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itself is active, structured, time limited, and focused on current problems. As

patients begin to think and act more realistically, their symptoms and behavior

improve.2

Interpersonal psychotherapy, a time-limited treatment for major depressive

disorder. Interpersonal psychotherapy as useful for patients who face conflicts

with significant others or who are having difficulty adjusting to a life transition.2

Psychoanalytic psychotherapy can refer to a spectrum of talking therapies

ranging from once-weekly face-to-face psychodynamic therapy all the way to full-

blown five times weekly, on-the-couch psychoanalysis. Psychoanalytic

psychotherapy is based on Sigmud Freud theory. Basic approach is focused on

uncovering unconscious conflicts of the patients mental life. Basic technique is

free association, with close attention paid to transference, countertransference,and

resistance. Length of therapy varies from a few months to a few years. 5

Psychoanalytic psychotherapies have been demonstrated to be highly effective

and useful treatments for a wide range of disorders. Recent surveys suggest that

psychoanalytic psychotherapy is still the major form of psychotherapy taught in

training programs and the form of therapy that mental health professionals choose

when they seek their own treatment.2 But, there are criticism for psychoanalytic

psychotherapy. The main criticism of this type of therapy, is that it takes a long

time. It is certainly not an easy task and is not a magical cure. It is a slow, gradual

process. It can be uncomfortable as well as enriching and requires commitment to

face and to work through difficult feelings.9

Cause of that, the writer want to

explore how the effectiveness of psychoanalytic psychotherapy.


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CHAPTER II

CONTENT

II.1 DEPRESSION

A. DefinitionDepression is a common disorder with serious personal,

interpersonal and societal consequences, affecting about 15% of the

general population.1 Depression is a feeling state of dejection, sadness,

or unhappiness, which may be brief in duration, and a clinical

syndrome characterized by persistent sadness, profound

discouragement, or despair which persists two weeks or more and is

associated with a change from previous functioning.3

B. Epidemiology and prevalenceWomen are twice as likely to suffer from depression, and

symptoms generally increase with age. Recent studies suggest a rising

incidence of depression in younger age groups, particularly young

men, which may be linked to the relative rise in suicide rates.1

i. GenderApproximately 15% of the general population report depressive

symptoms, with 10% of primary care consultations being due to

depressive disorders. Most crosscultural community surveys have

found major depressive disorder to be about twice as prevalent in

women as in men, the lifetime prevalence being approximately

20% compared to 10%, respectively.1

ii. AgeIn the elderly there appears to be a leveling out of the gender

difference for major depression, although the overall prevalence


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of depressive symptoms appears to increase with age. Several

studies suggest a rising incidence of depression in younger age

groups, particularly in young men, which may be linked to the

relative rise in suicide rates in this age group when compared to

the declining rates in the general population. Major depression in

childhood is no longer considered rare, the point prevalence in

children lying in the range 0.52.5%. Depression is notably more

common in adolescents than in younger children, having an

average period prevalence of around 34%.4

C. EtiologyDepression has many causes which include such as genetic factors,

neurotransmitter disturbances and psychosocial factors.

i. Genetic FactorGenetic influences are most marked in patients with more severe

forms of depressive disorder and biological symptoms. Potential

genetic markers for affective disorders have been localized to

chromosomes X, 4, 5, 11, 18 and 21.

2

ii. Neurotransmitter Disturbance

There is evidence that abnormalities in the level or function of the

serotonin (5-hydroxytryptamine, 5-HT), norepinephrine and

dopamine neurotransmitters acting on central nervous system

neurons may be important in the pathophysiology of depression,

although this evidence is inconclusive. The results of

neuroendocrine studies suggest that depression is associated with

decreased neurotransmission at postsynaptic 5-HT1A receptors.

Many antidepressants are thought to produce their therapeutic

effects by acting upon these postsynaptic 5-HT1A receptors.

Depression is also associated with increased 24-h

adrenocorticotropic hormone (ACTH) levels, as well as elevated


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urinary and plasma cortisol levels. Abnormalities of

noradrenergic and dopaminergic neurotransmission are also

important in the etiology of depression. Animal studies suggest

norepinephrine plays a major role in maintaining arousal and

drive.2

iii. Psychosocial FactorLow self-esteem, an obsessional personality, the experience of

adversity in childhood and maladaptive negative patterns of

thinking about oneself and others, are all recognized psychologic

risk factors for depression. Other factors include excessive

undesirable recent life events, usually involving loss (such as

bereavement, divorce and redundancy), and persisting major

difficulties, including being a lone parent, overcrowding,

prolonged unemployment, poverty and lack of social support or

intimacy.4

D. DiagnosisBased on PPDGJ-III, diagnostic criteria for depression (F32) is

consist of major and minor symptoms.

