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Psychotherapy

Psychotherapy is interpersonal treatment based on the understanding Understanding Decision-making Capacity and Legal Competence of psychological principles and mechanisms of mental disease. The treatment approach is often individualized, depending on the psychiatric condition(s) or circumstance. Psychodynamic therapy seeks to bring forward unconscious or repressed thoughts to help address the current behavior. Cognitive-behavioral therapy corrects faulty assumptions and tries to replace maladaptive behavior with healthier alternatives. Psychoeducation provides patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship with information about the disorder, including anticipated problems and treatment so that they are able to manage. Other forms include supportive therapy (short-term therapy to help through a life crisis), motivational interviewing (changing maladaptive behaviors by guiding the patient to be the agent of change for themself), interpersonal therapy (focusing on the relationships rather than repressed thoughts), and dialectical behavioral therapy (using a hierarchy of treatment targets, like reduction of suicidal and dangerous behavior). Treatment is offered in different formats (individual, family, couple, or group). The goals vary and can include changing the individual’s behaviors and thoughts, improving relationships, reducing psychiatric symptoms as well as functional impairment, and involving the family to enhance treatment.

Last updated: Jan 14, 2022

Editorial responsibility: Stanley Oiseth, Lindsay Jones, Evelin Maza

Overview

Definition and types

Psychotherapy is interpersonal treatment rooted in psychological principles and mechanisms of mental disease.

Psychotherapy helps patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship identify and diminish adverse feelings and thoughts and develop health-promoting behaviors.

Types of psychotherapy:

  • Cognitive and behavioral therapy
  • Psychoanalysis or psychodynamic psychotherapy
  • Interpersonal therapy
  • Motivational interviewing
  • Dialectical behavioral therapy
  • Supportive psychotherapy
  • Psychoeducation
  • Group and family therapy

Features of psychotherapy

  • Systemic interaction:
  • Psychological principles of mental disorders:
    • Mental health and disease are affected by psychological mechanisms.
    • This phenomenon is seen in inhibited memory Memory Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. Psychiatric Assessment of severe psychological trauma contributing to mental disorders—that is, dissociative disorders.
  • Targeted domain: In order for psychotherapy to be effective, a defined goal must be set.
  • Shared features among psychotherapies: 
    • All types of psychotherapy are unique, but all also share common features.
    • Psychotherapy involves verbal interchanges between the patient and therapist.
    • Nonverbal cues Nonverbal cues Transmission of emotions, ideas, and attitudes between individuals in ways other than the spoken language. Clinician–Patient Relationship are also seen in “talking therapies,” which are important to the therapist regardless of the method used.

Psychodynamic Therapy

Description

  • Psychodynamic therapy is based on the principle of psychoanalysis (that most mental disorders are caused by deep unconscious conflicts):
    • Previous childhood experiences and relationships contribute to the person’s current situation and behavior.
    • The goal of this method is to help the patient gain insight Insight Psychiatric Assessment into and resolve their past experiences.
  • Psychoanalysis requires long-term treatment (frequent visits for years).
  • Psychodynamic therapy is more brief (about once a week, but can go for months).
  • This method is best suited for young, intelligent adults with no psychosis.

