Therapies and therapists

Forms of therapy

Four forms of therapy were studied: solution-focused therapy, short-term psychodynamic psychotherapy, long-term psychodynamic psychotherapy, and psychoanalysis.

The goals of the therapies and the therapy process

Solution-focused therapy

Solution-focused therapy is a brief resource-oriented and goal-focused therapeutic approach which helps clients change by constructing solutions (Johnson & Miller, 1994). The technique includes the search for pre-session change, miracle and scaling questions, exploration of exceptions, use of a one-way mirror and consulting break, positive feedback and home assignments. The orientation was based on an approach developed by de Shazer et al. (1986).

Short-term psychodynamic psychotherapy

Short-term psychodynamic psychotherapy is a brief, focal, transference-based therapeutic approach which helps patients by exploring and working through specific intra-psychic and interpersonal conflicts.

Short-term psychodynamic psychotherapy is characterized by the exploration of a focus, which can be identified by both the therapist and the patient. This consists of material from current and past interpersonal and intra-psychic conflicts and the application of confrontation, clarification and interpretation in a process in which the therapist is active in creating the alliance and ensuring the time-limited focus. The orientation was based on approaches described by Malan (1976) and Sifneos (1978).

Long-term psychodynamic psychotherapy

Long-term psychodynamic psychotherapy is an open-ended, intensive, transference-based therapeutic approach which helps patients by exploring and working through a broad area of intra-psychic and interpersonal conflicts.

Long-term psychodynamic psychotherapy is characterized by a framework in which the central elements are exploration of unconscious conflicts, developmental deficits, and distortions of intra-psychic structures. Confrontation, clarification and interpretation are major elements, as well as the therapist's actions in ensuring the alliance and working through in the therapeutic relationship to attain conflict resolution and greater self-awareness.

Therapy includes both expressive and supportive elements, the use of which depends on patient needs. The orientation follows the clinical principles of long-term psychodynamic psychotherapy (Gabbard 2004).

Psychoanalysis

Psychoanalysis is an open-ended, the most intensive, transference-based psychodynamic therapeutic approach which helps patients by analyzing and working through a broad area of intra-psychic and interpersonal conflicts. Psychoanalysis aims to enhance the patient to resolve neurotic conflicts and to foster maturational processes.

The therapeutic setting and technique are characterized by facilitating maximal development of transference by the use of couch and free association for exploring unconscious conflicts, developmental deficits, and distortions of intra-psychic structures. Confrontation, clarification, interpretation and working through are major elements, as well as ensuring the development and protection of working alliance to attain conflict resolution, greater self-awareness and developmental growth (Greenson 1985).

Psychotherapists and performance of the therapies

• A total of 71 therapists participated in the study: 6 therapists provided solution-focused therapy, 12 short-term psychodynamic psychotherapy, 41 long-term psychodynamic psychotherapy, and 30 psychoanalysis.

• The therapists were mainly psychologists.

• The therapists had practiced for at least 2 years after training in the specific form of psychotherapy. The mean number years of experience carrying out brief treatments was 9 for both the short-term psychodynamic psychotherapy and the solution-focused therapists, and experience of long-term treatments 18 years for the therapists giving long-term psychodynamic psychotherapy and 15 years for those giving psychoanalysis.

• All therapists providing psychodynamic psychotherapy had received standard training in psychoanalytically oriented psychotherapy, and psychoanalysts standard training in psychoanalysis, approved by the respective training institutes in Finland. Clinical principles of psychodynamic and psychoanalytic orientation and technique were adhered to in each basic training course although the emphasis of different theoretical models varied (eg. ego psychological, object-relations, self-psychological and attachment models) (Gabbard 2004). During their training, the therapists received a minimum of 3 years' training in psychodynamic psychotherapy and analysts a minimum of 4 years' training in psychoanalytic treatment. Those giving short-term therapy received 1-2 additional years of specific short-term focal psychodynamic therapy training. Solution-focused therapists had been trained for the method and received a qualification provided by a local institute.

• In psychodynamic psychotherapies and psychoanalysis, the therapies were conducted in accordance with clinical practice, where the therapists might modify their interventions according to patient's needs within the framework of the respective treatment. Accordingly, no adherence monitoring was organized and no manuals were used. The solution-focused therapy was manualized and adherence monitoring was performed.