Major symptoms include :

y Depressed mood to a degree that is definitely abnormalfor theindividual, present for most of the day and almost every day,

largely uninfluenced by circumstances and sustained for at

least 2 weeks.

y Loss of interest or pleasure in activities that are normallypleasurable.

y Decreased energy or increased fatiquability.Minor symptoms include :

y Loss of confidence or self esteemy Unreasonable feelings of self-reproach or excessive and

inappropriate guilt


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y Recurrent thoughts of death or suicide, or any suicidalbehaviour

y Complaints or evidence of diminished ability to thick orconcentrate, such as indecisiveness or vacillation

y Change in psychomotor activity, with agitation or retardation(either subjective or objective)

y Sleep disturbance of any typey Change in appetite (decrease or increase) with corresponding

weight change

There are 4 stage of depression include mild depression (F32.0),

moderate depression (F32.1), severe depression without psychotic

features (F32.2) and severe depression with psychotic features

(F32.3).

Mild depression (F32.0)

At least 2 major symptoms with at least 2 minorsymptoms

No severe symptoms (in singular) The period of symptoms must be at least 2 weeks Little disturbance in everyday activity

Moderate depression (F32.1)

At least 2 major symptoms with at least 3 (4 is morepreferred) minor symptoms

The period of symptoms must be at least 2 weeks Visible disturbance in everyday activity

Severe depression without psychotic features (F32.2)

All major symptoms with at least 4 minor symptoms The period of symptoms must be at least 2 weeks Impossibility in conducting daily activity (suicide

ideation alone may contribute to severe depression)

Severe depression with psychotic features (F32.3)

All major symptoms with at least 4 minor symptoms


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Research has shown that medication alone and combination

treatment are both effective in reducing the rate of depressive

recurrences in older adults. Psychotherapy alone also can be effective

in prolonging periods free of depression, especially for older adults

with minor depression, and it is particularly useful for those who are

unable or unwilling to take antidepressant medication.7

a. MedicationThe available antidepressants differ in their pharmacology, drug-

drug interactions, and short- and long-term adverse effects. They

do not differ in overall efficacy, speed of response, or long-term

effectiveness. For those with atypical features, strong evidence

indicates that tricyclic drugs are less effective than the

monoamine oxidase inhibitors (MAOIs). There is some

suggestion of efficacy for the selective serotonin reuptake

inhibitors (SSRIs) in atypical depression.2

b. PsychotherapyThe objectives of formal psychotherapy used alone to treat mood

disorders are identical to those for medication: (1) symptom

remission; (2) psychosocial restoration; and (3) prevention of

relapse or recurrence. When used in combination with

medication, psychotherapies can achieve such additional

objectives as reducing the secondary psychosocial consequences

of the disorder.2

Cognitive therapy may be slightly less effective in those with

more-dysfunctional attitudes, while interpersonal psychotherapy

may be somewhat less effective in those with more-interpersonal

problems. Time-limited therapies are usually preferred over time-

unlimited therapies for symptom reduction because they have

established efficacy (time-unlimited therapies do not) and because

medication is an effective alternative if psychotherapy alone fails.

Some believe that reconstructive (time-unlimited)


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psychotherapies are more useful in the treatment of Axis II

disorders.2

c. Combined treatmentMedication and formal psychotherapy are often combined in

practice, yet data from randomized controlled trials suggest that

the combination does not predictably add to the symptom-

reducing effects of either treatment alone, at least in less complex,

chronically ill patients. Conversely, the combination may result in

both symptom reduction and psychosocial restoration, which is an

additional rationale for using the combined approach.2

d. Electroconvulsive therapyECT is effective, even in patients who have failed to respond to

one or more medications or combined treatment. It is effective in

both psychotic and nonpsychotic forms of depression. Usually, 8

to 12 treatments are needed.2

II.2 PSYCHOTHERAPY

The kind of psychotherapy such as psychoanalytic, psychoanalytic

psychotherapy, behavior therapy, cognitive therapy, interpersonal therapy,

family therapy, etc.

