In this series, I dig a little deeper into the meaning of psychological terms.
This week’s term: 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 theorist who contributed to 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.
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.
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.
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 use of coping and defense mechanisms. The third dimension looks at manifest symptoms and concerns.
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 was far nuttier than I was. I was in hospital following a suicide attempt, and his first meeting with me 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?
You can find the rest of the What Is series here.