Combined Psychotherapies: Searching for an Order of Operations in a Disordered World

Abstract Recent studies of psychotherapy demonstrate that therapists of different orientations–psychodynamic, cognitive-behavioral, interpersonal, and dialectical behavioral–provide beneficial treatment. Despite the stated adherence of clinicans to one orientation or another, review of session transcripts reveals a substantial overlap in the techniques utilized. Nonspecific or patient factors are the chief determinants of how therapy is conducted in practice. Nevertheless, the psychodynamic orientation offers the most comprehensive approach to therapy because it considers unconscious factors, including transference, enactments, and aspects of the patient's personal relationships. The psychodynamic formulation indicates the basis for determing how psychotherapy might best be conducted for the specific patient.