The DA Fast Guide to Psychodynamic Therapy - Depression Alliance
Psychodynamic Therapy

The DA Fast Guide to Psychodynamic Therapy

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Therapy is a good place to start for anyone who’s struggling with their mental health. Whether the problem is related to addiction or something else like depression, gender dysphoria, anxiety, grief, or trauma, psychodynamic therapy can help. Talking it out with a therapist can help us to:

  1. Figure out the problem, and get to know WHY it’s happening to us
  2. Begin the work of changing unhealthy behaviors and lifestyles for the best

Psychodynamic Therapy: What is It?

In the simplest terms possible, psychodynamic therapy is when a patient meets with a licensed psychologist to talk through their problems, thoughts, feelings, and relationships. When someone talks about seeing the shrink, getting help, or talking to someone, they’re most likely referring to psychodynamic therapy. It is the classic and familiar talk therapy that’s been around for decades.

What makes this type of therapy unique is its global approach, which means that it brings together all the different parts of a whole person. Unlike CBT which tends to focus on specific target behaviors, such as substance abuse or self-harm, psychodynamic therapy dives deeper, to the root of the problem.

Psychodynamic Therapy Theory

Psychology is a science, which means that it makes use of theories and the scientific method. When it comes to psychodynamic therapy, the theories behind it aim to explain why mental illness occurs, and what we can do to overcome it.

A theory is a logical system of ideas that attempts to explain something larger. They can be tested, refined and even disproven using experiments or case studies. Theories can exist in opposition to one another and even build off of each other over time. This is how the psychodynamic approach emerged from earlier forms of talk therapy.

The theories that support psychodynamic therapy can be traced back to the works of Sigmund Freud (1856-1939). Based on his clinical interviews with mentally ill patients, he developed his novel psychoanalytic method. What happened between Freud and his patients was groundbreaking work, but other major thinkers like Carl Jung, Lacan, Adler,  Winnicott, and others were able to spot weak points and contribute new ideas and approaches to treating mental illness with talk therapy. Psychodynamic therapy is the result of the contributions of all of

While these two words sound alike, psychodynamic and psychoanalytic, it’s important to remember that they are not the same thing! The psychoanalytic method refers specifically to Freud’s early system of interviewing patients, which is more intensive and narrow in scope than the modern psychodynamic therapy. Psychodynamic theory combines the knowledge and research of many different psychologists and has been improving and evolving over the decades since Freud.

How Does Psychodynamic Therapy Suggest the Mind Works?

There are 3 main components to understanding the psychodynamic perspective on how the mind works.

  1. Behavior is ruled by unconscious motives and forces

This is the foundational belief that supports psychodynamic therapy. Even though it appears like we are in complete control of our thoughts and actions, that’s not really the case according to psychodynamic theory. Like the tip of the iceberg floating above water, the conscious mind we have access to is only a tiny percentage of the whole thing. There is so much more going on underneath!

There are always deeply buried motives, desires, beliefs, memories, and traumas from the past that affect our current mood and behavior. Unfortunately, these powerful motivators can be difficult to figure out. That’s especially true for people going through depression, PTSD, anxiety, addiction, or other forms of mental illness. That’s because these painful symptoms and disorders are signs that we are using unhealthy defense mechanisms to separate ourselves from painful memories and thoughts stored in the unconscious. These disconnect us even further from our unconscious mind and muddy the already murky water.

  1. Childhood experiences affect us all the way through adulthood

Early development and family bonding are important themes in psychodynamic therapy. The time between infancy and early adulthood are critical, formative years and what happens to us during our youth can affect our personality for life. Traumatic, frightening, or strange events from those years can play major parts in a patient’s experience and treatment. Also, the style of the relationship you had with your mother, father, or primary caretaker comes up often during psychodynamic therapy.

  1. There are 3 separate components to the mind: The Id, the Ego, and the Superego

While trying to parse out where all of our different, sometimes conflicting, thoughts and beliefs come from it’s helpful to use these 3 concepts. The Id, the Ego, and the Superego are always at odds with each other to govern our behavior and thoughts.

The Id – This is our animalistic self, whose focus is self-preservation and obtaining pleasure. This is the part of you that says “grab that last slice of pizza before anyone else!”

The Superego – The superego is the righteous, moral part of ourselves that balances out the careless, selfish id. It’s the part of ourselves that will say “I won’t take the last slice because I am better than that!”

The Ego – This is the realist, conscious part of ourselves, which helps us to meet the demands of both our id and superego. For example, the ego will balance our desire to both eat the pizza and behave appropriately. The ego would say something like “I am hungry but Susan hasn’t gotten a second slice yet, so I will ask her first if I can take it.”

How Does Psychodynamic Therapy Cause Change?

By participating in this type of talk therapy, patients gain insight. That is, a better point of view and greater understanding of those unconscious forces that are negatively affecting their mood and behavior.

What Happens in a Psychodynamic Therapy Session?

There is a lot of wiggle room in a psychodynamic therapy session, and there’s not one set script. We are free to talk about anything and everything that’s on our minds when we’re with our therapists. Still, this type of therapy does have some reliable, established techniques.

Intake is the most formal and scripted phase of psychodynamic therapy. During the first 1-3 sessions, your therapist will work to quickly draw out the most relevant information about you, your symptoms, and your past. This is to get a grasp of the bigger picture and identify the highest priority issues to talk about first.

Once that is over, you will get into a rhythm of meeting once or twice a week with your therapist to just talk.

Psychodynamic Therapy

Techniques Used in Psychodynamic Therapy

  • “How does that make you feel?”

It’s basic, but simply inquiring into the deeper meaning behind our thoughts, behaviors statements, and experiences is the number one technique that drives psychodynamic therapy.