Concepts in psychodynamic therapy

Table: Important processes related to psychodynamic therapy
Concept Description
Unconscious
  • Thoughts repressed/ideas blocked because of the conflict they create
  • Psychotherapy tries to bring out the unconscious for analysis.
Free association
  • The patient is instructed to talk freely about ideas that come to mind, even if they seem to be loosely related.
  • A means by which the therapist accesses the unconscious process by linking topics and identifying areas of resistance Resistance Physiologically, the opposition to flow of air caused by the forces of friction. As a part of pulmonary function testing, it is the ratio of driving pressure to the rate of air flow. Ventilation: Mechanics of Breathing and patterns of thinking.
  • These methods help to define unconscious conflicts that might have led to the patient’s current problem.
Dream analysis
  • Dreams are seen to represent conflict between urges and fears.
  • One of the best ways to understand the unconscious mind is to interpret the individual’s dreams.
  • Helps determine therapeutic goals
Transference
  • Unconscious redirection of feelings and desires about important people in the patient’s life onto the therapist
  • Example: seen in a patient with repressed feelings of abandonment who becomes irate when the therapist is late
Countertransference
  • Unconscious redirection of feelings about important figures in the therapist’s life onto the patient
  • Can interfere with objectivity (requires awareness on the part of the therapist)
  • Example: patient reminds physician/therapist of their younger sibling
Defense mechanism
  • Means unconsciously used by the patient to cope with conflicts and sustain interactions with people important to the patient
  • Can be:
    • Immature or primitive ( denial Denial Refusal to admit the truth or reality of a situation or experience. Defense Mechanisms, splitting Splitting Defense Mechanisms, projection Projection A defense mechanism, operating unconsciously, whereby that which is emotionally unacceptable in the self is rejected and attributed (projected) to others. Defense Mechanisms)
    • Higher-level ( humor Humor Defense Mechanisms, repression Repression Defense mechanisms involving approach and avoidance responses to threatening stimuli. The sensitizing process involves intellectualization in approaching or controlling the stimulus whereas repression involves unconscious denial in avoiding the stimulus. Defense Mechanisms, rationalization Rationalization A defense mechanism operating unconsciously, in which the individual attempts to justify or make consciously tolerable, by plausible means, feelings, behavior, and motives that would otherwise be intolerable. Defense Mechanisms)
Resistance Resistance Physiologically, the opposition to flow of air caused by the forces of friction. As a part of pulmonary function testing, it is the ratio of driving pressure to the rate of air flow. Ventilation: Mechanics of Breathing
  • Conscious and unconscious forces within the patient that oppose the purpose of the patient’s evaluation and the goals of the treatment
  • Patient misses or is late to appointments or refuses to open up regarding an issue.

Types

  • Classical psychotherapy: Unresolved conflicts lead to psychopathology (i.e., depression).
  • Ego psychology:
    • Originated from Sigmund Freud’s id-ego-superego model
    • Takes defense mechanisms Defense mechanisms Defense mechanisms are normal subconscious means of resolving inner conflicts between an individual’s subjective moral sense and their thoughts, feelings, or actions. Defense mechanisms serve to protect the self from unpleasant feelings (anxiety, shame, and/or guilt) and are divided into pathologic, immature, mature, neurotic, and other types. Defense Mechanisms into consideration (conflicts are explored, as well as the defensive attempts made by the patient)
  • Object relations:
    • A child’s relation to an object develops the psyche and shapes future relationships.
    • Objects are persons, usually a mother.
  • Self-psychology:
    • Understanding Understanding Decision-making Capacity and Legal Competence the patient from within their subjective experience
    • Achieved by:
      • Empathy: Positive experience with the therapist helps form a therapeutic alliance.
      • Mirroring: using positive responses of others to see the positive in oneself
      • Idealizing: having another individual or an external other who is calm to provide comfort when one is having conflict

Psychoeducation

  • Psychoeducation serves as the foundation for other forms of psychotherapy.
    • Provide the patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship with information about the diagnosis that is necessary to help them accept their condition
    • Discusses treatment options, thus empowering the patient to anticipate problems and become proactive in the management of their condition
  • Components of psychoeducation include:
    • Review of diagnosis 
    • Course and prognosis Prognosis A prediction of the probable outcome of a disease based on a individual’s condition and the usual course of the disease as seen in similar situations. Non-Hodgkin Lymphomas of disorder 
    • Outline of different treatment options 
    • Discussion of common comorbidities Comorbidities The presence of co-existing or additional diseases with reference to an initial diagnosis or with reference to the index condition that is the subject of study. Comorbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival. St. Louis Encephalitis Virus 
    • Identification Identification Defense Mechanisms of warning signs and a plan to prevent relapse Relapse Relapsing Fever 
  • Useful in a wide variety of settings for many diagnoses (e.g., bipolar Bipolar Nervous System: Histology disorder)

Supportive Therapy

  • Supportive therapy is a type of therapy used in many settings and is usually brief.
  • The therapy emphasizes empathy and aims to reduce the subjective distress of the patient. 
    • Helps patient(s) cope with illness
    • Helps patient(s) handle a crisis and maintain optimism
  • The therapist listens to patient’s concerns, with a focus Focus Area of enhancement measuring < 5 mm in diameter Imaging of the Breast on encouragement and patient’s strengths, thus enabling a decrease in negative thinking.

