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Psychodynamic Therapy

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CONTENTS

The psychodynamic theory in psychology is an approach Sigmund Freud (1856-1939) and his successive supporters invoked to describe the roots of human behavior. The psychodynamic strategy covers all psychological theories that view the health of individuals as a result of conscious and unconscious influences interacting between and within personality structures.

Although Sigmund Freud’s psychoanalytic approach was the genesis of psychodynamic theory, the psychodynamic perspective as a whole encompasses all theories based on his concepts, including those of Erik Erikson, Anna Freud, Melanie Klein, Carl Jung, and Alfred Adler. The terms psychodynamic theory and psychoanalysis are often mixed up. Keep in mind that Freud’s concepts were psychoanalytic, whereas the word ‘psychodynamic’ relates to both his concepts and those of his adherents. Freud’s psychoanalytic approach is both a therapy and theory.

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Sigmund Freud (1890-1930) formulated a series of theories that provided the backbone of the psychodynamic approach. His concepts are clinically deduced – i.e., premised on what his clients revealed to him during their treatment. The psychodynamic practitioner would generally be managing the patient for anxiety or depression-related disorders. The unconscious mind incorporates cognitive processes that are unreachable to conscious experience but that impact decisions, emotions, or behavior (Wilson, 2002).

The unconscious mind, as per Freud (1915), drives human behavior. Like that of an iceberg, the most crucial function of the mind is the aspect you cannot see. Our emotions, intentions, and judgments are certainly strongly impacted by our personal past encounters and sequestered in the unconscious mind. Our emotional responses as adults (which include psychological issues) are centered in our childhood experiences:

According to psychodynamic theory, childhood events shape our adult personalities. Childhood trauma can linger in the unconscious and induce adult issues. Problems in childhood structure personality by modifying the drives (particularly in psychosexual growth). Even accidental verbal slips have a cause (unconscious). So all actions are determined. Psychodynamic theory is objectivist, believing that our actions are entirely dictated by unconscious forces.

Parapraxes, also widely recognized as Freudian slips or tongue slips, are unconscious feelings and thoughts that transfer to the conscious mind. We disclose our true feelings by accidentally expressing something. Freud felt that there were no coincidences and that every conduct (even slips of the tongue) was meaningful (i.e., all behavior is determined). Personality is divided into three parts: id, ego, and super-ego.

A fundamental and instinctual psychological trait is the id. It includes the sex (life) drive – Eros (that includes the libido) as well as the aggressive (death) impulse – Thanatos. We grow up to be mediators between our implausible id and our external reality. It is the personality’s decision-making facet. The superego contains societal norms and ideals taught from parents and others. The superego and id are constantly at odds with the conscious mind (the ego). This clash causes anxiety, wherein the ego can handle by using defense mechanisms.

Psychodynamic therapy is based on the assessment and awareness of emotional and mental processes from a psychological perspective. It is based on classical psychoanalysis and incorporates concepts from self-psychology object relations, and ego psychology. It was established as a more straightforward, less time-consuming substitute to psychoanalysis.

Psychodynamic therapy is concerned with the origins and development of various psychological states. Thus, it aims to alleviate symptoms and enrich people’s lives and their mental health. Psychodynamic therapists assist patients in gaining insight into their lives and current problems. Additionally, they assess the patterns that individuals evolve over time. To accomplish this, therapists discuss the following life events with a client during therapy:

Emotional thoughts
Childhood encounters
Belief systems and religious views

Recognizing repeated patterns can assist individuals in determining how they prevent anguish or grow coping mechanisms. This understanding may enable them to begin altering those patterns. Psychodynamic therapy is centered on the therapeutic alliance. It can reveal how an individual interacts with their family and friends. Additionally, transference in therapy can demonstrate how a person’s early interactions affect him or her today. Transference is the process of passing on one’s feelings toward a parent, for example, to a therapist. This detailed scrutiny of interpersonal connections can assist individuals in comprehending their role in relationship patterns. It may give them the ability to alter that dynamic.

Families, individuals, couples, and teams can all benefit from psychodynamic psychotherapy. It can be utilized for either short- or long-term treatment. Brief psychotherapy is a goal-directed approach that may require up to 25 sessions. Psychodynamic therapy on a long-term basis may take up to 2 years or more.

Considering the nature of defense mechanisms and the lack of access of the predetermined forces acting in the unconscious, psychoanalytic therapy in its traditional form is a long process that frequently requires between two and five meetings a week over a few years. This method presupposes that symptom decrease alone is insignificant, as if the foundational conflict remains unresolved, additional psychotic symptoms will merely be swapped.

