Psychodynamic therapy - Dr. Axe

According to Good Therapy website, psychodynamic therapy was developed as a “simpler, less-lengthy alternative to psychoanalysis.” Never heard of this approach before and wondering, “What is psychodynamic therapy?”

In simple terms, it’s a way of interpreting a client’s past in order to understand how it affects his or her present moods and behaviors.

Someone’s past is considered the foundation and formation of that person’s psychological processes, so gaining insight into one’s earlier experiences can help explain why she or he is dealing with certain symptoms, such as depression, and what that person can do to improve his or her coping skills.

What Is Psychodynamic Therapy?

The definition of psychodynamic therapy (also called insight-oriented therapy) is “a form of therapy that focuses on unconscious processes as they are manifested in a person’s present behavior.”

The psychodynamic approach involves a client and therapist examining unresolved conflicts from the client’s past that have contributed to unwanted thought patterns, habits and symptoms.

These “past conflicts” often include dysfunctional relationships, often during childhood, which may lead to problems such as addictions and depression.

Psychodynamic therapy is one form of psychoanalytic therapy (or talk therapy between a therapist and patient). Compared to other forms of psychoanalytic therapy, it usually requires less frequency and number of sessions in order to help a patient reach her or his goals.

Something else that makes it stand apart is that it it focuses on mental/emotional experiences, rather just symptoms and behaviors.

Types

It’s possible to practice psychodynamic therapy in a group or family setting, as a couple, or as an individual.

Some clients use this approach with their therapists for only a short period of time, while others rely on it as a long-term therapy approach spanning several years or more.

Psychodynamic therapy is actually considered a category of therapies rather than a single type.

Here are some psychodynamic therapy examples and approaches that therapists use:

  • Brief PDT, which is generally conducted over the course of only a few sessions. This may be used to help victims of rape, accidents, terrorism or other situation.
  • Psychodynamic family therapy, used to help resolve conflicts.
  • Open dialogue therapy, in which information is freely shared by the client.
  • Music therapy, in which clients expresses themselves through use of music or another form of art, sometimes while also talking.
  • Journaling/writing to share emotions, fears, thoughts, etc.

Goals/How It Works

What is psychodynamic therapy used for? The primary goals of psychodynamic therapy is to improve a client’s self-awareness and understanding of how the past has influenced current behavior.

A client might wish to change an aspect of her or his identity, personal narrative or personality or to give up unwanted habits. It’s believed that this can happen more easily when the therapist helps the client reveal unconscious content of his/her psyche.

What is a psychodynamic approach exactly, and how does it work?

  • During  a session a therapist and client discuss the client’s emotions, thoughts, early-life experiences and beliefs. This is done via open-ended dialogue and questions.
  • Part of the process is recognizing, acknowledging, understanding, expressing and overcoming negative and contradictory feelings and repressed emotions.
  • The patient commits to deeply exploring and analyzing earlier experiences in order to tie him/her to present emotions and relationship patterns.
  • With help from the therapist, the client can change her/his recurring thought patterns and let go of unhelpful defense mechanisms and unhealthy relationships.

Theory, Perspective, Key Concepts

Psychodynamic theory is based on the belief that behavior is influenced by unconscious thought. This theory is the basis for the “Psychodynamic Diagnostic Manual” (PDM), which was released in 2006 and is used as an alternative to the “Diagnostic and Statistical Manual” (DSM).

The key difference the DSM and PDM is that DSM focuses on observable symptoms associated with mental health conditions, while the PDM describes subjective experiences.

What are the key features of psychodynamic approach?

  • The focus is on the psychological roots of emotional suffering. Self-reflection and self-examination are important concepts for getting to the root of one’s problems.
  • PDT theory states that the relationships and circumstances of early life continue to affect people as adults. The relationship between therapist and patient is used as a “a window into problematic relationship patterns in the patient’s life.”
  • Uncovering defense mechanisms is also a key concept. These can include denial, repression and rationalization, which can contribute to relationship troubles and addictive behaviors.

Benefits/Uses

Is psychodynamic therapy effective? According to the American Psychological Association, research has shown that psychoanalytic theory can be clinically applied to a wide range of psychological disorders, including:

  • Depression
  • Anxiety
  • Personality disorders
  • Addictions/substance abuse
  • Social anxiety disorder/difficulty forming or maintaining personal relationships
  • Eating disorders
  • Panic disorders
  • Post-traumatic stress disorder (PTSD)
  • Physical ailments, such as chronic pain

1. May Help Reduce Depression and Anxiety

PDT sessions can lead to increased self-esteem and self-compassion, better use of one’s skills/talents and coping abilities, improved relationships, and healthier habits — all of which can help to reduce depression and anxiety symptoms.

A meta-analysis by the Cochrane Collaboration that included data from 33 studies demonstrated hat short-term psychodynamic therapy significantly improved patients’ depression and anxiety symptoms, with modest to moderate clinical benefits.

The analysis included patients with a variety of problems with emotional regulation, including those with general, somatic, anxiety and depressive symptoms, as well as interpersonal problems and social adjustment. In all outcome categories, patients saw significantly greater improvement in the treatment versus the control groups.

