Intensive short-term dynamic residential treatment program for patients with treatment-resistant disorders
Section snippets
Intensive short-term dynamic residential treatment program for patients with treatment‐resistant disorders
A large percentage of patients in psychiatric care respond inadequately to treatment (see e.g., STAR-D study (Trivedi et al., 2006)). In terms of effect sizes (Cohen, 1988) psychotherapy treatments tend to help about half of treated patients considerably or moderately. A further 20% to 25% are helped to some extent, while those remaining continue unchanged or are deteriorated (Lambert, 2013, Solbakken and Abbass, 2014). In terms of clinically significant change in symptom levels (Jacobson and
The treatment program and its components
Bearing in mind the long-standing and chronic disorders suffered by these patients and their tendency to fail treatment, the treatment program developed differed substantially from those of traditional routine treatment settings (Solbakken and Abbass, 2014, Solbakken and Abbass, 2013). First, patients were to be treated in a residential setting in order to reduce the risk of drop-out. Second, a pre-set, non-negotiable time limit of 8 weeks was provided. Third, a highly intensive treatment
Sample characteristics
A total of 60 patients consecutively admitted to the unit comprised the treatment sample for the present study. In the sample, the mean age was 39 years (SD: 10.8, range: 19–62), 65.6% were female. A total of 88.3% had diagnoses of affective disorders (recurrent major depressive episode: 56.7%, major depressive episode: 20.0%, dysthymia: 30.0%, bipolar disorder type II: 6.7%). Anxiety disorders were present in 71.7% (social phobia: 31.7%, agoraphobia: 28.3%, general anxiety disorder: 28.3%,
Discussion
This study indicates that an ISTDP-based in-patient treatment program can be highly effective in treating patients with highly comorbid, treatment resistant disorders. Treated patients reported considerable reductions in overall symptomatology, interpersonal problems, and target complaints (anxiety/depression, relational difficulties, and social role dysfunction). Effects were large, accrued quickly, and persisted more than a year after treatment. A total of 48.3% to 53.3% (depending on the
Limitations
Limitations of this study warrant clarification. The study included a relatively small sample size; even though large enough to give sufficient power to reliably identify at least medium effects. Also, there was no randomization of patients to wait-list or treatment. Thus, coincidental improvements cannot be completely ruled out, although patients׳ previous limited treatment effects make chance less likely as the cause of reported gains. The fact that these patients had been suffering for many
Conclusion
A treatment program based on principles from Intensive Short-term Dynamic Psychotherapy with an eight week time-limit appears to be effective in alleviating dysfunction, suffering and relational problems of severely suffering patients with a spectrum of common treatment resistant disorders. The treatment program quickly reduced target complaints, symptoms and interpersonal problems for patients who, based on their previous treatment experiences, were expected to fare poorly in treatment. Gains
Role of funding source
The present study received no external grants or funding and was financed as an integral part of day to day running at the hospital unit at which the treatments were given. Time for analyzing data and writing the article was allocated by the respective universities at which the authors are employed.
Conflict of interest
The authors acknowledge bias in favor of the Intensive Short-term Dynamic Psychotherapy treatment used in this article as they are practitioners and teachers of.
Acknowledgments
We would like to thank staff and patients at Unit E of the Residential Facility at DPS Drammen, Vestre Viken Health Trust for their patience and hard work during the collection of data for this study. We would also like to thank all other staff at the Residential Facility and at the DPS Drammen who have contributed in various ways. The study received no external grants or funding and was financed as an integral part of day to day running at the hospital unit at which the treatments were given.
References (52)
- et al.
Single-blind clinical trial of psychotherapy for treatment of psychogenic movement disorders
Parkinsonism Relat. Disord.
(2006) - Abbass, A., 2015. Reaching Through Resistance. Kansas City: Seven Leaves...
Intensive short-term dynamic psychotherapy in a private psychiatric office: clinical and cost effectiveness
Am. J. Psychother.
(2002)The cost-effectiveness of short-term dynamic psychotherapy
J. Pharmacoecon. Outcomes Res.
(2003)Small-Group Videotape training for psychotherapy skills development
Acad. Psychiatry
(2004)Intensive short-term dynamic psychotherapy for treatment resistant depression: a pilot study
Depress. Anxiety
(2006)- et al.
Bringing character changes with Davanloo’s intensive short term dynamic psychotherapy
AD HOC Bull. Short Term Dyn. Psychother.
(2007) - et al.
The cost-effectiveness of intensive short-term dynamic psychotherapy
Psychiatr. Ann.
(2013) - et al.
Intensive short-term dynamic psychotherapy for DSM–IV personality disorder: a randomized controlled trial
J. Nerv. Mental Dis.
(2008) - et al.
Intensive short-term dynamic psychotherapy to reduce rates of emergency department return visits for patients with medically unexplained symptoms: preliminary evidence from a pre–post intervention study
Can. J. Emerg. Med. Care
(2009)
Web-conference supervision for advanced psychotherapy training: a practical guide
Psychotherapy
Intensive short-term dynamic psychotherapy: a systematic review and meta-analysis of outcome research
Harv. Rev. Psychiatry
The effect of implementing the outcome questionnaire-45.2 feedback system in Norway: a multisite randomized clinical trial in a naturalistic setting
Psychother. Res.
Psychotherapeutic perspectives in urethral syndrome
Stress Med.
Psychoanalysis, with whom, for what, and how? Comparisons with psychotherapy
J. Am. Psychoanal. Assoc.
The influence of client variables on psychotherapy
Statistical Power Analysis for the Behavioral Sciences
Treatment outcome of residential treatment with ISTDP
AD HOC Bull. Short Term Dyn. Psychother.
Unlocking the Unconscious
Intensive Short-Term Dynamic Psychotherapy: Selected Papers of Habib Davanloo
ISTDP. Extended major direct access to the unconscious
Eur. Psychother.
Dynamic assessment of ego functioning in Davanloo’s ISTDP
The SCL-90 and the MMPI: a step in the validation of a new self-report scale
Br. J. Psychiatry
Structured clinical interview for the DSM-IV axis II personality disorders (SCID-II). (Version 2.0)
Co-Creating Change: Effective Dynamic Therapy Techniques
Outpatient psychotherapy for borderline personality disorder-randomized trial of schema-focused therapy vs. transference focused therapy
Arch. Gen. Psychiatry
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