamic Therapy, Second Edition: A Guide to Evidence-Based Practice , in which Summers and Barber comprehensively describe their therapeutic model. -->
• sample chapter
• All titles by Richard F. Summers
• Author's website
• All titles by Jacques P. Barber
• contributors Jacques P. Barber , PhD, ABPP, Dean and Professor, Derner Institute of Advanced Psychological Studies, Adelphi University, Garden City, New York Karla Campanella , MD, Psychiatrist in private practice; Psychiatrist, Philhaven Behavioral Health and Cornerstone Family Health Associates; Consulting Psychiatrist, Physicians Alliance Limited, Lancaster, Pennsylvania Samuel J. Collier , MD, Assistant Professor, Department of Psychiatry, University of Texas Southwestern Medical Center at Austin; Seton Family of Hospitals, Austin, Texas C. Pace Duckett , MD, Psychiatrist in private practice, Bryn Mawr, Pennsylvania; Clinical Associate, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Lauren J. Elliott , MD, Psychiatrist, Psych Associates of Maryland, Towson, Maryland Patricia Harney , PhD, Associate Director of Psychology and Psychology Training and Director of Psychology Internship Training, Cambridge Health Alliance/Harvard Medical School, Cambridge, Massachusetts Kimberlyn Leary , PhD, MPA, Chief Psychologist, Cambridge Health Alliance, and Associate Professor of Psychology in Psychiatry, Harvard Medical School, Cambridge, Massachusetts Kevin McCarthy , PhD, Assistant Professor, Chestnut Hill College, and Research Associate, Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania Margot Montgomery O’Donnell , MD, Clinical Associate, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Bianca Previdi , MD, Clinical Associate, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Dana A. Satir , PhD, Clinical Assistant Professor, Department of Counseling Psychology, University of Denver, Denver, Colorado Robert Schweitzer , PhD, Associate Professor, School of Psychology and Counselling, Queensland University of Technology, Queensland, Australia Dhwani Shah , MD, Clinical Associate, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Staff Psychiatrist, Counseling and Psychological Services, Princeton University, Princeton, New Jersey Brian A. Sharpless , PhD, Assistant Professor of Psychology and Director, Psychology Clinic, Washington State University, Pullman, Washington Richard F. Summers , MD, Clinical Professor of Psychiatry and Co-Director of Residency Training, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Holly Valerio , MD, Clinical Associate, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Alix Vann , PhD, Psychologist in private practice, Brisbane, Queensland, Australia -->

Order both items for $60.95, instead of $81.00 if bought separately! order package

Free Shipping on Online Orders!

• Applies only to prepaid online orders from U.S. customers.
• Packages sent via USPS Media Mail. You may choose to pay for rush shipping instead.
• Shipping charges to Canada are a flat $10.00 per order via CanPar.
• You may return Guilford books (undamaged) within 30 days of receipt for a full refund.

• Mental Health Academy

• Case Studies
• Communication Skills
• Counselling Microskills
• Counselling Process
• Children & Families
• Ethical Issues
• Sexuality & Gender Issues
• Neuropsychology
• Practice Management
• Relationship Counselling
• Social Support
• Therapies & Approaches
• Workplace Issues
• Anxiety & Depression
• Personality Disorders
• Self-Harming & Suicide
• Effectiveness Skills
• Stress & Burnout
• Diploma of Counselling
• Diploma of Financial Counselling
• Diploma of Community Services (Case Management)
• Diploma of Youth Work
• Bachelor of Counselling
• Bachelor of Human Services
• Master of Counselling

A Case Using Brief Psychodynamic Therapy

By Leanne Tamplin

Wendy is a 54 year old woman who has two adult children and has been married for twenty-nine years. Her husband, Steve, has recently and unexpectedly informed her that he no longer loves her and that he wants a divorce. Wendy was shocked to hear this, and she now reports that she is constantly crying and feels extremely anxious. Wendy has not told anyone about this situation, although she and Steve have agreed to explain his decision to their children within the week.

In this scenario, the counsellor will be using a brief psychodynamic approach. For ease of writing, the Counsellor is abbreviated to “C”.

Wendy attended eighteen appointments over an eight month period. The first six appointments were held weekly, the next ten were fortnightly, and the last two were spaced out over two months. Wendy and Steve have been married for twenty-nine years and have lived in the same area for all of that time. They have two children – Damien 24 years of age, and Amanda 26 years. Damien still lives at home with his parents.

Wendy has not yet told anyone, neither family nor friends, about her situation and becomes anxious when she considers doing this. She and Steve have agreed to tell their children within the next week, and Steve plans to move out of the family home at that time. Wendy and Steve are no longer sleeping in the same bed, although up until his recent disclosure, they had been sleeping together and kissing and hugging from time to time. Wendy’s reported anxiety/depression symptoms included: difficulty sleeping, difficulty relaxing, thinking about Steve/their marriage/the future all the time, feeling exhausted, feeling “tightness” in her chest and her throat, a loss of appetite, crying several times every day, and a loss of interest in “everything”.

Session Details

In the initial appointment, Wendy reported a very distressing couple of weeks. She began to describe her situation starting at twelve months ago when Steve began attending a gym and reading personal development books. Wendy stated that at that time, Steve seemed to change, and she thought it was a part of a “mid-life crisis” that he would eventually recover from. Around the same time, Wendy confronted Steve because she felt that they weren’t communicating much and she was feeling “left out” of his new interests. At that time, Steve told Wendy that he thought they were “drifting apart”. As a result of this conversation, Wendy then made a concentrated effort to improve things – she created opportunities for them to be together, she encouraged their discussions with one another, and she shared more of herself and her feelings in their conversations. That was the last time they had discussed anything about their relationship, and Wendy thought that things had been much improved by her efforts over the last twelve months. When Steve told her over dinner a week ago that he didn’t feel that he loved her anymore and that he would like a divorce, Wendy was shocked and devastated.

C’s role in these initial stages was to listen, to assist Wendy to expand and elaborate on her story, to help her to identify her emotions, and to provide her with unconditional positive regard and a non-judgmental environment. From a psychodynamic perspective, these early sessions were also about developing a productive therapeutic relationship and trying to understand Wendy’s life from her perspective, that is, to walk in her shoes. C listened empathically and shared in the variety of emotions that Wendy reported, including shock, anger, sadness, devastation, betrayal, disappointment, frustration, disbelief, and a sense of complete lack of control. These were discussed at length, as well as the situations that had caused the emotions. As a brief psychodynamic counsellor expects that there will be around twenty appointments, or more, there was no need to hurry Wendy. C and Wendy travelled through each event and emotion as they occurred.

Wendy reported that although the sessions were difficult, she felt “relief” when she left and looked forward to her next appointment. She described an almost immediate, but minor, decrease in her anxiety symptoms, with a continuing reduction over time. After discussion, she re-introduced the use of her own relaxation strategies that she had used successfully in the past.

C encouraged Wendy to allow herself to express her feelings as much, and as often, as possible. In response to this suggestion, she began a journal and wrote in it regularly, she accepted and catered for times alone to cry, and she gradually began to discuss her situation with close and trusted family, friends, and work colleagues. This latter action required extensive discussion about her fears of disclosure and how she would manage the repercussions.

In the first three appointments, the focus was on “holding” Wendy during her crisis, and on allowing Wendy to express herself and to describe her situation in it’s entirety, without judgment or analysis. After this stage, however, C began reporting to Wendy any observations or thoughts about what was happening for her, as well as identifying patterns in her actions and highlighting significant steps that she had taken. For example, in session seven, C noticed that Wendy was reluctant to criticise Steve for his behaviour. C described this observation to Wendy and asked her if she had noticed it herself. Wendy had not noticed, but once it was brought to her attention, she said that she could see it clearly. She said that she still loved Steve, and that she held onto the hope that he would change his mind. She went on to describe her plan to take him back should that occur. C empathised with the sudden and drastic change that had occurred in Wendy’s life and her plans for the future, and normalised her reaction to cling to the possibility of her life returning to the familiar and to having some feeling of control. C also explored this further, asking Wendy: how likely she thought Steve’s return was; how this event might take place; and how she thought she would respond if it occurred. In this way, Wendy’s beliefs and feelings about Steve were opened up, accepted, and their impact was acknowledged. Wendy was later able to identify the value of this belief in keeping her “together” at this point, and also said that she understood the reality that he was unlikely to return. This is an important occurrence in brief psychodynamic therapy, as it is an example of the unconscious becoming conscious.

At the commencement of the twelfth session, Wendy reported that she had a terrible week where she had cried frequently. She had spoken to Steve and had been very disappointed with his distance and coldness towards her. She described these events while laughing and speaking quickly and minimising their significance. C challenged this incongruence between Wendy’s behaviour and her words, by describing the observation to Wendy. Wendy reported that she was probably speaking fast because she had just met with a friend who would not be able to handle the truth about her devastation. Her quick speaking and laughing, Wendy suggested, was how she acted “together” when she didn’t want people to know how distressed she really was. C asked if this was also how she felt in our counselling sessions (note: from a psychodynamic perspective, often an experience a client is describing in relation to others can be a reflection of the experience they are having in the counselling room). Wendy said that she did want to improve her well-being, and so had hoped that she would be “together” when she came to counselling this time.

C asked Wendy to discuss the consequences of appearing “not together”. During this conversation, Wendy said that she felt that it was hard to be herself and that, in fact, she had not been able to be herself since Steve told her twelve months ago that they were drifting apart. From that time on, she had been acting as if everything was okay, when really she felt scared and alone. C and Wendy then talked about the possible impact of this kind of “pretending” on her marital relationship, on the counselling relationship, and on her relationships generally. They discussed where this behaviour may have been learned (Wendy felt it was from her parents’ relationship) and what had caused her to begin using it. After some long conversation about this, Wendy admitted that she had not been happy in her marriage for some time because she was afraid of losing Steve and afraid of being “left out”. It was at that point that she saw her “pretending” in her marriage as a form of self-protection.

During this conversation, Wendy also said that laughing about her problems was to make it easier for her friend to cope with the sad news. Wendy realised that she tried to make her distress easier for everyone to cope with, including Steve. She reported that she was even making it as easy as possible for Steve to leave her. She decided then that she would no longer do this, and would instead be true to her own feelings and express them whenever necessary. She stated that she would start to be herself around Steve, and everyone else. From this point on in our sessions, whenever she noticed herself laughing and talking fast about her sadness, she slowed down, took a deep breath, and connected with her true self. Developing this kind of insight is integral to successful brief psychodynamic therapy, and it sometimes starts with the counsellor paying attention to a small but significant occurrence within the therapy room.

From session fourteen, Wendy began a level of mourning for the lost relationship and her lost future – she described the loss as if she had begun accepting that it was really over. Wendy decided to bring family photos to counselling and reflected on the great events in their marriage. Wendy also started speaking more easily about negative experiences in their marriage and described times when she had felt taken advantage of and belittled. C saw this as evidence of Wendy’s increasing acceptance of the reality that the marriage was not perfect, and also as a way for Wendy to move further away from it.

Wendy often stated “what do I do now?”. C encouraged Wendy to begin to think about the things she had always wanted to do but had sacrificed when she married to have a family. Over time, Wendy made some solid decisions about her future concerning:

• Full-time work
• Disclosing her story to others
• Travelling to an island for a holiday
• Not waiting for Steve’s next move before she made hers
• Making some goals for the next two years that she could achieve with or without Steve

When Wendy raised fears of her ability to accomplish the goals she had set herself, C would encourage her to reflect on the personal traits she had demonstrated in counselling, and in her ability to handle Steve’s decision. In particular, she could see her own strength, her courage, and her honesty with herself as attributes that could get her through. Gradually, Wendy became more assertive and started living her life “as if” he would not come back, even though she continued to hope that he would return.

Wendy was keen to start thinking about ending counselling in session sixteen. C and Wendy agreed to two more appointments over two months in order to reflect on her progress over the last six months and identify how she would continue to progress without counselling. At session eighteen, Wendy’s anxiety symptoms were no longer present and she was feeling more in control of her life. She continued to cry and mourn her lost relationship regularly, although the frequency of her tears had greatly reduced.

Key Concepts of Brief Psychodynamic Therapy Applied:

• Developing a positive therapeutic relationship, including the use of empathy
• “Holding” a client through a crisis – not physically, but psychological holding to give them a sense of stability and certainty.
• Looking at the here-and-now in the counselling relationship
• Making the unconscious, conscious and fostering insight
• The underlying belief that providing a safe environment for a client to explore their experiences will give them the opportunity to understand themselves better, change their patterns, and make sense of the situations at hand.

Subscribe to our newsletter

You’ll regularly receive powerful strategies for personal development, tips to improve the growth of your counselling practice, the latest industry news, and much more.

Keyword search

AIPC specialises in providing high quality counselling and community services courses, with a particular focus on highly supported external education. AIPC is the largest provider of counselling courses in the Australia, with over 27 years specialist experience.

Learn more: www.aipc.net.au

Recent Posts

• Men and Emotions: From Repression to Expression
• Men, Emotions and Alexithymia
• The Fine Art of Compassion
• The Benefits of Intentional Daydreaming
• Solution-focused Techniques in Counselling

Recommended Websites

• Australian Counselling Association
• Life Coaching Institute

Advertisement

The Case Study Method in Psychodynamic Psychology: Focus on Addiction

• Original Paper
• Published: 07 November 2016
• Volume 45 , pages 215–226, ( 2017 )

Cite this article

• Lance M. Dodes 1 , 2 &
• Josh Dodes 3  

3000 Accesses

5 Citations

1 Altmetric

Explore all metrics

The case study method has been essential in psychoanalysis and psychodynamic therapy, since it is the only way to describe and explore the deepest levels of the human psyche. Addiction is no more and no less than a particular psychological mechanism, identical at its core to other psychological compulsions, and is therefore best understood and reported by this method that explores the mind in depth. We will discuss the value of the case report method in general and in specific with regard to psychoanalysis and addiction, criticisms raised about this method, and comparisons of it with nomothetic research.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price includes VAT (Russian Federation)

Instant access to the full article PDF.

Rent this article via DeepDyve

Institutional subscriptions

Similar content being viewed by others

Gehlen’s Philosophical Anthropology: Contemporary Applications in Addiction Research

The Phenomenological Elements of Addiction: A Heideggerian Perspective

Psychopathology

Bornstein, R. F. (2007). Nomothetic psychoanalysis. Psychoanalytic Psychology, 24 , 590–602.