Cognitive-Behavioral Therapy

Description

  • One of the most widely used and most effective methods of therapy
  • Dr. Aaron Beck is credited with the creation of this method, which is based on the theory that thoughts, behaviors, and emotions are all linked.
  • Combination of cognitive therapy and behavioral therapy (CBT): 
    • Cognitive therapy: 
      • The perception Perception The process by which the nature and meaning of sensory stimuli are recognized and interpreted. Psychiatric Assessment of things affects our behavior, thus psychological problems arise from distorted thinking.
      • Determines and corrects the thinking (maladaptive beliefs and faulty assumptions) that exacerbates the psychopathology
    • Behavioral therapy: 
      • Manipulates the physiologic and external environment
      • Uses thought exercises and experiences to reduce symptoms (relaxation, reinforcement, and graduated exposure Exposure ABCDE Assessment to stimuli)
      • The goal is to replace maladaptive behaviors with healthier alternatives.
  • A structured, interactive, and present-oriented approach  
  • Patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship are generally highly motivated.
  • Ranges from 5 to 20 sessions

Behavioral therapy

The following are techniques:

  • Classic conditioning:
    • A stimulus can evoke a conditioned response.
    • Seen in the Pavlov’s dog experiment, in which a bell was run when the dog was fed, so over time, whenever a bell was rung, the dog salivated.
  • Operant conditioning: Instrumental learning (as seen in Skinner’s box) has behavioral consequences.
    • Positive reinforcement: 
      • Something is added to increase the behavior.
      • Adding a rewarding experience → ↑ behavior 
      • Rat presses on lever and gets food → ↑ rate of pressing
    • Negative reinforcement:  
      • Something is removed to increase the behavior.
      • Removal of adverse stimulus → ↑ behavior 
      • Rat presses on lever and noise stops→ ↑ rate of pressing
    • Positive punishment: 
      • Something is added to decrease the behavior.
      • Adding an aversive stimulus to an undesired behavior → ↓ behavior
      • A fine is given for speeding → ↓ speeding
    • Negative punishment: 
      • Something is removed to decrease the behavior.
      • Removal of stimulus after an undesired behavior → ↓ behavior
      • A toy is taken from a child when they throws a tantrum → ↓  tantrums
    • Extinction: weakening and loss of the conditioned response when reward or reinforcement is discontinued
  • Deconditioning:
    • Systematic desensitization:
      • This technique is based on the principle that phobias Phobias Neurological Examination are a learned behavior that can be modified. 
      • The patient performs relaxation techniques while an anxiety-provoking stimulus is being presented in gradually increasing doses. 
      • For example, for a patient who is afraid of dogs: pictures of dogs are shown, then a stuffed animal, then a more realistic exposure Exposure ABCDE Assessment
    • Implosion:
      • Degree of “imagined” stimuli is increased and the patient is instructed to remain relaxed.
      • Involves intensive recollection of anxiety-provoking situations
      • The patient who is afraid of dogs is asked to imagine going to a dog park.
    • Flooding:
      • Patient is immersed in the actual stimulus.
      • The patient who is afraid of dogs goes to a dog park.
    • Aversion therapy:
      • A negative stimulus is repeatedly paired with a specific behavior to create an unpleasant response, leading to a behavioral change.
      • Example: alcoholic Alcoholic Persons who have a history of physical or psychological dependence on ethanol. Mallory-Weiss Syndrome (Mallory-Weiss Tear) patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship are given disulfiram so when they drink alcohol, they will get violently sick.
    • Token economy:
      • If a patient shows certain behaviors, they get a reward for positive reinforcement.
      • Children with conduct disorders can be treated with this technique.
    • Biofeedback:
      • Physiologic data (i.e., HR and BP measurements) are given to patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship during times of distress.
      • This feedback allows the patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship to make changes in their body (e.g., relax).
      • Example: A patient with migraines is encouraged to visualize the dilation of her arteries Arteries Arteries are tubular collections of cells that transport oxygenated blood and nutrients from the heart to the tissues of the body. The blood passes through the arteries in order of decreasing luminal diameter, starting in the largest artery (the aorta) and ending in the small arterioles. Arteries are classified into 3 types: large elastic arteries, medium muscular arteries, and small arteries and arterioles. Arteries: Histology whenever experiencing pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways (to mentally control the physiologic state).

