What is Psychodynamic Therapy???

Psychodynamic Therapy Defined….

 “Psychodynamic theory (sometimes called psychoanalytic theory) explains personality in terms of unconscious psychological processes (for example, wishes and fears of which we’re not fully aware), and contends that childhood experiences are crucial in shaping adult personality.” (Borstein, 2013).  According to my course textbook, psychodynamics involves the interplay of forces within the mind, (Corsini & Wedding, 2010).  Psychiatric symptoms are interpreted as byproducts of inner conflict between conscious and unconscious parts of the psyche.  Corsini & Wedding (2010) state:  “psychotherapies that follow in a psychoanalytic tradition are referred to as psychodynamic treatments.  They retain the central dynamic principles of psychoanalysis but do not make use of the metapsychology, or formal structures of the mind” (p. 17).

Key Assumptions of Psychodynamic Theory

“Primacy of Unconscious” (Borstein, 2013).

According to psychodynamic therapy, “the majority of psychological processes take place outside conscious awareness.” (Borstein, 2013).   Consequently, this perspective interprets behaviors, thoughts, and feelings as having both manifest and latent meanings (Barth, 2014).   With this in mind, a primary goal of this therapy method is to explore those aspects of ourselves that are unconscious and bring them into awareness (Shedler, 2010).  Interestingly, research on the brain has confirmed the notion that many of the mind’s inner workings remain outside our awareness (Borstein, 2013).

The Role of Childhood Experience

“A third characteristic shared by psychoanalytically oriented clinicians is a belief that childhood experiences influence personality development, current relationships, and emotional vulnerabilities” (Corsini & Wedding, 2010, p. 21).  Borstein, (2013) adds that while other approaches also acknowledge the influence of childhood experiences, psychoanalytic approaches state they are determinants of our personality.   Corsini & Wedding, (2010) add that personality is a byproduct of the interaction between biological factors and personal experience.  These lasting personality characteristics are often experienced as defense mechanisms, and basic attitudes towards life (Corsini & Wedding, 2010).

The Principle of Causality.

“The third core assumption of psychodynamic theory is that nothing in mental life happens by chance—that there is no such thing as a random thought, feeling, motive, or behavior. This has come to be known as the principle of psychic causality” (Borstein, 2013).  This assumption stems from the previous assumption regarding the primacy of unconsciousness.  Behaviors, attitudes, and thoughts are not random and meaningless.  They have a meaning that reflects something unrecognized within our minds.

Transference & Countertransference

Corsini & Wedding, (2010), state that “in psychoanalysis, the analysis of transference is fundamental to treatment” (p. 18).  Transference is a term that refers to a Freud’s assertion that clients can be observed to transfer feelings onto their therapist that originate in early relationships.  Countertransference, then refers to the transference of a therapist’s emotions from early relationships onto the client.  By attending to the issue of transference and countertransference in therapy, it is possible to examine the impact of the unconscious and early childhood experiences on a client’s present-day functioning (Corsini & Wedding, 2010).

Tenents and Features…

Tenents of Psychodynamically-Oriented Practitioners

Barth, (2014), describes psychodynamic therapy as a talk therapy that involves recognizing, expressing, and understanding both latent and manifest meanings in our thoughts, feelings and behaviors.  This requires therapists to listen for defense mechanisms and feelings of resistance.  Examining how this exists as a form of self-protection is useful.  Patterns of interaction & behavior can help understand how relationships & aspects of the inner self reflect repetitive patterns (Barth, 2014). These repetitive patterns tend to reflect early unresolved experiences originating in childhood. Finally, the therapeutic relationship, and any transference issues are made a “subject of inquiry” as symptomatic of unresolved issues in the unconscious.

“Psychodynamically oriented practitioners…agree on certain basic tenents: (1) provide a setting in which the client feels safe; (2) help clients recognize ways to avoid distressing emotions; (3) be aware of the importance of relationships; (4) be aware of a client’s sense of self; (5) pay attention to the therapeutic relationship; (6) look for patterns of behavior that have been repeated over time; (7) think about and explore conscious meaning (Barth, 2014, p. 23).”

Features of Psychodynamic Theory – (Shedler, 2010).

