I would like to delineate a possible trajectory of an integrated therapeutic approach, combining cognitive-behavioral (CB) and psychodynamic techniques in the treatment of individuals with psychotic conditions.
Firstly, any treatment plan has to begin with a formulation, I believe this is the first step where we can implement an integrated approach and combine different psychotherapeutic languages - for example incorporating psychodynamic concepts and hypotheses when construing the “4 Ps” model which is common in CB formulations.
As psychosis is, commonly, cognition-centered, the next phase involves addressing cognitive biases and implementing meta-cognitive techniques in order to evaluate and challenge beliefs and broaden the explanations given to life events. Throughout this phase we also continue to be mindful of psychodynamic material (e.g – transference and counter-transference, defense mechanisms, object relations etc.) integrating it into the case formulation, thereby deepening our understanding of the client and providing more finely tailored interventions.
In the next step of the treatment, CB interventions can facilitate basic integration, specifically - learning and re-learning how to “make connections”. Then, the psychodynamic approach has the potential to broaden and deepen the connections that become available.
Finally, as the treatment continues, the role of the psychodynamic approach becomes more prominent. This is a gradual process and it always entails a “spiral” development, thus the therapist should have the patience and the sensitivity to know when to utilize more psychodynamic interventions and when to continue with CB techniques.
During the course of the lecture, using clinical examples, we will outline concrete steps one can take to bridge CB and psychodynamic interventions.
I believe that our clients would benefit immensely from an integrated and flexible therapeutic approach - with therapists adapting treatment modalities to be more effective and attuned to the individual needs of every client.
Individual cognitive behavioural therapies and related approaches , Individual psychodynamic therapies , Other themes in therapeutic approaches
