Psychodynamic Therapy Still Works for Treatment of Schizophrenia

In recent years, support of psychodynamic psychotherapy for the treatment of schizophrenia spectrum and other forms of psychosis has diminished. This is not entirely a result of lack of validity or efficacy, but rather an investigative shift from traditional methods of therapy to more novel approaches. However, according to a recent study led by Bent Rosenbaum of the Department of Psychology at the University of Copenhagen in Denmark, psychodynamic therapy is still one of the most effective forms of treatment.

Rosenbaum compared treatment as usual (TaU) to TaU with supportive psychodynamic psychotherapy (SPP) in a sample of 269 adults admitted for psychosis. The participants were measured for global functioning and symptom severity before, during, and after the two-year treatment period. Rosenbaum found that the SPP group improved far more than the TaU group with respect to all levels of functioning and symptoms of psychosis. Over the course of two years of treatment, there were significant gains on social functioning and significant decreases on maladaptive symptoms for the participants in the SPP group.

These findings demonstrate that psychodynamic therapy and the core elements associated with that approach can still adequately serve the needs of many individuals with schizophrenia and other psychotic issues. Rosenbaum believes that when working with psychotic clients, clinicians should focus on the fundamental aspects of psychodynamic therapy. This includes overcoming obstacles to emotional processing, mental functioning relating to sense of self, and the development and maintenance of relational bonds. Cognitive development and attention to the present should also be incorporated to ensure maximum benefits for clients who struggle with these issues.

Rosenbaum hopes that this research will bring clinicians back to SPP and approaches of that kind. “It furthers recovery when it is used as a supplement to medical and social treatment modalities.” He added, “SPP should thus be taken into account as a modality in future research and treatment.” Doing so will open avenues of treatment for clients with varying levels of mental illness.

Rosenbaum, Bent, Susanne Harder, Per Knudsen, Anne Koster, Anne Lindhardt, Matilde Lajer, Kristian Valbak, and Gerda Winther. Supportive psychodynamic psychotherapy versus treatment as usual for first-episode psychosis: Two-year outcome. Psychiatry: Interpersonal & Biological Processes 75.4 (2012): 331-41. Print

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  • felix a

    January 18th, 2013 at 11:42 PM

    developing newer therapies is a good thing.but the older ones should not be discarded wither.improvements could be made and the older and newer methods could be used in the end of the day what produces the best results whether in isolation or in tandem is what should be encouraged and that may not always be the newer techniques.

  • Fallon

    January 19th, 2013 at 4:13 AM

    I will give you that there are times when you want to seek out something exciting and different all for the sake of making some advances in science. I get that because I think that through further research and study you do generally find ways to better serve a given population and perhaps even offer them the hope that they have not felt for a long time. But this should not be at the expense of giving up on something that continues to work. I want to take two steps ahead all the time too, but many times we need to be happy with what we have, and as the old saying goes, if it ain’t broke, don’t fix it.

  • Cate

    January 19th, 2013 at 12:31 PM

    I think we have to separate treatment from palliative add-ons, both of which have value. Psychosis Spectrum Disorders typically are treated with medicines, and over time we will continue to see medicines improve. Research into things like COX-2 inhibitors and inflammation is interesting, as are other research-based approaches. Once the medical illness is addressed, to the extent we currently can, the person who has that illness should be able to have any palliative therapy they want, meaning any therapy that makes them feel better and more able to cope with being very ill. But the practitioner should be honest enough to use a therapy best suited to client need, not just operate from their own preferred toolset. Honestly, folks, most people who are that ill will benefit from simple compassionate listening.

  • adrian

    January 19th, 2013 at 12:36 PM

    its always true with all things,isnt it?newer one comes along and the older is forgotten. but its always a good idea to step back and see if the older one has some advantages over the new. maybe we can derive the best of both?

  • Lud

    January 21st, 2013 at 4:56 AM

    Yeah, I am like the others.

    I too think that it is great when we set out to learn new things and discover new ways to improve the lives of others. But that doesn’t mean that we have to throw away the things that have also continued to work in the past. We can learn from that, grow from that, even come up with some new ideas from that. But just because something is new or unique doesn’t necessarily make it better.

  • devon

    January 22nd, 2013 at 12:14 AM

    maybe they should try out both forms side by side in a study involving a large number of people.then they could deduce which works better.and even then one form may be better suited for an individual even though it may not prove to be the BETTER of the two!so individualization may well be more important than the the absolute performance.

  • Alexander

    January 31st, 2013 at 12:47 PM

    What Rosenbaum have been doing here is remarkable. Remember that outside Scandinavia psychodynamic approaches to schizophrenia largely have frowned upon the last decades. The long tradition of a humanistic, need adapted, phenomenologically informed, psychodynamic approach (with solid doses of klein and bion) is still alive in parts of psychiatry here. One interesting aspect is that this study was done in the “field”, covering 1/4th of Denmarks population. It thus means we have good reason to asume it works in the real world, compared to a flood of small RCT’s conducted under quite different conditions. There’s a manual available if you contact Rosenbaum, his email is in the article

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