A. Psychoanalytic and psychoanalytic psychotherapyFormal psychoanalysis, usually involving four or five sessions a week

with the patient reclining on a couch, is taught in psychoanalytic

institutes throughout the country. During his life, Sigmund Freud

(18561939), the founder of psychoanalysis, predicted that the

principles of the talking cure would ultimately be adapted into

forms of psychotherapy. With some trepidation, he recognized that the

pure gold offered by psychoanalysis would ultimately be alloyed

with the copper of suggestion.


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Developments in the field since Freud's death suggest that his

trepidation was perhaps unwarranted. Psychoanalytic psychotherapies

have been demonstrated to be highly effective and useful treatments

for a wide range of disorders. Recent surveys suggest that

psychoanalytic psychotherapy is still the major form of psychotherapy

taught in training programs and the form of therapy that mental health

professionals choose when they seek their own treatment. This

modality usually takes place anywhere from one to three times per

week, with the patient and therapist sitting face to face. This type of

psychotherapy goes by a variety of names, including expressive

psychotherapy, expressive-supportive psychotherapy, insight-oriented

psychotherapy, intensive psychotherapy, and exploratory

psychotherapy. In addition, a variation known as psychoanalytically or

psychodynamically informed supportive psychotherapy is also widely

practiced.2

B. Behavior therapyBehavior therapy involves changing what patients do, to improve their

health. Behavior therapy includes a methodology, referred to as

behavior analysis, for the strategic selection of behaviors to change

and a technology to bring about behavior change, such as modifying

antecedents or consequences or giving instructions. Behavior therapy

is based on learning theory, especially operant and classical

conditioning. Behavior therapy is more useful for phobia, compulsive,

psychophysiologic reaction and sexual disfunction.2

C. Cognitive therapyCognitive therapy employs specific treatment strategies to correct

these habitual thinking errors found in different psychopathological

states. Treatment employs a combination of verbal interventions and

behavior modification techniques. The therapy itself is active,


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structured, time limited, and focused on current problems. As patients

begin to think and act more realistically, their symptoms and behavior

improve.Cognitive therapy has been used successfully in the treatment

of depressive disorders, anxiety disorders (e.g. phobias, panic

disorder, obsessive-compulsive disorder) eating disorders, substance

abuse, & personality disorders.2

D. Interpersonal therapyInterpersonal psychotherapy, a time-limited treatment for major

depressive disorder, was developed in the 1970s. The American

Psychiatric Association (APA) Practice Guideline for Major

Depressive Disorder in Adults describes interpersonal psychotherapy

as useful for patients who face conflicts with significant others or who

are having difficulty adjusting to a life transition. The clinical practice

guidelines for treatment of depression in primary care settings

recommended interpersonal psychotherapy for short-term treatment of

nonpsychotic depression, to remove symptoms, prevent relapse and

recurrence, correct causal psychological problems with secondary

symptom resolution, and correct secondary consequences of

depression.2

III.3 PSYCHOANALYTIC

A. HistoryTerm psychoanalysis is used to refer to a theory of the mind, a

procedure or method of inquiry, and a type of treatment. Technique

Freud's early use of hypnosis was profoundly influenced by his friend

and older colleague, Josef Breuer, a Viennese internist. In his work

with Anna O., Breuer had discovered that when his patient was placed

in a hypnotic trance, her symptoms disappeared as a consequence of


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their verbal expression. Anna O. dubbed this treatment the talking

cure. Freud felt he should be more fully trained in hypnotic

techniques, so he spent the year 1885 to 1886 with the French

neurologist Jean-Martin Charcot at the Salpetrire in Paris. When

Freud opened his practice back in Vienna in 1887, he used hypnosis to

remove symptoms through suggestion. His results with this technique

were less than encouraging, so he shifted to the cathartic method

based on Breuer's account of his treatment of Anna O.2

B. Theory of PsychoanalyticSigmund Freud said that psychoanalysis was three things :

y A theory of how the mind works. Psychoanalysis attempts tounderstand and explain the normal and the abnormal functioning of

the human mind at all ages. Many of the central psychoanalytic

conceptsthe unconscious, psychic determinism, infantile

sexuality and the theory of drives, the Oedipus complex,

ambivalence, anxiety, the defense mechanisms, psychic conflict,

the structure of the mind or of the psychic apparatusform a bodyof scientific knowledge that has now become part of our

intellectual heritage.

y An investigative or research method. The technique of freeassociation by the patient (analysand) makes it possible for the

analyst to gain access to the data and processes of mental life,

conscious or otherwise and rational or not. The data thus retrieved

are rendered coherent and intelligible according to the theory of

psychoanalysis.

y A specific form of therapy of mental illness. Psychoanalysis usesfree association to obtain data in the form of thoughts, feelings,

memories, fantasies, and dreams and then proceeds to order and

comprehend the data within the framework of psychoanalytic


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theory. Through interpretation of psychic data, leading to insight

and working through, the treatment process is carried

progressively forward.