The assessor is typically a ‘blank page,’ revealing very little about themself in order to enable the patient to operate on their unconscious without external influence. The psychoanalyst encourages the patient to acquire insights into their behavior and the significance of their complaints through a variety of interventions, such as inkblots, free association, parapraxes, transference analysis, resistance analysis, and interpretation (including dream analysis).

Inkblots Rorschach inkblots. Due to the lack of accessibility of predetermined forces operating in the unconscious and the nature of defense mechanisms. The Rorschach inkblot is meaningless in and of itself; it is ambiguous (i.e., unclear). What matters is what you make of it. Individuals will perceive things differently depending on the unconscious connections they make. The inkblot is referred to as a measurement tool because the patient interprets the inkblot by ‘projecting’ data from their unconscious mind. Behavioral psychologists including B.F. Skinner, on the other hand, has condemned this strategy as unscientific and subjective.

Freudian Slip. Unconscious feelings and thoughts can transmit to the conscious mind via parapraxes, commonly referred to as Freudian slips or tongue slips. We expose what is truly on our minds when we say something we did not intend to say. For instance, during a speech, a dietitian meant to remark that we should always seek the finest bread but mistakenly said bed. Another instance is when a coworker’s new partner is addressed by the surname of a prior one whom he preferred. Freud felt that tongue slips revealed unconscious thoughts and that there were no coincidences; all conduct (even tongue slips) was meaningful (i.e., all behavior is determined).

Free Association. In psychodynamic psychotherapy, free association is a technique in which a patient expresses whatsoever thoughts come to mind. This technique entails the therapist presenting a word or concept, and the patient responding instantly with the first thing that occurs to them. It is expected that during free association, pieces of repressed memories may resurface, providing a glimpse into the unconscious mind. Free association may be ineffective if the patient exhibits resistance and is unwilling to express his or her thoughts. On the contrary, the appearance of resistance (e.g., an abnormally extended pause) is generally a strong indicator that the client is approaching a significant suppressed thought in his or her mind and that additional exploration by the therapist is necessary.

Freud said that sometimes, his free-associating patients received an emotionally intense and clear recollection to the point of reliving it. This is similar to a “flashback” from a battle or a sexual assault. A distressing memory that is so real that it feels as though it is occurring again is referred to as abreaction. If such an upsetting memory occurs in psychotherapy or with a caring friend and the individual afterward feels better—relieved or cleansed—this is referred to as catharsis. Freud often gained vital understanding into the patient’s difficulties as a result of these extremely emotional experiences.

Dream Analysis. Freud described dream analysis as “the royal road to the unconscious.” He contended that the conscious mind functions similarly to a filter, but is less watchful while we sleep. As a consequence, suppressed ideas are brought to the surface – even if what we remember was changed during the dreaming process. As a result, we must differentiate between a dream’s apparent and hidden content. The former is what we recall. That is, in fact, what it implies. Freud thought that the actual meaning of dreams generally had a sexual connotation, and in his theories of sexual metaphor, he opines the deeper meanings of commonly occurring dream patterns.

Transference. Along with observing communication nuances, psychodynamic therapists are aware that patients commonly unintentionally project their sentiments, aspirations, anxieties, and grudges toward real persons in their life and these might be passed onto the therapist. Transference is a term that refers to the process by which individuals transmit their emotions from the original person to the therapist as a target of those sentiments. Although patients do not always identify transference when it happens, the psychodynamic therapist can understand the correlation, guiding the patient in locating the real origin of those emotions. They frequently involve individuals who represent unsolved problems in the individual’s life and may even indicate misdirected shame or guilt that the individual felt in these interactions.

On the other hand, therapists may have unconscious sentiments toward their patients at any point during therapy, as they, too, are human. Countertransference is a significant feature in psychodynamic treatment. Therapists are educated to identify their own issues in order to minimize their undue effect in therapy. As a result, countertransference can be employed by the therapist to obtain a greater understanding of the patient’s perspective and to approach those challenges appropriately.

All of the therapies listed below are based on psychodynamic theory, however they utilize the concept in different ways.

Brief Psychodynamic Therapy. The term of brief psychodynamic therapy distinguishes it from other psychodynamic therapies. This form of treatment usually takes only a few consultations, or just one. Sometimes all it gets to address a problem is a few key explanations into one’s awareness of the mind. One meeting might identify an event or situation that triggered a patient’s anxiety and develop a coping technique. While nobody should assume complete resolution in one session, recognizing and addressing a specific issue can be pretty fast.

