What is psychodynamic therapy?

Psychodynamic therapy is a spinoff of psychoanalysis, meant to capture the brilliance of Freud’s work but without all the nonsense. It also incorporates more modern research findings on the brain in an attempt to create a more practical, down-to-earth type of therapeutic approach. The primary focus of psychodynamic therapy is conquering subconscious patterns that sabotage our lives; patterns which have been established through past experience. Or as Jonathan Shedler, a psychodynamic practitioner and associate professor of psychiatry at the University of Colorado School of Medicine puts it:

“Freud’s legacy is not a specific theory but rather a sensibility: an appreciation of the depth and complexity of mental life and a recognition that we do not fully know ourselves. It is also an acknowledgment that what we do not know is nonetheless manifested in our relationships and can cause suffering – or, in a therapy relationship, can be examined and potentially reworked.”  (Shedler, 2010A, p. 54)

The process of psychodynamic therapy: How it works

The process of psychodynamic therapy involves…

  1. Exploring emotions: Therapists encourage patients to explore the full repertoire of their emotions, including feelings that are threatening, troubling, contradictory, or which they may initially be unable to express.
  1. Examining avoidances or evasion habits: We often create defense mechanisms to avoid the issues that trouble us. Psychodynamic therapists look to spot and address such patterns.
  1. Identifying recurring patterns: We all tend to engage in unhealthy patterns, such as sabotaging our own success or choosing romantic partners that aren’t suitable for us. Therapists aim to help patients identify these patterns and correct them.
  1. Discussing the past: Our past experiences do indeed shape our current behavior, and psychodynamic therapists try to help patients free themselves from the ghost of past experiences in order to live more fully in the present.
  1. A focus on relationships: One of the principles of psychodynamic therapy is a recognition that most mental health problems arise from troubled relationship patterns: An inability to express emotions, a fear of rejection, a possessive attitude towards others, etc.
  1. Examination of the patient-therapist relationship: Psychodynamic therapists believe that a person’s habitual relationship patterns emerge in the therapy relationship as well, and so spotting and changing these patterns with a therapist plays a central role in changing the social patterns in the person’s overall life.
  1. Valuing fantasy life: You still get to keep your dream interpretations and analysis of daytime fantasies, which is either good or bad news, depending on how into such stuff you are. While less of an emphasis should be placed on these things (as the validity of dream interpretations has been debunked repeatedly), psychodynamic therapists still believe that dreams and fantasies provide a valuable source of information about a person’s hopes, desires and fears. This can indeed be helpful, so long as the therapist doesn’t get too carried away with trying to read your subconscious through your dreams.


The Pro’s and Cons of Psychodynamic Therapy

The benefits of psychodynamic therapy

  1. Psychodynamic therapy is particularly good for troubled marriages or family conflict, because such problems are commonly created by unhealthy relationship patterns that trace far back, often to a person’s childhood and patterns of interaction with their own parents. (For example, the father who comes from a verbally abusive household does not recognize how critical and condescending he is with his daughter, since to him, this is what he’s come to know as far as how parents and children interact. So he recreates the same abusive pattern he grew up with, unaware that these problematic patterns are abnormal and creating conflict within the family.) We would recommend psychodynamic therapy for families with a history of: verbal abuse, physical abuse, harsh or dysfunctional discipline patterns, those from neglectful homes or who grew up in cold, emotionally neglectful households, adult children of substance abusers, and some other situations that commonly give rise to ingrained patterns of interacting that aren’t healthy. Psychodynamic therapy may work better than cognitive behavioral therapy in some of these situations.
  1. There has been some promising research on psychodynamic therapy, with some studies showing it to be as effective as cognitive behavioral therapy, and with effects that often last long after therapy has ended. (Shedler, 2010B) However, the field is still relatively new and the research rather scarce, so more work is required before we can place it in the same league as cognitive behavioral therapy, which has a well-established history of evidence-based research.
  1. Psychodynamic therapists claim to have dumped the psychoanalysis tendency to keep patients in therapy forever, and so you should be able to reach an “end” date where progress has been made to the point that therapy is no longer needed.
  1. Psychodynamic therapists are often medical doctors who can prescribe medication.


The disadvantages of psychodynamic therapy

  1. The fact that it emerges from psychoanalysis makes us a bit uneasy. At this juncture it’s hard to say whether psychodynamic therapy truly is a practical and reformed way to implement Freud’s basic theories without all the nonsense, or whether psychodynamic therapy is merely a re-branding effort designed to evade the horrific track record of traditional psychoanalysis. Only time will tell. If psychodynamic practitioners can keep Freud’s genius while mixing it with modern neuroscience and the best from other methods while avoiding the tendency to fortune tell from a patient’s history, they may be onto something. But many of the potential pitfalls are still there, particularly the focus on creative dot-connecting and the emphasis on negative events in a patient’s history. We fear that some therapists may revert back to classic psychoanalysis under a different name.
  1. In the way it’s described it still may be more intensive and demanding than other types of therapies, and will probably require dozens of sessions at the minimum. Thus, we would not recommend it for dealing with isolated events, which would be better served through cognitive therapy.
  1. Psychodynamic therapy may be good for family therapy as a group, and may also be helpful for older teens, but we would not recommend it for children. Even with the assumed improvements over traditional psychoanalysis, it’s still less practical for children than cognitive behavioral therapy, and still runs high in the risk for harmful suggestion, making it potentially dangerous. Psychodynamic therapy for kids AS PART OF a family therapy plan should be okay.


*You can read more on psychodynamic therapy in a web article written by Jonathan Shedler, at http://psychsystems.net/shedler.html