C. Phases of the Analytic ProcessThe analytic process has traditionally been divided into three phases,

include :

1. Opening phaseThe patient's establishment of a therapeutic alliance with the

analyst, involves developing trust and a willingness to work

collaboratively with the analyst in the pursuit of understanding.

The opening phase also provides a chance for patients to tell their

story or free-association.2

2. Middle phasePhsycoanalytic technique, include :

- TransferenceTransference refers to the displacement onto the analyst of

attitudes and feelings originally experienced in relationships

with people from the past. Transference patterns appear

automatically and unconsciously in the analytic relationship.

Analysands suddenly find themselves reacting to the analyst

with intense feelings that are inappropriate, at least in part, to

the current situation. Patients unconsciously reenact a past

relationship instead of remembering and verbalizing it.

- InterpretationInterpretation is one of the analyst's primary therapeutic

instruments in psychoanalysis. It involves an explanatory

statement by the analyst that links a symptom, thought, feeling,

or behavior to its unconscious meaning. It is the vehicle by

which the analyst delivers understanding to the patient. In the

ideal situation, interpretation is designed to make the patient


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consciously aware of unconscious (or preconscious) material

that is close to the surface of consciousness.

- CountertransferenceCountertransference is the analyst's transference to the patient.

Freud viewed it as interfering with the analyst's optimal

functioning, and he issued a command that the analyst shall

recognize this counter-transference in himself and overcome

it.

The conceptualization of countertransference as stemming

from the analyst's unconscious conflicts displaced onto the

patient.

- ResistanceResistance is inevitably encountered in any long-term

psychodynamic treatment.4 They manifest themselves in every

aspect of the patient's behavior and associations and may take

a variety of forms, including falling asleep during sessions,

forgetting the analyst's observations, withholding important

thoughts and feelings from the analyst, demanding symptom

relief instead of understanding from the analyst, falling silent

during the sessions, failing to pay the bill, and even free

associating so literally that none of the material is connected or

used constructively to produce understanding.2

3. Termination phasePhase of analysis requires that the patient mourn and give up

infantile attachments to parental figures at the same time that the

loss of the analyst as a real person is being mourned. Autonomy,

independence, and development of the capacity for continuing

self-analysis are also prominent issues to be addressed during the

termination phase.2


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III.4 PSYCHOANALYTIC PSYCHOTHERAPY

The term psychoanalytic psychotherapy can refer to a spectrum of

talking therapies ranging from once-weekly face-to-face psychodynamic

therapy all the way to full-blown five times weekly, on-the-couch

psychoanalysis.6 Psychoanalytic psychotherapy is based on the observation

that we sometimes try to deal with problems by trying to keep them out of

our mind as a way of getting rid of them. However, they will continue to

have an important effect on our feelings and behaviour. Early experiences

are important in shaping the way the mind works but a large part of our

mind operates outside of our consciousness. From an early age, we find

ways of managing our experiences and this influences how we cope in

later life.5

The relationship with the therapist is an important part of the

therapy. He or she offers a confidential, safe and private place where the

unconscious patterns of our inner world can be played out. The safe setting

that they create means that emotional conflicts can be relived and new

solutions can be found to old problems. This process helps us to identify

those patterns of behaviour, which we keep repeating.

5

Seven features reliably distinguished psychodynamic therapy from

other therapies, include (1) focus on affect and expression of emotion, (2)

exploration of attempts to avoid distressing thoughts and feelings, (3)

identification of recurring themes and patterns. (4) discussion of past

experience (developmental focus), (5) focus on interpersonal relations, (6)

focus on the therapy relationship.