Brief psychodynamic treatment has been used for:

Sexual assault;
Brain injury in Road traffic accidents
Survivors of terrorist attacks
Stress or feelings of hopelessness;
A family tragedy (divorce, cheating spouse, or finding out a secret).

Psychodynamic Family Therapy. Psychodynamic treatment is performed inside a family, whether that be the two individuals in a loving relationship, children and their parents, grandparents, and grandkids, siblings, or a traditional family unit. This treatment is generally long-term (unlike CBT or IPT-based family therapy) and is often prompted by chronic family issues. This therapy focuses on unsolved disputes and unconscious processes and it does so through the lens of family relationships. The therapist will guide the members of the family through family history, particularly traumatic experiences.

Often, this method of treatment highlights the necessity of the adult members of the family dealing with any disputes with their own parents as a method to better understand the disputes with their child(ren) and partner(s). Psychodynamic treatment can allow families to find and resolve the deep-rooted issues that give way to family troubles, leading to a happier and healthier family relationship.

Psychodynamic Art / Music Therapy. This non-traditional style of psychodynamic psychotherapy involves the exploration of emotions and moods through music or art. Like other forms of psychological treatment, this treatment is non-structured and non-directive, enabling the patient to conduct the session. It does not necessitate any musical or artistic talent or expertise, only that patients be able to use music or artwork to represent themselves.

Patients may present particular pieces and speak about the feelings they elicit, link them to memories from childhood, or interpret the significance they find in these works. Or, patients could bring in a particular piece of music that they think they can resonate with on a subconscious level. Furthermore, individuals can really develop music or art in the session. It doesn’t have to be “great” artwork or singing, it only needs to convey the ideas or sentiments of the patients in a coherent manner.

With artistry and/or musical expression, the client and therapist can build an understanding and establish a crucial link. They may discover that music and art are better approaches to profound communication than conversing. This sort of treatment may be especially suited for people who are timid or otherwise find it hard to speak, and also people who are feeling overwhelming anxiety or terror which music or art might offer to relieve.

To have a better understanding of the psychodynamic perspective, let’s take a look at a few distinct examples and their explanations.

Compulsive hand-washing may be related to a childhood trauma that has manifested in this tendency.
Nail-biting could be provoked by a traumatic childhood incident.
A childhood incident that instilled fear in an open environment in an adult may cause agoraphobia.
Childhood abuse may play a role in hoarding tendencies.
Aversion to numbers can be a compulsive behavior that may have been initiated during early childhood.
Nervousness rituals like repeatedly completing a task (closing and opening a cupboard) may be connected to a childhood event.
Skin scratching or plucking of hair is a compulsive behavior that is typically associated with developmental traumatization.
Obsessively counting steps may be related to a childhood incident.
Any unreasonable conduct, such as judgment paralysis, might be attributed to adverse childhood experiences or maturation.
Neurotic behaviors, such as chronic anxiety, can be traced back to developmental difficulties or disruptions during childhood.
Sexual obsessions and associated sexual behavioral disorders are psychodynamically tied to the maldevelopment of sexual stages in early life.

While evaluating psychodynamic therapy’s efficiency poses certain difficulties, research indicates that it may be beneficial in the treatment of a number of psychiatric issues. One explanation of why it may be difficult to analyses psychodynamic therapy’s complete efficiency is that most of the mental alterations it causes are difficult to quantify. While it is reasonably straightforward to quantify changes in various acute symptoms, it is clearly more difficult to quantify fundamental changes in personality, as observed by scientist Jonathan Shedler in an American Psychological Association press release.

Symptoms of an Existential Crisis

Amidst this challenge, research still supports psychodynamic therapy’s effectiveness and usage in the treatment of a range of illnesses. According to one important study published in the journal American Psychologist, the data supports psychodynamic therapy’s effectiveness. Another study discovered that psychodynamic treatment may be equally beneficial as cognitive-behavioral therapy in some cases (CBT).

Short Term Psychodynamic Psychotherapy (STPP) has been reported to have effect sizes varying from 0.34–0.71 when compared to no treatment and to be slightly more effective than other therapies when followed up. Other reviews discovered an impact size of 0.78–0.91 for somatic diseases versus no treatment, and 0.69 for depression treatment. A 2012 meta-analysis of Intensive Short-Term Dynamic Psychotherapy (ISTDP) published in the Harvard Review of Psychiatry discovered impact sizes ranging from 0.84 for interpersonal issues to 1.51 for depression. In general, ISTDP showed a 1.18 effect size compared to no therapy.

