Psychodynamic therapy involves

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By Jillian Levy, CHHC

April 28, 2020

According to Good Therapy website, psychodynamic therapy was developed as a “simpler, less-lengthy alternative to psychoanalysis.” Never heard of this approach before and wondering, “What is psychodynamic therapy?”

In simple terms, it’s a way of interpreting a client’s past in order to understand how it affects his or her present moods and behaviors.

Someone’s past is considered the foundation and formation of that person’s psychological processes, so gaining insight into one’s earlier experiences can help explain why she or he is dealing with certain symptoms, such as depression, and what that person can do to improve his or her coping skills.

What Is Psychodynamic Therapy?

The definition of psychodynamic therapy (also called insight-oriented therapy) is “a form of therapy that focuses on unconscious processes as they are manifested in a person’s present behavior.”

The psychodynamic approach involves a client and therapist examining unresolved conflicts from the client’s past that have contributed to unwanted thought patterns, habits and symptoms.

These “past conflicts” often include dysfunctional relationships, often during childhood, which may lead to problems such as addictions and depression.

Psychodynamic therapy is one form of psychoanalytic therapy (or talk therapy between a therapist and patient). Compared to other forms of psychoanalytic therapy, it usually requires less frequency and number of sessions in order to help a patient reach her or his goals.

Something else that makes it stand apart is that it it focuses on mental/emotional experiences, rather just symptoms and behaviors.

Related: What Is Art Therapy? Benefits & How It’s Used to Help Heal

Types

It’s possible to practice psychodynamic therapy in a group or family setting, as a couple, or as an individual.

Some clients use this approach with their therapists for only a short period of time, while others rely on it as a long-term therapy approach spanning several years or more.

Psychodynamic therapy is actually considered a category of therapies rather than a single type.

Here are some psychodynamic therapy examples and approaches that therapists use:

• Brief PDT, which is generally conducted over the course of only a few sessions. This may be used to help victims of rape, accidents, terrorism or other situation.
• Psychodynamic family therapy, used to help resolve conflicts.
• Open dialogue therapy, in which information is freely shared by the client.
• Music therapy, in which clients expresses themselves through use of music or another form of art, sometimes while also talking.
• Journaling/writing to share emotions, fears, thoughts, etc.

Goals/How It Works

What is psychodynamic therapy used for? The primary goals of psychodynamic therapy is to improve a client’s self-awareness and understanding of how the past has influenced current behavior.

A client might wish to change an aspect of her or his identity, personal narrative or personality or to give up unwanted habits. It’s believed that this can happen more easily when the therapist helps the client reveal unconscious content of his/her psyche.

What is a psychodynamic approach exactly, and how does it work?

• During  a session a therapist and client discuss the client’s emotions, thoughts, early-life experiences and beliefs. This is done via open-ended dialogue and questions.
• Part of the process is recognizing, acknowledging, understanding, expressing and overcoming negative and contradictory feelings and repressed emotions.
• The patient commits to deeply exploring and analyzing earlier experiences in order to tie him/her to present emotions and relationship patterns.
• With help from the therapist, the client can change her/his recurring thought patterns and let go of unhelpful defense mechanisms and unhealthy relationships.

Theory, Perspective, Key Concepts

Psychodynamic theory is based on the belief that behavior is influenced by unconscious thought. This theory is the basis for the “Psychodynamic Diagnostic Manual” (PDM), which was released in 2006 and is used as an alternative to the “Diagnostic and Statistical Manual” (DSM).

The key difference the DSM and PDM is that DSM focuses on observable symptoms associated with mental health conditions, while the PDM describes subjective experiences.

What are the key features of psychodynamic approach?

• The focus is on the psychological roots of emotional suffering. Self-reflection and self-examination are important concepts for getting to the root of one’s problems.
• PDT theory states that the relationships and circumstances of early life continue to affect people as adults. The relationship between therapist and patient is used as a “a window into problematic relationship patterns in the patient’s life.”
• Uncovering defense mechanisms is also a key concept. These can include denial, repression and rationalization, which can contribute to relationship troubles and addictive behaviors.

