Perhaps one of the most well-known types of therapy, psychodynamic therapy is a therapeutic approach based on the psychoanalytic theory. It that aims to help patients address mental health issues by exploring their thoughts and feelings. When you hear the word “therapy,” this is probably what you imagine. That’s because it’s the predominant therapy modality featured in our pop culture.
How Does Psychodynamic Therapy Work?
The basic assumption of psychodynamic therapy is that our current behaviors and actions, including those that are problematic or self-destructive, are caused by unconscious emotions and thoughts that we aren’t aware of. According to this approach, we unconsciously use defense mechanisms to hide painful memories and experiences from ourselves. These defense mechanisms can include repression, denial, and rationalization.
Psychodynamic therapy can help you better understand the deep-rooted and unconscious factors that dictate your current beliefs, behaviors, thoughts, actions, and emotions. Together with your therapist, you will uncover your deeply buried emotions and thoughts. By gaining insight into these feelings, you can then work on eliminating self-destructive behaviors. Psychodynamic therapy is a very effective strategy for becoming “unstuck” from undesired patterns and behaviors.
The History of Psychodynamic Therapy
Psychodynamic therapy is based loosely on the work and research of famed Austrian psychoanalyst Sigmund Freud’s psychoanalytic theory. The premise of psychoanalytic theory is that psychological problems are rooted in the unconscious minds. Freud believed that people could be cured by unmasking unconscious thoughts and motivations. Psychodynamic therapy has its roots in this theory.
How Does Psychodynamic Therapy Differ From Other Therapies?
The major factor that makes psychodynamic therapy different from other types of therapy is its particular focus. Psychodynamic therapy is focused on past experiences and how we unconsciously process feelings and emotions related to those experiences. It is thought that these things are what shapes current behavior.
Cognitive behavioral therapy (CBT), is based on the idea that conscious thoughts impact current behavior. CBT helps patients become aware of and change maladaptive thinking patterns. CBT does not dive deep into the unconscious or past experiences like psychodynamic therapy.
Also, cognitive-behavioral therapy tends to be short-term, time-limited therapy. Whereas, psychodynamic therapy tends to be longer. If you are considering this option, it’s important to note that it could require at least a year of sessions before seeing the full scope of results.
People often confuse psychodynamic therapy with psychoanalysis but they are not the same. Psychodynamic therapy is loosely based on psychoanalytic theory. However, psychodynamic therapy is much shorter in duration. Psychoanalytic therapy can last years as it can take a very long time to bring deeply repressed feelings to the consciousness. Therapists who perform psychoanalysis must have an additional five years or more of training. This teaches them how to address the deepest unconscious levels of a client’s mind.
Many people view psychodynamic therapy as the “express lane” version of classic psychoanalysis. It is true that psychodynamic therapy was designed to provide a more concise alternative to psychoanalysis. Therefore, it tends to last a year or less. Additionally, a therapist who performs psychodynamic therapy does not have to be a certified psychoanalyst. However, they usually have advanced training in psychodynamic theory.
Is Psychodynamic Therapy Effective?
Whether or not psychodynamic therapy is effective has been hotly debated.
Until recently, it was mainly believed that there was very little empirical research to support the idea that this specific branch of therapy works for things like anxiety and depression. That is because previously, there had been very little formal research and evidence into the efficacy of psychodynamic therapy. Many of Sigmund Freud’s ideas were based on case studies, which were not exactly empirically sound. And early practitioners were more focused on clinical work rather than conducting research studies. However, in recent decades, that has changed and many more research studies have been conducted.
In the research, there has been strong support for the use of psychodynamic therapy in the treatment of borderline personality disorder. It is quite effective for personality disorders, in particular. A meta-analysis review found that this particular type of therapy was significantly more effective for the treatment of personality disorders compared to control studies.