Article   Google Scholar  

Damasio, A. (2012). Self comes to mind: Constructing the conscious brain . New York: Vintage Books.

Google Scholar  

Director, L. (2002). The value of relational psychoanalysis in the treatment of chronic drug and alcohol use. Psychoanalytic Dialogues, 12 , 551–579.

Dodes, L. (1990). Addiction, helplessness, and narcissistic rage. Psychoanalytic Quarterly, 59 , 398–419.

PubMed   Google Scholar  

Dodes, L. (1996). Compulsion and addiction. Journal of the American Psychoanalytic Association, 44 , 815–835.

Article   PubMed   Google Scholar  

Dodes, L. (2002). The heart of addiction . New York: HarperCollins.

Dodes, L. (2009). Addiction as a psychological symptom. Psychodynamic Practice, 15 , 381–393.

Dodes, L. (2011). Breaking addiction: A 7-step handbook for ending any addiction . New York: HarperCollins.

Dodes, L., & Dodes, Z. (2014). The sober truth: Debunking the bad science behind 12-step programs and the rehab industry . Boston: Beacon Press.

Eagle, M. N., & Wolitzky, D. L. (2011). Systematic empirical research versus clinical case studies: A valid antagonism? Journal of the American Psychoanalytic Association, 59 , 791–817.

Eriksson, J. (2010). The epistemological status of the case history and the play-character of clinical psychoanalysis: Two doctoral dissertations. Scandinavian Psychoanalytic Review, 33 , 40–46.

Flyvbjerg, B. (2006). Five misunderstandings about case-study research. Qualitative Inquiry, 12 , 219–245.

Fonagy, P. (2013). There is room for even more doublethink: The perilous status of psychoanalytic research. Psychoanalytic Dialogues, 23 , 116–122.

Article   PubMed   PubMed Central   Google Scholar  

Gottdiener, W. H., & Suh, J. J. (2012). Expanding the single-case study: A proposed psychoanalytic research program. Psychoanalytic Review, 99 , 81–102.

Hoffman, I. Z. (2012). Response to Safran: The development of critical psychoanalytic sensibility. Psychoanalytic Dialogues, 22 , 721–731.

Ioannidis, J. (2005). Why most published research findings are false. PLOS Medicine, 2 (8). Retrieved from http://buster.zibmt.uni-ulm.de/dpv/dateien/DPV-Wiss-False-Research-Findings.pdf .

Irwin, J. W. (1996). Science or hermeneutics? Psychoanalysis in search of self-definition. Modern Psychoanalysis, 21 , 61–89.

Jones, E. E., & Windholz, M. (1990). The psychoanalytic case study: Toward a method for systematic inquiry. Journal of the American Psychoanalytic Association, 38 , 985–1015.

Josephs, L., Anderson, E., Bernard, A., Fatzer, K., & Streich, J. (2004). Assessing progress in analysis interminable. Journal of the American Psychoanalytic Association, 52 , 1185–1214.

Khantzian, E. (1978). The ego, the self and opiate addiction: Theoretical and treatment considerations. International Journal of Psychoanalysis, 5 , 189–198.

Krystal, H., & Raskin, H. (1970). Drug dependence: Aspects of ego function . Detroit: Wayne State University Press.

Longhofer, J., & Floersch, J. (2012). The coming crisis in social work: Some thoughts on social work and science. Research on Social Work Practice, 22 , 499–519.

Lothane, Z. (2001). A response to Grünbaum’s “A century of psychoanalysis critical retrospect and prospect” (and other texts): Requiem or reveille? International Forum of Psychoanalysis, 10 , 113–132.

Lush, M. (2011). Clinical facts, turning points and complexity theory. Journal of Child Psychotherapy, 37 , 31–51.

Luyten, P., Blatt, S. J., & Corveleyn, J. (2006). Minding the gap between positivism and hermeneutics in psychoanalytic research. Journal of the American Psychoanalytic Association, 54 , 571–610.

Marks-Tarlow, T. (2015). Commentary on dynamical systems therapy: Theory and practical applications. Psychoanalytic Dialogues, 25 , 131–135.

Midgeley, N. (2006). The inseparable bond between cure and research: Clinical case study as a method of psychoanalytic inquiry. Journal of Child Psychotherapy, 32 , 122–147.

Milkman, H., & Frosch, W. (1973). On the preferential abuse of heroin and amphetamine. Journal of Nervous and Mental Disease, 156 , 242–248.

Moos, R. H., & Moos, B. S. (2006). Participation in treatment and Alcoholics Anonymous: A 16-year follow-up of initially untreated individuals. Journal of Clinical Psychology, 62 , 735–750.

Pine, F. (1988). The four psychologies of psychoanalysis and their place in clinical work. Journal of the American Psychoanalytic Association, 36 , 571–596.

Rabinovich, M., & Kacen, L. (2013). Qualitative coding methodology for interpersonal study. Psychoanalytic Psychology, 30 , 210–231.

Robins, L., Helzer, J., & Davis, D. (1975). Narcotic use in Southeast Asia and afterward. Archives of General Psychiatry, 32 , 955–961.

Rothenberg, M. A. (2004). Down to cases: The ethical value of “non-scientificity” in dyadic psychoanalysis. Journal of the American Psychoanalytic Association, 52 , 125–150.

Safran, J. D. (2012). Doublethinking or dialectical thinking: A critical appreciation of Hoffman’s “doublethinking” critique. Psychoanalytic Dialogues, 22 , 710–720.

Thelen, E. (2005). Dynamic systems theory and the complexity of change. Psychoanalytic Dialogues, 15 , 255–283.

Tillman, J. G., Clemence, A. J., & Stevens, J. L. (2011). Mixed methods research design for pragmatic psychoanalytic studies. Journal of the American Psychoanalytic Association, 59 , 1023–1040.

Waldron, S. Jr. (1997). How can we study the efficacy of psychoanalysis? Psychoanalytic Quarterly, 66 , 283–322.

Waldrup, M. M. (1992). Complexity: The emerging science at the edge of order and chaos . New York: Touchstone Books.

Wallerstein, R. S. (2009). What kind of research in psychoanalytic science? International Journal of Psycho-Analysis, 90 , 109–133.

Warren, C. S. (2012). Faustian science and the future of psychoanalysis. Journal of the American Psychoanalytic Association, 60 , 131–144.

Wieder, H., & Kaplan, E. (1969). Drug use in adolescents. Psychoanalytic Study of the Child, 24 , 399–431.

Wurmser, L. (1974). Psychoanalytic considerations of the etiology of compulsive drug use. Journal of the American Psychoanalytic Association, 22 , 820–843.

Wurmser, L. (1984). The role of superego conflicts in substance abuse and their treatment. International Journal of Psychoanalytic Psychotherapy, 10 , 227–258.

Download references

Author information

Authors and affiliations.

Boston Psychoanalytic Society, Newton, USA

Lance M. Dodes

Harvard Medical School, Boston, USA

Philadelphia, USA

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to Lance M. Dodes .

Rights and permissions

Reprints and permissions

About this article

Dodes, L.M., Dodes, J. The Case Study Method in Psychodynamic Psychology: Focus on Addiction. Clin Soc Work J 45 , 215–226 (2017). https://doi.org/10.1007/s10615-016-0610-5

Download citation

Published : 07 November 2016

Issue Date : September 2017

DOI : https://doi.org/10.1007/s10615-016-0610-5

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Psychoanalysis
• Psychodynamic
• Psychotherapy
• Find a journal
• Publish with us
• Track your research

• Bipolar Disorder
• Therapy Center
• When To See a Therapist
• Types of Therapy
• Best Online Therapy
• Best Couples Therapy
• Best Family Therapy
• Managing Stress
• Sleep and Dreaming
• Understanding Emotions
• Self-Improvement
• Healthy Relationships
• Student Resources
• Personality Types
• Guided Meditations
• Verywell Mind Insights
• 2024 Verywell Mind 25
• Mental Health in the Classroom
• Editorial Process
• Meet Our Review Board
• Crisis Support

Examples of Psychodynamic Therapy to Treat Depression

Arlin Cuncic, MA, is the author of The Anxiety Workbook and founder of the website About Social Anxiety. She has a Master's degree in clinical psychology.

Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania.

MICROGEN IMAGES/SCIENCE PHOTO LIBRARY / Getty Images

Psychodynamic Therapy vs. Other Therapies for Depression

• Process of Psychodynamic Therapy
• Main Features
• Who It's For
• Who It's Not For
• Short-Term Psychodynamic Therapy

Psychodynamic therapy for depression refers to a type of therapy that involves examining a person's past in order to fix their present situation. This type of therapy has its origin in Freudian psychoanalysis .

During psychodynamic therapy, the client will become aware of emotions and feelings that may have been repressed . In addition, the client will make these subconscious elements part of their present awareness to deal with unresolved problems and feelings. In this article, we'll discover examples of psychodynamic therapy and find out how it can help treat depression.

Psychodynamic therapy for depression is one of a handful of other talk therapies used for depression. Whereas psychodynamic therapy focuses on unearthing the past to change the present, other therapies tend to focus more on the present without consideration for the past.

• For example, cognitive-behavioral therapy (CBT) for depression involves changing thinking patterns or behaviors in order to alleviate depression. In this way, these therapies are based on the idea that faulty thinking patterns underlie depression or maintain depression.
• As another example, interpersonal therapy (IPT) for depression involves focusing on current issues and problems in relationships in order to improve functioning.

These types of therapies are usually time-limited (e.g., four months long), follow a structured format, and don't involve digging into your past. On the other hand, psychodynamic therapy for depression may take place over a much longer time frame (e.g., up to a year), sessions tend to be more open-ended with room for exploration, and the past is heavily emphasized in terms of how it affects your current functioning.

As one final difference, psychodynamic therapy considers the relationship between the therapist and client to be one piece of the puzzle when dealing with patterns of thoughts and behaviors. This is unlike other therapies, such as CBT and IPT, in which the relationship with the therapist is considered important (e.g., in terms of rapport) but is not part of the therapy process itself.

Process of Psychodynamic Therapy for Depression

Below is what you can expect if you will be meeting with a psychodynamic therapist for your depression.

You will engage in open-ended discussions with your therapist rather than following a structured plan each week. This means you'll be able to talk freely about whatever is on your mind, with your therapist guiding you through this process.

Unlike with classical psychoanalysis, you likely won't be lying on a couch with your therapist behind you. Rather you'll sit seated in a chair as you would with other therapies.

Once Per Week

You'll meet at least once a week but possibly more often. Your appointments will likely last up to an hour long. You will stay in therapy for at least several months, but depending on your therapist and your treatment plan , your therapy could last years.

Your therapist will help you to focus on patterns in your life and how your past experiences and subconscious mind affect your behavior in the present.

Speak Freely

However, while your therapist may interrupt you to ask questions or redirect the discussion, it is not their place to give opinions on what you say. Instead, the therapist remains a neutral sounding board, which helps to strengthen your relationship and encourage you to speak more freely.

Discover Feelings

You may discover feelings and emotions that you were unaware of before entering psychodynamic therapy. While this process tends to be less intense than during psychoanalysis, it will help you to identify patterns of feelings and behaviors and how your past affects your present .

Research on Psychodynamic Therapy for Depression

Psychodynamic therapy for depression has received less research attention than other types of therapy. However, in the past few decades, more studies have been completed. Despite some problems in measurement, it has been shown that psychodynamic therapy for depression is at least as effective as other evidence-based therapies.

In a review of 54 studies with 3946 subjects examining the use of short-term psychodynamic therapy for depression, it was found that short-term psychodynamic therapy was more effective than a control condition and no different from other forms of therapy.

In addition, it was shown that short-term psychodynamic therapy for depression showed better results in relieving symptoms of anxiety .

Main Features of Psychodynamic Therapy for Depression

Psychodynamic therapy for depression has features that make it unique. Below are the main features of this type of therapy.

Explore Range of Emotions

Psychodynamic therapy for depression investigates a range of emotions, including sadness, anger, distress, loss of desire, etc.

During therapy, clients explore a range of feelings including those that they may not have been aware of in the past (e.g., feelings of being let down, feeling unsafe).

Build Your Resources

Psychodynamic therapy focuses on building the client's internal resources to be able to deal with problems going forward without the aid of the therapist. For example, a client with depression may learn how to explore how reactions to present-day circumstances may be influenced by past events.

One such example might be reacting to a stressful day by withdrawing from friends and family. The client, armed with an understanding of this reaction based on their unique history, would be in a better place to make use of tools to pull themselves out of this phase of withdrawal.

Identify Defense Mechanisms

During psychodynamic therapy, the therapist may work to identify defense mechanisms used by the client. These behaviors and reactions observed in the client serve to avoid dealing with difficult topics.

For example, a client may actively try to suppress bad memories, may change the topic when uncomfortable situations are discussed or may show up late for therapy sessions, or miss them altogether to try to halt or stall progress.

A client may also try to point the blame on external circumstances rather than taking responsibility for their own role in a situation. In the case of depression, a client may try to avoid talking about distressing events from their past or cancel appointments to avoid facing their problems.

Finding Patterns

During psychodynamic therapy, the therapist works with the client to identify patterns that may be below the client's level of awareness. These patterns can only be perceived with the help of the therapist.

The therapist then works to explain to the client why these patterns are important to their current functioning and how they affect their behaviors and feelings in the present.

Talking about these patterns allows the client to examine their past and see how those experiences have shaped who they are in the present moment.

Examining Relationships

Psychodynamic therapy also focuses on the relationship between the therapist and the client. For example, the therapist views how the client reacts in therapy as a signal of the types of reactions that the client has to other people outside of therapy. In this way, the relationship with the therapist serves as a springboard to work on problems relating to others that interfere with the client getting their needs met.

In the case of a depressed client, this might mean identifying how lack of interest, low mood, and other depressive symptoms could be affecting relationships with other people. In addition, the therapist will look for signs of transference.

Transference happens when a client makes assumptions about what the therapist is thinking based on their own past relationships. The therapist watches for instances of transference and then points them out to the client. The hope is that the client then gains insight to be aware of this behavior and avoid it in the future.