A 2011 study published in the American Journal of Psychiatry compared 103 psychodynamic treatments against a non-dynamic rival and discovered that six were superior, five were inferior, 28 were comparable, and 63 were adequate. The study concluded that this could serve as a foundation for “empirically validating” psychodynamic psychotherapy. Psychodynamic therapy was shown to be equally effective as other therapies, including cognitive behavioral therapy, in a meta-analysis of randomized controlled studies published in 2017.

In complicated mental disorders, a 2011 meta-analysis found that long-term psychodynamic psychotherapy was superior to less intensive kinds of psychotherapy. Psychotherapy may be required for a longer period of time depending on the severity of the underlying disorder. Individuals performing at Level 1 of the DSM Personality Functioning Scale, for example, would require less treatment than individuals functioning at Level 2 or higher. Additionally, studies have shown that people who underwent psychodynamic psychotherapy continued to grow following treatment, whereas those who received cognitive behavioural therapy did not.

Psychodynamic therapy was found to be equally beneficial as other proven treatments in a 2017 evaluation published in the American Journal of Psychiatry. Nonetheless, the study’s authors urged that additional research be conducted to ascertain who profited most from this method of therapy.

Jonathan Shedler is famous for his research on ‘Psychodynamic Psychotherapy’s Efficacy.’ He explores the concept of psychodynamic psychotherapy as well as the long-awaited and significant discoveries about its sustained effects. Advantages are associated with the growth of internal capacities and abilities. Psychodynamic psychotherapy aims to alleviate uncomfortable and counterproductive symptoms while also developing and strengthening internal resources and competencies to enhance overall standard of living.

The internal psychological energies that are nurtured vary according to different conditions. They include the following:

Enhancing self-esteem
Increasing one’s capacity for fulfilling relationships
Faith in one’s own skills
Improving self- and other-awareness
Acceptance and tolerance of a broader range of feelings
Gradually increasing one’s capacity to deal with challenges and hardships
Advantages that last and improve in value through time
Advantages that last and improve in value through time

Another notable benefit was consistently mentioned in Shedler’s investigations was that he discovered “…the benefits of psychodynamic therapy not only endure but increase with time…”, whereas the benefits of other non-psychodynamic therapies decreased with time. Every meta-analysis Shedler investigated established the same long-term advantages. The studies included in this volume covered a broad spectrum of ailments, including personality disorders, anxiety, depression, physical disorders, and other complicated mental illnesses.

The results of two research trials that tracked patients with borderline personality disorders for five years following the conclusion of psychodynamic psychotherapy are now published. These studies showed extremely strong and long-lasting advantages not previously demonstrated by any other treatment.

Some of the well-known disadvantages and/or limitations of Psychodynamic therapy are as under:

Therapy requires numerous sessions and quite time-consuming. It is still unlikely to bring forth definitive answers for particular human behavior.
Patients must be willing to devote a lot of money and time to the treatment; they should be committed.
They can uncover some unpleasant and painful memories that had been suppressed, which leads to considerable agony.
This sort of treatment is not suitable and effective for all persons and all sorts of personality disorders.
The structure of Psychoanalysis generates an imbalance of power between client and therapist that might raise ethical concerns.
Neglects the contemplative practice (e.g., thinking)
Psychoanalytic therapy place an inordinate degree of significance on psychological characteristics, omitting biological/genetic variables that impact and are related to mental health issues.
Excessively predetermined (little free-will)
Unverifiable (proving it wrong is difficult)
Case Studies – Contextual and Results cannot be generalized
The approach is overly simplistic and reductionist because it divides the human psyche into the id, ego, and superego, as well as the five psychosexual stages.

Most people believe they don’t have the time and energy required for this type of long-term activity and that all they want is to address their immediate problem. Cognitive-behavioral therapy (CBT) or simply behavioral techniques are most appropriate for these individuals. Many patients prefer to avoid all forms of talk therapy in favor of medication-assisted symptom control. Unsurprisingly, this appears to be the case for an increasing number of people,.

One genuine criticism leveled with psychodynamic treatment is that it is usually unfocused, lacking clear objectives and a sense of direction. This does not have to be the case, as psychodynamic theory contains nothing that stops individuals from creating and striving towards attainable goals. Even so, it is not as narrowly focused as CBT or behavioral therapy work, simply because CBT and behavioral methods were established to identify problems directly through rational and behavioral intervention strategies, whereas the psychodynamic method avoids direct confrontation with problems and instead focuses on assisting clients in discovering answers to problems within own selves through insight-oriented activity.

