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What is psychodynamic psychotherapy?

What is psychodynamic psychotherapy?

Psychodynamic psychotherapy describes a particular approach to psychological treatment which has its roots in psychoanalysis, but over time has been influenced by new developments in neuropsychology, attachment theory, humanistic, transpersonal and body oriented approaches to human nature. There are many different schools of psychodynamic psychotherapy (Freudian; Jungian; Kleinian; Object Relations; Gestalt; Lacanian; Cognitive Analytic; attachment based) and the list keeps growing.

All psychodynamic approaches seek to better understand the self and they use the therapeutic relationship to illuminate aspects of the self that were formerly hidden, misunderstood or neglected.

Despite their differences, there are certain processes and techniques which distinguish all psychodynamic psychotherapies from other types of psychological therapy. These have been identified as follows (1):

• A focus on experiencing and expressing emotion.
• Paying attention to attempts to avoid upsetting thoughts and feelings.
• Describing and understanding why certain life patterns keep repeating.
• Exploring and understanding how past experiences influence the present.
• A focus on interpersonal relationships and their impact on emotional life.
• Paying attention to the therapeutic relationship.
• A willingness to explore fantasy life and concerns in a non directive manner.

The following section explains how these techniques and processes work together to create a therapeutic experience for the client.

How does psychodynamic psychotherapy work?

The therapist helps the client to feel, identify and make sense of feelings that may be troubling, contradictory or confused. This emotional insight differs from being only intellectually aware of the problems. Emotional awareness enables lasting change to take place on a much deeper level.

Because certain thoughts and emotions are so troubling they are often actively avoided. This avoidance keeps unhelpful patterns in place. The therapist makes it safe enough to explore these concerns and actively brings avoidances into awareness. Increased awareness improves life choices.

Sometimes people are very aware of their self destructive patterns but feel helpless to change them. The therapist, by paying attention to how the client repeats these patterns within the session, helps clients to understand and change the patterns.

Psychodynamic psychotherapy does not focus on the past for its own sake.  It seeks to reveal how current difficulties are driven by long held beliefs and feelings that, once relevant, are no longer helpful. These emotions and thoughts filter the way in which the here and now is experienced. The goal is not to live in the past but to live more fully in the present by learning to adapt to new circumstances.

Problematic patterns of relating to other people interfere with a person’s ability to meet their own emotional needs and goals in life. Psycho -dynamic psychotherapy pays great attention to how clients interact with other people, so that clients can learn to better meet their needs.

The therapeutic relationship between client and therapist provides an ideal opportunity not only to understand what is happening in other relationships and where things can go wrong but to experience something different …in effect, to rework these patterns with the therapist.

The style of sessions is usually nondirective. Clients are encouraged to speak their mind and to reveal their hopes, dreams and fears. By helping the client to put what deeply concerns them into words, without judging them and without increasing the pressure by setting arbitrary goals, the therapist is ideally placed to make links that previously lay hidden.

Who might benefit from psychodynamic psychotherapy?

There is evidence that patients who receive psychodynamic psychotherapy are not only able to maintain gains made in sessions but that they continue to improve over time due to an increased ability to put their new knowledge to work in everyday life (2).

Evidence supports the efficacy of psychodynamic psychotherapy for depression, anxiety, panic, somatoform disorders (body related issues), eating disorders, substance - abuse and personality disorders. Psychodynamic psychotherapy has proved particularly effective as a therapy for clients with personality disorders. This may be because the process of treatment not only teaches clients new skills, but offers a reparative relationship in which to practice them. This means that the new learning is more profound and becomes ‘wired in’ on an emotional and a neurophysiological level.

Studies have shown that clients emerging from psychodynamic psychotherapy show lower scores for depression, anxiety, guilt, shame, feelings of inadequacy, and fears of rejection but significantly higher scores for satisfaction in pursuing long term goals, enjoying challenges, contentment, empathy for others, assertiveness, ability to hear and  benefit from emotionally threatening material and resolution of past painful experiences.

Psychodynamic psychotherapy therefore does not just focus on alleviating symptoms of distress; it helps to create positive resources, new capacities and skills in relating. It does this partly through increasing the client’s self awareness and partly through offering a safe relationship in which this new way of living can be tested.

(1) Blagys, M.D. and Hilsenroth, M.J. (2000). Distinctive activities of short-term psychodynamic –interpersonal psychotherapy: A review of the comparative psychotherapy process literature. Clinical Psychology: Science and Practice, 7, 167-188.
(2) Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, Vol.65, No.2, 98-109.

(Acknowledgement – This document owes much to Shedler 2010.)

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