Fantasy Life

Psychodynamic therapy may explore aspects of the client's imaginary or fantasy life, including imagery or dreams . Since the client is allowed to speak freely during therapy, there is an opportunity to explore all of this fantasy content and the meaning behind it in terms of the present-day struggles. For example, in the case of depression, a client might talk about dreams or fantasies related to feeling a loss of interest in their life.

Benefits of Psychodynamic Therapy for Depression

Below are some of the benefits you might be able to expect from this type of therapy.

• Greater self-awareness . Clients may attain greater insight and self-awareness about their feelings and behaviors and the subconscious conflicts that may help explain them. This insight may help to relieve you of the symptoms of depression that you are experiencing.
• Tools for self-management . Psychodynamic therapy may also help you to develop internal psychological resources to manage depressive symptoms on your own. This can include recognizing patterns in your feelings and behaviors, identifying past experiences and subconscious factors that may influence your present behavior, and working to use tools from therapy in your life going forward.
• Stronger capacity . In this way, psychodynamic therapy for depression may help you to develop a stronger capacity to manage the issues in your life that cause you to suffer. Through psychodynamic therapy for depression, you may learn healthier ways to cope with issues in your life that bring up repressed and subconscious emotions. This may lead to you being able to live a more fulfilling life.
• Promote self-examination and self-reflection . Psychodynamic therapy will allow you to develop coping strategies to deal with new problems based on awareness and intentional action rather than reactive feelings and behaviors.

Who Is Best Suited for Psychodynamic Therapy for Depression?

Psychodynamic therapy for depression might be suitable for you if you struggle to make sense of your depression and need help to dig into your feelings and discover underlying issues that may be influencing your thoughts and behaviors.

Treatment-Resistant Depression

This type of therapy may be helpful for you if your depression has been resistant to other forms of treatment , or if you have relapsed after a period of improvement. This is because psychodynamic therapy for depression is aimed at uncovering the root problem of your psychological issues, which many other therapies for depression fail to address.

Problematic Childhood

If you had a problematic childhood or upbringing, have experienced negative events in your life, or feel as though being able to express yourself in therapy or talk in an open-ended way might be more helpful than following a manualized treatment program, then psychodynamic therapy might work for you.

This type of therapy might also be suited to you if you are interested in understanding the meaning underlying your depressive symptoms and how your past life events are impacting your current feelings, emotions, and behaviors.

Negative Core Beliefs

Psychodynamic therapy for depression may also be helpful for you if you have core beliefs that are negatively impacting your mood and behavior. Examples of these beliefs in depression might include the feeling that everything is hopeless , feelings of guilt or shame , or feeling as though life has no meaning.

Psychodynamic therapy may also be helpful for you if you have a history of problematic relationships with other people in your life that are contributing to your depression. The reason for this is that your therapist will be watching how you interact with them.

For example, if you avoid talking about difficult issues with your therapist, then they may point out that you might also avoid talking about hard topics with people in your personal life.

Making these types of connections in other types of therapy may be harder since the therapist isn't using the relationship inside therapy to inform what you do outside therapy. This type of therapy will also give you the chance to try out new ways of relating to people that might help to alleviate your depression.

Longer-Term Therapy

Psychodynamic therapy may also be more cost-effective for you in the long-term, particularly if you are paying out of pocket for therapy. While it might be tempting to go with a shorter-term therapy, there is evidence that psychodynamic therapy for depression helps to prevent relapse.

This means that you may end up feeling better for a longer period of time, making it less likely that you will need to go back to your therapist, or a different therapist, for additional treatment.

This type of therapy may also be ideal for you if you are less interested in a "quick fix" and prefer to spend more time getting to the root of your problem. While it may take longer for you to see results, and it may feel as though you are moving too slowly, putting the work into examining your past and how it influences you today will ensure that you are addressing also potential obstacles to feeling better.

Comorbid Personality Disorder

Psychodynamic therapy for depression may also be a good option for you if you are also diagnosed with a comorbid personality disorder . Research has shown that this type of therapy may show better outcomes for depression than other types of therapy, for those with a diagnosed personality disorder.

This makes sense if you consider the fact that personality disorders may become part and parcel of depression, and many manualized treatment modalities may fail to consider the impact that personality has on depression.

In contrast, psychodynamic therapy would take into account all of the factors that have lead you to where you are today, including any personality disorders or personality conflicts. This may be especially true if you have been diagnosed with borderline personality disorder .

Finally, this type of therapy may be good for you if you are looking for an add-on therapy in addition to medication. Research has shown that psychodynamic therapy is more effective than medication alone, so it's reasonable to assume that combining this type of therapy with medication will have positive outcomes.

Who Might Not Be Suited to Psychodynamic Therapy for Depression?

How do you know if this type of therapy might be wrong for you? Below are some cases in which psychodynamic therapy may not be the best fit for you. Read through the list and see if any seem to describe your situation.

• You prefer to work through problems with a focus on present-day issues rather than delving into your past experiences or subconscious conflicts.
• You aren't interested in attending therapy over the long term or for more than one session per week.
• You don't like the idea of your therapist examining the relationship you have with them in therapy and applying it to your real life.
• You don't have good insight into your feelings or emotions or have trouble expressing them verbally. Or you don't enjoy speaking freely without specific guidance on what to say.
• You want to examine your past and how it influences you today, but you don't feel ready for that type of emotional examination right now. At this time, you want a strictly present-focused approach that will help you get back on your feet and taking action in your life.
• You are opposed to the idea that your past influences your present experience, or feel strongly that the psychodynamic tradition or form of therapy is flawed. This might be the case if you have poor perceptions of this type of therapy based on stories you have heard or your perception of psychoanalysis. While this could change over time, you might be better off starting with a more time-limited therapy that is focused on the present day.
• Your depression is severe to the point that attending therapy would feel impossible. In this case, you may be struggling with a biological cause that could be better addressed with medication to get your depressive symptoms under control.

Short-Term Psychodynamic Therapy for Depression

Are you interested in psychodynamic therapy but concerned about the time commitment or the cost? If so, you might prefer short-term psychodynamic therapy.

While traditional psychodynamic therapy tends to be longer lasting over months or years, with clients sometimes meeting their therapist multiple times per week, short-term psychodynamic therapy takes place over a much shorter time frame. This type of psychodynamic therapy is actually becoming much more common for managing specific emotional problems and can take place over as little as a 12 to 20 week period.

While in the past, evidence for the use of this type of therapy for depression was scarce, increasingly, it is being recognized as a valuable contribution in the field of therapy. This type of therapy may promote long-term reversal of symptoms and is a viable alternative to other approaches such as cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT).

Above all else, remember that any type of therapy will involve facing difficult emotions and exploring better ways to cope. While it might feel difficult at the time, you will be creating a better foundation for your future. Be sure to attend all therapy sessions and put in your best efforts. In the end, nobody can force you to do the work. However, you will make more progress in therapy if you can make it a priority in your life. While depression might make this feel impossible, try doing the bare minimum that your therapist asks of you and being consistent with it.

Get Help Now

We've tried, tested, and written unbiased reviews of the best online therapy programs including Talkspace, BetterHelp, and ReGain. Find out which option is the best for you.

Ribeiro Â, Ribeiro JP, von Doellinger O. Depression and psychodynamic psychotherapy . Braz J Psychiatry. 2018;40(1):105-109.

Driessen E, Hegelmaier LM, Abbass AA, et al. The efficacy of short-term psychodynamic psychotherapy for depression: A meta-analysis update . Clin Psychol Rev. 2015;42:1-15.

Luyten P, Blatt SJ. Psychodynamic treatment of depression . Psychiatr Clin North Am. 2012;35(1):111-129.

By Arlin Cuncic, MA Arlin Cuncic, MA, is the author of The Anxiety Workbook and founder of the website About Social Anxiety. She has a Master's degree in clinical psychology.

Case Study Research Method in Psychology

Saul Mcleod, PhD

Editor-in-Chief for Simply Psychology

BSc (Hons) Psychology, MRes, PhD, University of Manchester

Saul Mcleod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.

Learn about our Editorial Process

Olivia Guy-Evans, MSc

Associate Editor for Simply Psychology

BSc (Hons) Psychology, MSc Psychology of Education

Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.

On This Page:

Case studies are in-depth investigations of a person, group, event, or community. Typically, data is gathered from various sources using several methods (e.g., observations & interviews).

The case study research method originated in clinical medicine (the case history, i.e., the patient’s personal history). In psychology, case studies are often confined to the study of a particular individual.

The information is mainly biographical and relates to events in the individual’s past (i.e., retrospective), as well as to significant events that are currently occurring in his or her everyday life.

The case study is not a research method, but researchers select methods of data collection and analysis that will generate material suitable for case studies.

Freud (1909a, 1909b) conducted very detailed investigations into the private lives of his patients in an attempt to both understand and help them overcome their illnesses.

This makes it clear that the case study is a method that should only be used by a psychologist, therapist, or psychiatrist, i.e., someone with a professional qualification.

There is an ethical issue of competence. Only someone qualified to diagnose and treat a person can conduct a formal case study relating to atypical (i.e., abnormal) behavior or atypical development.

 Famous Case Studies

• Anna O – One of the most famous case studies, documenting psychoanalyst Josef Breuer’s treatment of “Anna O” (real name Bertha Pappenheim) for hysteria in the late 1800s using early psychoanalytic theory.
• Little Hans – A child psychoanalysis case study published by Sigmund Freud in 1909 analyzing his five-year-old patient Herbert Graf’s house phobia as related to the Oedipus complex.
• Bruce/Brenda – Gender identity case of the boy (Bruce) whose botched circumcision led psychologist John Money to advise gender reassignment and raise him as a girl (Brenda) in the 1960s.
• Genie Wiley – Linguistics/psychological development case of the victim of extreme isolation abuse who was studied in 1970s California for effects of early language deprivation on acquiring speech later in life.
• Phineas Gage – One of the most famous neuropsychology case studies analyzes personality changes in railroad worker Phineas Gage after an 1848 brain injury involving a tamping iron piercing his skull.

Clinical Case Studies

• Studying the effectiveness of psychotherapy approaches with an individual patient
• Assessing and treating mental illnesses like depression, anxiety disorders, PTSD
• Neuropsychological cases investigating brain injuries or disorders

Child Psychology Case Studies

• Studying psychological development from birth through adolescence
• Cases of learning disabilities, autism spectrum disorders, ADHD
• Effects of trauma, abuse, deprivation on development

Types of Case Studies

• Explanatory case studies : Used to explore causation in order to find underlying principles. Helpful for doing qualitative analysis to explain presumed causal links.
• Exploratory case studies : Used to explore situations where an intervention being evaluated has no clear set of outcomes. It helps define questions and hypotheses for future research.
• Descriptive case studies : Describe an intervention or phenomenon and the real-life context in which it occurred. It is helpful for illustrating certain topics within an evaluation.
• Multiple-case studies : Used to explore differences between cases and replicate findings across cases. Helpful for comparing and contrasting specific cases.
• Intrinsic : Used to gain a better understanding of a particular case. Helpful for capturing the complexity of a single case.
• Collective : Used to explore a general phenomenon using multiple case studies. Helpful for jointly studying a group of cases in order to inquire into the phenomenon.

Where Do You Find Data for a Case Study?

There are several places to find data for a case study. The key is to gather data from multiple sources to get a complete picture of the case and corroborate facts or findings through triangulation of evidence. Most of this information is likely qualitative (i.e., verbal description rather than measurement), but the psychologist might also collect numerical data.

1. Primary sources

• Interviews – Interviewing key people related to the case to get their perspectives and insights. The interview is an extremely effective procedure for obtaining information about an individual, and it may be used to collect comments from the person’s friends, parents, employer, workmates, and others who have a good knowledge of the person, as well as to obtain facts from the person him or herself.
• Observations – Observing behaviors, interactions, processes, etc., related to the case as they unfold in real-time.
• Documents & Records – Reviewing private documents, diaries, public records, correspondence, meeting minutes, etc., relevant to the case.

2. Secondary sources

• News/Media – News coverage of events related to the case study.
• Academic articles – Journal articles, dissertations etc. that discuss the case.
• Government reports – Official data and records related to the case context.
• Books/films – Books, documentaries or films discussing the case.

3. Archival records

Searching historical archives, museum collections and databases to find relevant documents, visual/audio records related to the case history and context.

Public archives like newspapers, organizational records, photographic collections could all include potentially relevant pieces of information to shed light on attitudes, cultural perspectives, common practices and historical contexts related to psychology.

4. Organizational records

Organizational records offer the advantage of often having large datasets collected over time that can reveal or confirm psychological insights.

Of course, privacy and ethical concerns regarding confidential data must be navigated carefully.

However, with proper protocols, organizational records can provide invaluable context and empirical depth to qualitative case studies exploring the intersection of psychology and organizations.

• Organizational/industrial psychology research : Organizational records like employee surveys, turnover/retention data, policies, incident reports etc. may provide insight into topics like job satisfaction, workplace culture and dynamics, leadership issues, employee behaviors etc.
• Clinical psychology : Therapists/hospitals may grant access to anonymized medical records to study aspects like assessments, diagnoses, treatment plans etc. This could shed light on clinical practices.
• School psychology : Studies could utilize anonymized student records like test scores, grades, disciplinary issues, and counseling referrals to study child development, learning barriers, effectiveness of support programs, and more.

How do I Write a Case Study in Psychology?

Follow specified case study guidelines provided by a journal or your psychology tutor. General components of clinical case studies include: background, symptoms, assessments, diagnosis, treatment, and outcomes. Interpreting the information means the researcher decides what to include or leave out. A good case study should always clarify which information is the factual description and which is an inference or the researcher’s opinion.

1. Introduction

• Provide background on the case context and why it is of interest, presenting background information like demographics, relevant history, and presenting problem.
• Compare briefly to similar published cases if applicable. Clearly state the focus/importance of the case.

2. Case Presentation

• Describe the presenting problem in detail, including symptoms, duration,and impact on daily life.
• Include client demographics like age and gender, information about social relationships, and mental health history.
• Describe all physical, emotional, and/or sensory symptoms reported by the client.
• Use patient quotes to describe the initial complaint verbatim. Follow with full-sentence summaries of relevant history details gathered, including key components that led to a working diagnosis.
• Summarize clinical exam results, namely orthopedic/neurological tests, imaging, lab tests, etc. Note actual results rather than subjective conclusions. Provide images if clearly reproducible/anonymized.
• Clearly state the working diagnosis or clinical impression before transitioning to management.

