Sunday, July 18, 2010

What is Psychodynamic Therapy, Anyway?

For some, psychodynamic therapy has a bad name. For others, it is a bit of a mystery. What some people might not know is that psychodynamic therapy (a broader application of psychoanalytic therapy) has evolved over the years since Freud discovered the unconscious and theorized that all mental distress originates from unresolved sexual and aggressive conflicts.

Present-day psychodynamic therapy tends to be more accessible and “user-friendly.” Psychologist Jonathan Shedler (2010) found that contemporary psychodynamic therapy is effective and that patients who receive this type of therapy benefit from it and continue to improve after their therapy ends. Shedler (2010, pp. 98-100) discusses seven features that characterize the practice of contemporary psychodynamic therapy and distinguish it from other therapeutic approaches. Here is a brief discussion of these features.

1. Focus on and expression of emotion. The psychodynamic therapist encourages the client to express their full range of emotions, to put words to their emotional experience.

2. Exploration of attempts to avoid uncomfortable thoughts and feelings. We all tend to use certain behaviors and, sometimes, addictions to avoid thoughts and feelings that cause us pain and discomfort. These avoidance behaviors are explored in psychodynamic therapy, to understand how the client uses them to cover over thoughts and feelings. Clients can then work on experiencing previously avoided thoughts and feelings in a safe, non-judgmental context.

3. Exploration of themes and patterns. Increasing awareness and understanding of the themes and patterns in one’s thoughts, feelings, self-concept, relationships and experiences allows a person to make more satisfying choices and to avoid self-defeating behaviors.

4. Exploration of past experiences. Awareness and understanding of a client's past, and how past experiences re-play in the present, can help explain the client's current psychological challenges. "The goal is to help patients free themselves from the bonds of past experience in order to live more fully in the present.” (Shedler, 2010, p.99).

5. Focus on interpersonal relationships. Interpersonal relationships can suffer when one’s self-defeating, recurring behaviors interfere with intimacy and the ability to get one’s emotional needs met in a relationship.

6. Focus on the therapy relationship. A person’s relationship themes and patterns tend to play out in the therapy relationship as well. This provides an opportunity for the therapist and client to explore the client’s interpersonal patterns in a very direct, in-the-moment way.

7. Exploration of wishes, fantasies and dreams. A foundation of psychodynamic theory is that a person’s wishes, fantasies and dreams contain valuable information about a person’s view of themselves and others. Exploration of this material in therapy provides the client and therapist with additional avenues of discovering what is blocking the client from living a more authentic life, as well as the means for the client to begin to live more authentically.

In my work, I use a blend of psychodynamic therapy and mindfulness-based cognitive-behavioral therapy. Cognitive-behavioral therapy can help clients become more aware of their thinking, and how their thinking affects their feelings and behavior. The mindfulness component helps clients sharpen their awareness and learn to breathe and relax even in the midst of uncomfortable or distressing thoughts and feelings. (See my earlier blog entry entitled, A Simple Approach to Working with Mindfulness).

These approaches work well together. Mindfulness-based cognitive-behavioral therapy helps strengthen client’s awareness and ability to tolerate difficult moments, both useful skills for working in a psychodynamic mode. Most important to me is discovering and utilizing a mode of working that seems helpful to each client.

Shedler, J., (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 65, 98-109.