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A. The Differentiation between Psychoanalytic and PsychoanalyticPsychoterapy

Characteristics of PsychoanalyticGoals Partial personality reorganization

Appreciation of conflicts and related defensemechanisms

Partial reconstruction of the pastSymptom relief

Improved interpersonal relationshipsPatients characteristics Includes all criteria for psychoanalysis

Moderate to severe personality disordersSome affective disorders with and withoutmedication (e.g., major depression)

Techniques Active therapeutic stance

Face to face (sitting up)One to three sessions weekly

Limited free associationActive focus on current life issues

Limited transference analysis

Some supportive techniquesLiberal use of medication

Clarification and interpretationLength of treatment Months to years (may or may not be shorter than

psychoanalysis) 3

Characteristics of PsychoanalysisGoals Personality reorganization

Resolution of childhood conflicts

Patients characteristics Psychoneuroses and mild to moderate personality

disordersPsychological mindedness

Introspectiveness

Can experience and learn from intense affects orconflicts without acting them out

Reasonable object relationships

High motivationCan tolerate frustration and therapeutic regression

Techniques Use of couchFour or five sessions weekly

Free associationNeutrality

Abstinence

Analysis of defensesAnalysis of transference


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B. Indication

C. ContraindicationFor the most part, contraindications to any psychoanalytic

psychotherapy that is heavily weighted toward the expressive end of

the therapeutic continuum are as follows :

Poor impulse control

Significant cognitive deficits

Severely dysfunctional interpersonal relationships

Little ability to tolerate frustration, anxiety and depression

Significant lack of introspective capacity

D. Type of Psychoanalytic Psychotherapy Expressive psychotherapy

Expressive psychotherapy is the treatment of choice for persons

with enough ego strength, intelligence, and anxiety tolerance to

participate in therapy and with serious but relatively circumscribed

neurotic conflicts and symptomsie, individuals who need help

Putative Indications for Psychoanalytic Psychotherapy

NeurosesPersonality disorders (except antisocial personality disorder)Post traumatic stress disorders

Adjustment disordersParaphilias*

Mood disorders*

Anxiety disorders*

Somatoform disorders*Sexual and gender identity disorders*Eating disorders*

Substance abuse disorders*

Dissociative disorders*Relational problems

Impulse-control disorders*Psychological problems affecting medical illnesses

3


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but not the greater commitment implied by a decision to enter

analysis.

Supportive psychotherapySupportive psychotherapy attempts to shore up the patients

psychological defenses and enhance his or her ability to cope with

the trials of illness or psychological defi cits and the challenges

they impose on the patients daily activities

Contraindications to Expressive Psychoanalytic Psychotherapy

Major ego deficits

Poor motivation

Signifi cant cognitive deficitsInability to obtain symptom relief through understanding

Inability to verbalize affectsLack of psychological mindednessMinimal impulse control

No social support network

Low frustration tolerance

Inability to form therapeutic alliance 3

Characteristics of Supportive Psychoanalytic Psychotherapy3

Goals Maintain current level of psychological

functioningRestore premorbid adaptation, if possible

Enhance coping mechanisms

Strengthen defense mechanism unless theyare maladaptive

Support reality testingRelieve symptomsDecrease mental distress

Patients characteristics Severe character disorders

Chronic ego deficits

Thought disordersLimited psychological mindedness

Limited motivation

Poor interpersonal relationshipsRegression proneness

Some potential for therapeutic alliance

Extreme passivityHigh premorbid adaptation

Flexible defensesThose in crisis situations (catastrophic

loss, acute psychic trauma, medicalillness)


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E. Efficacy of Psychoanalytic PsychotherapyMeta-analytical studies of psychotherapy have demonstrated

unequivocally that psychotherapy is effective (Luborsky et al., 1975;

Smith et al., 1980; Lambert et al., 1986). The study by Smith and

coworkers (1980), for example, demonstrated that 80% of those

patients treated in psychotherapy fared better on outcome measures

than those who received no treatment. Luborsky and coworkers (1993)

have demonstrated that psychoanalytic psychotherapy is as effective as

cognitive, behavioral, experiential, and group therapies and

hypnotherapy.3

Treatment length was also positively correlated with better

outcomes. Another study showed that intensive psychoanalytic

psychotherapy four times a week was more effective in treating

children with learning difficulties than once-a-week sessions.