3. Management and Outcome

• Indicate the total duration of care and number of treatments given over what timeframe. Use specific names/descriptions for any therapies/interventions applied.
• Present the results of the intervention,including any quantitative or qualitative data collected.
• For outcomes, utilize visual analog scales for pain, medication usage logs, etc., if possible. Include patient self-reports of improvement/worsening of symptoms. Note the reason for discharge/end of care.

4. Discussion

• Analyze the case, exploring contributing factors, limitations of the study, and connections to existing research.
• Analyze the effectiveness of the intervention,considering factors like participant adherence, limitations of the study, and potential alternative explanations for the results.
• Identify any questions raised in the case analysis and relate insights to established theories and current research if applicable. Avoid definitive claims about physiological explanations.
• Offer clinical implications, and suggest future research directions.

5. Additional Items

• Thank specific assistants for writing support only. No patient acknowledgments.
• References should directly support any key claims or quotes included.
• Use tables/figures/images only if substantially informative. Include permissions and legends/explanatory notes.
• Provides detailed (rich qualitative) information.
• Provides insight for further research.
• Permitting investigation of otherwise impractical (or unethical) situations.

Case studies allow a researcher to investigate a topic in far more detail than might be possible if they were trying to deal with a large number of research participants (nomothetic approach) with the aim of ‘averaging’.

Because of their in-depth, multi-sided approach, case studies often shed light on aspects of human thinking and behavior that would be unethical or impractical to study in other ways.

Research that only looks into the measurable aspects of human behavior is not likely to give us insights into the subjective dimension of experience, which is important to psychoanalytic and humanistic psychologists.

Case studies are often used in exploratory research. They can help us generate new ideas (that might be tested by other methods). They are an important way of illustrating theories and can help show how different aspects of a person’s life are related to each other.

The method is, therefore, important for psychologists who adopt a holistic point of view (i.e., humanistic psychologists ).

Limitations

• Lacking scientific rigor and providing little basis for generalization of results to the wider population.
• Researchers’ own subjective feelings may influence the case study (researcher bias).
• Difficult to replicate.
• Time-consuming and expensive.
• The volume of data, together with the time restrictions in place, impacted the depth of analysis that was possible within the available resources.

Because a case study deals with only one person/event/group, we can never be sure if the case study investigated is representative of the wider body of “similar” instances. This means the conclusions drawn from a particular case may not be transferable to other settings.

Because case studies are based on the analysis of qualitative (i.e., descriptive) data , a lot depends on the psychologist’s interpretation of the information she has acquired.

This means that there is a lot of scope for Anna O , and it could be that the subjective opinions of the psychologist intrude in the assessment of what the data means.

For example, Freud has been criticized for producing case studies in which the information was sometimes distorted to fit particular behavioral theories (e.g., Little Hans ).

This is also true of Money’s interpretation of the Bruce/Brenda case study (Diamond, 1997) when he ignored evidence that went against his theory.

Breuer, J., & Freud, S. (1895).  Studies on hysteria . Standard Edition 2: London.

Curtiss, S. (1981). Genie: The case of a modern wild child .

Diamond, M., & Sigmundson, K. (1997). Sex Reassignment at Birth: Long-term Review and Clinical Implications. Archives of Pediatrics & Adolescent Medicine , 151(3), 298-304

Freud, S. (1909a). Analysis of a phobia of a five year old boy. In The Pelican Freud Library (1977), Vol 8, Case Histories 1, pages 169-306

Freud, S. (1909b). Bemerkungen über einen Fall von Zwangsneurose (Der “Rattenmann”). Jb. psychoanal. psychopathol. Forsch ., I, p. 357-421; GW, VII, p. 379-463; Notes upon a case of obsessional neurosis, SE , 10: 151-318.

Harlow J. M. (1848). Passage of an iron rod through the head.  Boston Medical and Surgical Journal, 39 , 389–393.

Harlow, J. M. (1868).  Recovery from the Passage of an Iron Bar through the Head .  Publications of the Massachusetts Medical Society. 2  (3), 327-347.

Money, J., & Ehrhardt, A. A. (1972).  Man & Woman, Boy & Girl : The Differentiation and Dimorphism of Gender Identity from Conception to Maturity. Baltimore, Maryland: Johns Hopkins University Press.

Money, J., & Tucker, P. (1975). Sexual signatures: On being a man or a woman.

Further Information

• Case Study Approach
• Case Study Method
• Enhancing the Quality of Case Studies in Health Services Research
• “We do things together” A case study of “couplehood” in dementia
• Using mixed methods for evaluating an integrative approach to cancer care: a case study

Related Articles

Research Methodology

Qualitative Data Coding

What Is a Focus Group?

Cross-Cultural Research Methodology In Psychology

What Is Internal Validity In Research?

Research Methodology , Statistics

What Is Face Validity In Research? Importance & How To Measure

Criterion Validity: Definition & Examples

• Onsite training

3,000,000+ delegates

15,000+ clients

1,000+ locations

• KnowledgePass
• Log a ticket

01344203999 Available 24/7

Cognitive Psychology: Everything You Need to Know

Cognitive Psychology is the scientific study of mental processes such as perception, memory, reasoning, and decision-making. This blog will shed light on Cognitive Psychology, the different elements of Cognition, and insights into Cognitive Behavioural therapy. Read along to understand the intricacies of the human mind and its processes.

Exclusive 40% OFF

Training Outcomes Within Your Budget!

We ensure quality, budget-alignment, and timely delivery by our expert instructors.

Share this Resource

• Handle Stress and Develop Your Resilience
• Child Psychology Course
• Psychology Course
• Prevention Psychology Training
• Positive Psychology Course

Have you ever forgotten a significant birthday? Misunderstand something that was communicated to you? Or simply question why your mind works the way it does? The answer lies in Cognitive Psychology! A genuinely fascinating subject that explains workings of the mind.  

This fascinating field sheds light on the inner workings of our minds, unravelling its different processes like thoughts, memories, and actions. So, what are you waiting for? Let your mind process the various processes of your mind with an understanding of Cognitive Psychology. 

Table of Contents 

1) What Is Cognitive Psychology?  

2) Important areas of Cognitive Psychology  

3) The Cognitive approach in practice  

4) Careers in Cognitive Psychology

5) Reasons to Consult a Cognitive Psychologist 

6) Conflicts and debates  

7) Conclusion 

What Is Cognitive Psychology? 

Cognitive Psychology is a branch of Psychology that studies mental processes, including how we acquire, process and store information. It largely focuses on the internal processes like attention, perception and memory. The other processes that it also aims to explain are language, problem-solving, and decision-making.  

Cognitive Psychologists strive to decipher how we think and why we behave the way we do, providing insights into our mind and its interactions with the world.  

Important areas of Cognitive Psychology 

As discussed, Cognitive Psychology focuses on the inner workings of our mind. Here are the most important areas that it strives to understand.  

Memory 

Memory is a fundamental concept in Cognitive Psychology that focuses on how knowledge is taken in, stored and retrieved. Some of the questions that are pursued by researchers include: "Why do we forget certain things?" or "How can we improve memory recall?" For example, research that focuses on memory consolidation highlights how much sleep is important in optimising memories. 

Perception 

Perception involves how we interpret sensory information to understand our environment. Cognitive Psychologists study things like visual illusions to reveal how our brains process deceptions. It further explains why we may sometimes perceive things that aren’t really there. 

Language 

Another important area of research is language processing which is concerned with the comprehension and generation of language. This entails examining how children learn to speak and how adults understand speech and how they write it. It helps in the formulation of improved educational tools and equipment as well as communication gadgets. 

Problem-Solving 

Applied research focuses on the ways in which we deal with different issues. Cognitive Psychology deals with how we approach challenges, make choices and learn in new environments. This knowledge is used in fields such as education, which focuses on creating good learning techniques to address problem-solving skills. 

Learn to manage stress mindfully and build resilience with our Handle Stress And Develop Your Resilience Training   - register now!  

The Cognitive Approach in Practice 

Cognitive Psychology has greatly benefited the treatment of mental health issues. Until the 1970s, the provision of mental health care mainly embraced psychoanalytic, behavioural and humanistic approaches. 

The coming of the "cognitive revolution” brought focus to how people thought. It made people curious about how their ways of thinking could play a part in their psychological disorders. This change led to the emergence of new approaches to address certain diseases like depression, anxiety disorders as well as phobias. 

What Is Cognitive Behavioral Therapy? 

Cognitive Behavioral Therapy (CBT) is a widely used therapeutic approach. It combines cognitive and behavioural techniques to treat mental health issues. CBT focuses on identifying and challenging negative thought patterns that affect behaviours. Then, replace them with healthier, more adaptive ones. It has been proven effective in treating conditions such as depression, anxiety, PTSD, and OCD, making it a cornerstone of modern psychotherapy. 

Careers in Cognitive Psychology 

Cognitive Psychology offers diverse career opportunities across various sectors. Professionals in this field may work in academia, research, healthcare, or industry, applying their expertise to solve real-world problems. 

Academic and Research Positions 

Many cognitive Psychologists work as University Professors or Researchers, conducting studies to advance our understanding of mental processes. They may teach courses, mentor students, and publish their findings in academic journals. 

Clinical and Counselling Roles 

Cognitive Psychologists can also work as clinical or counselling Psychologists. They use their knowledge to diagnose and treat mental health issues. They often employ CBT and other evidence-based therapies to help clients overcome challenges and improve their mental health. 

Aid in creating a safe space for everyone around you with our Mindfulness Training - sign up now!  

Industry and Technology 

In the tech industry, cognitive Psychologists contribute to the development of user-friendly interfaces, Artificial Intelligence (AI), and human-computer interaction. Their insights make sure that technology is designed in ways that align with human cognitive capabilities. 

Educational Consulting 

Cognitive Psychologists collaborate with educational institutions to design curricula and teaching strategies that optimise learning and memory retention. By applying principles from Cognitive Psychology, they create impactful educational programs and assessments. 

Reasons to Consult a Cognitive Psychologist 

Here are the reasons to consult a cognitive psychologist: 

1) Mental health issues: Cognitive Psychologists use evidence-based therapies like CBT. It can be used to address conditions such as anxiety, depression, and PTSD. This can help clients develop healthier thought patterns and behaviours. 

2) Learning and memory: They can assist in developing strategies to improve memory and learning skills. It is particularly useful for students and individuals with learning difficulties. 

3) Decision-making and problem-solving: Cognitive Psychologists help enhance problem-solving and decision-making abilities. They are beneficial for both personal growth and professional development. 

4) Behavioural changes: They support individuals in making significant behavioural changes. It can help people quit smoking or manage stress, by altering cognitive patterns. 

Conflicts and Debates 

Since the dawn of perception, there have been conflicts, here are some important conflicts and debates in Cognitive Psychology: 

Free will vs determinism 

The debate between free will and determinism explores whether our behaviours are driven by internal and external factors. Or if we have the autonomy to choose our actions. Cognitive Psychologists examine the extent to which cognitive processes are influenced by genetics, environment, and personal agency.   

Nature vs Nurture 

This longstanding debate of Nature vs Nurture questions the relative contributions of genetic inheritance (nature) and environmental factors (nurture) to human development. Cognitive Psychology studies how these elements interact to shape our cognitive abilities and behaviours. This offers insights into human potential and individual differences. 

Holism vs. Reductionism 

Holism and reductionism are approaches to studying cognitive processes. Holism considers the whole system. In contrast, reductionism breaks down processes into simpler parts. Both perspectives provide valuable insights but also have limitations in fully understanding complex mental functions. Cognitive Psychologists often integrate both approaches to gain a comprehensive understanding of Cognition. 

Idiographic vs. Nomothetic 

The idiographic approach focuses on individual cases and personal experiences. In contrast, the nomothetic approach seeks general laws applicable to all individuals. Cognitive Psychologists use both methods to balance personalised understanding with broader generalisations, enriching the study of human Cognition. 

Conclusion 

In this blog, we discussed how Cognitive Psychology offers a fascinating insight into the workings of our minds. By studying how we think, learn, and remember, cognitive Psychologists help you understand yourself better. Additionally, we discussed a few important areas of Cognitive Psychology, and the career paths it can lead to. 

Learn how you can prevent psychological distress that can lead to extreme adversities - sign up for our Prevention Psychology Training now!  

Frequently Asked Questions

Cognitive Psychology primarily focuses on understanding mental processes like perception, memory, reasoning, and decision-making.  

Cognitive Psychology can improve everyday life by enhancing learning strategies, improving memory, and developing better problem-solving skills.  

The Knowledge Academy takes global learning to new heights, offering over 30,000 online courses across 490+ locations in 220 countries. This expansive reach ensures accessibility and convenience for learners worldwide .    

Alongside our diverse Online Course Catalogue, encompassing 17 major categories, we go the extra mile by providing a plethora of free educational Online Resources like News updates, Blogs , videos, webinars, and interview questions. Tailoring learning experiences further, professionals can maximise value with customisable Course Bundles of TKA .  

The Knowledge Academy’s Knowledge Pass , a prepaid voucher, adds another layer of flexibility, allowing course bookings over a 12-month period. Join us on a journey where education knows no bounds .    

The Knowledge Academy offers various Health & Safety Courses , including Advance First-Aid Training, Active and Healthy Lifestyle Training, and Counselling Certifications. These courses cater to different skill levels, providing comprehensive insights into What is Yoga .     

Our Health & Safety Blogs cover a range of topics related to Psychology , offering valuable resources, best practices, and industry insights. Whether you are a beginner or looking to advance your Health and Safety knowledge, The Knowledge Academy's diverse courses and informative blogs have you covered.  

Upcoming Health & Safety Resources Batches & Dates

Fri 26th Jul 2024

Fri 8th Nov 2024

Get A Quote

WHO WILL BE FUNDING THE COURSE?

My employer

By submitting your details you agree to be contacted in order to respond to your enquiry

• Business Analysis
• Lean Six Sigma Certification

Share this course

Our biggest spring sale.

We cannot process your enquiry without contacting you, please tick to confirm your consent to us for contacting you about your enquiry.

By submitting your details you agree to be contacted in order to respond to your enquiry.

We may not have the course you’re looking for. If you enquire or give us a call on 01344203999 and speak to our training experts, we may still be able to help with your training requirements.

