Psychodynamic Therapy

psychodynamic therapy

Psychodynamic Psychotherapy

Psychodynamic psychotherapy is the oldest form of psychological therapy used today. Dynamic Psychotherapy, or Psychodynamic therapy, focuses on how influential forces during early development can shape and mold how we think and relate to ourselves and others. Psychodynamic therapy seeks to understand how each patient’s individual life story and subjective experience contribute to emotional suffering. 
 
Psychodynamic therapy is based on the work of Viennese Neurologist Sigmund Freud, who developed psychoanalysis. Freud was influenced by many prominent Viennese physicians including Josef Breuer, Hippolyte Bernheim (who coined the term Psychotherapy) and Jean Martin-Charcot. Building upon the works of his predecessors and mentors, Sigmund Freud developed a “talking cure” as a cathartic treatment for people suffering from an ailment he termed “psychoneurosis.”
 
Freud and his followers believed psychopathology could result from the sequestering of unwanted feelings and memories from conscious awareness.  The goal of psychoanalysis was to “render the unconscious conscious” or bring the suppressed memories and unconscious feelings, desires, and motives into awareness where they could be integrated with the rest of mental life.
 
To do this, Freud employed a technique termed free association whereby patients would lie on a couch facing away from the psychoanalyst and discuss whatever came to mind. Freud believed unconscious material could be accessed through nonverbal behavior and transference/countertransference patterns as they arise in the relationship between patient and therapist. In addition, he believed dreams were driven by unconscious processes that could be analyzed and interpreted. 
 
Psychodynamic theory views mental life and behavior as the result of compromise between conflicting motives as each of us must make choices in the face of many conflicting wishes, fears, and morals. Psychodynamic theory further postulates that all behavior reflects the mind’s effort to maximize pleasure and satisfaction and minimize anxiety and other distressing feelings. The numerous motivations and conflicts are mostly outside our awareness (unconscious) and so, too, are the defense mechanisms we employ to deal with these conflicts (see defense mechanisms post).

The Importance of Childhood

Psychodynamic theory sees adult psychological life as an extension of the mental life of childhood. Childhood experiences, both positive and negative, influence the developing psyche. Psychodynamic therapists are interested in the enduring experiences of the body and of relationships with caretakers in early life. These early experiences are the building blocks for developing unconscious wishes, fantasies, motivations, and core beliefs in adulthood. An exploration of childhood experiences and relationships can help identify where unconscious psychic conflicts originated. It is important to note that contemporary neuroscience and neurobiology provide substantial evidence for the existence of unconscious processes. 

Goals of Psychotherapy

(1) Resolution of internal conflict

(2) Improvement in the quality of one’s relationships

(3) Increased satisfaction with work

(4) More cohesive sense of self

Typical Structure of Therapy: Patient meets with the therapist 1–2 times/week for 45-50 minute sessions.

Therapy Terms

Free Association: Technique invented by Freud as a replacement for hypnosis as a tool for accessing unconscious material. By noticing apparent gaps in associations, psychoanalysts can pick up resistances and clues to unconscious material.

Resistance: 
Resistance reflects the patient’s use of defenses in the therapy to avoid unpleasant emotions, but also to resist change. Examples include silences, missed appointments, forgetting, refusing medication and/or dismissing other interventions the therapist makes. Resistance is a window into the patient’s past and internal mind and is explored together in therapy.

Transference: 
The unconscious mechanism by which patients experience the doctor as a significant figure from the past and thus feelings from the past are reactivated in the here and now with the therapist. Transference occurs in all relationships, but one aspect of dynamic psychotherapy is that the transference is utilized as a tool with which to understand and ultimately modify past patterns of relationships.

Countertransference: 
The set of feelings evoked in the therapist by the patient. Thought to be a joint creation of feelings induced by the patient via projective identification and unresolved conflicts from the therapist’s past. The therapist must be highly self-aware in order to separate his/her own conflicts from the aspect of countertransference that is useful information about the patient’s internal world.

Therapeutic Alliance: 
The shared positive feelings between therapist and patient, relatively free of transference distortion, which support their pursuit of the goals of the treatment.

Working Through: 
The repetitive interpretation of transference and resistance until it is integrated by the patient. The therapist points out patterns in the patient’s outside relationships and relates it to patterns in the relationship with the therapist and in early relationships. It is thought that by re-experiencing these patterns in the relationship with the therapist, they are gradually modified and reintegrated.

Termination: 
Termination is the final phase of the therapy during which the patient reviews the work of the treatment and prepares for the future. The termination phase is likely to reawaken conflicts that have been explored earlier in the treatment, especially conflicts related to separation and autonomy.

References

Caligor, E, Kernberg OF, Yoeman,s FE,(2007) Handbook for Dynamic Psychotherapy for Higher Level Personality Pathology, American Psychiatric Press, 2007

Gabbard, G.O.(2004) Long-term Psychodynamic Psychotherapy: a basic text. Washington, DC, American Psychiatric Publishing, Inc. 2004

Gabbard, G.O (2005): Psychodynamic Psychiatry in Clinical Practice. 4th Edition. Washington, DC, American Psychiatric Publishing, Inc. 2005.

Luborsky L, Crits-Cristoph P (1990) UnderstandingTransference: The Core Conflictual Relationship Theme Method. New York: Basic Books.

Ferrando J., Stephen et al (2008) Psychiatry in Review. 3rd Edition. Educational Testing and Assessment Systems, Inc.

Vaillant G, Bond M, Vaillant C (1986) An empirically validated hierarchy of defense mechanisms. Archives of General Psychiatry 43: 786–94.

Bordin E (1976) The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research and Practice 16: 252–60.

Allen J, Fonagy P, Bateman A (2008) Mentalizing in Clinical Practice. Washington, DC: American Psychiatric Association.

Hinshelwood R, Zarate O (2006) Introducing Melanie Klein. London: Icon Books.

Stein S (1999) Bion. In S Stein (ed.) Essentials of Psychotherapy. Oxford: Butterworth-Heinemann.

Phillips A (2007) Winnicott. Harmonsworth: Penguin.

Bowlby J (2005) A Secure Base: Parent–Child Attachment and Healthy Human Development. Hove: Routledge.

Mitchell S, Black M (1995) Freud and Beyond: A History of Modern Psychoanalytic Thought. New York: Basic Books.

Stevens A (2001) Jung: A Very Short Introduction. Oxford: Oxford University Press.

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TASK 6: THE VOICES

  • What was your internal dialogue like?
  • What were the voices in your head saying?
  • Were they mean? Were they positive or negative?
  • Describe what you noticed.

TASK 5: THE SOUND

TASK 4: THE SIGHT AND SMELL

TASK 3: THE TASTE

TASK 2: THE TALK

TASK 1: THE WALK

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