Cognitive therapy

  • Fundamentals of cognitive therapy:
    • Education
    • Relaxation
    • Coping skills training
    • Stress management
    • Assertiveness training
  • Some of the techniques:
    • Journaling: allows self-reflection by identifying thought patterns and related emotions
    • Cognitive restructuring:
      • Process of challenging and reframing negative thoughts and looking at a situation from a different perspective
      • Can be achieved by guided questioning by the therapist

Interpersonal Therapy

  • Interpersonal therapy focuses on interpersonal difficulties resulting in psychological problems:
    • Grief over loss
    • Interpersonal skill deficits
    • Disputes
    • Role transitions
  • This therapy is based on the theory that relationships are the most important aspect leading to psychological disorders.
    • The patient’s social experiences should be addressed (e.g., relationship Relationship A connection, association, or involvement between 2 or more parties. Clinician–Patient Relationship distress leads to a higher rate of depression).
    • This form of therapy is opposed to the psychoanalytical theory that it is intrapsychic conflict that leads to psychological problems.

Motivational Interviewing

  • Motivational interviewing is a counseling approach that aims to change behaviors (e.g., substance abuse disorders).
  • The therapist understands the patient’s perspectives and the problematic behaviors and tries to match strategies to promote change depending on the patient’s readiness.
  • Key elements:
    • Expressing empathy: engage the patient without judgment Judgment The process of discovering or asserting an objective or intrinsic relation between two objects or concepts; a faculty or power that enables a person to make judgments; the process of bringing to light and asserting the implicit meaning of a concept; a critical evaluation of a person or situation. Psychiatric Assessment and assess patient’s readiness to change
    • Identifying discrepancies between the behaviors and personal values:
      • Obtain patient’s thoughts on what is hoped for, the current behavior, and how these match up.
      • In the process, the behavior-change goal or target is focused on and motivation can be built on this.
    • Expecting resistance Resistance Physiologically, the opposition to flow of air caused by the forces of friction. As a part of pulmonary function testing, it is the ratio of driving pressure to the rate of air flow. Ventilation: Mechanics of Breathing and accepting it: Avoid arguments or confrontation.
    • Support self-efficacy: 
      • Belief that the patient can achieve a specific behavior
      • It is the patient who decides to change, makes the plans, and  implements the plans to reach the goal.
      • The clinician Clinician A physician, nurse practitioner, physician assistant, or another health professional who is directly involved in patient care and has a professional relationship with patients. Clinician–Patient Relationship’s role is guidance and encouragement.

Dialectical Behavioral Therapy

  • Dialectical behavior therapy is a variation of CBT developed by Dr. Marsha Linehan for borderline personality disorder Borderline Personality Disorder A personality disorder marked by a pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts. Cluster B Personality Disorders (BPD).
  • Involves managing treatment targets with the aim of reducing suicidal or dangerous behavior, treatment-interfering behavior, and quality Quality Activities and programs intended to assure or improve the quality of care in either a defined medical setting or a program. The concept includes the assessment or evaluation of the quality of care; identification of problems or shortcomings in the delivery of care; designing activities to overcome these deficiencies; and follow-up monitoring to ensure effectiveness of corrective steps. Quality Measurement and Improvement of life-interfering behavior, among others
  • Primary focuses:

Group Therapy

  • Group therapy is an approach involving discussion, sharing of feelings, and peer support.
    • Develops a support system of people with similar difficulties
    • The patient(s) get immediate feedback from peers.
    • Listening to others going through the same problems may help the patient gain insight Insight Psychiatric Assessment into their condition.
    • The therapist is also able observe patient interactions.
  • An example of this is Alcoholic Alcoholic Persons who have a history of physical or psychological dependence on ethanol. Mallory-Weiss Syndrome (Mallory-Weiss Tear) Anonymous.
  • Useful in grief or bereavement, substance abuse, adjustment disorders Adjustment Disorders Maladaptive reactions to identifiable psychosocial stressors occurring within a short time after onset of the stressor. They are manifested by either impairment in social or occupational functioning or by symptoms (depression, anxiety, etc.) that are in excess of a normal and expected reaction to the stressor. Adjustment Disorder, and personality disorders Personality Disorders A major deviation from normal patterns of behavior. Cluster A Personality Disorders.