Or select from our popular topics

• ITIL® Certification
• Scrum Certification
• Change Management Certification
• Business Analysis Courses
• Microsoft Azure Certification
• Microsoft Excel Courses
• Microsoft Project
• Explore more courses

Press esc to close

Fill out your  contact details  below and our training experts will be in touch.

Fill out your   contact details   below

Thank you for your enquiry!

One of our training experts will be in touch shortly to go over your training requirements.

Back to Course Information

Fill out your contact details below so we can get in touch with you regarding your training requirements.

* WHO WILL BE FUNDING THE COURSE?

Preferred Contact Method

No preference

Back to course information

Fill out your  training details  below

Fill out your training details below so we have a better idea of what your training requirements are.

HOW MANY DELEGATES NEED TRAINING?

HOW DO YOU WANT THE COURSE DELIVERED?

Online Instructor-led

Online Self-paced

WHEN WOULD YOU LIKE TO TAKE THIS COURSE?

Next 2 - 4 months

WHAT IS YOUR REASON FOR ENQUIRING?

Looking for some information

Looking for a discount

I want to book but have questions

One of our training experts will be in touch shortly to go overy your training requirements.

Your privacy & cookies!

Like many websites we use cookies. We care about your data and experience, so to give you the best possible experience using our site, we store a very limited amount of your data. Continuing to use this site or clicking “Accept & close” means that you agree to our use of cookies. Learn more about our privacy policy and cookie policy cookie policy .

We use cookies that are essential for our site to work. Please visit our cookie policy for more information. To accept all cookies click 'Accept & close'.

FOCUSED REVIEW article

Clinical case studies in psychoanalytic and psychodynamic treatment.

This article mentions parts of:

Theoretical pluralism in psychoanalytic case studies

• Read original article

• Centre for Psychoanalytic Studies, University of Essex, Colchester, UK

This manuscript provides a review of the clinical case study within the field of psychoanalytic and psychodynamic treatment. The method has been contested for methodological reasons and because it would contribute to theoretical pluralism in the field. We summarize how the case study method is being applied in different schools of psychoanalysis, and we clarify the unique strengths of this method and areas for improvement. Finally, based on the literature and on our own experience with case study research, we come to formulate nine guidelines for future case study authors: (1) basic information to include, (2) clarification of the motivation to select a particular patient, (3) information about informed consent and disguise, (4) patient background and context of referral or self-referral, (5) patient's narrative, therapist's observations and interpretations, (6) interpretative heuristics, (7) reflexivity and counter-transference, (8) leaving room for interpretation, and (9) answering the research question, and comparison with other cases.

Introduction

Psychoanalysis has always been, according to its inventor, both a research endeavor and a therapeutic endeavor. Furthermore it is clear from Freud's autobiography that he prioritized the research aspect; he did not become a doctor because he wished to cure people in ill health ( Freud, 2001 [1925] ). His invention of the psychoanalytic approach to therapy, involving the patient lying down and associating freely, served a research purpose as much as a therapeutic purpose. Through free association, he would be able to gain unique insight in the human mind. Next, he had to find a format to report on his findings, and this would be the case study. The case study method already existed in medicine ( Forrester, 2016 ), but Freud adjusted it considerably. Case studies in medical settings were more like case files, in which the patient was described or reduced to a number of medical categories: the patient became a case of some particular ailment ( Forrester, 2016 ). In Freud's hands, the case study developed into Kranken Geschichten in which the current pathology of the patient is related to the whole of his life, sometimes even over generations.

Although Freud's case studies have demonstrably provided data for generations of research by analysts ( Midgley, 2006a ) and various scholars ( Pletsch, 1982 ; Sealey, 2011 ; Damousi et al., 2015 ), the method of the case study has become very controversial. According to Midgley (2006b) , objections against the case study method can be grouped into three arguments. First there is the data problem: case studies provide no objective clinical data ( Widlöcher, 1994 ), they only report on what went right and disregard any confusion or mistakes ( Spence, 2001 ). Second, there is the data analysis problem: the way in which the observations of the case study are analyzed lack validity; case studies confirm what we already know ( Spence, 2001 ). Some go even so far to say that they are purely subjective: Michels calls case studies the “crystallization of the analyst's countertransference” ( Michels, 2000 , p. 373). Thirdly, there is the generalizability problem: it is not possible to gain generalizable insight from case studies. Reading, writing and presenting case studies has been described as being a group ritual to affirm analysts in their professional identity, rather than a research method ( Widlöcher, 1994 ).

These criticisms stand in contrast to the respect gained by the case study method in the last two decades. Since the 1990s there has been an increasing number of psychoanalytic and psychodynamic clinical case study and empirical case studies being published in scientific journals ( Desmet et al., 2013 ; Cornelis et al., in press ). It has also been signaled that the case study method is being revived more broadly in the social sciences. In the most recent, fifth edition of his seminal book on case study research, Yinn (2014) includes a figure showing the steady increase of the frequency with which the term “case study research” appears in published books in the period from 1980 to 2008.

KEY CONCEPT 1. Clinical case study A clinical case study is a narrative report by the therapist of what happened during a therapy together with the therapist's interpretations of what happened. It is possible that certain (semi)-structured assessment instruments, such as a questionnaire or a diagnostic interview are included in clinical case studies, yet it is still the therapist that uses these, interprets and discusses them.

KEY CONCEPT 2. Empirical case studies In an empirical case study data are gathered from different sources (e.g., self-report, observation,…) and there is a research team involved in the analyses of the data. This study can take place either in a naturalistic setting (systematic case study) or in a controlled experimental environment (single-case experiment).

In addition to the controversy about the case study method, psychoanalysis has developed into a fragmented discipline. The different psychoanalytic schools share Freud's idea of the unconscious mind, but they focus on different aspects in his theoretical work. Some of the schools still operate under the wings of the International Psychoanalytic Association, while others have established their own global association. Each school is linked to one or several key psychoanalysts who have developed their own version of psychoanalysis. Each psychoanalytic school has a different set of theories but there are also differences in the training of new psychoanalysts and in the therapeutic techniques that are applied by its proponents.

Based on this heterogeneity of perspectives in psychoanalysis, a research group around the Single Case Archive investigated the current status of case study research in psychoanalysis ( Willemsen et al., 2015a ). They were particularly interested to know more about the output and methodology of case studies within the different psychoanalytic schools.

KEY CONCEPT 3. Single case archive The Single Case Archive is an online archive of published clinical and empirical case studies in the field of psychotherapy ( http://www.singlecasearchive.com ). The objective of this archive is to facilitate the study of case studies for research, clinical, and teaching purposes. The online search engine allows the identification of sets of cases in function of specific clinical or research questions.

Our Survey Among Case Study Authors About their Psychoanalytic School

In order to investigate and compare case studies from different psychoanalytic schools, we first had to find a way of identifying to which school the case studies belonged. This is very difficult to judge straightforwardly on the basis of the published case study: the fact that someone cites Winnicott or makes transference interpretations doesn't place him or her firmly within a particular psychoanalytic school. The best approach was to ask the authors themselves. Therefore, we contacted all case study authors included in the Single Case Archive (since the time of our original study in 2013, the archive has expanded). We sent emails and letters in different languages to 445 authors and received 200 replies (45% response rate). We asked them the following question: “ At the time you were working on this specific case, to which psychoanalytic school(s) did you feel most attached? ” Each author was given 10 options: (1) Self Psychology (1.a Theory of Heinz Kohut, 1.b Post-Kohutian Theories, 1.c Intersubjective psychoanalysis), (2) Relational psychoanalysis, (3) Interpersonal psychoanalysis, (4) Object relational psychoanalysis (4.a Theory of Melanie Klein, 4.b Theory of Donald W. Winnicott, 4.c Theory of Wilfred R. Bion, 4.d Theory of Otto F. Kernberg), (5) Ego psychology (or) “Classic psychoanalysis” (5.a Theories of Sigmund Freud, 5.b Ego psychology, 5.c Post-Ego psychology), (6) Lacanian psychoanalysis, (7) Jungian psychoanalysis, (8) National Psychological Association for Psychoanalysis (NPAP) related theory, (9) Modern psychoanalysis related to the Boston or New York Graduate School of Psychoanalysis (BGSP/NYGSP), (10) Other. Respondents could indicate one or more options.

Analysis of the responses indicated that the two oldest schools in psychoanalysis, Object-relations psychoanalysis and Ego psychology, dominate the field in relation to case studies that are published in scientific journals. More than three quarters of all case study authors (77%) reported these schools of thought to be the ones with which they considered themselves most affiliated. Three more recent schools were also well-represented among case studies: Self Psychology, Relational Psychoanalysis, and Interpersonal Psychoanalysis. Lacanian Psychoanalysis, Jungian Psychoanalysis, NPAP related Theory and Modern Psychoanalysis related to the BGSP/NYGSP were only rarely mentioned by case study authors as their school of thought. This does not mean that clinicians or researchers within these latter schools do not write any case studies. It only means that they publish few case studies in the scientific journals included in ISI-ranked journals indexed in Web of Science. But they might have their own journals in which they publish clinical material.

Our survey demonstrated that the majority of case study authors (59%) feel attached to more than one psychoanalytic school. This was in fact one of the surprising findings in our study. It seems that theoretical pluralism is more rule than exception among case study authors. There were some differences between the psychoanalytic schools though in terms of pluralism. Case study authors who feel attached to Self Psychology and Interpersonal Psychoanalysis are the most pluralistic: 92 and 86%, respectively also affiliate with one or more other psychoanalytic schools. Case study authors who feel attached to Object Relations Psychoanalysis are the “purest” group: only 69% of them affiliate with one or more other psychoanalytic schools.

KEY CONCEPT 4. Theoretical pluralism A situation in which several, potentially contradicting, theories coexist. It is sometimes interpreted as a sign of the immaturity of a science, under the assumption that a mature science should arrive at one single coherent truth. Others see theoretical pluralism as unavoidable for any applied discipline, as each theory can highlight only part of reality.

Psychoanalytic Pluralism and the Case Study Method

We were not really surprised to find that Object Relations psychoanalysis and Ego psychology were the most dominant schools in the field of psychoanalytic case studies, as they are very present in European, Latin-American and North-American psychoanalytic institutes. We were more surprised to find such a high degree of pluralism among these case study authors, given the fact that disputes between analysts from different schools can be quite ardent ( Green, 2005 ; Summers, 2008 ). Others have compared the situation of psychoanalytic schools with the Tower of Babel ( Steiner, 1994 ).

It has been argued that the case study method contributes to the degree of theoretical pluralism within psychoanalysis. The reason for this is situated in the reasoning style at the basis of case study research ( Chiesa, 2010 ; Fonagy, 2015 ). The author of a psychoanalytic case study makes a number of observations about the patient within the context of the treatment, and then moves to a conclusion about the patient's psychodynamics in general. The conclusion he or she arrives at inductively gains its “truth value” from the number and quality of observations it is based on. This style of reasoning in case study research is very similar to how clinicians reason in general. Clinicians look for patterns within patients and across patients. If they make similar observations in different patients, or if other psychoanalysts make similar observations in their patients, the weight of the conclusion becomes greater and greater. The problem with this reasoning style is that one can never arrive at definite conclusions: even if a conclusion is based on a large number of observations, it is always possible that the next observation disconfirms the conclusion. Therefore, it could be said, it is impossible to attain “true” knowledge.

The above argument is basically similar to objections against any kind of qualitative research. To this, we argue with Rustin (2003) that there is not one science and no hierarchy of research methods. Each method comes with strengths and weaknesses, and what one gains in terms of control and certainty in a conventional experimental setup is lost in terms of external validity and clinical applicability. Numerous researchers have pleaded for the case study approach as one method among a whole range of research methods in the field of psychoanalysis ( Rustin, 2003 ; Luyten et al., 2006 ; Midgley, 2006b ; Colombo and Michels, 2007 ; Vanheule, 2009 ; Hinshelwood, 2013 ). Leuzinger-Bohleber makes a distinction between clinical research and extra-clinical research ( Leuzinger-Bohleber, 2015 ). Clinical research is the idiographic type of research conducted by a psychoanalyst who is working with a patient. Unconscious phantasies and conflicts are symbolized and put into words at different levels of abstraction. This understanding then molds the perception of the analyst in subsequent clinical situations; even though the basic psychoanalytic attitude of “not knowing” is maintained. The clinical case study is clinical research par excellence . Extra-clinical research consists in the application of different methodologies developed in the natural and human sciences, to the study of the unconscious mind. Leuzinger-Bohleber refers to empirical psychotherapy research, experimental research, literature, cultural studies, etc. We believe that the clinical case study method should step up and claim its place in psychoanalytic research, although we agree that the method should be developed further. This paper and a number of others such as Midgley (2006b) should facilitate this methodological improvement. The clinical research method is very well-suited to address any research question related to the description of phenomena and sequences in psychotherapy (e.g., manifestation and evolution of symptoms and therapeutic relationship over time). It is not suitable for questions related to causality and outcome.

We also want to point out that there is a new evolution in the field of psychotherapy case study research, which consists in the development of methodologies for meta-studies of clinical case studies ( Iwakabe and Gazzola, 2009 ). The evolution builds on the broader tendency in the field of qualitative research to work toward integration or synthesis of qualitative findings ( Finfgeld, 2003 ; Zimmer, 2006 ). The first studies which use this methodology have been published recently: Widdowson (2016) developed a treatment manual for depression, Rabinovich (2016) studied the integration of behavioral and psychoanalytic treatment interventions, and Willemsen et al. (2015b) investigated patterns of transference in perversion. The rich variety of research aims demonstrates the potential of these meta-studies of case studies.

KEY CONCEPT 5. Meta-studies of clinical case studies A meta-study of clinical case studies is a research approach in which findings from cases are aggregated and more general patterns in psychotherapeutic processes are described. Several methodologies for meta-studies have been described, including cross-case analysis of raw data, meta-analysis, meta-synthesis, case comparisons, and review studies in general.