Benefits/Uses

Is psychodynamic therapy effective? According to the American Psychological Association, research has shown that psychoanalytic theory can be clinically applied to a wide range of psychological disorders, including:

• Depression
• Anxiety
• Personality disorders
• Addictions/substance abuse
• Social anxiety disorder/difficulty forming or maintaining personal relationships
• Eating disorders
• Panic disorders
• Post-traumatic stress disorder (PTSD)
• Physical ailments, such as chronic pain

1. May Help Reduce Depression and Anxiety

PDT sessions can lead to increased self-esteem and self-compassion, better use of one’s skills/talents and coping abilities, improved relationships, and healthier habits — all of which can help to reduce depression and anxiety symptoms.

A meta-analysis by the Cochrane Collaboration that included data from 33 studies demonstrated hat short-term psychodynamic therapy significantly improved patients’ depression and anxiety symptoms, with modest to moderate clinical benefits.

The analysis included patients with a variety of problems with emotional regulation, including those with general, somatic, anxiety and depressive symptoms, as well as interpersonal problems and social adjustment. In all outcome categories, patients saw significantly greater improvement in the treatment versus the control groups.

When patients were assessed nine months or more after treatment ended, it was found that many experienced lasting psychological changes.

2. Can Help Improve Social Functioning

A meta-analysis published in Archives of General Psychiatry that included 17 randomized controlled trials found evidence that PDT was significantly more effective than a control and just as effective as other types of psychotherapy, such as cognitive behavioral therapy, for supporting those with a variety of psychiatric symptoms and poor social functioning.

3. Could Improve Personality Traits and Relationships

American Psychologist published findings from one meta-analyses comprising 160 studies focused on psychodynamic therapy, featuring more than 1,400 patients with a range of mental health problems. Researchers found substantial treatment benefits, even among patients with personality disorders — considered to be deeply ingrained maladaptive traits that are commonly difficult to treat.

It was found that psychodynamic psychotherapy “sets in motion psychological processes that lead to ongoing change, even after therapy has ended.” With the therapist’s help, patients are able to practice self-exploration, examine their own emotional blind spots and better understand relationship patterns so they can be improved.

What to Expect

During a PDT session, here’s what typically takes place:

• Therapists lead the discussion but usually work with clients to first identify a focus/goal and important issues, which helps create structure for the sessions. Having a clear focus makes it possible to do interpretive work in a relatively short time.
• The client/patient speaks freely and openly to the therapist about anything that comes to mind, including current issues, fears, desires, dreams and fantasies.
• Session normally last about one hour. Frequency is typically once or twice per week, as opposed to three to five days a week with traditional psychoanalysis. Many people are able to attend PDT sessions for a shorter amount of time than other psychoanalytic sessions, although six months to one year (or more) of treatment may still be needed.
• Research shows that patients often experience ongoing improvements after therapy has ended, although follow-up sessions can still be beneficial.

Most therapists do not exclusively practice PDT but rather incorporate it into other therapeutic approaches. You can expect that your therapist may combine PDT theories with psychological techniques used in cognitive behavioral therapy (CBT) or other approaches.

Tips/Techniques

PDT therapists use certain techniques to help clients connect the dots between their past experiences and their current problems.

Psychodynamic therapy techniques and those used in CBT have a number of things in common. CBT seeks to change conscious thoughts and observable behaviors that are destructive.

The firsts step in achieving this is making patients more aware of their own thoughts and behaviors, which is also a focus of PDT.

One distinction between CBT and PDT is that CBT focuses on thoughts and beliefs more, while PDT encourages a patient to explore and talk about emotions more.

