Contributions of Psychodynamic Approaches to Treatment of PTSD and Trauma: A Review of the Empirical Treatment and Psychopathology Literature

Abstract

Reviews of currently empirically supported treatments for post-traumatic stress disorder (PTSD) show that despite their efficacy for many patients, these treatments have high nonresponse and dropout rates. This article develops arguments for the value of psychodynamic approaches for PTSD, based on a review of the empirical psychopathology and treatment literature. Psychodynamic approaches may help address crucial areas in the clinical presentation of PTSD and the sequelae of trauma that are not targeted by currently empirically supported treatments. They may be particularly helpful when treating complex PTSD. Empirical and clinical evidence suggests that psychodynamic approaches may result in improved self-esteem, increased ability to resolve reactions to trauma through improved reflective functioning, increased reliance on mature defenses with concomitant decreased reliance on immature defenses, the internalization of more secure working models of relationships, and improved social functioning. Additionally, psychodynamic psychotherapy tends to result in continued improvement after treatment ends. Additional empirical studies of psychodynamic psychotherapy for PTSD are needed, including randomized controlled outcome studies.

PTSD and its treatment in people with intellectual disabilities

“…However, in a recent meta-analysis on treatments of PTSD in children an incremental efficacy of EMDR has been found when compared to other forms of PTSD treatments (Rodenburg, Benjamin, de Roos, Meijer, & Stams, in press). In contrast, although widely used, there is as yet no empirical evidence for a clinically important effect of psychodynamic therapy on PTSD (Schottenbauer, Glass, Arnkoff, & Gray, 2008;National Collaborating Centre for Mental Health, 2005).…”

Written Exposure Therapy as Step One in Reducing the Burden of PTSD: The Composite Cases of "Alex," "Bruno," and "Charles"

“…The authors concluded that it is not necessarily OEF/OIF/OND status that predicts higher dropout, but rather the Veterans' ages, which may be associated with competing life responsibilities that inhibit treatment engagement. Schottenbauer, Glass, Arnkoff and Gray (2008) argued that research on alternative approaches to PTSD treatment was needed based on the large nonresponse and dropout rates found in treatment studies using Prolonged Exposure and Cognitive Processing Therapy. As such, researchers have developed novel treatments for PTSD using a variety of technologies.…”

Treating Posttraumatic Stress Disorder in South Africa: An Integrative Model Grounded in Case-Based Research

“…All treatments that have been systematically evaluated in controlled trials require manuals that specify therapist competences. These include not only CBT (e.g., McDonagh et al, 2005) but also experiential (e.g., Paivio & Nieuwenberg, 2001) and psychodynamic therapies (such as those reviewed by Schottenbauer et al, 2008).…”