Another meta-analysis compared the effectiveness of psychodynamic therapy to various short-term psychotherapies. Patients in these studies were diagnosed with either personality, mood disorders, or anxiety disorders. The therapy took place long-term, over a year. This meta-analysis, published in the Journal of the American Medical Association found that patients who received psychodynamic therapy significantly benefited compared to controls. Furthermore, improvements were noted long after therapy ended.
Which Conditions Can Psychodynamic Therapy Treat?
Psychodynamic therapy can be worthwhile in addressing a variety of issues. Research suggests that psychodynamic therapy can be as effective as cognitive-behavioral therapy. What’s more, the benefits of psychodynamic therapy appear to increase over time. Here’s a rundown of the mental health and interpersonal problems that it is commonly used for:
- Depression
- Relationship problems
- Social and generalized anxiety
- Self-destructive behaviors
- Phobias
- Sexual problems
- Psychosomatic disorders
- Substance abuse disorders
- Bulimia nervosa
- Anorexia nervosa
- Obsessive-compulsive disorder (OCD)
Benefits of Psychodynamic Therapy
This particular kind of therapy can enable you to:
- Identify unhealthy patterns. This type of therapy offers a way for you to identify dysfunctional patterns that are holding you back. One of the main goals of this form of therapy is to identify defense mechanisms that result in unhealthy or maladaptive behaviors. The thought is that by recognizing patterns, you can then change them.
- Understand avoidance. Avoiding your emotions is bad for your mental health. People who abuse substances may do so because of unhealthy avoidance patterns. Unfortunately, avoidance is often automatic and ingrained in our behavior. We don’t even realize that we’re doing it. Psychodynamic therapy helps you recognize and overcome this defense mechanism. Once you become more aware of avoidance, you can learn to deal with things straight on rather than by using avoidance.
- Access emotions that are just below under the surface. People have a tendency to repress painful emotions, such as sadness, anger, and shame. However, negative emotions are a part of life. And, it’s healthy to deal with these emotions when they arise. Psychodynamic therapy can help you become more aware of these feelings so that you can learn how to cope with them in healthy ways.
- Improve relationships. Psychodynamic therapy often focuses on relationships. It is believed that earlier relationships affect your current ones. For instance, perhaps your mother left the family when you were four years old. You have always had trouble dealing with being abandoned. Therefore, you avoid getting too close to anyone and sabotage relationships before they even start. This leads to a series of relationships that go nowhere. Psychodynamic therapy can help you identify these dynamics and learn how to make positive relationship changes.
What Techniques Are Used in Psychodynamic Therapy?
Psychodynamic therapy uses a variety of techniques and interventions. Here are some of the most common ones.
Free Association
One of the hallmarks of psychodynamic therapy is the use of free association. Many people believe that the purpose of free association is to help you uncover hidden memories. However, this is not entirely true.
Free association originated with Freudian theory. He recognized that the human mind is designed to avoid emotional pain at all costs. It creates defense mechanisms that trick us into thinking we are not in pain. These defense mechanisms include denial, repression, transference, and projection. As a result, your true feelings and thoughts about people, experiences, and self may be very different than what you tell yourself.
Free association offers a way to get around these mechanisms. It helps us get to painful memories that need to be healed. Free association also allows you to say what you think without judgment or denial. This works great for people who struggle with self-assertiveness. It can empower you to get over the urge to keep your feelings bottled inside out of a need to avoid conflict.
So, how does free association work? Your therapist may start by encouraging you to relax and perhaps gently shut your eyes. You’ll be asked to say the first thing that pops into your head — without worrying that it will sound unacceptable or weird. The therapist will listen for things that could relate to the current problems in your life. Together, you will process what came out of your free association and talk about ways to deal with those feelings that are deeply buried.
Here’s an example: Let’s say that your wife cheated on you in the past. You believe that you are over the betrayal. However, small things that she does irritate you. In reality, you are not over the pain. During free association, the therapist says partner, and you say “betrayal.” This is a pretty good indication that you have not processed the hurt and pain. Your therapist will help you process these feelings and deal with the betrayal.