Therapists use some of the following techniques to help facilitate PDT sessions:

• Talking openly about about automatic ways of thinking and life patterns that once seemed inevitable or uncontrollable, so they can be reconsidered. Speaking “openly” means discussing anything that comes to mind in an unstructured, uncensored way, which provides access to thoughts and feelings that might otherwise remain outside of awareness.
• “Free association” practices, in which the therapist reads a list of words and the client responds immediately with the first word that comes to mind.
• Identifying new choices and options for existing problems, perhaps by journaling and writing them down.
• Identifying ways in which the client avoids distressing thoughts and feelings, including defense mechanisms that are used. A therapist will often redirect the attention of patients to issues they are avoiding.
• Considering ways that the client can be more flexible and adaptive, perhaps by discussing news ways of coping in difficult situations.
• Role-playing situations so the client can better understand how she/he contributes to relationship patterns.
• Use of Rorschach inkblots, which the therapist presents as the client freely describes what he/she sees.
• Dream analysis to open up discussion about patterns, fears, etc.

Risks and Side Effects

Because a “therapeutic alliance” between client and provider is to important in PDT, it’s crucial to find a therapist who is knowledgeable and properly trained.

Be sure to work with a therapist whom you both feel comfortable with and who is trained specifically in this type of therapy, perhaps as well as CBT. Look for a provider who is licensed, experienced in social work, a psychotherapist or other mental health or medical professional with advanced training in psychoanalysis.

One challenge with this approach may be the cost, considering that several sessions for at least a few months are needed to show improvements. Although it may not be the most cost-effective way to deal with psychiatric problems, it can teach clients skills that can be used for a lifetime, which is why improvements in symptoms often increase with time.

Conclusion

• What is psychodynamic therapy (PDT)? It’s a form of psychoanalytic therapy that focuses on unconscious processes as they are manifested in a person’s present behavior.
• According to psychodynamic theory, relationships and circumstances of early life continue to affect people as adults. Talking about early-life, unconscious problems can help people find ways to solve them and improve their mental well-being.
• Benefits of PDT can include helping manage depression, anxiety, phobias and addictions.
• The goal of PDT sessions is to become more self-aware of one’s thoughts, feelings, perceptions and experiences. A “therapeutic alliance” between therapist and client allows this to happen.
• Psychodynamic therapy vs. CBT: Which is better? CBT (which seeks to change conscious thoughts and observable behaviors) may be used with PDT since they both work to uncover ingrained beliefs and habits. Both have been shown to be effective and for benefits to last or even increase over time.

Psychodynamic Methods of Therapy (PDP) - Psikhologos

The basic premise of any form of psychoanalytic therapy is that the individual's problems that trouble him in the present cannot be successfully resolved without a deep understanding of their unconscious, the origins of which are rooted in the relationship of early childhood with parents and other children in the family. The aim of psychoanalysis is to bring the individual's conflicts (repressed emotions and motives) to his awareness so that he can attempt to resolve them on a more rational and realistic basis. Psychodynamic forms of therapy include traditional Freudian psychoanalysis and later forms of therapy developed from it. nine0003

One of the main methods used by psychoanalysts to recover unconscious conflicts is free association. The client was encouraged to let go of the free flow of thoughts and feelings and talk about whatever came to mind without correcting or discarding anything. To achieve this, however, is not easy. In conversation, we usually try to keep the thread that runs through our remarks and cut out non-essential thoughts. In addition, most of us have learned all our lives to be careful and think before we speak, so thoughts that we consider inappropriate, stupid, or shameful usually go unspoken. nine0003

However, with time and with the support of the psychoanalyst, free association becomes easier. But even when individuals consciously try to give their thoughts a free ride, they suddenly find that something stops them. When the patient becomes silent, suddenly changes the subject, or is unable to recall the details of an event, the analyst assumes that he is resisting recalling certain thoughts or feelings. Freud believed that such blockage or resistance results from the fact that the individual unconsciously controls the sensitive areas that are precisely to be explored. nine0003

Another method often used along with free association is dream analysis. Freud believed that dreams are "a direct path to the unconscious" and that they represent unconscious desires or fears in disguise. He divided the content of dreams into manifest (obvious, conscious) and latent (hidden, unconscious). By discussing the manifest content of the dream and then freely associating it, analyst and client attempt to extract the unconscious meaning. nine0003