When patients were assessed nine months or more after treatment ended, it was found that many experienced lasting psychological changes.

2. Can Help Improve Social Functioning

A meta-analysis published in Archives of General Psychiatry that included 17 randomized controlled trials found evidence that PDT was significantly more effective than a control and just as effective as other types of psychotherapy, such as cognitive behavioral therapy, for supporting those with a variety of psychiatric symptoms and poor social functioning.

3. Could Improve Personality Traits and Relationships

American Psychologist published findings from one meta-analyses comprising 160 studies focused on psychodynamic therapy, featuring more than 1,400 patients with a range of mental health problems. Researchers found substantial treatment benefits, even among patients with personality disorders — considered to be deeply ingrained maladaptive traits that are commonly difficult to treat.

It was found that psychodynamic psychotherapy “sets in motion psychological processes that lead to ongoing change, even after therapy has ended.” With the therapist’s help, patients are able to practice self-exploration, examine their own emotional blind spots and better understand relationship patterns so they can be improved.

What to Expect

During a PDT session, here’s what typically takes place:

  • Therapists lead the discussion but usually work with clients to first identify a focus/goal and important issues, which helps create structure for the sessions. Having a clear focus makes it possible to do interpretive work in a relatively short time.
  • The client/patient speaks freely and openly to the therapist about anything that comes to mind, including current issues, fears, desires, dreams and fantasies.
  • Session normally last about one hour. Frequency is typically once or twice per week, as opposed to three to five days a week with traditional psychoanalysis. Many people are able to attend PDT sessions for a shorter amount of time than other psychoanalytic sessions, although six months to one year (or more) of treatment may still be needed.
  • Research shows that patients often experience ongoing improvements after therapy has ended, although follow-up sessions can still be beneficial.

Most therapists do not exclusively practice PDT but rather incorporate it into other therapeutic approaches. You can expect that your therapist may combine PDT theories with psychological techniques used in cognitive behavioral therapy (CBT) or other approaches.

Tips/Techniques

PDT therapists use certain techniques to help clients connect the dots between their past experiences and their current problems.

Psychodynamic therapy techniques and those used in CBT have a number of things in common. CBT seeks to change conscious thoughts and observable behaviors that are destructive.

The firsts step in achieving this is making patients more aware of their own thoughts and behaviors, which is also a focus of PDT.

One distinction between CBT and PDT is that CBT focuses on thoughts and beliefs more, while PDT encourages a patient to explore and talk about emotions more.

Therapists use some of the following techniques to help facilitate PDT sessions:

  • Talking openly about about automatic ways of thinking and life patterns that once seemed inevitable or uncontrollable, so they can be reconsidered. Speaking “openly” means discussing anything that comes to mind in an unstructured, uncensored way, which provides access to thoughts and feelings that might otherwise remain outside of awareness.
  • “Free association” practices, in which the therapist reads a list of words and the client responds immediately with the first word that comes to mind.
  • Identifying new choices and options for existing problems, perhaps by journaling and writing them down.
  • Identifying ways in which the client avoids distressing thoughts and feelings, including defense mechanisms that are used. A therapist will often redirect the attention of patients to issues they are avoiding.
  • Considering ways that the client can be more flexible and adaptive, perhaps by discussing news ways of coping in difficult situations.
  • Role-playing situations so the client can better understand how she/he contributes to relationship patterns.
  • Use of Rorschach inkblots, which the therapist presents as the client freely describes what he/she sees.
  • Dream analysis to open up discussion about patterns, fears, etc.

Risks and Side Effects

Because a “therapeutic alliance” between client and provider is to important in PDT, it’s crucial to find a therapist who is knowledgeable and properly trained.

Be sure to work with a therapist whom you both feel comfortable with and who is trained specifically in this type of therapy, perhaps as well as CBT. Look for a provider who is licensed, experienced in social work, a psychotherapist or other mental health or medical professional with advanced training in psychoanalysis.

One challenge with this approach may be the cost, considering that several sessions for at least a few months are needed to show improvements. Although it may not be the most cost-effective way to deal with psychiatric problems, it can teach clients skills that can be used for a lifetime, which is why improvements in symptoms often increase with time.

Conclusion

  • What is psychodynamic therapy (PDT)? It’s a form of psychoanalytic therapy that focuses on unconscious processes as they are manifested in a person’s present behavior.
  • According to psychodynamic theory, relationships and circumstances of early life continue to affect people as adults. Talking about early-life, unconscious problems can help people find ways to solve them and improve their mental well-being.
  • Benefits of PDT can include helping manage depression, anxiety, phobias and addictions.
  • The goal of PDT sessions is to become more self-aware of one’s thoughts, feelings, perceptions and experiences. A “therapeutic alliance” between therapist and client allows this to happen.
  • Psychodynamic therapy vs. CBT: Which is better? CBT (which seeks to change conscious thoughts and observable behaviors) may be used with PDT since they both work to uncover ingrained beliefs and habits. Both have been shown to be effective and for benefits to last or even increase over time.

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