Posted on: October 1, 2021
Psychodynamic Therapy: An Overview
The roots of psychodynamic therapy lie predominantly in Freud’s approach to psychoanalysis which, when it was first developed, was known as ‘the talking cure’.
Psychodynamic therapy can be described as being ‘focused on understanding how we can meaningfully conceive of mental disorders as specific organizations of an individual's conscious or unconscious beliefs, thoughts and feelings. 1
Placing non-conscious functioning at the center of its domain of interest, psychodynamic therapy helps the patient explore their unconscious as part of their present experience, giving them an understanding of how unresolved psychological traumas and unconscious feelings can have a profound influence on their behavior, ‘in particular their capacity to regulate affect and adequately handle their social environment. 2
What distinguishes psychodynamic therapy from psychoanalysis and cognitive behavioral therapy (CBT)?
Although it shares the same core principles of psychoanalysis, psychodynamic therapy is far less intensive.
Unlike psychoanalysis, which involves open-ended exploration of a patient’s feelings in multiple sessions per week, psychodynamic therapy typically takes place once a week in 50-minute sessions. Patients sit in a chair and face the therapist rather than lying on a couch, and sessions are open-ended and based on a process of free association.
As both psychodynamic therapy and cognitive behavioral therapy (CBT) are often used to treat depression, the efficacy of these therapies is often compared. For the most part, it is the nature of their psychological focus that distinguishes them.
CBT sessions adhere to formal structures and work towards a set of specific learning agendas. The therapy is focused on understanding and modifying certain processes or behaviors; working on identifying and ultimately changing dysfunctional patterns of thought. While psychodynamic therapy can be both time-limited and longer-term, CBT is always a time-limited, short-term therapy that focuses on learning new patterns to deal with current problems rather than understanding why the dysfunctional patterns are present.
In contrast, psychodynamic therapy encourages patients to talk freely about whatever is on their mind at that moment. By doing this, a pattern of behavior and feelings related to past experiences will emerge. The therapist will then put the focus onto those patterns in order for the patient to recognize the way past experiences are affecting the way they behave in the present, and can begin to recognize these patterns themselves.
In 2000, Blagys and Hilsenroth conducted a literature search which allowed them to determine seven features concerning process and technique which could reliably distinguish psychodynamic therapy from other therapies. These are:
1. Focus on affect and expression of emotion
2. Exploring attempts to avoid distressing thoughts and feelings (defence and resistance)
3. Identifying recurring themes and patterns
4. Discussion of past experience (developmental process)
5. Focus on interpersonal relations
6. Focus on the therapy relationship (including transference)
7. Exploration of wishes and fantasies
Therefore, it can be said that the goal of psychodynamic therapy is not to rid the patient of their symptoms, but rather to arm them with the tools they need to recognize how past experiences influence the way they relate to themselves and others. It encourages them to recognize dysfunctional or defensive patterns of behavior, achieving a greater sense of emotional maturity and personal growth, as well as an increased understanding of their unconscious desires and impulses.
What are the benefits of psychodynamic therapy?
Today, we are seeing a resurgence in the importance in psychodynamic therapy in the therapist’s toolkit. Peter Fonagy and Alessandra Lemma (Fonagy et al., 2012) have argued that it is important patients aren’t treated with a ‘one size fits all’ approach, citing the fact that CBT won’t be suitable for every patient, and that other therapeutic modalities should be offered for the benefit of public health.
Psychodynamic therapy will have most benefit for patients who are capable of self-reflection, have an interest in exploring their internal life and behaviors, and have a genuine desire to seek self-knowledge in this respect.
A study by Falk Leichsenring and Susanne Klein (2014) showed psychodynamic therapy to be efficacious in common mental disorders including depressive disorders, anxiety disorders, somatoform disorders, personality disorders, eating disorders, complicated grief, post-traumatic stress disorder, and substance-related disorders.
As psychodynamic therapy seeks to strengthen the patient’s inner capacities and resources, individual patient benefits may include:
• increased self-esteem
• the ability to foster more satisfying relationships
• increased understanding of self and others
• recognition and tolerance of a wider range of emotions
Is psychodynamic therapy an effective treatment?
There is a common misconception that psychodynamic therapy is ineffective and outdated. Its greatest criticism is that it is unscientific in its approach to human behavior and that its concepts, heavily rooted in Freud’s theories, are subjective and difficult to test.
This kind of therapy is not didactic or problem-solving. The patients probably already know what would be best for them, and so it is not about giving advice but about setting conscious goals towards help, recognizing the need for change, and overcoming the unconscious desire for homeostasis.
However, recent studies by Jonathan Shedler have found that psychodynamic therapy produces an effect size that is at least as large as other psychotherapies such as CBT and psychoanalysis, and which has been demonstrated to have increased by up to 50 percent when patients were re-evaluated nine or more months after their therapy ended (Shedler, 2010).
By encouraging patients to work towards achieving greater insight into the recurring themes and patterns, as well as their attempts to avoid distressing thoughts and feelings, it is the aim of psychodynamic therapy to equip patients with the internal psychological resources and greater capacity for understanding their individual psychological issues that have previously caused them emotional harm.
Available evidence demonstrates that psychodynamic therapy is equally as effective as other forms of psychological treatment, including CBT and psychoanalysis, moreover the effects may be long lasting and extend beyond symptom remission.
Further reading on psychodynamic therapy
If you want to learn more about psychodynamic therapy, you can download a free chapter from A Clinical Guide to Psychodynamic Psychotherapy by Deborah Abrahams and Paul Rohleder or purchase the book here .
1. A Clinical Guide to Psychodynamic Psychotherapy, by Deborah Abrahams and Paul Rohleder, page 9.
2. A Clinical Guide to Psychodynamic Psychotherapy, by Deborah Abrahams and Paul Rohleder, page 10.