Psychologically healthyEffective social network

Techniques Predictability and consistency of therapist

Conversational styleConfrontation, clarification, educationInability to verbalize affects

Problem-solving focusProvide encouragement, advice, praise,

reassurance

Environmental intervention

Strengthen reality testingShore up defense mechanisms

Discourage regression

Infrequent genetic reconstructionInfrequent transference analysis

Less therapeutic neutrality

Frequent use of medicationLength of treatment Usually once weekly or lessDuration of sessions fl exible

Varies from brief therapy for those

reactive disorders in individuals who donot need or are not motivatedfor further

help to lifelong treatment of patients withsome chronic disorders3


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While psychoanalytic psychotherapy is often thought to be

prohibitively expensive, this study of patients with borderline

personality disorder suggests that in many cases providing such

treatment is highly cost-effective. Borderline patients tend to use up a

great many health care dollars in visits to emergency rooms, visits to

other medical specialists, psychiatric hospitalization, and various

diagnostic workups. There is considerable cost savings in providing

regular therapy over an extended period of time. Almost all of the

outcome measures included a reduction in overall expense as well. In

other words, implied in the cost-offset notion is that treating mental

illnesses is beneficial primarily because it reduces overall costs of

other medical care.2


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CHAPTER III

CONCLUSION

Psychoanalytic psychotherapy is a technique for treating emotional and

psychological problems called the 'talking cure'. Its aim is to try and understand

difficulties that go on inside our minds, which often get in the way of our leading

more fulfilling lives.6 Psychoanalytic psychotherapy is one of kind of therapy for

depression patient.

In order to do this people undertaking psychotherapy are offered a regular,

reliable and confidential space which provides them with an opportunity to be as

honest, and as spontaneous as possible about their thoughts, feelings and dreams.

In return the therapist does not give advice but is non-judgemental and listens

very carefully in order to help them think about and understand their experience.6

Although, there are criticism of psychoanalytic psychotherapy such as the

high cost and long time treatment, psychoanalytic psychotherapies have been

demonstrated to be highly effective and useful treatments for a wide range of

disorders, such as depression.2

Based on study by Luborsky et al., 1975; Smith et

al., 1980; Lambert et al., 1986 demonstrated that 80% of those patients treated in

psychotherapy fared better on outcome measures than those who received no

treatment.

Long time treatment was also positively correlated with better outcomes.

Intensive psychoanalytic psychotherapy more effective than others. Long time

treatment psychoanalytic psychotherapy is often thought to be prohibitively

expensive fee. But actually psychoanalytic psychotherapy is cheaper than other

therapies. Many treatment such as visit the emergency room, medical specialist,

hospitalization and various diagnostic workups is not only spend your money, but

spend your time to work. In other words, implied in the cost-offset notion is that

treating mental illnesses is beneficial primarily because it reduces overall costs of

other medical care.2


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REFERENCES

1. Elvira, Sylvia D. 2010. Buku Ajar Psikiatri. Jakarta : Fakultas KedokteranUniversitas Indonesia

2. Kaplan, Harold I. dll. 2010. Sinopsis Psikiatri: Ilmu Pengetahuan PerilakuPsikiatri Klinis Jilid Dua. Terjemahan oleh Dr. Widjaja Kusuma. Jakarta:

Binarupa Aksara

3. Kay, Jerald., Tasman, Allan. 2006. Essentials of Psychiatry. West Sussex :John Wiley & Sons Ltd

4. Maramis, Willy F. 2009. Catatan Ilmu Kedokteran Jiwa 2ndedition. Surabaya:Airlangga University Press

5. Wang, William Weiqi. 2010. Comprehensive Psychiatry Review. New York :CambridgeUniversity Press

6. American Psychoanalytic Association. 2009. About Psychoanalytic.http://www.apsa.org/About_Psychoanalysis.aspxAccessed, Jan 17th 2011

7. National Institute of Mental Health. 2008. Depression.http://www.nimh.nih.gov/health/topics/depression/index.shtml Accessed,

Jan 17th 2011

8. Shedler, J. 2010. The Efficacy of Psychodynamic Psychotherapy. AmericanPsychologist, Vol.65. No.2. p. 98-109.

http://www.apa.org/pubs/journals/releases/amp-65-2-shedler.pdf

Accessed, Jan 17th

2011

9. The Association for Psychotherapy in East London & The APEL CharitableTrust. What is Psychoanalytic Psychotherapy.

http://www.apel.org.uk/what.htm Accessed, Jan 17th

2011

10.The British Psychoanalytic Council. 2005. What is PsychoanalyticPsychotherapy.

http://www.psychoanalytic-council.org/main/download/What_Is_PP.pdf

Accessed, Jan 17th

2011

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