The papers in this issue of this journal collectively illustrate how meaningful empirical research in psychoanalytic psychotherapy, both quantitative and qualitative, can be conducted in real-life settings without huge resources. The contribution of a psychoanalytic approach to working in mental health services within the public sector is amply demonstrated in these articles in their focus on treatments underpinned by a psychoanalytic model, and in challenging the biological supremacy in the understanding of the aetiology and treatment of psychiatric disorders.
The first two papers add to the existing literature, some of which has been previously published in Psychoanalytic Psychotherapy, on a relatively recently developed short-term psychodynamic therapy, dynamic interpersonal therapy (DIT), which has been at the forefront of the expansion of evidence-based talking therapies available in the UK National Health Service (NHS) by its inclusion within Improving Access to Psychological Therapy (IAPT) services in primary care settings. These two articles complement each other in that the first provides preliminary evidence for the effectiveness of this treatment model based on changes in symptoms measured by outcome monitoring, and the second focuses at the level of the individual patient in exploring their personal experiences of receiving therapy.
In ‘Development of dynamic interpersonal therapy in complex care (DITCC): a pilot study’, Amra Rao and her colleagues describe the development of the DIT model in working with patients presenting with complex depression, and the results of a pilot study which found preliminary evidence of its effectiveness in this patient population in an improvement in wellbeing and distress and declines in depression and anxiety. Significantly, outcomes were measured on a session by session basis, a research method that is often viewed with suspicion by psychoanalytic clinicians due to fears that this breaches the boundaries of the therapeutic relationship and interferes with the development of the transference. However, if the frequency of data collection is viewed in itself an integral part of the boundaries of the interpersonal space between therapist and patient setting, this can be thought about within a transference countertransference framework as in any psychoanalytic therapy. Moreover, the measurement of the patient’s overt symptomatology in each session provides an immediate picture of his or her current functioning, which can be linked to their conscious and unconscious experience of the therapeutic relationship, and potentially allows its inevitable ruptures to be identified and repaired earlier than in a therapy where outcome monitoring occurs less often.
Patient experience is the subject of the next two papers. ‘Dynamic interpersonal therapy as experienced by young adults’, by Caja Landström, Lisa Levander and Björn Philips, reports a study in Stockholm of six young adults (19–25 years old) who were interviewed about their subjective experiences of DIT and the changes that they reported as a result of treatment. This paper is a welcome contribution to the limited literature on psychotherapy in young adults, given that the reported prevalence of anxiety, depression and other mental disorders is rising in this population. Thematic analysis of the patients’ interviews revealed that these patients attributed to their therapy a greater understanding of and ability to express their emotions and needs, and an improved capacity to set and manage boundaries within their interpersonal relationships. The authors note that DIT might be a particularly suitable therapy for young people because its interpersonal focus on current relationships and relationship patterns is salient for these patients, who are in a phase in life where old relationship patterns are tested out in new relationships, as well as the therapist’s active and collaborative stance facilitating engagement in the treatment.
The final research paper in this issue, ‘Managing the monster in the mind: a psychoanalytically informed qualitative study exploring the experiences of people diagnosed with obsessive-compulsive disorder’ by Kathleen Mulhall, John O’Connor and Katarina Timulakova, from Dublin, describes patients’ experiences of a relatively common mental condition, obsessive-compulsive disorder (OCD), which has been thought about predominantly from a biological and cognitive behavioural approach, and the psychoanalytic literature on OCD is surprisingly sparse, most of which expands upon Freud’s original conceptualisations of the disorder. The lack in the contemporary mental health field of a psychoanalytic and relational understanding of OCD, in which symptoms are seen as defences against underlying feelings of shame and aggression, and where the person’s obsessions and compulsions may hold unconscious interpersonal meanings, limits treatment of the disorder to its overt manifestations and does not address their underlying intra- and interpersonal dynamics. The results of this study, which interviewed five men and one woman suffering from OCD using a psychoanalytically informed framework, identified interpersonal experiences within the participants’ narratives that appeared to link with the origins and development of their symptoms, and yielded three core themes, which the authors categorised as ‘handling parental turmoil’, ‘enduring criticism’ and ‘struggling with emotional expression’. The paper’s discussion of these themes highlights the importance of the role of relationships and emotional processing, particularly of anger, in the psychopathology of OCD, and suggest that psychodynamic approaches which explicitly address these areas in therapy could increase the engagement of patients, and compliment existing medical and cognitive treatments.