In this series, I dig a little deeper into the meaning of psychological terms. This week’s term is psychodynamic psychotherapy.
Psychodynamic psychotherapy is a type of talk therapy that does a deep dive into the past to help uncover what’s going on in the unconscious mind in order to figure out problems in the person’s life. It’s based on psychoanalytic therapy, but is less intensive, with a typical frequency of 1 or 2 sessions per week (as opposed to 4-5 per week for psychoanalysis). Sigmund Freud was a major contributor to the development of this therapeutic approach.
Maladaptive approaches, which are often unconscious, are seen as arising early in life, usually in early childhood. By uncovering and resolving the conflicts that led to the development of these maladaptive responses, symptoms are expected to improve.
Therapeutic techniques
The relationship between client and therapist is very important in this type of therapy. Therapeutic techniques include free association, dream analysis and work with transference. Repressed emotions are brought to the surface and examined in terms of their effects on current decision-making.
Transference occurs when the client projects feelings toward a figure from their early life onto the therapist. This can then be explored and underlying conflicts can be addressed. A high level of trust is required in order for transference to be incorporated effectively in the therapy. Another element of the therapy is that defense mechanisms are identified and worked through.
Dimensions of functioning
This was new to me when I was doing some reading for this post, but there is a Psychodynamic Diagnostic Manual put together by the American Psychoanalytic Association and a few other groups. It takes a 3-dimensional approach to mental and overall functioning. The first dimension is personality patterns and disorders. The second dimension covers mental functioning across a number of different areas, including information processing, self-regulation, establishing and maintaining relationships, and the use of coping and defense mechanisms. The third dimension looks at manifest symptoms and concerns.
Role of psychodynamic psychotherapy
The research evidence support for psychodynamic psychotherapy is mixed. I haven’t looked into this in any detail, but there’s not the clear level of support that there is for, say, cognitive behavioural therapy. I would suspect, though, with the nature of the therapy, it would be more difficult to design solid research studies compared to a more structured, time-limited form of therapy.
Psychodynamic psychotherapy is usually done by therapists in private practice, so it’s not something I’ve encountered in my work as a nurse. My only up close and personal encounter was during my last hospitalization. My psychiatrist was a psychodynamic guy, and although I was the patient, he seemed far nuttier than I was. I was in hospital following a suicide attempt, and he was meeting me for the first time. He wanted to know if I remembered my brother being born and if I enjoyed it the first time I had sex. I know I shouldn’t judge a whole field of therapy based on one nutbar, but I find it hard to set aside that bias.
Do you have any experience with psychodynamic psychotherapy?
Related posts on MH@H
- Psychotherapy Alphabet Soup: CBT, DBT, ACT, and More
- What Is… Containment in Therapy
- What is… a Defense Mechanism
- What Is… Freud’s Psychoanalytic Theory
- What Is… Transactional Analysis
- What Is… Transference & Countertransference
References
- Psychology Today: Psychodynamic therapy
- Wikipedia: Psychodynamic Diagnostic Manual | Psychodynamic psychotherapy
The Psychology Corner has an overview of terms covered in the What Is… series, along with a collection of scientifically validated psychological tests.
Ashley L. Peterson
BScPharm BSN MPN
Ashley is a former mental health nurse and pharmacist and the author of four books.
I’m not sure that was what it was called back then, but when my middle son started having issues in school, we ran the gamut of drugs, psychiatrists, and a psychologist who did talk therapy as well as biofeedback, which I believed was working great, yet my son did not. Unfortunately for him, he quit everything and decided to self-medicate which caused many of the problems he has to this day. Now he is in his early 30’s and I wish he would find a good psychologist and get back to it, but he is too old to listen to me anymore. 😉
I hope that at some point he’ll realize that it’s something that could help him.
Ooo another one that I loved to read as it reminded me of all the stuff in my psych degree! It’s interesting you’ve had an experience of it as I think psychodynamic psychotherapy is increasingly rare in practical application as a standalone model these days (maybe I’m wrong, but I don’t come across it being employed all that much).xx
Yeah it definitely seems to have moved out of the mainstream.
I had psychodynamic therapy for a couple months last year. Before that, I had two CBT therapists, the first one had a more integrative approach though and it wasn’t just pure CBT, plus it was much more extended than CBT due to my life situation back then and that. While with the first therapist it was going great and I found CBT really helpful for things I was struggling with back then, as I changed therapists and my life got more stable I came to a conclusion that most of my major issues are actually rooted in the past and since I had the possibility to finally focus on them I decided to look for some form of therapy that would help me to uncover and get rid of or alter my perception of that past sh*t. And I chose psychodynamic therapy since it seemed to be a fairly good thing for me, considering both my issues and that I generally tend to analyse things a lot, both in terms of my surroundings and other people as well as introspection, though I was a bit afraid of the intensity of it. I had someone asking me why psychodynamic and not psychoanalysis since they are similar but I always had an impression, maybe a bit stereotypical, that psychoanalysis is actually quite nutty and creepy, and too out there haha. I guess this therapeutic model was indeed good for me, but I realised quite quickly that there is almost no connection whatsoever between me and my therapist, and that actually at times I didn’t feel fully safe with her emotionally. She was nice as a person and made an impression of a warm and very spontaneous person on me, but we just didn’t get each other and couldn’t get close enough to each other. I couldn’t trust her fully and felt like she’s pressuring on me that I should. Actually, after almost every session, I felt pretty low and confused and worse than before it. I thought it might be that whole pain of healing thing or such but I guess it was way too early for that and we weren’t doing such deep work yet. Plus she seemed to have some incredible problem with my blindness that was frustrating me immensely, so I felt I need to quit, and that’s what I did. As I said I think psychodynamic therapy isn’t a bad thing, but, as in every kind of therapy, and in every relationship, you just need to find the right person, and you probably need to have a bit of luck to do that. I was also very attached to my first therapist – the CBT one – so it’s possible that I compare other therapists to her so much that no one can be good enough for me to replace her. Funnily enough, the psychodynamic therapist also asked me about the feelings I had when my brother was born, though I guess in my case it could be a bit more relevant since it’s my first memory and my relationship with my brother has always been… mmhmm, odd. And the thing with them being so preoccupied with sex is a little weird indeed, especially in case of people like me who never had sex. 😀
I suspect that for any type of therapy if the connection with the therapist isn’t there it’s just not going to work.
I had a good psychodynamic psychotherapist, although I think she used elements of other types of therapies over time. The relationship between was important, though. The first year or two had a lot of ups and downs before I really began to trust her.
That’s a pretty significant commitment to keep going that long waiting for the trust to be established.
You are doing amazing work! Keep on doing it! 🙏
Thanks!