Lack of Basic Information in Psychoanalytic Case Studies

The second research question of our study ( Willemsen et al., 2015a ) concerned the methodological, patient, therapist, and treatment characteristics of published psychoanalytic case studies. All studies included in the Single Case Archive are screened by means of a coding sheet for basic information, the Inventory of Basic Information in Single Cases (IBISC). The IBISC was designed to assess the presence of basic information on patient (e.g., age, gender, reasons to consult), therapist (e.g., age, gender, level of experience), treatment (e.g., duration, frequency, outcome), and the methodology (e.g., therapy notes or audio recoding of sessions). The IBISC coding revealed that a lot of basic information is simply missing in psychoanalytic case studies ( Desmet et al., 2013 ). Patient information is fairly well-reported, but information about therapist, treatment and methodology are often totally absent. Training and years of experience are not mentioned in 84 and 94% of the cases, respectively. The setting of the treatment is not mentioned in 61% of the case studies. In 80% of the cases, it was not mentioned whether the writing of the case studies was on the basis of therapy notes, or audiotapes. In 91% of the cases, it was not mentioned whether informed consent was obtained.

Using variables on which we had more comprehensive information, we compared basic information of case studies from different psychoanalytic schools. This gave us a more detailed insight in the type of case studies that have been generated within each psychoanalytic school, and into the difference between these schools in terms of the kind of case study they generate. We found only minimal differences. Case studies in Relational Psychoanalysis stand out because they involve older patients and longer treatments. Case studies in Interpersonal Psychoanalysis tend to involve young, female patients and male therapists. Case study authors from both these schools tend to report on intensive psychoanalysis in terms of session frequency. But for the rest, it seems that the publication of case studies throughout the different psychoanalytic schools has intensified quite recently.

Guidelines for Writing Clinical Case Studies

One of the main problems in using psychoanalytic case studies for research purposes is the enormous variability in quality of reporting and inconsistency in the provision of basic information about the case. This prevents the reader from contextualizing the case study and it obstructs the comparison of one case study with another. There have been attempts to provide guidelines for the writing of case studies, especially in the context of analytic training within the American Psychoanalytic Association ( Klumpner and Frank, 1991 ; Bernstein, 2008 ). However, these guidelines were never enforced for case study authors by the editors from the main psychoanalytic journals. Therefore, the impact of these guidelines on the field of case study research has remained limited.

Here at the end of our focused review, we would like to provide guidelines for future case study authors. Our guidelines are based on the literature and on our experience with reading, writing, and doing research with clinical case studies. We will include fragments of existing case studies to clarify our guidelines. These guidelines do not provide a structure or framework for the case study; they set out basic principles about what should be included in a case study.

Basic Information

First of all, we think that a clinical case study needs to contain basic information about the patient, the therapist, the treatment, and the research method. In relation to the patient , it is relevant to report on gender, age (or an age range in which to situate the patient), and ethnicity or cultural background. The reader needs to know these characteristics in order to orientate themselves as to who the patient is and what brings them to therapy. In relation to the therapist , it is important to provide information about professional training, level of professional experience, and theoretical orientation. Tuckett (2008) emphasizes the importance for clinicians to be explicit about the theory they are using and about their way of practicing. It is not sufficient to state membership of a particular group or school, because most groups have a wide range of different ways of practicing. In relation to the treatment itself, it is important to be explicit about the kind of setting, the duration of treatment, the frequency of sessions, and details about separate sequences in the treatment (diagnostic phase, follow-up etc.). These are essential features to share, especially at a time when public sector mental health treatment is being subjected to tight time restrictions and particular ways of practising are favored over others. For example short-term psychotherapies are being implemented in public services for social and economic reasons. While case studies carried out in the public sector can give us information on those short-term therapies, private practice can offer details about the patient's progress on a long-term basis. Moreover, it is important to report whether the treatment is completed. To our astonishment, there are a considerable number of published case studies on therapies that were not finished ( Desmet et al., 2013 ). As Freud (2001 [1909] , p. 132) already advised, it is best to wait till completion of the treatment before one starts to work on a case study. Finally, in relation to the research method , it is crucial to mention which type of data were collected (therapy notes taken after each session, audio-recordings, questionnaires, etc.), whether informed consent was given, and in what way the treatment was supervised. Clinicians who would like to have help with checking whether they included all necessary basic information case use the Inventory for Basic Information in Single Cases (IBISC), which is freely available on http://www.singlecasearchive.com/resources .

Motivation to Select a Particular Patient

First of all, it is crucial to know what the motivation for writing about a particular case comes from. Some of the following questions should be kept in mind and made explicit from the beginning of the case presentation. Why is it interesting to look at this case? What is it about this case or the psychotherapist's work that can contribute to the already existing knowledge or technique?

“This treatment resulted in the amelioration of his [obsessive-compulsive] symptoms, which remained stable eight years after treatment ended. Because the standard of care in such cases has become largely behavioral and pharmacological, I will discuss some questions about our current understanding of obsessive-compulsive phenomena that are raised by this case, and some of the factors that likely contributed to the success of psychoanalytic treatment for this child ( McGehee, 2005 , p. 213–214).”

This quotation refers to a case that has been selected on the basis of its successful outcome. The author is then interested to find out what made this case successful.

Informed Consent and Disguise

As regulations on privacy and ethics are becoming tighter, psychotherapists find themselves with a real problem in deciding what is publishable and what is not. Winship (2007) points out that there is a potential negative effect of research overregulation as clinicians may be discouraged from reporting ordinary and everyday findings from their clinical practice. But he also offers very good guidelines for approaching the issue of informed consent. A good practice is asking for consent either at the start of the treatment or after completion of the treatment: preferably not during treatment. It is inadvisable to complete the case study before the treatment has ended. It is also advisable that the process of negotiating consent with the patient is reported in the case study.

“To be sure that Belle's anonymity was preserved, I contacted her while writing this book and told her it would not be published without her complete approval. To do this, I asked if she would review every word of every draft. She has ( Stoller, 1986 , p. 217).”

In relation to disguise, one has to strike a balance between thin and thick disguise. Gabbard (2000) suggests different useful approaches to disguising the identity of the patient.

Patient Background and Context of Referral or Self-Referral

It is important to include relevant facts about the patient's childhood, family history, siblings, any trauma or losses and relationship history (social and romantic) and the current context of the patient's life (family, working, financial). The context of referral is also key to understanding how and why the patient has come to therapy. Was the patient encouraged to come or had wanted to come? Has there been a recent crisis which prompted the intervention or an on-going problem which the patient had wanted to address for some time?

“Michael was one of the youngest children in his family of origin. He had older brothers and sisters who had been received into care before his birth. His parents separated before he was born. There had been some history of violence between them and Michael was received into care on a place of safety order when he was an infant because his mother had been unable to show consistent care toward him ( Lykins Trevatt, 1999 , p. 267).”

Patient's Narrative, Therapist's Observations, and Interpretations

A case study should contain detailed accounts of key moments or central topics, such as a literal transcription of an interaction between patient and therapist, the narration of a dream, a detailed account of associations, etc. This will increase the fidelity of the case studied, especially when both patient's and therapist's speech are reported as carefully as possible.

“Martha spoke in a high-pitched voice which sounded even more tense than usual. She explained that her best friend's mum had shouted at her for being so withdrawn; this made her angry and left her feeling that she wanted to leave their home for good. I told Martha that she often tried to undo her bad feelings by acting quickly on her instincts, as she did not feel able to hold her feelings in her mind and bring them to her therapy to think about with me. Martha nodded but it was not clear whether she could really think about what I just said to her. She then said that she was being held in the hospital until a new foster placement could be found. “In the meantime,” she said in a pleased tone, “I have to be under constant supervision” ( Della Rosa, 2015 , p. 168).”

In this example, observations of nonverbal behavior and tonality are also included, which helps to render a lively picture of the interaction.

Interpretative Heuristics

In which frame of reference is the writer operating? It is important to know what theories are guiding the therapist's thinking and what strategies he employs in order to deal with the clinical situation he is encountering. Tuckett (1993) writes about the importance of knowing what “explanatory model” is used by the therapist in order to make sense of the patient and to relate his own thinking to a wider public for the purpose of research. This idea is also supported by Colombo and Michels (2007) who believe that making theoretical orientations as explicit as possible would make the case studies intelligible and more easily employed by the research community. This can be done by the therapists explaining why they have interpreted a particular situation in the way they have. For example, Kegerreis in her paper on time and lateness (2013) stresses throughout how she is working within the object-relations framework and looking out for the patient's use of projective mechanisms.

“She was 10 minutes late. Smiling rather smugly to herself she told me that the wood supplied for her new floor had been wrongly cut. The suppliers were supposed to come and collect it and hadn't done so, so she had told them she was going to sell it to a friend, and they are now all anxious and in a hurry to get it.

I said she now feels as if she has become more powerful, able to get a response. She agrees, grinning more, telling me she does have friends who would want it, that it was not just a ploy.

She said she had found it easier to get up today but was still late. I wondered if she had a sense of what the lateness was about. She said it was trying to fit too much in. She had been held up by discussing the disposal of rubble with her neighbors.

I said I thought there was a link here with the story about the wood. In that she had turned the situation around. She had something that just didn't work, had a need for something, but it was turned around into something that was the suppliers' problem. They were made to feel the urgency and the need. Maybe when she is late here she is turning it around, so it is me who is to be uncertain and waiting, not her waiting for her time to come.

We maybe learn here something of her early object relationships, in which being in need is felt to be unbearable, might lead to an awful awareness of lack and therefore has to be exported into someone else. One could go further and surmise that in her early experience she felt teased and exploited by the person who has the power to withhold what you need ( Kegerreis, 2013 , p. 458).”

There can be no doubt reading this extract about the theoretical framework which is being used by the therapist.

Reflexivity and Counter-Transference

A good case study contains a high degree of reflexivity, whereby the therapist is able to show his feelings and reactions to the patient's communication in the session and an ability to think about it later with hindsight, by himself or in supervision. This reflexivity needs to show the pattern of the therapist's thinking and how this is related to his school of thought and to his counter-transferential experiences. How has the counter-transference been dealt with in a professional context? One can also consider whether the treatment has been influenced by supervision or discussion with colleagues.

“Recently for a period of a few days I found I was doing bad work. I made mistakes in respect of each one of my patients. The difficulty was in myself and it was partly personal but chiefly associated with a climax that I had reached in my relation to one particular psychotic (research) patient. The difficulty cleared up when I had what is sometimes called a ‘healing’ dream. […] Whatever other interpretations might be made in respect of this dream the result of my having dreamed it and remembered it was that I was able to take up this analysis again and even to heal the harm done to it by my irritability which had its origin in a reactive anxiety of a quality that was appropriate to my contact with a patient with no body ( Winnicott, 1949 , p. 70).”

Leaving Room for Interpretation

A case study is the therapist's perspective on what happened. A case study becomes richer if the author can acknowledge aspects of the story that remain unclear to him. This means that not every bit of reported clinical material should be interpreted and fitted within the framework of the research. There should be some loose ends. Britton and Steiner (1994) refer to the use of interpretations where there is no room for doubt as “soul murder.” A level of uncertainty and confusion make a case study scientifically fruitful ( Colombo and Michels, 2007 ). The writer can include with hindsight what he thinks he has not considered during the treatment and what he thinks could have changed the course for the treatment if he had been aware or included other aspects. This can be seen as an encouragement to continue to be curious and maintain an open research mind.

Answering the Research Question, and Comparison with Other Cases

As in any research report, the author has to answer the research question and relate the findings to the existing literature. Of particular interest is the comparison with other similar cases. Through comparing, aggregating, and contrasting case studies, one can discover to what degree and under what conditions, the findings are valid. In other words, the comparison of cases is the start of a process of generalization of knowledge.

“Although based on a single case study, the results of my research appear to concur with the few case studies already in the field. In reviewing the literature on adolescent bereavement, it was the case studies that had particular resonance with my own work, and offered some of the most illuminating accounts of adolescent bereavement. Of special significance was Laufer's (1966) case study that described the narcissistic identifications of ‘Michael’, a patient whose mother had died in adolescence. Both Laufer's research and my own were conducted using the clinical setting as a basis and so are reflective of day-to-day psychotherapy practice ( Keenan, 2014 , p. 33).”

As Yinn (2014) has argued for the social sciences, the case study method is the method of choice when one wants to study a phenomenon in context, especially when the boundaries between the phenomenon and the context are fussy. We are convinced that the same is true for case study methodology in the fields of psychoanalysis and psychotherapy. The current focused review has positioned the research method within these fields, and has given a number of guidelines for future case study researchers. The authors are fully aware that giving guidelines is a very tricky business, because while it can channel and stimulate research efforts it can as well-limit creativity and originality in research. Moreover, guidelines for good research change over time and have to be negotiated over and over again in the literature. A similar dilemma is often pondered when it comes to qualitative research ( Tracy, 2010 ). However, our first impetus for providing these guidelines is pedagogical. The three authors of this piece are experienced psychotherapists who also work in academia. A lot of our students are interested in doing case study research with their own patients, but they struggle with the methodology. Our second impetus is to improve the scientific credibility of the case study method. Our guidelines for what to include in the written account of a case study, should contribute to the improvement of the quality of the case study literature. The next step in the field of case study research is to increase the accessibility of case studies for researchers, students and practitioners, and to develop methods for comparing or synthesizing case studies. As we have described above, efforts in that direction are being undertaken within the context of the Single Case Archive.

Author Contributions

JW has written paragraphs 1–4; ER and JW have written paragraph 5 together; SK has contributed to paragraph 5 and revised the whole manuscript.

Conflict of Interest Statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Author Biography

Bernstein, S. B. (2008). Writing about the psychoanalytic process. Psychoanal. Inq. 28, 433–449. doi: 10.1080/0735516908022126694

CrossRef Full Text | Google Scholar

Britton, R., and Steiner, J. (1994). Interpretation: selected fact or overvalued idea? Int. J. Psychoanal. 75, 1069–1078.

PubMed Abstract | Google Scholar

Chiesa, M. (2010). Research and psychoanalysis: still time to bridge the great divide? Psychoanal. Psychnol. 27, 99–114. doi: 10.1037/a0019413

Colombo, D., and Michels, R. (2007). Can (should) case reports be written for research use? Psychoanal. Inq. 27, 640–649. doi: 10.1080/07351690701468256

Cornelis, S., Desmet, M., Meganck, R., Cauwe, J., Inslegers, R., Willemsen, J., et al. (in press). Interaction between obsessional symptoms interpersonal dynamics: an empirical single case study. Psychoanal. Psychnol. doi: 10.1037/pap0000078

CrossRef Full Text

Damousi, J., Lang, B., and Sutton, K. (2015). Case Studies and the Dissemination of Knowledge . New York, NY: Routledge.

