Psychodynamic approach in therapy is best suited for those who want to achieve more than just reducing or eliminating unwanted symptoms. This is an insight-oriented approach that seeks to bring lasting changes through the deeper understanding of one’s mental and emotional processes, which by design takes a long time to achieve.
Many people feel that they have neither time nor energy for this kind of long-term work and that all they need is to get rid of their presenting problem as fast as possible. For those folks cognitive-behavioral therapy (CBT) or purely behavioral methods are most suitable. Many people want to skip any kind of talk therapy all together and just to manage their symptoms with medications. Unfortunately, this seems to be the case with more and more people, and I will discuss why it is unfortunate in the upcoming series on psychiatry and psychiatric drugs.
One of the legitimate criticisms of psychodynamic therapy is that it is often unfocused, that it has no clearly defined goals and no clear direction. It doesn’t have to be that way as there is nothing in the psychodynamic theory that prevents setting achievable goals and working on accomplishing them. In general though it is not as specifically focused as the work of CBT or behavioral therapy simply because CBT and behavioral methods were designed to address problems directly through logical and behavioral interventions whereas the psychodynamic method doesn’t approach problems head on but rather focuses on helping the client find answers and solutions within themselves through the insight-oriented work.
Even though psychodynamic therapy is not about providing direct guidance, it shouldn’t be experienced by the client as something vague, undefined and unfocused. Though the goals may be more general, could change during the process and the way to achieving them may feel more like walking on a winding road through a forest with lots of twists and turns and dead ends than walking a straight line, nevertheless the goals should be clearly defined at the onset of therapy because both the therapist and the patient should know what they are working on. Reviewing therapy goals and evaluating therapy progress has to be a standard practice of any therapy regardless of the modality. Otherwise, therapy may easily turn into something other than a professional service that is supposed to focus on solving clearly defined problems and instead be inappropriately used to fill the void in the patient’s life that is supposed to be filled by friendships and other social and close relationships. Once therapy turns into that kind of endeavor, it carries a great potential for harm and often harm does take place under those circumstances.
Another legitimate criticism of psychodynamic therapy is the excessive emphasis on the relationship between the therapist and the client at the expense of other important things the client needs to work on. While things that arise within the client-therapist relationship can provide important information about the client’s habitual ways of relating to others and are certainly worth being addressed in therapy if the therapist believes they may contribute into the client’s problems, by no means this should become the sole focus of therapy.
Sadly, I’ve heard and continue to hear too many stories from former and present therapy clients where their therapies had quickly become endless explorations of the relational dynamics between them and their therapists to the point that all other problems and concerns those clients wanted to discuss in therapy were dismissed, which felt to them like their lives were put on hold. This also re-created traumatic experiences they had in their past relationships without any healing resolution despite the therapists’ claims that this method was designed to heal past relational traumas.
I had this harmful experience myself in my own therapy and so I have a first hand knowledge of the dark side of making a “relationship” with a therapist the most important part of therapy. When I first sought therapy, I did it for the purpose of getting a professional opinion about the life struggles I was experiencing at the time and the ways to resolve them. I certainly was not looking for a “relationship” with the therapist. At some point, somehow, on my therapist’s insistence, it became about the “relationship” between me and him. At the time I didn’t challenge his suggestion that the “relationship” should be the centerpiece of my therapy work because I trusted that, as a professional a.k.a an “expert”, he knew how therapy works better than I did. Since the “relationship” became the central point to focus on, all other important areas of my life I needed to understand and to improve were pushed aside, which essentially felt like putting my life on hold for the whole duration of therapy.
The potential downsides of psychodynamic therapy don’t have to manifest if the practitioner of this method is a mindful, responsible person who brings the right intentions into his or her work. If done with mindfulness, psychodynamic psychotherapy can be an excellent method for personal growth and for healing emotional traumas that cripple people on many levels. This approach encourages deep personal exploration, which increases self-awareness and makes one more capable of making the best life choices they can make for themselves. This, in my view, is one of the most powerful methods to assist a person in becoming the most autonomous and mature individual they can be. However, as anything powerful, it has a potential to harm as much as it has to heal, therefore, those who practice it should do it with utmost responsibility and mindfulness.