The pros of psychodynamic psychotherapy include:

Focuses on the underlying aspects of psychological discomfort and the complication of human behavior
One of the few treatments that place an emphasis on personality
The benefits of therapy may build over time.
Promotes freedom of expression
Examining recurring themes in the therapeutic relationship (between therapist and patient) may yield important information.
The patient has the final say over what is discussed.

The cons of psychodynamic psychotherapy include:

Less regulated than cognitive behavioral therapy
Demands longer-term engagement
Can be costly (due to the long-term nature of the therapy)
Discloses one’s childhood/personal background, which some others may find objectionable.
Involves therapist perception – lacks impartiality
Depends on difficult-to-prove theoretical conceptions – i.e. The unconscious mind.

The pros of CBT include:

Concise and goal-oriented
More economical therapy (due to its shorter duration)
Enabling – by teaching strategies that you can utilize even after therapy is completed
There is much scientific evidence for its efficacy in a number of areas.
Collaborative therapy; a cooperative effort between you and your psychotherapist.

The cons of CBT include:

Focuses on just contemporary issues and overlooks childhood issues
Requires effort because you must practice the techniques outside of the meetings.
Because of its highly organized character, it may not be appropriate for individuals with complex mental health problems or cognitive impairments.
The stress on your individual desire to change ignores larger issues, such as community or family.

To conclude psychodynamic psychotherapy vs. cognitive-behavioral therapy:

Lengthier, open-ended vs. Brief, quick, contracted
Considers the past extensively in order to address problems in the present vs. Being primarily focused on the present
The past contributes to your current problems, whereas your ideas contribute to a cycle that contributes to your problems.
Client-driven and unstructured vs. Therapist-driven and controlled
Based on sessions vs. Includes homework and skill development in between sessions
Emphasis on the client-therapist interaction as opposed to a singular focus on the individual.

Relative efficacy. Although there are just a few head-to-head clinical studies evaluating the efficacy of CBT to certain other psychotherapies for Anxiety disorder, there is some evidence that CBT is more effective. CBT was proved to be better than interpersonal therapy or applied relaxation with exposure in individual studies. Correlations of CBT and psychodynamic therapy did not reveal that either treatment was superior. In a 2013 clinical research, 495 patients with Anxiety disorder were compared to waitlist versus CBT with psychodynamic therapy adapted to the treatment of Anxiety disorder. At post-assessment, participants in both the CBT and psychodynamic therapy subgroups reported fewer anxiety symptoms than those on the waitlist. On various social anxiety measures, CBT showed a better response than psychodynamic therapy at post-evaluation; however, the variations were modest in magnitude and were not found on follow-up evaluations up to 2 years after the start of therapy.

CBT was proved to be better to no treatment, pills placebo, psychosocial control conditions, and numerous psychotherapies such as interpersonal therapy, psychodynamic therapy, meditation, and supportive therapy in a systematic analysis of 101 research trials. To quantify the efficacy of each treatment relative to other therapies, network meta-analyses use all data available from clinical studies, including those that have not been evaluated in contrast directly.

FAQs

What is a Psychodynamic Therapist

The psychodynamic therapist’s job is to collaborate with the patient to uncover the underlying causes of their symptoms. The therapist fulfills this duty by encouraging patients to express their feelings and helping them in identifying reoccurring trends in their thinking, feelings, and actions. They can help clients in determining the meaning of these patterns and the impact they have on the client. One of the therapist’s most critical duties is to delve into the patient’s background. Discussions regarding the patient’s early childhood and past personal experiences will almost certainly take up a major part of psychodynamic consultations, as this kind of treatment implies these events had a massive effect on the patient’s current concerns.

Who was the founder of the Psychodynamic approach

The psychodynamic theory began as a personality theory founded by Sigmund Freud. It has undergone substantial evolution over time, with numerous theories contributing to it. Freud believed that human conduct could be described by intrapsychic dynamics and interpersonal processes that occurred outside of an individual’s consciousness and were influenced by their early childhood experiences.

What does Psychodynamic Therapy focus on

Psychodynamic therapy is focused on the psychological aspects of emotional distress. It is characterized by self-examination and self-reflection, as well as the utilization of the therapist-patient interaction as a portal into the patient’s troublesome social ties. Its objective is not just to treat the most evident symptoms, but also to assist individuals in living healthier lifestyles.

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Psychodynamic Therapy