Research papers

Depression and psychodynamic psychotherapy – notes on a 2017 paper from Brazil

INTRODUCTION

This blogpost contains brief notes by me (Juline) made on 4 March 2018 from a clinical perspective on the paper cited below. The notes are made for my personal use but are published here in case they are of use to others.

Ribeiro, Ângela & P. Ribeiro, João & von Doellinger, Orlando. (2017). Depression and psychodynamic psychotherapy. Revista Brasileira de Psiquiatria. http://www.scielo.br/scielo.php?pid=S1516-44462017005011103&script=sci_abstract  doi: 10.1590/1516-4446-2016-2107.  Retrieved 03-March-2018.

OVERVIEW OF THE PAPER

The paper is a narrative review of the effectiveness of psychodynamic therapy models in the treatment of depression and depressive disorders. It is supportive of psychodynamic therapy models as effective treatment in their own right and by comparison with other therapies, including pharmacotherapy.

THE PRESENTATION OF PSYCHODYNAMIC PSYCHOTHERAPY

Although the authors’ stated aim is to evaluate the evidence for the effectiveness of psychodynamic psychotherapy in treating depression, this paper tends toward a positive presentation of it. This manifests as follows:

  •  A generally positive presentation of psychodynamic psychotherapy as an effective treatment for depressive disorders, though some arguably well-balanced papers are cited.
  • Noting that empirical evidence supporting its effectiveness has grown and that meta-analyses have confirmed its use in treating depressive disorders
  • Noting positive results in post-treatment outcome and relapse prevention
  • Presenting a shifting paradigm in relation to the treatment of depressive disorder, including that
    • there is growing literature regarding the importance of these treatment options
    • current treatment guidelines are “increasingly advocating psychotherapy as a treatment option for depressive disorders”, with or without antidepressant medications (citing US/UK 2010 sources)
    • the classical biological / psychosocial distinction is fading.

 “The classical biological / psychosocial distinction is fading”

This seems to be a position taken by the authors and the paper does not attempt to set out evidence for this. Related positions taken in the paper are as follows:

  • Psychological, social and biological processes are thought to over-determine the etiology of depression
  • Psychotherapy and pharmacotherapy both produce changes in brain functioning evidenced in the neuroscientific literature, so that both can be considered biological treatments

CONTEXTUAL MATERIAL PROVIDED IN THE PAPER

Context is provided by way of the following sections.

Depression and major depressive disorder (MDD)

An overview.

Defining psychodynamic psychotherapy in its own right and by comparison with other modalities

As well as setting out noting the psychological and developmental assumptions underpinning psychodynamic psychotherapy and its operational approach, this section notes the influence of factors common to all psychotherapies in influencing depression outcomes. It cites one study concluding [as is reasonably well established] that the nature of the therapeutic relationship, in particular operating with an explicit interpersonal context, predicts outcome better than any specific treatment approach per se.

Depression from the psychodynamic perspective

This describes the origins of psychodynamic thinking in the work of Freud, Abraham and Klein but is disappointing in not attempting to present a contemporary psychodynamic perspective on depression.

FURTHER WORK / NOTES TO SELF

  • Widen evidence as to where psychodynamic therapy is more / less effective to ensure my current assumptions on this are correct
  • Rooting psychotherapy in neuroscience is an interesting (necessary) endeavour. Review models for rooting psychodynamic psychotherapy in neural correlates.

 

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