Related posts: “Psychodynmic Psychotherapy”, “Psychoanalysis”, “Types of Therapy”
Considering the nature of defense mechanisms and the lack of access of the predetermined forces acting in the unconscious, psychoanalytic therapy in its traditional form is a long process that frequently requires between two and five meetings a week over a few years. This method presupposes that symptom decrease alone is insignificant, as if the foundational conflict remains unresolved, additional psychotic symptoms will merely be swapped.
The assessor is typically a ‘blank page,’ revealing very little about themself in order to enable the patient to operate on their unconscious without external influence. The psychoanalyst encourages the patient to acquire insights into their behavior and the significance of their complaints through a variety of interventions, such as inkblots, free association, parapraxes, transference analysis, resistance analysis, and interpretation (including dream analysis).
Inkblots Rorschach inkblots. Due to the lack of accessibility of predetermined forces operating in the unconscious and the nature of defense mechanisms. The Rorschach inkblot is meaningless in and of itself; it is ambiguous (i.e., unclear). What matters is what you make of it. Individuals will perceive things differently depending on the unconscious connections they make. The inkblot is referred to as a measurement tool because the patient interprets the inkblot by ‘projecting’ data from their unconscious mind. Behavioral psychologists including B.F. Skinner, on the other hand, has condemned this strategy as unscientific and subjective.
Freudian Slip. Unconscious feelings and thoughts can transmit to the conscious mind via parapraxes, commonly referred to as Freudian slips or tongue slips. We expose what is truly on our minds when we say something we did not intend to say. For instance, during a speech, a dietitian meant to remark that we should always seek the finest bread but mistakenly said bed. Another instance is when a coworker’s new partner is addressed by the surname of a prior one whom he preferred. Freud felt that tongue slips revealed unconscious thoughts and that there were no coincidences; all conduct (even tongue slips) was meaningful (i.e., all behavior is determined).
Free Association. In psychodynamic psychotherapy, free association is a technique in which a patient expresses whatsoever thoughts come to mind. This technique entails the therapist presenting a word or concept, and the patient responding instantly with the first thing that occurs to them. It is expected that during free association, pieces of repressed memories may resurface, providing a glimpse into the unconscious mind. Free association may be ineffective if the patient exhibits resistance and is unwilling to express his or her thoughts. On the contrary, the appearance of resistance (e.g., an abnormally extended pause) is generally a strong indicator that the client is approaching a significant suppressed thought in his or her mind and that additional exploration by the therapist is necessary.
Freud said that sometimes, his free-associating patients received an emotionally intense and clear recollection to the point of reliving it. This is similar to a “flashback” from a battle or a sexual assault. A distressing memory that is so real that it feels as though it is occurring again is referred to as abreaction. If such an upsetting memory occurs in psychotherapy or with a caring friend and the individual afterward feels better—relieved or cleansed—this is referred to as catharsis. Freud often gained vital understanding into the patient’s difficulties as a result of these extremely emotional experiences.
Dream Analysis. Freud described dream analysis as “the royal road to the unconscious.” He contended that the conscious mind functions similarly to a filter, but is less watchful while we sleep. As a consequence, suppressed ideas are brought to the surface – even if what we remember was changed during the dreaming process. As a result, we must differentiate between a dream’s apparent and hidden content. The former is what we recall. That is, in fact, what it implies. Freud thought that the actual meaning of dreams generally had a sexual connotation, and in his theories of sexual metaphor, he opines the deeper meanings of commonly occurring dream patterns.
Transference. Along with observing communication nuances, psychodynamic therapists are aware that patients commonly unintentionally project their sentiments, aspirations, anxieties, and grudges toward real persons in their life and these might be passed onto the therapist. Transference is a term that refers to the process by which individuals transmit their emotions from the original person to the therapist as a target of those sentiments. Although patients do not always identify transference when it happens, the psychodynamic therapist can understand the correlation, guiding the patient in locating the real origin of those emotions. They frequently involve individuals who represent unsolved problems in the individual’s life and may even indicate misdirected shame or guilt that the individual felt in these interactions.
On the other hand, therapists may have unconscious sentiments toward their patients at any point during therapy, as they, too, are human. Countertransference is a significant feature in psychodynamic treatment. Therapists are educated to identify their own issues in order to minimize their undue effect in therapy. As a result, countertransference can be employed by the therapist to obtain a greater understanding of the patient’s perspective and to approach those challenges appropriately.
