psychodynamic therapy — Photo by SHVETS production:

Defining Psychodynamic Psychotherapy

Psychodynamic psychotherapy was born out of traditional psychoanalysis and focuses on gaining insight into unconscious motivations and drives in order to make long-lasting change and increase self-awareness. In other words, there is exploration into how past experiences (unconsciously) impact current behaviors and functioning. Sometimes, the terms psychodynamic therapy and psychoanalytic therapy are interchangeable, and psychodynamic therapy may also be called insight-oriented therapy at times.

The History Behind Psychodynamic Psychotherapy

Psychodynamic therapy stems from psychoanalysis, which is often associated with Sigmund Freud. Freud’s work split off into other models influenced by Anna Freud, Melanie Klein (Object Relations Therapy), Alfred Adler (Individual Therapy), Carl Jung (Analytical Therapy), etc. Psychodynamic psychotherapy has adapted throughout the years (i.e. not laying on a couch). There are many different flavors of psychodynamic therapy, but they tend to have some overlap in goals and interventions.

Psychodynamic therapy photo — Photo by Alex Green:

How Does Psychodynamic Psychotherapy Work?

Psychodynamic therapy works by striving toward several goals, including uncovering unhelpful unconscious dynamics (both the emotional unconscious and cognitive unconscious), gaining insight into how the past affects present concerns, and defying defense mechanisms to improve functioning. There are several techniques and interventions used to move toward achieving the above goals.

Free Association is speaking without filtering words in order to try to dig deeper into the unconscious. This may sound silly, but it’s really helpful to get past the logical and defensive mental processes and find the emotional processes underneath. A psychodynamic therapist may ask, “What’s on your mind today?” “Tell me more,” or “What does that make you think or feel?” The point is to be unstructured and find connections between things shared.
Dream Analysis is when dream content is interpreted to find themes or representations that connect to one’s unconscious (latent content). It is not necessarily common these days, but when used appropriately, it can be very powerful. For example, if you have a dream about anxiously running away because bees are chasing you, could you be running from and avoiding all the stressors in your life? If you dream about being unable to escape a room or being trapped in a mud puddle, is it possible you feel stuck in some aspect of life?
Interpretation refers to the therapist’s explanations and connections of what a client is communicating (their conscious thoughts) in order to guide the client toward uncovering unconscious content. Interpretations can be “lightened” to lessen the chance of resistance. Examples may include, “I wonder if you’re sabotaging because success is scary,” “Is it possible you are trying to rescue your coworkers because your mother did not rescue you from your pain?” or “It seems like you may be avoiding the spotlight, perhaps because of how your father criticized you when you drew his attention.” More information about interpretation in therapy can be found here.
Transference Analysis (Transference) is interpreting how a client’s previous attachment dynamics are projected in the current relationship with their therapist. This technique takes time to and trust to implement, as it can be quite vulnerable, but also potent. An example of this may be, “It seems you are nervous to tell me your emotions, and I remember you telling me your mom always invalidated your emotions. I wonder if this is connected.” In this example, the client previously learned that expressing emotions to their mother was hurtful, so they unconsciously assume the therapist’s reaction to emotional sharing will be hurtful as well.

Is Psychodynamic Psychotherapy Helpful?

A super interesting and hopeful note about the efficacy of psychodynamic therapy is that change actually continues to occur after treatment has ended, whereas the benefits of other forms of therapy tend to decrease after termination of treatment (Shedler, 2010). This is because psychodynamic psychotherapy attempts to go beyond symptom reduction (but symptom reduction does occur) to achieve long-term change. There is often an increase in self-awareness and emotional insight, which leads to emotional growth, distress tolerance, and even improved communication with others. Additionally, treatment often leads to corrective experiences resulting in healing previous pain points.

Limitations of Psychodynamic Psychotherapy

Unfortunately, there’s no treatment that is perfect and curative. There can be several disadvantages to psychodynamic therapy.

Worse Before Better: Often in psychodynamic therapy, clients can go through a period of feeling worse before they start to feel better. This is because it doesn’t feel good to face pain and figure out those unconscious dynamics that negatively impact functioning. Think about it as the pain of digging out the embedded splitter(s) before treating the infection caused by it.
Unstructured and Unspecific: For some, there is a preference for clear and structured treatment geared toward specific goals. Psychodynamic psychotherapy is not manualized or linear, since the unconscious can be quite messy.
Invisible Progress: Progress in psychodynamic therapy is usually invisible and intangible (but it most definitely happens!). It may take a while to see the shift in relational or emotional dynamics, whereas treatments that focus on behavioral change are often more immediately observable. This is because growth from psychodynamic treatment is more internal. However, invisible doesn’t mean non-existent! It’s like not noticing you’re getting taller until you go to the doctor and you’ve grown an inch!

Summary

Psychodynamic psychotherapy stems from Freud’s psychoanalytic work and utilizes interventions such as free association, dream analysis, interpretation, and transference analysis to move toward goals such as uncovering the unconscious, gaining insight, and confront maladaptive defense mechanisms. This often results in symptom reduction, long-term change, increased emotional insight, increased self-awareness, improved communication, and healing past pain.

While psychodynamic psychotherapy may not be a good fit for all, it is a strong, helpful form of treatment with many benefits. Are you interested in psychodynamic therapy and located in Virginia, Pennsylvania, or a PsyPact state? Check out my bio here to see if we’d be a good fit!

References

Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 65(2), 98-109. https://doi.org/10.1037/a0018378

What is Psychodynamic Psychotherapy?