The above list of tenants provide a good overview of the psychodynamic approach.  In his article “The Efficacy of Psychodynamic Psychotherapy,” Shedler, 2010 describes what makes this approach unique in comparison to other therapy methods.   Psychodynamic therapy is focused on more than simply on present-day symptom reduction.  It is aimed at provide a historical context for an individual’s dysfunction in order to build up their coping skills and self-awareness.  These goals are accomplished in the context of a therapeutic relationship that can empower a client to engage in self-exploration (Shedler, 2010).  What follows is a listing of seven unique features of psychodynamic therapy:

“Seven features reliably distinguished psychodynamic therapy from other therapies…(1) Focus on affect and expression of emotion…(2) Exploring attempts to avoid distressing thoughts and feelings…(3) Identifying recurring themes and patterns…(4) Discussion of past experience (developmental focus)…(5) Focus on interpersonal relations…(6) Focus on the therapy relationship…(7) Exploration of wishes and fantasies (Shedler, 2010, p. 11-12).”

Psychodynamic Theory “In Action”

What Change Looks Like

“Change is seen as a gradual process of (1) opening up to self-discovery, (2) discovering of relating and perceiving that stand in the way of current functioning, (3) finding ways to disentangle the influences of the past from the present and, (4) finding new ways to cope (Corsini & Wedding, 2010, p. 38).”   Messer, (2013) notes thatht he following are key mechanisms of change: (1) an understanding of the role of affect; (2) insight into transference issues; and (3) a therapeutic alliance.  For example, examining one’s way of relating and perceiving can happen by gaining insight into transference issues.  Opening up to the process of self-discovery can happen through a process of free association.

Purpose of Interventions

What exactly is the useful purpose of examining the unconscious?  Is it always necessarily useful to discuss one’s childhood in order to ascertain the pragmatic solutions to present-day problems?  According to my textbook, what follows are the theoretical reasons underlying the psychodynamic approach:

Purpose One: “to uncover inner problems that had been disguised as symptoms (Corsini & Wedding, 2010, p. 39).

According to this approach, it is useless to develop a solution without an understanding of the problem’s source.  As stated earlier understanding the unconscious is a primary element of this method.  Therefore, the first step towards healing and growth occurs as an individual understands the meanings expressed in various symptoms.  While they may appear unrelated and random, this asserts they are likely related to early unresolved experiences in one’s childhood.

Purpose Two: “To become integrated (Corsini & Wedding, 2010, p. 39)”

According to this approach internal conflict is a reflection of the fact that latent and manifest components of the self are at odds with one another.  The solution, therefore, is a full integration of those aspects of oneself that are at odds.  An awareness of those unconscious aspects of the self is just a first step.

Purpose Three: “To uncover the sources of past pain that may be embedded in the present (Corsini & Wedding, 2010, p. 39)”

This approach is useful in addressing unresolved pains of our childhood and examining how they influence our daily lives in the present.  This historical approach is helpful in contextualizing the “how come” and why certain experiences keep repeating in our lives.

Purpose Four: “Discover what stands in the way of appropriate actions for the self (Corsini & Wedding, 2010, p. 39).”

Finally, this approach is useful in addressing an inexplicable stuckness, or why even the “best plans sometimes go nowhere because of other forces within the patient” (Corsini & Wedding, 2010, p. 39).   It appears to me that this approach insists upon an understanding the problems at their core.  The problems are, in this respect, not what they might appear on the surface.  Instead they often reflect unresolved aspects of our history and unconscious.

When is this Approach Useful?

This approach is not useful when a “client needs immediate intervention, has no access to feelings, is not able to think abstractly, or confused/psychotic” (Barth, 2014, p. 24).  It is useful when a client is” (1) interested in gaining insight into their feelings, thoughts, and behaviors; (2) can tolerate the feelings and thoughts that emerge; (3) displaying resistance and disengagement; (4) displays transference issues. Barth, 2014).

References

Barth, F. D. (2014). Contemporary Psychodynamic Models. In Integrative Clinical Social Work Practice (pp. 17-28). Springer New York.
Bornstein, R. (2013). The Psychodynamic Perspective. In R. Biswas-Diener & E. Diener (Eds), Noba textbook series: Psychology. Champaign, IL: DEF publishers. DOI:nobaproject.com.
Corsini , R.J. & Wedding, D. (2010). Current psychotherapies. John Wiley & Sons, Inc.

Messer, S. B. (2013). Three mechanisms of change in psychodynamic therapy: insight, affect, and alliance. Psychotherapy, 50(3), 408.

Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. The American psychologist, 65(2), 9-25.

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