Exploring the Use of Psychodynamic Psychotherapy

The Psychodynamic Approach

The psychodynamic approach involves viewing a therapy patient’s current problems as being related to unresolved historical/developmental issues from as far back as childhood or adolescence.  This approach also emphasizes utilizing the emerging dynamics within the patient-therapist relationship as a means to understanding repetitive unconscious patterns in the patient’s relational life.

While psychoanalysis was first developed to treat “hysteria” and other psychosomatic conditions, psychodynamic therapy evolved from psychoanalysis and has been refined over time to address many psychosocial and psychiatric conditions including anxiety, depression, obsessive-compulsive disorders, personality disorders, and relationship difficulties.  Scientific research has demonstrated that psychodynamic psychotherapy is just as, or even more, effective at treating a range of conditions when compared to other major intervention approaches commonly applied in psychotherapy.

Originating with the work of Freud in Vienna in the late nineteenth century, the psychodynamic perspective is steeped in the view that the human condition involves unconscious processes and dynamics which create gaps between what a person believes or values and how a person behaves in the world.  These gaps suggest the presence of what Frued called “conflict.”

The most fundamental conflict we all face involves the desire to act immaturely to fulfill our own desires; these instinctual urges exist in opposition to our need to act maturely and meet the demands and obligations of adult life and the people about whom we care.  For Freud, aspects of mental conflict are often denied or repressed into the unconscious and thereby exist outside of our awareness.

In psychodynamic psychotherapy, positive change occurs as therapy shifts material into conscious awareness, helping the patient gain new insights into his or her inner life.  This quest for self-knowledge ultimately enables the patient to make decisions and adopt new attitudes that represent a deeper connection to one’s “true self.”

Unconscious Processes

Freud initially divided the mind horizontally, i.e., segmenting the mind into the “conscious” and the “unconscious.”  With each developmental phase of early life, the child grapples with challenges, unresolved relational traumas, and difficult experiences that could not be represented or psychically metabolized easily.  Because the mind cannot tolerate some of this material, Freud argued that through defensive processes such as repression, the mind stores this material in the unconscious where it is kept sequestered away from conscious awareness.

Although this sequestering helps a person adapt and move on, experiential material stored in the unconscious continues to accumulate across the lifespan and remains alive, organically influencing thoughts, attitudes, cognitions, and behavior.  The “Freudian slip” is a well-known example of how unresolved conflicts from the past (stored in the unconscious) affect present-day functioning.

In psychodynamic psychotherapy, the therapist utilizes a variety of techniques to engage and explore the patient’s unconscious mind.  Free association involves the therapist’s encouraging the patient to say whatever comes to mind, no matter how tangential or illogical it may sound, to begin to draw out unconscious material and use it to infiltrate and likely alter the patient’s narrative (conscious, rational) assumptions about his or her life.

Another technique used in the psychodynamic approach is the exploration of the dynamics between the conscious and unconscious.  Followers of Freud elaborated the “structural model” and its application to treatment, which involves helping the patient recognize the tripartite organization of the mind (id, ego, and superego) and determine which components may have been under- or over-emphasized throughout development.  For example, some patients are highly defended against their own instinctual desires and urges (often due to an emphasis on family or cultural values mobilized by the superego), while other patients have difficulty regulating their emotional states and acting optimally in the world (due to failures of the ego to modulate urges and respond appropriately to the demands of social situations).

Psychodynamic Psychotherapy

Insight-Oriented Therapy    

The goal of the psychodynamic approach is personal insight, i.e., the new awareness gained by learning how a person’s psychological dynamics have been impacted by and organized in response to historical events; it is these dynamics which ultimately determine the problems of one’s current life. Unlike other therapy approaches prioritizing behavior change, the psychodynamic approach posits that only with insight can the patient engender new experiences of the self, both in terms of one’s inner life and his or her social world.

Insight is often supported by the therapist’s ability to help the patient understand how maladaptive attitudes and behaviors often emerging early in life have constricted the patient’s ability to act more effectively in the world and to gain a sense of fulfillment.  By listening very closely to the patient session after session and increasing the patient’s connection to deep unresolved emotional material, memories, and relationships, the patient gradually makes new “meanings” of the events that have shaped his or her life.

Transference and Countertransference

Another important component of psychodynamic psychotherapy, and a significant pathway to insight, involves the notion of transference.  A phenomenon discovered by Freud and initially described in The Interpretation of Dreams, transference occurs when a patient unconsciously “transfers” onto the therapist attitudes, feelings, and perceptions originally directed toward significant others in the patient’s past for whom the patient holds strong, and often unresolved, sentiment.

Transference is mobilized by the therapist’s remaining somewhat anonymous to the patient (Freud’s notion of the “blank slate”) and not overburdening the patient with intrusive self-disclosures. This enables the patient to transfer important feelings toward figures from his or her past onto the neutral and benign therapist.  As the transference evolves in psychodynamic psychotherapy and is explored, both the patient and therapist can begin to recognize and investigate the patient’s memories and interpersonal experiences that heretofore have been delegated to the unconscious. The “working through” process involves the patient’s increasing capacity to see things as they are, rather than to approach people and situations with old unresolved biases and expectations.

Similarly, as treatment intensifies, the psychodynamic therapist may “transfer” onto the patient, i.e., the patient may become reminiscent of figures from the therapist’s own past.   If the therapist is well-trained and experienced, he or she can utilize this countertransference productively and professionally.  Countertransference is especially enlightening if the therapist harnesses it to apprehend certain unnamed impressions about the patient that are meaningful and important but not yet available to conscious awareness. Unlike other therapeutic approaches, the psychodynamic perspective emphasizes the psychotherapist’s capacity to use his or her own inner life as a vehicle for seeing and understanding the patient.

Conclusion: The Experience of Being Known

Evolving from the work of Frued, the psychodynamic therapy approach offers the therapy patient an opportunity for self-insight through the close examination of how the patient attempted to adapt to early life experiences.

At the root of the approach is the therapist’s attempt to provide a safe, welcoming environment in which the patient does not feel judged or coerced.  The Freudian perspective ultimately suggests that many problems and maladaptive tendencies originally emerged in a person’s life, often during childhood, as attempts to cope with relational demands to be someone other than who they authentically are. The psychodynamic therapist seeks to end this coercion in all its forms, so that the patient can finally access his or her identity via a profound sense of freedom.  At its best, psychodynamic therapy offers the patient the intimate experience of being known, perhaps for the first time, by another whose sole investment is helping the patient access and accept deeply personal truths.