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Contemporary psychodynamic psychotherapy: Evolving clinical practice By

David Kealy, & John S. Ogrodniczuk (Eds.), San Diego, CA: Academic Press, 2019.
Paperback USD 84.95, ISBN 97...

Article in British Journal of Psychology · June 2021

DOI: 10.1111/bjop.12519

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Review of Contemporary Psychodynamic Psychotherapy: Evolving Clinical Practice
Contemporary Psychodynamic Psychotherapy: Evolving Clinical Practice by David Kealy and John S. Ogrodniczuk
(Eds), San Diego, Academic Press, 2019. Softcover US $84.95. ISBN 9780128133736

Contemporary Psychodynamic Psychotherapy swings a powerful hammer at the belief that psychodynamic
psychotherapy is (1) a historical footnote in therapy, (2) without evidence supporting its efficacy, and (3)
unchanged since the early 20th century. This text is useful for students learning about psychodynamic
psychotherapy, and also useful for clinicians practicing it. For the former group, it functions as an excellent
starting point, orienting readers to different psychodynamic techniques, treatments for specific disorders, and
the current status of the discipline. For the latter group, it is a useful consolidation of current issues within
psychodynamic therapy. Because space prohibits it, I will not discuss each of the book’s 28 chapters.

The text is divided into five sections. The first, “conceptual advances”, discusses issues in psychodynamic
therapy. “Theoretical evolution in psychodynamic psychotherapy” (chapter 1) is a quick survey of the
development of psychodynamic thought beginning with Freud. It provides numerous references for readers
to further explore the development of ego, object-relations, and/or self-psychology. Chapter 2 discusses
issues related to transference and countertransference, focusing on therapeutic immediacy. Chapter 3
provides a review of the development of attachment and mentalization in current psychodynamic
psychotherapy. By the end of section one, the reader has an understanding that psychodynamic
psychotherapy is vibrant and expanding.

Section two, three chapters long, provides evidence for psychodynamic treatment and its constructs. Chapter
4 is a review of studies examining the efficacy of psychodynamic psychotherapy. This question has been
explored since at least 1982 (e.g., see Parloff, 1982; Glass, 2008; Leichsenring, Leweke, Klein, & Steinert,
2015). The findings are consistent and clear: Psychodynamic psychotherapy is effective (and sometimes
specific) for numerous disorders, even when strict criteria area applied. Chapters 5 and 6 provide updates on
research in the areas of the development of process in psychotherapy and psychodynamic constructs,
respectively. As is often the case with good reviews, even the reference sections of these chapters are
interesting.

Section three, seven chapters long, expands on section two by providing more specific details for what
evidence-based psychodynamic therapy involves for a variety of disorders. This section inadvertently
highlights the need for more psychodynamic therapy outcome research. For example, although chapter 10
discusses transference-focused psychotherapy for narcissistic personality disorder, no outcome data are
provided demonstrating the effectiveness of the ideas. Overall, however, this section is a rich resource for
beginning to explore psychodynamic therapy for different disorders. As the history of psychodynamic therapy
includes attitudes that were at best indifferent, and at worst hostile, to outcome research, the facts that (1)
there is an active psychodynamic therapy research community, (2) outcome studies show that psychodynamic
psychotherapy is generally as effective as established comparison treatments, and (3) outcome studies show
that psychodynamic psychotherapy is effective for common disorders, are important to recognize. The
chapters frequently use case studies or clinical vignettes to illustrate concepts, which helps increase
accessibility.

Section four, seven chapters long, is a breath of fresh air in what has been for decades a stagnant room.
Historically, psychodynamic (psychoanalytic) therapy has treated middle-class or wealthier patients, generally
from the dominant culture (e.g., white Anglo Americans in the US, Europeans in Europe, etc.). Chapters 15
to 17 review and update work with children, parents, and families. Updates are rich and clear, based on
research in the relevant areas. Chapter 18 (“Psychodynamic practice and LGBT communities”) addresses the
history of prejudice and discrimination against this community by psychodynamic theorists. The authors also
explore related issues such as minority stress, and LGBT parenting, neglected topics in the history of
psychodynamic literature. Section four also explores issues such as working with immigrants (chapter 19),
former child soldiers (chapter 21), trauma in the context of political violence (chapter 22). Chapter 20 stands
out in this section as less focused on special populations, as it explores dissociative process and subjective
experience. Psychodynamic writing needs more chapters like the ones in this section if it is to shed outdated
associations with heteronormativity and eurocentrism.

Section five is similarly invigorating, as it explores new (or revises old) contexts for the delivery of
psychodynamic therapy. Issues include internet-based services (chapter 23), inpatient medical settings
(chapter 28), and expanding the role of psychodynamic community engagement (chapter 27). Chapters 24 and
25, expanding attachment work with families, and community-based interventions for Aboriginal
communities in central Australia, respectively, could have been placed in the previous section. Overall,
however, this section clearly shows how psychodynamic therapy is being taken from the consulting room
(with its associated couch) and into the 21st century (with the internet and globalization).

The chapters are consistently clear, well-written, and focused. The text is relatively easy to read (another point
of divergence from early psychoanalytic writing), and its clarity is especially impressive as psychodynamic
topics are often abstract. Given its richness and breadth, this text is a must-have for students learning about
psychodynamic therapy, as well as clinicians practicing it. Although for psychodynamic practitioners, much of
the book reviews and expands upon what has already been know (that psychodynamic therapy is effective), it
goes beyond this by showing how psychodynamic work is growing into new contexts and adaptations.

Michael Sheppard, PhD, R.Psych

Private practice
Vancouver BC
References
Glass, R.M. (2008). Psychodynamic psychotherapy and research evidence: Bambi survives Godzilla? Journal of
the American Medical Association, 300: 1587–1589.

Leichsenring, F., Lewes, F., Klein, S. & Steinert, S. (2015). The empirical status of psychodynamic
 psychotherapy-an update: Bambi’s alive and kicking. Psychotherapy and Psychosomatics, 84¸129-148. DOI:
10.1159/000376584

Parloff M.B. (1982). Psychotherapy research evidence and reimbursement decisions: Bambi meets Godzilla.
American Journal of Psychiatry 139, 718–727.

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