In psychoanalysis, the relationship of the patient to the psychoanalyst is considered an important part of the treatment. Sooner or later the client develops strong emotional reactions to the analyst. Sometimes these reactions are positive and friendly, sometimes they are negative and hostile. Often these reactions are not adequate to what happens during psychotherapy sessions. The client's tendency to make the therapist the object of his emotional reactions is called transference: in his relationship to the analyst, the client expresses how he really feels about other people who are or were important in his life. Freud believed that the transference reflects relics, the consequences of childhood reactions to parents, and used this transference of relationships as a means of explaining to the patient the childhood origins of many of his worries and fears. By pointing out to his patients how they react to their fears, the psychoanalyst helps them to better understand their reactions to other people. The following excerpts show how the psychoanalyst first applies transference and then free association. nine0003

Client: I don't understand why you keep coming back to the fact that this step was right for me at that time in my life.

Analyst: This was discovered earlier. You want my approval before you take any action. Here, apparently, the point is that one of your conflicts with your wife is an attempt to get her approval of what you decided to do, and this conflict is now between us.

Client: Maybe so. The approval of others has always been important to me.

Analyst: Let's dwell on this for a bit. Associate freely with the idea of ​​gaining the approval of others. Just let the associations go by themselves, don't push them.

(Woody & Robertson, 1988, p. 129)

Traditional psychoanalysis is a long, intensive and costly process. Typically, the analyst will have 50-minute sessions with the client, several times a week, for at least a year, and often for several years. Many people find that self-study under traditional psychoanalysis is worth the expense, but others cannot afford the expense. In addition, people suffering from acute depression, anxiety, or psychosis usually cannot tolerate the lack of structure found in traditional psychoanalysis and need more urgent measures to alleviate their symptoms. nine0003

In response to these requests, and in response to changes in psychoanalytic theory since Freud, new forms of psychodynamic therapy have been developed that tend to be shorter and more structured than traditional psychoanalysis. Often these forms of therapy are referred to as interpersonal therapy (Klerman et al., 1984). Sessions of these forms of therapy are less frequent, usually once a week. At the same time, the full reconstruction of childhood experiences is given less importance and more attention is paid to the problems that arise in the process of the client's interaction with other people. The method of free association is usually replaced by a direct discussion of the most pressing issues, and the therapist can act in more direct ways, bringing up certain topics on his own and without waiting for the client to bring them up himself. Although transference is still seen as an important part of the therapeutic process, the therapist may attempt to limit the intensity of the transference. A number of studies show the effectiveness of interpersonal therapy in the treatment of depression, anxiety, alcoholism and drug addiction, and eating disorders (Markowitz & Weissman, 1995).

Still basic, however, is the psychoanalyst's belief that unconscious motives and fears are at the core of most emotional problems and that insight and development are essential to healing (Auld & Hyman, 1991). As we will learn in the next section, behavioral therapists disagree with these views.

Behavior Therapy

Behavior Therapy encompasses a range of different therapies based on the principles of conditioning and learning described in Chapter 7. stress and that some methods developed in learning experiments can help to replace maladapted responses with more adequate ones. While psychoanalysis seeks to understand how conflict from the past affects an individual's behavior, behavioral therapy mostly addresses behavior itself. See → nine0003

What is psychodynamic therapy? - Psychological Center "Transfiguration"

Psychodynamic therapy is an approach that involves promoting a deeper understanding of one's emotions and other mental processes. It helps people better understand how they feel and think. What is psychodynamic therapy?

By improving this understanding, people will be able to make better choices in their lives. They can also work to improve their relationships with others and work towards goals that will bring them greater happiness and fulfillment. nine0003

Psychodynamic therapy is rooted in psychoanalytic theory, but is often a less intense and lengthy process than traditional psychoanalysis. While psychoanalysis tends to put a lot of emphasis on the patient-therapist relationship, psychodynamic therapy also puts a lot of emphasis on the patient's relationship with other people in the outside world. What is psychodynamic therapy?

What is psychodynamic therapy?

