What is psychodynamic therapy, and is it effective?

Psychodynamic therapy and counselling have their origins in psychoanalysis, founded by Freud. In terms of your experience, psychodynamic therapy will focus on the following (for a useful overview of psychodynamic therapy, see Shedler 2010):

Exploring your emotions and experiences.

I will encourage you to connect to, and talk about, your emotions in whatever manner feels most natural and comfortable to you. Sometimes when feelings are painful or unbearable, we disconnect from them or push them out of awareness. The work of therapy involves uncovering or excavating these buried emotions, and the thoughts or experiences to which they are attached, so that they may have a voice.

Reflecting on and articulating past experiences, feelings, and thoughts.

In therapy we will explore experiences and themes from your past that may bear on the present in significant and sometimes unacknowledged ways. For instance, our habitual manner of relating to others, and to ourselves, is often grounded in childhood experiences that we are often unaware of. The past constructs and shapes how we think, feel, and act in the present. For example, a child who did not experience empathy or understanding from her parents may crave love and attention in her current relationships as a reaction against what occurred (or failed to occur) in the past.

Exploring your relationships with others.

Because babies and children are entirely dependent on their caregivers (mothers, fathers, or relatives or guardians), the way that you related to those carers, and how they related to you, will affect your relationships in the present. Other relationships in the past (such as mature romantic relationships or friendships) that carry weight or significance may also impact how we act and feel in relation to our friends, lovers, siblings, parents, or co-workers. Sometimes we form patterns or fixed habits: for instance, avoiding intimate relationships because we fear abandonment, or lack trust. These habits can be examined and unravelled, without judgment or blame, so that we may understand how they developed, how they affect your life now, and how to change them in order to flourish and live with greater freedom.

Attending to the relationship between the client and the therapist (you and I).

The ways that we relate to significant others (parents, friends, siblings, lovers) often become more rigid and fixed as we age. They are not impervious to change, however. Furthermore, our usual modes of relating are often replicated without awareness in the relationship between the client and his or her therapist (that is, between you and I). Thus, examining with care and understanding the way that you relate to me is one way of uncovering your habits of relating that may be unconscious or outside of awareness. For example, a client who finds it difficult to talk about her feelings or experiences in therapy may have been told in one way or another by parents or carers that their feelings were unacceptable, intolerable, or unimportant.

Examining repetitive patterns in your life and relationships.

Sometimes we feel ‘stuck’ or caught up in ways of feeling, acting, and experiencing that seem all-encompassing, or too powerful to change. In therapy we will carefully explore your emotions, memories, and associations (including fantasies such as dreams, day-dreams, wishes, and fears) so that the causes for your habitual patterns may be uncovered or excavated. Sometimes we use actions to express ourselves (our feelings, memories, or fears) instead of language (words and concepts). For instance, I might forget to contact someone who I want to avoid, or who I dislike, instead of directly admitting how I feel. We are often unaware that these actions have several meanings and various causes. Through therapy we may look for clues that will hopefully indicate which actions are guided by hidden causes of which we are unaware. Such awareness may allow a measure of freedom from rigid patterns of action and thought.

Sometimes psychodynamic therapy is dismissed as unscientific or ineffective compared to other methods of treatment, such as CBT or Person-centred therapy. However, studies have shown that psychodynamic and psychoanalytic therapy, and psychoanalysis, are very effective, and can have an enormous impact on the health and well-being of individuals (for an excellent overview of the scientific literature, see Shedler 2010a and 2010b).

Photo: Adorno mural in Frankfurt
By Vysotsky – Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=77220755