Dream Analysis
Psychodynamic theory calls for the exploration of one’s fantasy life, and this includes the psychological meaning behind dream imagery. Like some of the other interventions used in psychodynamic therapy, dream interpretation is rooted in psychoanalytic theory. Sigmund Freud believed that dreams are a way to get to the unconscious. He thought that dreams represent wish fulfillment. Dream analysis is used to tap into this unconscious material.
With dream analysis, you relate your dream to your therapist. He or she then helps you piece together repressed feelings that may be popping up in symbols, figures, and scenarios that are present in your dreams. Analyzing these dreams helps you gain a better and deeper understanding of yourself.
Transference Interpretation
Transference is a psychoanalytic concept where feelings for one person are transferred or applied to another. This theory hypothesizes that desires and feelings unconsciously retained from childhood relationships are transferred onto new relationships.
Example: Your boss at work loosely reminds you of your grandfather who was often irritable and rude. So, you become somewhat anxious whenever your boss calls you into his office.
Transference is often seen in the therapeutic relationship. Unconscious thoughts, feelings, and behaviors may be transferred onto the therapist. What’s the problem with transference? Transference encourages us to relate to others based on past experiences, which may or may not apply to the current situation at hand. In fact, it might be quite different than reality. So, for example, perhaps your boss is nothing like your grandfather. However, because he is a figure of authority, you react the same way. This causes you to miss out on a possible promotion because you are afraid to ask for one. You are afraid that your boss will react in the same way that your grandfather used to when you were young. However, there is no real evidence that this would be the case.
During sessions, your therapist will help you identify and interpret transference. Once emotions, beliefs, and ideas that are stuck in the unconscious are identified, you then come up with a game plan for dealing with them.
Other Psychodynamic Approaches
What if traditional psychodynamic therapy isn’t quite right for you? The good news is that various approaches arise from psychodynamic theories. These are offshoots of psychodynamic therapy.
One of the most familiar of these approaches is object relations. This type of therapy mainly focuses on relationships. Object relations theory was developed during the early part of the 20th century. Psychologist Karl Abraham first came up with the idea of object relations in a 1927 paper. However, British psychologist Melanie Klein was credited with developing the theory as we know it today. Psychiatrist Margaret Mahler later expanded on this theory.
Object relations theory ties back to Freud’s idea that human beings are primarily motivated by a need for contact and relationship with other humans. The belief is that relationships are more crucial to one’s personality and sense of self than are individual drives and abilities.
In object relations theory, the word “object” relates specifically to people or things that symbolically represent a person who played a major role in a person’s life when they were very young. Typically, this person will have been either a mother, father or another caregiver.
It is thought that we create mental images from our early relationships with those people. We are mostly unaware of these images. However, they stay with us throughout life and affect our relationships with others. Our early relationships shape all of our other relationships. That is why object relations therapy is often used in couples counseling.
The goal of object relations therapy is to help an individual unearth early mental images that may contribute to any present difficulties in one’s relationships with others. We can then adjust these images in ways that improve our current interpersonal functioning.
Finding the Right Psychodynamic Therapist
The first step is to look for a licensed social worker, psychologist, psychotherapist, or another mental health practitioner. Next, choose someone who has advanced education or training in psychodynamic therapy. Not all therapists practice this modality. Some graduate school programs emphasize these theories. So, it’s a good idea to ask the therapist if he or she has taken classes in this particular type of therapy.
Aside from finding a therapist with the right experience and relevant educational background, look for a therapist with whom you feel safe, comfortable, and understood. As mentioned earlier, the therapeutic relationship is so important in psychodynamic therapy. Plus, you will be diving deeply into difficult personal issues. This is one of the reasons why it’s so important that you find a therapist that you trust.
Sources
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Emily Mendez received an Ed.S and Masters degrees in counseling from Indiana University. She is a mental health writer and expert in the areas of mental health and substance abuse. As a former private practice psychotherapist, Emily specialized in treating adults and children suffering from depression, anxiety disorders, PTSD, and substance abuse.