Psychodynamic therapy is a form of talking therapy. It is based on the idea that talking to a specialist about the problems people are facing can help them find relief and find solutions. nine0003

By working with a psychodynamic therapist, people can better understand the thoughts, feelings, and conflicts that affect their behavior. This approach to therapy also helps people better understand some of the unconscious motives that sometimes influence how people think, feel, and act.

This approach to psychotherapy can help to cope with a mental or emotional disorder. It can promote self-reflection, understanding, and emotional growth.

By better understanding your emotional patterns and their roots, you are better equipped to deal with your problems and develop coping methods that will help you now and in the future. nine0003

Application

Although similar in many ways to psychoanalysis, it is often less frequent and shorter in duration. Like other forms of therapy, it can be used to treat a variety of mental health issues.

• Anxiety
• Depression
• Eating disorders
• Interpersonal problems
• Personality disorders
• Psychological stress
• Post-traumatic stress disorder
• Social Anxiety Disorder
• Substance Use Disorders

Factors that may influence which type of treatment is used include cost-effectiveness, availability, patient preferences, and the severity of the symptoms a person experiences. While cognitive behavioral therapy is a popular and effective approach, evidence suggests that psychodynamic therapy can be just as effective for many conditions. nine0003

Online therapy is another option you might consider. Some research also suggests that online psychodynamic therapy can be just as effective as online cognitive behavioral therapy. ³

What is online therapy?

Psychodynamic therapy helps people recognize repressed emotions and unconscious influences that may be influencing their current behavior. Sometimes people act in a certain way or react to others for reasons they don't really understand. nine0003

Psychodynamic therapy helps people learn to be aware, bear and put their emotional life into perspective. It also helps people learn to express their emotions in more adaptive and healthy ways.

Important Features

Some important aspects of psychodynamic therapy include:

• Pattern Recognition : Psychodynamic therapy helps people learn to recognize patterns in behavior and relationships. People often develop characteristic ways of responding to problems without being aware of these trends. However, the ability to notice them can help people find new approaches to solving problems. nine0064
• Understanding Emotions : Research has shown psychodynamic therapy to be helpful in learning and understanding emotions. By examining emotional experiences, people can better recognize the patterns that contributed to dysfunction and then be more willing to make changes.
• Relationship improvement : Relationships with other people are a key focus of psychodynamic therapy. By working with a therapist, people can understand how they often react to others. nine0064

The therapeutic relationship itself can serve as a way to explore a person's relationship with other people through a process known as transference. This gives people an immediate "in vivo" way to explore and then change their response pattern to improve their relationship.

How effective is it?

How effective is psychodynamic therapy and how does it compare with other forms of treatment?

Evaluating the effectiveness of psychodynamic therapy is somewhat difficult, but studies show that it can be useful in treating a variety of psychological problems. nine0003

One of the reasons why it can be difficult to evaluate the full effectiveness of psychodynamic therapy is that many of the changes it produces are difficult to measure.

As researcher Jonathan Shedler noted in an American Psychological Association (APA) press release, while it is relatively easy to measure changes in specific acute symptoms, it is much more difficult to measure basic personality changes.

Despite this difficulty, research supports the effectiveness and use of psychodynamic therapy for the treatment of various conditions. nine0003

• One notable review published in American Psychologist concluded that the evidence supports the effectiveness of psychodynamic therapy.
• Another study found that it could be as effective as cognitive behavioral therapy (CBT).
• A 2017 review published in American Journal of Psychiatry concluded that psychodynamic therapy is as effective as other known treatments. However, the study authors suggested that further research is needed to determine who benefited the most from this type of treatment. nine0064

What to expect

If you decide to try psychodynamic therapy, you can meet with a therapist weekly or several times a week. Each session usually lasts about 45 minutes and you will continue to see the therapist for several months. In some cases, you can continue classes for a year or more.

During psychodynamic therapy, people are often encouraged to talk about whatever is on their mind. This may include what they are currently experiencing or memories of events that happened in the past. nine0003

One form of psychodynamic therapy, known as brief psychodynamic therapy, is designed to produce results more quickly, often in 25 to 30 sessions.

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