Google Scholar

Della Rosa, E. (2015). The problem of knowledge in psychotherapy with an adolescent girl: reflections on a patient's difficulty in thinking and issues of therapeutic technique. J. Child Psychother. 41, 162–178. doi: 10.1080/0075417X.2015.1048125

Desmet, M., Meganck, R., Seybert, C., Willemsen, J., Van Camp, I., Geerardyn, F., et al. (2013). Psychoanalytic single cases published in ISI-ranked journals: the construction of an online archive. Psychother. Psychosom. 82, 120–121. doi: 10.1159/000342019

PubMed Abstract | CrossRef Full Text | Google Scholar

Finfgeld, D. L. (2003). Metasynthesis: the state of the art – so far. Qual. Health Res. 13, 893–904. doi: 10.1177/1049732303253462

Fonagy, P. (2015). “Research issues in psychoanalysis,” in An Open Door Review of Outcome and Process Studies in Psychoanalysis, 3rd Edn. , eds M. Leuzinger-Bohleber and H. Kächele (London: International Psychoanalytic Association), 42–60.

Forrester, J. (2016). Thinking in Cases . Cambridge: Polity.

Freud, S. (2001 [1909]). Analysis of a Phobia in a Five-Year-Old Boy, 10th Standard Edn. London: Vintage Books.

Freud, S. (2001 [1925]). An Autobiographical Study, 20th Standard Edn. London: Vintage Books.

Gabbard, G. O. (2000). Disguise or consent: problems and recommendations concerning the publication and presentation of clinical material. Int. J. Psychoanal. 81, 1071–1086. doi: 10.1516/0020757001600426

Green, A. (2005). The illusion of common ground and mythical pluralism. Int. J. Psychoanal. 86, 627–632.

Hinshelwood, R. D. (2013). Research on the Couch . London: Routledge.

Iwakabe, S., and Gazzola, N. (2009). From single-case studies to practice-based knowledge: aggregating and synthesizing case studies. Psychother. Res. 19, 601–611. doi: 10.1080/10503300802688494

Keenan, A. (2014). Parental loss in early adolescence and its subsequent impact on adolescent development. J. Child Psychother. 40, 20–35. doi: 10.1080/0075417X.2014.883130

Kegerreis, S. (2013). “When I can come on time I'll be ready to finish”: meanings of lateness in psychoanalytic psychotherapy. Br. J. Psychother. 29, 449–465. doi: 10.1111/bjp.12053

Laufer, M. (1966). Object loss in adolescence. Psychoanal. Study Child 31, 269–293.

Leuzinger-Bohleber, M. (2015). “Development of a plurality during the one hundred year old history of research of psychoanalysis,” in An Open Door Review of Outcome and Process Studies in Psychoanalysis, 3rd Edn. , eds M. Leuzinger-Bohleber and H. Kächele (London: International Psychoanalytic Association), 18–32.

Klumpner, G. H., and Frank, A. (1991). On methods of reporting clinical material. J. Am. Psychoanal. Assoc. 39, 537–551. doi: 10.1177/000306519103900211

Luyten, P., Blatt, S. J., and Corveleyn, J. (2006). Minding the gap between positivism and hermeneutics in psychoanalytic research. J. Am. Psychoanal. Assoc. 54, 571–610. doi: 10.1177/00030651060540021301

Lykins Trevatt, D. (1999). An account of a little boy's attempt to recover from the trauma of abuse. J. Child Psychother. 25, 267–287. doi: 10.1080/00754179908260293

McGehee, R. H. (2005). Child psychoanalysis and obsessive-compulsive symptoms: the treatment of a ten-year-old boy. J. Am. Psychoanal. Assoc. 53, 213–237. doi: 10.1177/00030651050530011301

Michels, R. (2000). The case history. J. Am. Psychoanal. Assoc. 48, 355–411. doi: 10.1177/00030651000480021201

Midgley, N. (2006a). Re-reading “Little Hans”: Freud's case study and the question of competing paradigms in psychoanalysis. J. Am. Psychoanal. Assoc. 54, 537–559. doi: 10.1177/00030651060540021601

Midgley, N. (2006b). The “inseparable bond between cure and research”: clinical case study as a method of psychoanalytic inquiry. J. Child Psychother. 32, 122–147. doi: 10.1080/00754170600780273

Pletsch, C. E. (1982). Freud's case studies and the locus of psychoanalytic knowledge. Dynamis 2, 263–297.

Rabinovich, M. (2016). Psychodynamic emotional regulation in view of Wolpe's desensitization model. Am. J. Psychol. 129, 65–79. doi: 10.5406/amerjpsyc.129.1.0065

Rustin, M. (2003). Research in the consulting room. J. Child Psychother. 29, 137–145. doi: 10.1080/0075417031000138415

Sealey, A. (2011). The strange case of the Freudian case history: the role of long case histories in the development of psychoanalysis. Hist. Human Sci. 24, 36–50. doi: 10.1177/0952695110383460

Spence, D. P. (2001). Dangers of anecdotal reports. J. Clin. Psychol. 57, 37–41. doi: 10.1002/1097-4679(200101)57:1<37::AID-JCLP5>3.0.CO;2-S

Steiner, R. (1994). “The tower of Babel” or “After Babel in contemporary psychoanalysis”? – Some historical and theoretical notes on the linguistic and cultural strategies implied by the foundation of the International Journal of Psycho-Analysis, and on its Relevance today. Int. J. Psychoanal. 75, 883–901.

Stoller, R. J. (1986). Sexual Excitement: Dynamics of Erotic Life . London: Maresfield Library.

Summers, F. (2008). Theoretical insularity and the crisis of psychoanalysis. Psychoanal. Psychnol. 25, 413–424. doi: 10.1037/0736-9735.25.3.413

Tracy, S. J. (2010). Qualitative quality: eight “big tent” criteria for excellent qualitative research. Qual. Inq. 16, 837–851. doi: 10.1177/1077800410383121

Tuckett, D. (1993). Some thoughts on the presentation and discussion of the clinical material of psychoanalysis. Int. J. Psychoanal. 74, 1175–1190.

Tuckett, D. (2008). Psychoanalysis Comparable and Incomparable: The Evolution of a Method to Describe and Compare Psychoanalytic Approaches . New York, NY: Routledge.

Vanheule, S. (2009). Psychotherapy and research: a relation that needs to be reinvented. Br. J. Psychother. 25, 91–109. doi: 10.1111/j.1752-0118.2008.01103.x

Widdowson, M. (2016). Transactional Analysis for Depression: A Step-by-step Treatment Manual . Abingdon: Routledge.

Widlöcher, D. (1994). A case is not a fact. Int. J. Psychoanal. 75, 1233–1244.

Willemsen, J., Cornelis, S., Geerardyn, F. M., Desmet, M., Meganck, R., Inslegers, R., et al. (2015a). Theoretical pluralism in psychoanalytic case studies. Front. Psychol. 6:1466. doi: 10.3389/fpsyg.2015.01466

Willemsen, J., Inslegers, R., Meganck, R., Geerardyn, F., Desmet, M., and Vanheule, S. (2015b). A metasynthesis of published case studies through Lacan's L-schema: transference in perversion. Int. J. Psychoanal. 96, 773–795. doi: 10.1111/1745-8315.12179

Winnicott, D. W. (1949). Hate in the counter-transference. Int. J. Psychoanal. 30, 69–74.

Winship, G. (2007). The ethics of reflective research in single case study inquiry. Perspect. Psychiatr. Care 43, 174–182. doi: 10.1111/j.1744-6163.2007.00132.x

Yinn, R. K. (2014). Case Study Research: Design and Methods . Thousand Oaks, CA: Sage.

Zimmer, L. (2006). Qualitative meta-synthesis: a question of dialoguing with texts. J. Adv. Nurs. 53, 311–318. doi: 10.1111/j.1365-2648.2006.03721.x

Keywords: clinical case study, methodology, psychotherapy research, psychoanalysis, psychoanalytic schools, theoretical pluralism, review

Citation: Willemsen J, Della Rosa E and Kegerreis S (2017) Clinical Case Studies in Psychoanalytic and Psychodynamic Treatment. Front. Psychol . 8:108. doi: 10.3389/fpsyg.2017.00108

Received: 29 November 2016; Accepted: 16 January 2017; Published: 02 February 2017.

Reviewed by:

Copyright © 2017 Willemsen, Della Rosa and Kegerreis. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: [email protected]

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Braz J Psychiatry
• v.40(1); 2018

Depression and psychodynamic psychotherapy

Ângela ribeiro.

Departamento de Psiquiatria e Saúde Mental, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal

João P. Ribeiro

Orlando von doellinger.

Depression is a complex condition, and its classical biological/psychosocial distinction is fading. Current guidelines are increasingly advocating psychotherapy as a treatment option. Psychodynamic psychotherapy models encompass a heterogeneous group of interventions derived from early psychoanalytic conceptualizations. Growing literature is raising awareness in the scientific community about the importance of these treatment options, as well as their favorable impact on post-treatment outcomes and relapse prevention. Considering the shifting paradigm regarding treatment of depressive disorder, the authors aim to provide a brief overview of the definition and theoretical basis of psychodynamic psychotherapy, as well as evaluate current evidence for its effectiveness.

Introduction

Depression is considered a frequent and complex condition. According to the World Health Organization, it is expected to be the third leading cause of disability worldwide by 2020. 1 The lifetime prevalence of major depressive disorder (MDD) is estimated at around 2-20%. The Global Burden of Disease Study 2010 2 revealed it as the second most prevalent cause of illness-induced disability, affecting people of all ages and social status, and a major impact factor in social, professional, and interpersonal functioning. Mathers et al. 3 predicted MDD as the leading worldwide cause of disease burden in high-income countries by the year 2030. The decrement in health associated with depression is described as significantly greater than that associated with other chronic diseases. 4 More than 60% of patients with MDD have a clinically significant impairment in their quality of life. 5

Common features of all depressive disorders include the presence of sad or irritable mood, accompanied by somatic and cognitive changes that significantly affect the individual’s capacity to function. 6 Overall, depression is characterized by a general feeling of sadness, anhedonia, avolition, worthlessness, and hopelessness. Cognitive and neurovegetative symptoms, such as difficulty in concentrating, memory alterations, anorexia, and sleep disturbances, are also present.

Various known risk factors for depression have been recorded in the literature: female gender, older age, poorer coping abilities, physical morbidity, impaired level of functioning, reduced cognition, and bereavement. Depression has been associated with an increased risk of mortality and poorer treatment outcomes in physical disorders. 7

Although not fully understood, psychological, social and biological processes are thought to overdetermine the etiology of depression; comorbid psychiatric diagnoses (e.g., anxiety and various personality disorders) are common in depressed people. 8

The classical biological/psychosocial distinction, which separates psychotherapy from pharmacotherapy as treatment options for depression, is fading out. Growing evidence from the neuroscientific literature supports similar (and different) changes in brain functioning with these approaches, concluding that both psychotherapy and pharmacotherapy are biological treatments, and that there is no legitimate ideological justification for the decline of the former. 9

Understandably, current treatment guidelines 10 , 11 for depressive disorders are increasingly advocating psychotherapy as a treatment option, alone or in combination with antidepressant medications.

Considering this shifting paradigm regarding treatment of depressive disorder, the authors aim to evaluate current evidence for the effectiveness of psychodynamic psychotherapy (PDP) in depression. A brief clarification of the definition of PDP and its theoretical basis for understanding depression are also presented.

A narrative review was performed, including recent and current published papers on PDP and its role as a treatment modality in depressive disorders. Recent empirical studies were also included in order to integrate authors’ critical perspectives, supported by classical and contemporary literature.

Defining psychodynamic psychotherapy

PDP models are derived from early psychoanalytic conceptualizations, including ego psychology, object-relations theory, self-psychology, and attachment theory. Treatment goals or focus and setting changes have been reconsidered by contemporary authors. Gabbard 12 described PDP’s basic principles as: much of mental life is unconscious; childhood experiences, in concert with genetic factors, shape the adult; the patient’s transference to the therapist is a primary source of understanding; the therapist’s countertransference provides valuable understanding about what the patient induces in others; the patient’s resistance to the therapeutic process is a major focus of therapy; symptoms and behaviors serve multiple functions, and are determined by complex and often unconscious forces; finally, the psychodynamic therapist assists the patient in achieving a sense of authenticity and uniqueness.

PDP operates on an interpretive-supportive continuum. Interpretive interventions enhance the patient’s insight about repetitive conflicts sustaining his or her problems. The prototypic insight-enhancing intervention is an interpretation by which unconscious wishes, impulses, or defense mechanisms are made conscious. Supportive interventions aim to strengthen abilities (“ego functions”) that are temporarily not accessible to a patient due to acute stress or that have not been sufficiently developed. Thus, supportive interventions maintain or build ego functions. Supportive interventions include, for example, fostering a therapeutic alliance, setting goals, or strengthening ego functions such as reality testing or impulse control. The use of more supportive or more interpretive (insight-enhancing) interventions depends on the patient’s needs. 13

Common factors of psychotherapy and specific features of the psychodynamic approach

Common factors are currently understood as a set of common elements that collectively shape a theoretical model about the mechanisms of change during psychotherapy. A recent meta-analysis 14 has shed light on strong evidence regarding factors such as therapeutic alliance, empathy, expectations, cultural adaptation, and therapist differences in terms of their importance for psychotherapeutic treatments in theory, research, and practice.

Overall, the influence of common factors in psychotherapies has been estimated at 30% when considering the variation in depression outcomes. Nonetheless, other factors, including specific techniques, expectancy, the placebo effect, and extratherapeutic effects, have also been studied. 15

Zuroff & Blatt 16 have concluded that the nature of the psychotherapeutic relationship, reflecting interconnected aspects of mind and brain operating together in an interpersonal context, predicts outcome more robustly than any specific treatment approach per se .

Regarding common factors in PDP, Luyten et al. 15 mentioned the important differences between psychodynamic and other treatments. Comparatively to cognitive-behavioral therapists, psychodynamic therapists tend to place stronger emphasis on certain aspects, namely: affect and emotional expression; exploration of patients’ tendency to avoid topics; identification of recurring behavioral patterns, feelings, experiences, and relationships; the past and its influence on the present; interpersonal experiences; the therapeutic relationship; and exploration of wishes, dreams, and fantasies. Along with these features, specific characteristics of a psychodynamic-oriented treatment have been described: a focus on the patient’s internal world; a developmental perspective; and a person-centered approach.

