Strengths of Psychodynamic Approach
Uncovering Underlying Issues
One of the strengths of psychodynamic intervention for is its capacity to identify underlying issues such as resentment and anger that may have their genesis in early childhood familial experiences. Psychodynamic therapy helps client's identify the past as it interferes with healthy attitudes and experiences of the present (Shedler, 2010). Ford (Transcript of Dr. Ford's analysis, 2006) discusses the collaborative process of bringing to light somewhat unconscious feelings experienced by the client, and indicates the similarity between this psychoanalytic technique and cognitive treatment. Psychodynamic therapy "encourages exploration and discussion of the full range of a patient's emotions" (Shedler, 2010, para.7). This helps the client begin to understand their internal emotions that may be contradictory, troubling, or threatening. In this client's case, her acute depression may come from such a range of underlying issues as well as the contemporary challenge of her husband's illness. Psychodynamic intervention would help the client contend with new challenges with a clearer understanding of underlying issues that may be clouding her ability to surmount current challenges.
Focus on relationships and Interpersonal Experiences
Secondly, psychodynamic therapy "places heavy emphasis on patients' relationships and interpersonal experience" (Shedler, 2010, para. 11). This would be especially important if some of the client's difficulties were, at least in part, from her interpersonal relationship with her husband and his inability to meet her emotional needs since his medical diagnosis. If this were the case, it would benefit the client to identify and explore her attachment in her relationships, specifically the one with her husband.
Limitations of Psychodynamic Approach
Lacks Immediacy to Some Symptoms
To reiterate the obvious limitation that Ford (Transcript of Dr. Ford's analysis, 2006) mentions is Abby's immediate need for possible psychopharmacological intervention as well as in-patient care. Although in-patient care and drug therapy would address Abbey's acute symptoms, they would delay immediate psychodynamic intervention. If the client does continue immediate psychodynamic therapy, another concern would be the lack of cognitive tools that might help in ameliorating her intense stress. If she begins pharmacological treatment without the in-patient care, she may have to wait 6-8 weeks for any relief gained from the drugs. During this time, without learning some self-management tools, she could continue to deteriorate.
The first limitation (other than the first, above mentioned one) is the time necessary for successful psychodynamic therapy. Even ruling out the immediacy in the client's need to relieve her acute symptoms, the long-term application of this type of therapy would might not yield enough relief in a reasonable amount of time (Scaturo, 2001). Although contemporary psychotherapy has altered its limitation relating to time constraints, the relief for the client may come sooner from other, or at least adjunct, therapies.
Psychodynamic Therapy as a Vacuum
A second limitation and criticism of psychotherapy is that the amelioration of many psychological issues cannot be accomplished within the vacuum of psychodynamic therapy. In this client's case, her most acute symptoms are directly related to her relationship with her husband. I imagine, at some point, the need to include her husband in her therapy. This would necessitate a more family-oriented medicine like family systems therapy (Scaturo, 2001). Although she has issues that are clearly her own, I imagine the inclusion of her family (her husband) would present a more holistic approach to her contemporary issues. The approach that includes her husband may, in fact, relieve some of her most pressing issues.
This type of therapy does not suit someone with immediate needs as is evident in the client's case, unless the more immediate needs are addressed first, or in concert with psychodynamic therapy (Scaturo, 2001). Certainly, from initial observation, this client does not seem strong enough to explore her emotions and relationships before addressing her severe depression and her overall poor quality of life.
One last thought is that this client may have placed herself in a vacuum of sorts. Many times, people with a broad support system do not deteriorate to the extent this client has. If she is somewhat estranged from her husband (they don't seem to be communicating well at this point) and she has no one else to talk to, she may simply find help in talking about her fears in a warm, empathetic, positive client-centered therapy. Although modern psychoanalytic therapy no longer uses the blank screen approach, any form of neutrality toward this client may not give her the warmth, tenderness, and caring she seems to need at this critical time .
Scaturo, D. J. (2001). The evolution of psychotherapy and the concept of manualization: An integrative perspective. Professional Psychology: Research and Practice, 32(5), 522-530. doi: 10.1037//0735-7028.32.5.522
Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 65(2), 98-109. doi: 10.1037/a0018378
Transcript of Dr. Ford's analysis, (2006). [Transcript]. Retrieved from https://class.waldenu.edu/webapps/portal/frameset.jsp?tab_tab_group_id=_2_1&url=%2Fwebapps%2Fblackboard%2Fexecute%2Flauncher%3Ftype%3DCourse%26id%3D_56303_1%26url%3D