The ego-analytic approach has also tended to
emphasize the importance of building the patient’s
trust through“reparenting”in the therapy relation-
ship. This approach sometimes even views transfer-
ence as an impediment to therapy and works
toward building adaptive defenses in the patient
(Blanck & Blanck, 1974).
Other Developments
In particular, the work of Horney, Sullivan, and
Adler was important in giving a new spin to psy-
choanalysis. Likewise, ego psychology and theories
of object relations have encouraged an emphasis on
the manner in which the patient relates to other
people rather than on conflicts among instinctual
forces. For example, object relations theorists see
the need to form relationships with others as a pri-
mary influence on human behavior. Therefore,
these theorists focus more on the role of love and
hate, as well as autonomy and dependency, in the
development of the self. In the self psychology of
Kohut (1977), the central task of maturation is not
the successful negotiation of the psychosexual stages
but the development of an integrated self.
Discussions of changes in psychoanalytic thera-
pies emphasize a shift in the therapeutic focus to the
“here and now”and to the interpersonal exchanges
that occur within it (W. P. Henry, Strupp, Schacht,
& Gaston, 1994). Strupp and Binder (1984) have
synthesized some of the more critical developmental
changes in psychoanalytic practice. They emphasize
a movement away from the recovery of childhood
memories and their analysis toward a focus on the
corrective emotional experiences that occur through
the agency of the therapeutic relationship. The trans-
ference relationship as it occurs now helps provide
the means for constructive changes in interpersonal
relations outside the therapy room.
Contemporary Psychodynamic Psychotherapy
Over the years, enough changes have been made in
traditional psychoanalysis that those who no longer
practice the strict Freudian techniques are often said
to be practicing“psychoanalytically oriented”ther-
apy orpsychodynamic psychotherapy(Shelder, 2010).
It is important to note that there is great diversity
in treatment techniques within this approach
(Gibbons et al., 2008). For example, contemporary
psychodynamic psychotherapy may involve only
one or two sessions per week instead of five, and
the entire treatment process can be either short-
term or open-ended (Shedler, 2010). The therapist
is no longer inevitably seated behind the patient’s
couch but now often sits at a desk, with the patient
seated in a facing chair. Perhaps the easiest way to
characterize these and other modifications is to
say that greater flexibility has been introduced.
Although many traditional Freudian tenets are still
observed, the overall context is not so rigid. For
example, free association is no longer absolutely
required by these psychodynamic therapists. The
importance of dreams may be downplayed some-
what. Medications and even hypnosis may be used.
We now turn to one particular form of psycho-
dynamic psychotherapy that in many ways exem-
plifies the perhaps radical shift from traditional
psychoanalytic therapy to a more focused, time-
limited treatment.Interpersonal Psychotherapy:
An Empirically Supported Treatment
Interpersonal psychotherapy (IPT)(Klerman, Weissman,
Rounsaville, & Chevron, 1984) is a brief, insight-
oriented approach that has been applied primarily
to depressive disorders, although it has been modi-
fied for use in the treatment of other disorders (e.g.,
substance dependence, bulimia) as well. When used
to treat depression, IPT involves thorough assess-
ment of depressive symptoms, targeting a major
problem area (e.g., delayed grief, role transitions
or disputes, or interpersonal deficits) and alleviating
depressive symptoms by improving relationships
with others (as by improving communication skills
and social skills). IPT has been shown effective in
treating acute depressive episodes and in preventing
or delaying the recurrence of depressive episodes
(Weissman & Markowitz, 1994). Box 12-3 outlines
the major features and characteristics of IPT. As wePSYCHOTHERAPY: THE PSYCHODYNAMIC PERSPECTIVE 357