Depression from the psychodynamic perspective

Psychodynamic understandings of depressive disorders were first described by Freud, Abraham, and Klein. Freud explored the individual’s reactions to an actual loss or disappointment associated to a loved person, or to a loss of an ideal. Plainly, he tried to explain why some people react with a mourning affect (surpassed after a period of time) and others succumb into melancholy (depression, as we now call it). Mourning is the reaction to the loss of a loved one or the loss of an abstraction, which has taken the place of something (a country, freedom, or an ideal, for example), and although it involves significant disruptions from one’s normal attitude towards life, it should not be regarded as pathological. Thus, mourning occurs following loss of an external object. Melancholy, on the other hand, arises from the loss of the object’s love and is an unconscious process where a remarkable decrease in self-esteem is observed. Culpability is also a feature clearly present in melancholic processes, as the loss of the object comes with feelings of guilt, stressing the ambivalent feelings towards the lost object; not only because the individual knows that he or she attacked (in fantasy or in reality) the lost object, but mostly because he or she desired that very loss (due to the object’s unsatisfactory presence and love). Freud clearly outlined the symptoms of melancholy: “... a profoundly painful dejection, cessation of interest in the outside world, loss of capacity to love, inhibition of all activity, and lowering of the self-regarding feelings to a degree that finds utterance in self-reproaches and self-revilings and culminates in delusional expectations of punishment.” 17 These features seem to resemble the current DSM definition of depression.

Abraham proposed a specific model for the melancholic process, 18 consisting of a series of explanatory events: after an initial frustration (loss of an object), the subject reacts with externalization of the introjected object and its destruction, thus to an early anal-sadistic stage. Identification with the object - (primary) narcissism - results in its introjection, thus explaining the sadistic vengeance against the object as part of the subject’s ego; one’s self-destruction often manifested as suicidal thoughts. Ambivalence plays a key role, as the subject struggles with his own survival and destruction.

Klein later elucidated the importance of the establishment of an internal world in which the lost external object is “reinstated.” Thus, in melancholy, there is a regression to an earlier failure to integrate good and bad partial objects into whole objects in the inner world. The depressive individual believes himself omnipotently responsible for the loss, due to his inherent destructiveness, which has not been integrated with loving feelings. Klein argues that pining, mourning, guilt, reparation, possibly delusional thinking, omnipotence, denial, and idealization characterize depression. 19

More recently, Luyten & Blatt 15 commented on these works as “still clinically relevant” but “often over specified, lacking theoretical precision, and too broad to be empirically tested.” However, these authors stated that unconscious motives and processes still play an important role in recent psychodynamic theories of depression.

Evidence for psychotherapy as a treatment for depressive disorders

A meta-analysis of direct comparisons found psychotherapy about as effective as pharmacotherapies for depressive disorders. 20 In another meta-analysis, Cuijpers et al. 21 included 92 different randomized controlled trials (RCTs) and demonstrated the efficacy of psychotherapy in comparison with pharmacotherapy – equal in the short-term and superior in the long-term, regarding relapse prevention. Different forms of psychotherapy have been compared, with no clear differences observed or, when so, with certain methodological specificities pointed out. 22 Nevertheless, the effectiveness of many well-recognized interventions has been regarded as possibly overestimated, considering that most evidence is based on symptom reduction. 23 A comprehensive meta-analysis 24 has highlighted the effectiveness of Interpersonal Psychotherapy (which has its structure and theoretical roots in PDP) in depression, as compared to other psychotherapies and vs. combined treatment, as well its role in preventing onset or relapse after successful treatment.

Extensive literature supports the efficacy of psychotherapy as an established treatment for MDD, stating its effectiveness and comparableness to that of antidepressant medications. The significance of these findings and possibility of publication bias have also been object of attention from the scientific community. A recent analysis stated an excess of significant findings relative to what would be expected for studies of psychotherapy’s effectiveness for MDD. 25

On this subject, Driessen et al. 26 found clear indications of study publication bias among U.S. National Institute of Health-funded clinical trials that examined the efficacy of psychological treatment for MDD, ascertained through direct empirical assessment. Through these data, the authors concluded that psychological treatment, like pharmacologic treatment, may not be as efficacious as the published literature would indicate.

Cuijpers et al. 27 published a meta-analysis on the effects of psychotherapies on remission, recovery, and improvement of MDD in adults. The response rate for the analyzed psychotherapies was 48% (vs. 19% in control conditions), and there was no significant difference between types of psychotherapy.

Evidence for psychodynamic psychotherapy as a treatment for depressive disorders

Shedler 28 presented five independent meta-analyses showing that the benefits of PDP not only endure, but also increase with time (including after treatment end). Patients reported significant symptom reductions, which held up over time, and increased mental capacities, which allowed them to continue maturing over the years. Additionally, Shedler presented several studies demonstrating that it is the psychodynamic process that predicts successful outcome in cognitive therapy, rather than the pure cognitive aspects of treatment – i.e., non-psychodynamic psychotherapies may be effective because the more skilled practitioners utilize techniques that have long been central to psychodynamic theory and practice.

Leichsenring et al. 22 conducted an empiric review of supported methods of PDP in depression and suggesting a unified protocol for the psychodynamic treatment of depressive disorders. The authors found a twofold risk for poor outcome in depression when patients were diagnosed with a comorbid personality disorder. However, several studies were found to have methodological limitations, such as taking a personality disorder diagnosis in account as a primary object of treatment, sample size differences, and divergent results, largely depending on the personality cluster identified. The findings of these authors contradict repeated claims that PDP is not empirically supported.

A subsequent systematic review by Leichsenring 29 identified and included a total of 47 RCTs providing evidence for PDP in specific mental disorders; it stated the efficacy of PDP compared to cognitive-behavioral therapy (CBT) (but not to other forms of psychotherapy) in MDD, and concluded that several RCTs provide evidence for the efficacy of PDP in depressive disorders (including comparisons with control groups, waiting-list condition at the end of treatment, group therapy, pharmacotherapy, and brief supportive therapy).

Varying results have also been observed according to treatment duration – specifically, short-term (STPDP) vs. long-term psychodynamic psychotherapy (LTPDP) as applied in patients with depressive disorders. One recent meta-analysis 30 evaluated the efficacy of a specific STPDP (experiential dynamic therapy) within multiple psychiatric disorders, and found the largest effect on depressive symptoms. A meta-analysis from the Cochrane Collaboration 31 studied the effects of STPDP for common mental disorders across several studies, including 23 RCTs. It showed significantly greater improvement in the treatment groups as compared to controls, with most improvement maintained on medium- and long-term follow up.

Another meta-analysis by Leichsenring et al. 32 examined the comparative efficacy of LTPDP in complex mental disorders in RCTs fulfilling specific inclusion criteria (therapy lasting for at least a year or 50 sessions; active comparison conditions; prospective design; reliable and valid outcome measures; treatments terminated). It concluded that LTPDP is superior to less intensive forms of psychotherapy in complex mental disorders.

More recently, Driessen et al. 33 published a meta-analysis of 54 studies highlighting STPDP outcomes in symptom reduction and function improvement during treatment. They found either maintained or further improved gains at follow-up, and stated that the efficacy of STPDP compared to control conditions and outcomes on depression did not differ from that of other psychotherapies.

A recent review 34 provided evidence towards maintained effects with both modalities as a treatment option for depression, emphasizing their moderate (rather than large) effects. PDP is noted as a preferred alternative to pharmacotherapy in depressive disorders; nevertheless, the authors highlight the high frequency of studies involving psychotherapy in combination with medication – or adding to the effectiveness of medication. In comparison with CBT, PDP is described as neither largely nor reliably different. No single type of PDP was found particularly efficacious within its different forms. Regarding LTPDP, its cost-effectiveness and early stage are mentioned when describing its value, especially in more complex and chronic cases of depression.

An extensive, growing body of literature confirms that the classical divergence in treatment approaches for depressive disorders is fading. Psychotherapy has been found as efficacious as pharmacotherapy, with different results regarding its superiority in short-term and long-term relapse prevention. 20 , 23 Moreover, a systematic review has elucidated the potential benefits of a change in intervention design in depression, switching the paradigm from a symptom-oriented one to more rehabilitation- and functioning-oriented therapies. 23 These results are in agreement with Westen et al, 35 who presented evidence that treatments focusing on isolated symptoms or behaviors (rather than personality, emotional, and interpersonal patterns) are not effective in sustaining even narrowly defined changes.

The large number of publications in this topic has drawn the attention of the scientific community, prompting systematic analyses with increasing complexity and the creation of specific protocols for psychotherapeutic intervention, bearing in mind the importance of structured interventions by qualified clinical staff.

Although it would stray from the primary scope of this review, it is worth highlighting the growing number and relevance of published neuroscientific literature that reports neuroimaging and neurochemical changes exerted by psychotherapeutic interventions, 9 specifically PDP. 36

The effectiveness of PDP has been found difficult to isolate due to its limitations as a measurable intervention, which has led to the proposition of unified protocols both to facilitate training and to improve the status of evidence. 22 The quality of PDP trials published from 1974 to 2010 was assessed in a review paper 37 which concluded that the existing RCTs of PDP mostly show superiority of PDP to an inactive comparator. Studies concerning longer-term treatments are scarce but highly relevant, as they focus on important individual aspects like chronic mood problems, which often result from a combination of depression, anxiety, and significant personality and relational problems. 15

While these aspects are simple to clarify, few studies have taken them into account. Further RCTs could provide new evidence on the effectiveness of PDP, as well as facilitate its clear integration among the range of standard treatment options to consider for depressive disorders. One important related aspect refers to the training of future therapists in PDPs: institutes are mostly small and independent, and lack the necessary resources to conduct expensive or large-scale studies.

This narrative review presents certain limitations. Only recent published studies or systematic reviews were included. Due to practical reasons, only English-language publications were included, which may have left out important published findings. Publication bias may also be a factor, perhaps resulting in studies or systematic reviews that only showed positive or equal results for PDP treatments. However, we emphasize the importance of gathering and comparing recent findings and systematic reviews with classical published works in the field of PDP.

In conclusion, despite its controversial history, PDP’s influence in the psychiatric panorama is definitely increasing. The effectiveness of PDP has been demonstrated in various studies which have compared it with other treatment modalities. In recent years, the body of empirical evidence supporting said effectiveness has grown, and, more recently, meta-analyses have confirmed the role of PDP in the treatment of depressive disorders.

Many advances have been made in to enable high-quality scientific research in this complex, layered field. Nonetheless, contemporary authors continue to claim the importance of early conceptualizations of the psychodynamic perspective toward depression and depressive disorders.

The authors report no conflicts of interest.

uOttawa launches groundbreaking MA in Psychedelics & Consciousness Studies

The University of Ottawa (uOttawa) is launching a one year  Master’s (MA) degree in Psychedelics & Consciousness Studies to debut in September 2024.

The program offers a comprehensive exploration of the therapeutic, spiritual, ritual, and naturalistic uses of psychedelics across cultures and throughout human history. The innovative program, a collaboration between uOttawa’s Faculty of Social Sciences and Faculty of Arts, aims to advance research in psychology, consciousness, comparative mysticism, and psychedelic-assisted interventions. It also includes a specialized training component for mental health professionals and spiritual care providers.

Integrating spiritual guidance and psychedelic-assisted therapy

"We are excited to offer this groundbreaking program that will not only advance academic research but also provide practical training for those working in mental health and spiritual care," says  Dr. Monnica Williams , Program Co-director and Full Professor at the School of Psychology. "Our goal is to equip students with the knowledge and skills needed to explore and harness the therapeutic potential of psychedelics in a culturally sensitive and scientifically informed manner."

“Our goal is to equip students with the knowledge and skills needed to explore and harness the therapeutic potential of psychedelics in a culturally sensitive and scientifically informed manner.”

Dr. Monnica Williams

— Program Co-director and Full Professor at the School of Psychology

The MA in Psychedelics & Consciousness Studies is built on two existing graduate microprograms in psychedelics, one in the  School of Psychology and one in the  Department of Classics and Religious Studies .

"The program is unique in Integrating spiritual guidance within the Psychedelic-Assisted Therapy framework," says  Dr. Anne Vallely , Co-director and Professor in the Department of Classics and Religious Studies. "While such transpersonal experiences can lead to life changing insights, they can also trigger existential challenges that go beyond what traditional clinical training can tackle. Our program addresses this by integrating psychological and spiritual training : students learn about the human quest for transcendence and the mythic structures of consciousness alongside the psychology of mental health, neuroscience, and the dynamics of therapeutic encounters."

Program Highlights

• Interdisciplinary Education: Students will explore the spiritual, ritual, and therapeutic uses of psychedelics to gain insights from diverse cultural perspectives.
• Advanced Research: Emphasis on innovative research in consciousness studies, comparative mysticism, and mental health.
• Culturally Sensitive Therapies: Students will learn to deliver culturally sensitive psychedelic-assisted therapies.
• Professional Training: Practical training for licensed medical providers to become skilled facilitators and integration counselors for psychedelic treatment sessions.
• Spiritual Care Training: Spiritual caregivers - including clergy and chaplains - will receive training to support individuals undergoing psychedelic treatments for mental health, bereavement, and end-of-life.
• Traditional Healing Practices: Based on Indigenous traditions of psychedelic plant use for wellness and spirituality, there is interdisciplinary training on psychedelics in shamanic or ritualistic settings, in collaboration with experienced Indigenous and traditional healers.  

“The program is unique in Integrating spiritual guidance within the Psychedelic-Assisted Therapy framework.”

Dr. Anne Vallely

— Program co-director and Professor in the Department of Classics and Religious Studies.

This one-year online MA program, which can be completed on a part-time basis over two years, is open to students worldwide. It is designed to cater to four primary groups:

• Licensed mental health and medical professionals.
• Ordained or commissioned clergy, chaplains, and spiritual care professionals.
• Shamanic and ritualistic traditional entheogenic healers.
• Researchers focused on advancing academic study of psychedelics.

Applications for the MA in Psychedelics & Consciousness Studies for Fall 2024 will open shortly. A French version of the program will be available in the near future.

For more information about the program, including admission requirements, courses offered, and application deadlines, please contact [email protected] .

Media enquiries:  [email protected]