Psychodynamic therapy approaches in depressive disorders. Pathogenesis models and empirical principles

Targets for psychodynamic psychotherapy are the core conflictual relational mode and its consequences for mood, social behaviour, and self image. Libido- and conflict-based concepts of the relational mode are increasingly being replaced by the concept of intersubjectivity, which includes also nonconflictual, healthy modes of relations as a basic human mental task. According to recent mother-infant interaction research, the psychotherapeutic effect on the relational mode can be interpreted in terms of procedural learning rather than insight-oriented discourse. The mother-infant paradigm is a particularly suitable research paradigm to elucidate unconscious procedural acquisition of mental representations of dyadic interactional styles. Procedural learning requires a more active corrective style of interacting on the therapist's side, beyond abstinence and control of countertransference. Evaluative studies show that psychodynamic psychotherapy of depression is nearly as effective as cognitive behaviour therapy (CBT) and interpersonal therapy (IPT).