Psychodynamic Therapy an Introduction

Psychodynamic Therapy is one of the oldest and most established forms of pscyhotherapy. It’s applied in the treatment of many psychological conditions including depression, anxiety, post-traumatic stress disorder and couple-counseling.

Psychodynamic therapy is strongly rooted in the theory and therapy of Freudian Psychoanalysis. Although many therapists and theorists have made significant changes and modifications to Freud's original framework of Psychoanalysis over the last 100 years. In fact, much of Freud's original sexuality based theory of human psychology has since been discredited.

The basic goal in psychodynamic psychotherapy is to help the client overcome life-interfering patterns of behavioral and emotional responding. This goal is approached primarily through exploring and resolving experiences and conflicts from earlier in the client’s developmental life history.

The idea here is that the client experiences problems in their current relationships because they unconsciously transfer emotional perceptions, feelings and reactions, from earlier life-experiences into their current situation. These unconscious experiences can often reach as far back as childhood and infancy.

For example, a client may come to psychodynamic psychotherapy because they are experiencing intense conflicts with their boss and co-workers. The clinical focus here would be on “disproportionate” and seemingly out of place emotional reactions. If emotions are not realistic for the situation, it’s argued, they may be coming from unconscious memories from the past.

The therapist then directs the client in an exploration by talking, of the basic themes and patterns that define the work related conflict. Significant childhood experiences are also explored to look for similar emotional and relational patterns.

Working with "The Inner Child"

A particular emphasis is often placed on looking at early parent-child and sibling relationships. In the work-related conflict described earlier, there may be “displaced” feelings with parents or other significant adults from the client’s past. Some therapists address these concepts in the present as though they were going on right now.

Unresolved conflicts from problematic sibling relationships may also play an important role. In this case, maladaptive interaction patterns with coworkers may be partly derived from early maladaptive interaction patterns with siblings.

Separating the Past from the Present

The psychodynamic therapist works from the perspective that emotional suffering and negative social interaction patterns in the present can be greatly improved through learning to tell the difference between current and past experiences.

For example, the client in the work-conflict scenario can learn to say to herself: “I’m not really angry at my boss, this is anger towards my mother for being so cold, distant and unsupportive when I was little. But that wasn’t her fault because she had and serious illness at the time.”

Many, psychodynamic therapists also work from the premise that surfacing, acknowledging and in some cases, meeting un-met emotional needs from childhood in the present, can have powerful therapeutic effects.

Many of these early needs and conflict patterns are said to emerge in the therapeutic relationship itself through what psychodynamic therapists call “psychological transference.” Accordingly, the client may transfer childhood perceptions and emotional expectancies onto the person of the therapist.

To the extent that such needs and expectancies are unrealistic, they can be explored and resolved in the present therapeutic relationship. This is done through the same process of learning to distinguish the past from the present that was used to resolve the work-related conflict in the earlier example. In that example, the process of transference was from parent to boss and from siblings to co-workers as opposed to from parent to therapist.

Many psychodynamic therapists feel and work from the assumption that some positive aspects of the “transference relationship” are necessary for the client’s optimal learning and therapeutic growth. For example meeting the client’s need to feel emotionally safe and protected (basic attachment needs) when talking about sensitive and deeply personal experiences can really facilitate the entire therapeutic process.

Psychodynamic Psychotherapy is classically considered more appropriate for people who have higher levels of verbal intelligence. Therapy can last from months to years depending on the theory and methods applied by a given psychodynamic psychotherapist.

Are there lots of studies to support the effectiveness of psychodynamic psychotherapy?

There are not as many strong empirical supports for positive claims of the general therapeutic effectiveness of psychodynamic psychotherapy as there are for other forms of therapy.

For example, cognitive behavioral therapy has been empirically demonstrated to have rapid and long lasting positive therapeutic outcomes across a large variety of emotional and behavioral challenges and disorders. Psychodynamic psychotherapy has not.

In cognitive behavioral therapy the emphasis is more on identifying dysfunctional or life-interfering patterns of thinking feeling and behaving and applying science-based strategies for making positive changes in these patterns.

Some highly effective evidence-based or best-practices forms of psychotherapy retain parts of what may be considered psychodynamic theory but put a much stronger emphasis on changing current patterns of interaction in emotionally healthy and sustainable ways.

For example "Emotion Focused Therapy for Couples" (EFT), is an “attachment based” approach that is more effective than any other psychotherapeutic approach for helping couples save and transform their relationships in as few as 7 sessions of structured therapy. EFT works very strongly to change contemporary attachment “behaviors” that have often been established in early caregiver child interaction-patterns.

Most evidence-based or clinically results-driven therapy approaches no longer emphasize the idea of transference in the classical, psychodynamic sense of the term. Instead, they prioritize building a strong therapeutic alliance or relationship between the client and the therapist.

This is because a positive therapeutic alliance has been empirically demonstrated to be one of the most important components of effective psychotherapy, regardless of the particular treatment method being applied by the psychotherapist.

Many weak, incorrect and even clinically harmful concepts and practices from the history of psychodynamic psychotherapy have formed the basis for developing strong treatment practices through a lengthy history of research, clarification and revision. In this way, the work of all psychiatrists, clinical psychologists and professional counselors has been influenced by psychodynamic psychotherapy.