Family Therapy and Marital Therapy

Family therapy

  • Treatment in which the family system is the focus Focus Area of enhancement measuring < 5 mm in diameter Imaging of the Breast
  • The entire family is seen together, facilitating group understanding Understanding Decision-making Capacity and Legal Competence of individual psychopathology and how it affects the family unit.
    • Impaired communications and relationships are addressed to help the patient with psychiatric illness and the rest of the family.
    • Helps identify conflicts that may arise and means to resolve these issues

Marital therapy

  • Couples therapy is used in marital conflicts, communication Communication The exchange or transmission of ideas, attitudes, or beliefs between individuals or groups. Decision-making Capacity and Legal Competence issues, sexual problems,
  • The therapist helps identify each individual’s needs and the obstacles to achieving these.
  • Sessions are usually conjoint, with each one also seeing a separate therapist.

Summary of Types of Psychotherapy

Table: Summary of the most important types of psychotherapy and their best indications
Type Description Indications
Psychoanalysis and psychodynamic therapy
  • Psychoanalysis: frequently per week, several years
  • Psychodynamic therapy: once a week, for months to years
  • Reveals unconscious aspects of a patient’s life
  • Identifies repressed experiences and feelings that are causing psychological problems
Psychoeducation (and family therapy)
  • Educates the patient and family with necessary information about the disease
  • Enables the patient to learn to anticipate and manage problems
  • Schizophrenia Schizophrenia Schizophrenia is a chronic mental health disorder characterized by the presence of psychotic symptoms such as delusions or hallucinations. The signs and symptoms of schizophrenia are traditionally separated into 2 groups: positive (delusions, hallucinations, and disorganized speech or behavior) and negative (flat affect, avolition, anhedonia, poor attention, and alogia). Schizophrenia (reduce relapses)
  • Bipolar Bipolar Nervous System: Histology disorder
Supportive psychotherapy
  • Focuses on helping the patient deal with a life crisis and cope with illness
  • More indicated for shorter-term use
  • Grief
  • Substance abuse
  • Depression
  • Anxiety Anxiety Feelings or emotions of dread, apprehension, and impending disaster but not disabling as with anxiety disorders. Generalized Anxiety Disorder
Cognitive-behavioral therapy (CBT)
  • Identifies irrational thoughts and assumptions leading to psychopathology
  • Replaces maladaptive behaviors with healthier alternatives
  • Depression
  • Anxiety Anxiety Feelings or emotions of dread, apprehension, and impending disaster but not disabling as with anxiety disorders. Generalized Anxiety Disorder disorders
  • Eating disorders
  • Impulse control disorders ( OCD OCD Obsessive-compulsive disorder (OCD) is a condition characterized by obsessions (recurring and intrusive thoughts, urges, or images) and/or compulsions (repetitive actions the person is compelled to perform) that are time-consuming and associated with functional impairment. Obsessive-compulsive Disorder (OCD), hoarding disorder, etc ETC The electron transport chain (ETC) sends electrons through a series of proteins, which generate an electrochemical proton gradient that produces energy in the form of adenosine triphosphate (ATP). Electron Transport Chain (ETC).)
  • PTSD PTSD Posttraumatic stress disorder is a psychiatric illness characterized by overwhelming stress and anxiety experienced after exposure to a life-threatening event. Symptoms last more than 1 month and involve re-experiencing the event as flashbacks or nightmares, avoiding reminders of the event, irritability, hyperarousal, and poor memory and concentration. Posttraumatic Stress Disorder (PTSD) (trauma-focused CBT)
  • Phobic disorders (CBT with exposure Exposure ABCDE Assessment)
  • Medical conditions ( insomnia Insomnia Insomnia is a sleep disorder characterized by difficulty in the initiation, maintenance, and consolidation of sleep, leading to impairment of function. Patients may exhibit symptoms such as difficulty falling asleep, disrupted sleep, trouble going back to sleep, early awakenings, and feeling tired upon waking. Insomnia, smoking Smoking Willful or deliberate act of inhaling and exhaling smoke from burning substances or agents held by hand. Interstitial Lung Diseases, low back pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways)
Interpersonal therapy
  • Short-term treatment focusing on loss, role, and transitions in life
  • Addresses interpersonal difficulties that lead to psychological problems
Depression
Group psychotherapy Patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship who share a diagnosis guide each other through recovery through discussions, sharing of feelings, and peer support.
  • Substance use disorders
  • Eating disorders
  • PTSD PTSD Posttraumatic stress disorder is a psychiatric illness characterized by overwhelming stress and anxiety experienced after exposure to a life-threatening event. Symptoms last more than 1 month and involve re-experiencing the event as flashbacks or nightmares, avoiding reminders of the event, irritability, hyperarousal, and poor memory and concentration. Posttraumatic Stress Disorder (PTSD)
  • Alcohol abuse
Motivational interviewing
  • An approach to help patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship change maladaptive behaviors
  • The patient makes the decision to change and tries reach a target behavior.
  • The therapist offers guidance.
Substance use disorders
Dialectical behavioral therapy Borderline personality disorder Borderline Personality Disorder A personality disorder marked by a pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts. Cluster B Personality Disorders
Marital therapy Couples go to a therapist who identifies individual needs along with the obstacles in meeting those needs. Marital and sexual conflicts