In our day to day lives, we often feel and think things, but we rarely if ever push ourselves to analyze them. Having somebody there, asking us to just go one step deeper with a thought or emotion is a powerful tool for self-discovery.

  • Rorschach Ink Blot Tests

This technique involves looking at inkblots and stating the first thing that we see in the ambiguous picture.

Not every practitioner uses this technique. Some say that it’s too open-ended and that the results are neither useful nor backed up by any evidence. Others embrace it as an illuminating way to get to know their patients a little more and get a feel for the way they think and see the world.

  • Education

As treatment progresses, therapists will teach their patients about relevant psychological concepts and self-soothing/self-care techniques. Some therapists use pamphlets and worksheets, while others will simply take some time during sessions to explain important topics. The idea is that heightened awareness and understanding will help empower you to overcome specific issues.

Does Psychodynamic Therapy Work?

Yes, it does! A multitude of empirical studies have shown that psychodynamic therapy is an effective treatment route, especially for anxiety, depression, eating disorders, and somatic disorders. Since psychodynamic therapy is a form of depth therapy, meaning it helps reveal hidden meanings and buried thoughts, it works best when we are open to new ideas, and participating as fully and genuinely as possible.

What Kinds of Concerns is Psychodynamic Therapy Best For?

Psychodynamic Therapy is known to be effective in a wide variety of situations. Most notably, however, are adjustment disorders and personality disorders.

Adjustment disorders are temporary psychological reactions to challenging times. People can experience a lot of distress and uncertainty in response to change, which leads to depression and anxiety. Talking through our feelings during hard times can help us be more resilient and clear-headed so we can overcome the problem.

Personality disorders respond very well to psychodynamic therapy. Many people mistakenly believe that personality disorders are permanent, and we have very little power to do anything about them. However, evidence shows that psychodynamic therapy can help personality disorder patients overcome, or at least reduce the harm of specific issues including impulsivity, irritability, and attachment.

How Are Psychodynamic Therapy Specialists Trained?

Becoming a psychodynamic therapist takes years of study and training. The journey includes:

  • Between 1,500-4,000 documented hours of work experience, a percentage of which includes shadowing and supervision with an established practitioner
  • Achieving a Master’s or Doctoral degree in a relevant field
  • Passing the licensure exam, the requirements of which vary by state
  • Meeting continuing education requirements to maintain licensure.

Concerns/Limitations of Psychodynamic Therapy

-Lack of Immediate Results

The main thing that discourages people from trying out psychodynamic therapy is the long duration of treatment. There is no guarantee you will experience the “results” you desire within any specified time frame. Some people may be satisfied enough with just a short, 8-week long treatment plan, while others may continue to struggle with their mental health after years and years of treatment.

-Lack of Specificity

Psychodynamic therapy’s greatest strength is it’s holistic approach to healing the complete individual. Unfortunately, the trade-off of that is the lack of specificity that some patients need. When someone has a very specific issue, such as a failing relationship or an addiction, their progress may reach a ceiling in psychodynamic therapy until they get the targeted help they need with that issue.

How to Find a Therapist

The simplest and most popular route is to search through your insurance provider. Most insurance providers have a search function on their website that will allow you to seek out mental health practitioners in your area that will accept your plan. You can also call your insurance provider up and ask for recommended providers.

Another option is to seek out a therapist on your own. You can ask friends and family for recommendations, talk to your primary care provider, or reach out to the individual private practices in your area.

What Should I be Looking for in an LMHP?

When deciding on a therapist, the key thing is that you feel comfortable and at ease with this person. The most educated and elite therapist may not necessarily be the best therapist if you simply do not click. It’s okay to “try out” a few therapists and stick with the one you like best.

These are some of the most common factors that can affect a therapist/client relationship:

  • Gender
    • Some people are more comfortable with a same-sex therapist, while others do not care either way. Consider how you will feel talking about things like sexuality with someone of the same or opposite gender.
  • Sexual Orientation
  • Age
  • Background
  • Race/Ethnic Background
    • Ask yourself, will you feel more comfortable with someone who personally knows about your cultural experience? If so, it is okay to seek out a therapist with a similar background as you.

Questions to Ask a Potential Therapist

  • What areas have you focused on during training/practicing?
  • Have you worked with someone like me/someone with similar issues as me before?

Make sure that each therapist you consider working with has a specialty that is relevant to your unique situation. If you are struggling with an eating disorder, then you should certainly be looking for someone who’s experienced and knowledgeable about that type of issue.

  • How long have you been practicing?

It’s not absolutely necessary to choose the oldest, most experienced therapist. However, knowing how long someone’s been practicing can give you a good idea of what to expect during treatment. A therapist with years and years of experience may have more wisdom, but they may not be as up-to-date and open as a therapist who’s just starting out.

  • How flexible are you?

Be aware of cancellation policies, how difficult it is to schedule a visit, and whether or not your therapist can be there for you during emergency situations. Do those terms seem fair to you? You should try to get to know the practical details of each therapists’ working policies before you begin treatment.

Final Thoughts on Psychodynamic Therapy

Talk therapy can be a life-changing experience for anyone who feels stuck, lost or sick. By revealing the unconscious factors that influence our mood and behavior, psychodynamic therapy helps us break free from mental illness.

Resources

  1. https://www.goodtherapy.org/learn-about-therapy/types/psychodynamic
  2. https://www.ncbi.nlm.nih.gov/books/NBK64952/
  3. https://www.psychologytoday.com/us/therapy-types/psychodynamic-therapy
  4. https://psychcentral.com/lib/psychodynamic-therapy/

About the Author Depression Alliance Staff

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