What is Psychodynamic Psychotherapy?

Psychodynamic psychotherapy is the oldest form of psychological therapy used today. Dynamic Psychotherapy, or Psychodynamic therapy, explores the influential forces during early development that can shape and mold how you think about, and relate to, yourself and others.

Psychodynamic therapy seeks to understand how your life story and subjective experience contribute to emotional suffering.

Typically, therapy sessions are once or twice per week for approximately 45-50 minutes. 

Core Psychodynamic Problems

Six (6) core psychodynamic problems account for over 90% of the reasons people seek therapy. Many times, the core problem isn’t readily apparent until the therapy progresses. But once the problem is identified, it becomes the primary focus of the therapy. 

1. Depression
2. Low Self Confidence
3. Fear of Abandonment/Rejection Sensitivity
4. Neuroticism/Overthinking/Overanalyzing 
5. Anxiety
6. Trauma

For most people, there is overlap but usually one core problem predominates. The goals of therapy will be specific to the patient’s core problem and will depend on the focus of the therapy.

General goals of therapy include:

• Resolution of internal conflict
• Improvement in the quality of one’s relationships
• Increased satisfaction with work
• A more cohesive sense of self
• A more cohesive life narrative 

Psychodynamic Theory

Psychodynamic theory views mental life and behavior as a 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).

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. 

For more information about psychodynamic therapy, click here. 

THERAPY TERMS

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. Resistances are windows into a patient’s past and present internal world. Resistances are explored in therapy.

Transference: The unconscious mechanism by which patients experience the therapist or psychiatrist as a significant figure from the past and thus feelings from the past are reactivated in the present. 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.
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