References

  1. Gabbard, G., DeJean, V. (2021). Unipolar depression: psychodynamic therapy. UpToDate. Retrieved July 12, 2021, from https://www.uptodate.com/contents/unipolar-depression-in-adults-psychodynamic-psychotherapy
  2. Ingersoll, K. (2021). Motivational interviewing for substance use disorders. UpToDate. Retrieved July 12, 2021, from https://www.uptodate.com/contents/motivational-interviewing-for-substance-use-disorders
  3. Lebow, J. (2021). Overview of psychotherapies. UpToDate. Retrieved July 11, 2021, from https://www.uptodate.com/contents/overview-of-psychotherapies
  4. Lomax J.W., Ivan M (2019). Psychodynamic psychotherapy and the therapeutic relationship. Chapter 11 of Ebert M.H., Leckman J.F., Petrakis I.L.(Eds.),  Current Diagnosis & Treatment: Psychiatry, 3rd ed. McGraw-Hill. https://accessmedicine.mhmedical.com/content.aspx?bookid=2509&sectionid=200802805
  5. McLean J. (2007). Psychotherapy with a narcissistic patient using Kohut’s self psychology model. Psychiatry (Edgmont) 4(10):40–47.
  6. Novotney, A. (2017). Psychoanalysis vs. psychodynamic therapy. Monitor on Psychology 48(11). http://www.apa.org/monitor/2017/12/psychoanalysis-psychodynamic
  7. Salomon, R.M. (2019). Adjustment disorders. Chapter 28 of Ebert, M.H., Leckman, J.F., Petrakis, I.L. (Eds.),  Current Diagnosis & Treatment: Psychiatry, 3rd ed. McGraw-Hill. https://accessmedicine.mhmedical.com/content.aspx?bookid=2509&sectionid=200806502
  8. Skodol, A. (2021). Psychotherapy for borderline personality disorder. UpToDate. Retrieved July 12, 2021, from https://www.uptodate.com/contents/psychotherapy-for-borderline-personality-disorder
  9. Swartz, H. (2021). Interpersonal therapy (IPT) for depressed adults: indications, theoretical foundations, general concepts and efficacy. UpToDate. Retrieved July 12, 2021, from https://www.uptodate.com/contents/interpersonal-psychotherapy-ipt-for-depressed-adults-indications-theoretical-foundation-general-concepts-and-efficacy

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