PSY 3310 Module 3 Psychoanalytic, Adlerian and Existential Approaches Paper: Evidence for Depth-Oriented Therapies Example

Old Patterns, New Evidence: Do Insight-Oriented Therapies Work?

Student Name

Bachelor of Arts in Psychology, Thomas Edison State University

PSY-3310: Clinical Interventions and Disorders

Mentor Name

Month Day, Year

Old Patterns, New Evidence: Do Insight-Oriented Therapies Work?

Introduction

In a case conference at our center, a therapist described her work with a client on "patterns he keeps repeating in relationships, which started long before he met any of his partners." I had assumed that psychodynamic therapy was mostly history, replaced by structured treatments. This paper explains three depth-oriented approaches and asks whether research supports them.

Psychoanalytic and Psychodynamic Therapy

Freud's psychoanalysis proposed that most mental activity happens outside awareness, that early relationships shape later patterns and that symptoms can express conflicts a person cannot face directly. Classical psychoanalysis involved frequent sessions and techniques such as free association. Modern psychodynamic therapy is usually less intensive but keeps the focus on emotions, unconscious patterns, defenses and the relationship between client and therapist, where old patterns often reappear and can be examined.

Adlerian Therapy

Alfred Adler, an early colleague of Freud, emphasized social interest, the striving to belong and contribute, and the ways people compensate for feelings of inferiority. Adlerian therapy explores a client's lifestyle, the beliefs and goals formed in childhood that guide behavior, often through early memories and family position, and encourages clients to pursue goals that connect them with others. Its ideas influenced later cognitive and family therapies.

Existential Therapy

Existential therapists, such as Rollo May, Viktor Frankl and Irvin Yalom, focus on universal human concerns: death, freedom and responsibility, isolation and the search for meaning. Rather than treating symptoms as illnesses, they help clients face these concerns, take responsibility for their choices and find meaning, even in suffering.

Evidence for Psychodynamic Therapy

Shedler (2010) reviewed meta-analyses and argued that psychodynamic therapy is supported by evidence, despite a common belief that it is not. Effect sizes for psychodynamic therapy were as large as those reported for other therapies considered evidence-based, and several studies found clients kept improving once therapy was over, unlike some other treatments whose effects faded. Shedler also noted that when sessions of other therapies were examined closely, the most successful ones often included psychodynamic elements, such as attention to feelings and to patterns that recur across relationships.

Leichsenring and Rabung (2008) meta-analyzed 23 studies of long-term psychodynamic psychotherapy, defined as lasting at least a year or 50 sessions, for patients with complex problems, including personality disorders, long-lasting conditions and several co-occurring disorders. Long-term psychodynamic therapy was more effective than shorter forms of therapy on overall outcome, target problems and personality functioning; after treatment, patients on average were better off than about 96 percent of patients in the comparison groups.

Evidence for Existential Therapy

Vos et al. (2015) meta-analyzed 15 trials of existential therapies with about 1,800 participants, many of whom had serious physical illnesses such as cancer. Meaning-centered approaches, which help clients identify sources of meaning, led to sizable gains in clients' sense of purpose and moderate easing of distress. Results for the remaining existential formats were smaller and more mixed. The authors called for more and larger trials.

Applying the Approaches

Consider a composite client, Michael, 41, whose third long relationship has ended with the same pattern: early closeness followed by his withdrawal and his partner's frustration. A psychodynamic therapist might explore how he learned in childhood that closeness leads to disappointment and notice when he begins to withdraw from the therapist. An Adlerian therapist might explore his early memories and belief that he must be self-sufficient. An existential therapist might explore his fear of depending on others and his freedom to choose differently.

Choosing a Fit

For Michael's long-standing relationship pattern, the evidence from Leichsenring and Rabung suggests that a longer psychodynamic therapy may be appropriate. If his concerns centered on meaning after a loss, a meaning-centered existential approach would fit the evidence Vos and colleagues reviewed.

Criticisms

Critics note that many psychodynamic studies are smaller and less tightly controlled than CBT trials, that long-term therapy is costly and that some outcomes, such as personality functioning, are hard to measure. Adlerian therapy has relatively little controlled research.

What Happens in a Psychodynamic Session

A session might begin with the client describing a disappointing week. The therapist listens for themes, such as feeling overlooked, and gently asks whether this feeling is familiar from earlier relationships. If the client seems to withdraw from the therapist, missing a session or speaking more guardedly, the therapist may wonder aloud whether something in the relationship feels similar. Over time, noticing these patterns as they happen allows the client to understand and change them.

Short-Term Psychodynamic Therapy

Not all psychodynamic therapy is long. Short-term forms, typically 12 to 30 sessions, focus on a specific relationship pattern and have been tested in trials for depression and anxiety, where they generally perform comparably to other active treatments. These briefer forms may fit community centers better than open-ended therapy.

Adlerian Ideas Today

Though Adlerian therapy has little trial research of its own, its ideas live on. Encouragement, attention to family and birth order and the focus on belonging appear in parenting programs and in school counseling, and the emphasis on beliefs about oneself anticipated cognitive therapy.

Measuring Change in Depth Therapies

Outcome research on these therapies often measures symptoms, but their aims are broader: changes in relationship patterns, self-understanding and personality functioning. Measuring such changes requires interviews and ratings that are harder to standardize, one reason these therapies have fewer large trials. Researchers have developed tools to rate personality functioning, which allow fairer comparisons with symptom-focused treatments.

Limits

Meta-analyses combine studies of varying quality. The client is a composite.

Conclusion

Shedler showed that psychodynamic therapy's effects are comparable to other evidence-based treatments and may grow over time, Leichsenring and Rabung showed that long-term psychodynamic therapy helps patients with complex disorders and Vos, Craig and Cooper found that meaning-centered existential therapy improves meaning and reduces distress. Insight-oriented therapies are not merely history; for some clients and problems, the evidence supports them.

References

Leichsenring, F., & Rabung, S. (2008). Effectiveness of long-term psychodynamic psychotherapy: A meta-analysis. JAMA, 300(13), 1551-1565. https://doi.org/10.1001/jama.300.13.1551

Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 65(2), 98-109. https://doi.org/10.1037/a0018378

Vos, J., Craig, M., & Cooper, M. (2015). Existential therapies: A meta-analysis of their effects on psychological outcomes. Journal of Consulting and Clinical Psychology, 83(1), 115-128. https://doi.org/10.1037/a0037167