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Psychodynamic therapy: what sits behind your thoughts, feelings, and actions.

What is psychodynamic psychotherapy?

Psychodynamic therapy explores and makes room for, the role of the unconscious mind in influencing behaviour.

In psychodynamic therapy, the therapist works with the patient to uncover hidden aspects of the self. The hidden aspects are explored to help understand how they may be affecting present behaviour. Often unconscious forces play out in the therapeutic relationship.

Psychodynamic therapy helps patients gain insight into their behaviour. As a result of the insight, patients may make changes that will lead to greater meaning and life satisfaction. 

How do psychodynamic therapy and cognitive behavioural therapy differ?

Psychodynamic therapy and cognitive behavioural differ in their focus and approach. Cognitive-behavioural therapy (CBT) is focuses on the relationship between thoughts, feelings, and behaviours. The goal of CBT is to help people identify and change unhelpful thoughts and behaviours. CBT is a short-term treatment for disorders such as depression, anxiety, and phobias.

A key difference between CBT and psychodynamic therapy is the role of symptoms. CBT seeks to treat symptoms with strategies and skills. Whereas, the psychodynamic approach sees symptom reduction as a by-product of greater self-awareness.

Compared to CBT, psychodynamic therapy is a longer-term treatment. Long-term psychodynamic therapy may last several years, while brief psychodynamic therapy may last as many as 25 sessions. Sessions are conducted on at least a weekly basis. This is so treatment can get to the core of a problem rather than be a catchup of events in the week.

Overall, psychodynamic therapy and cognitive behavioural therapy are two different approaches to psychotherapy that can be helpful for different people.

Psychodynamic therapy in practice

Psychodynamic therapy is conducted by clinicians such as psychologists, psychiatrists, and psychotherapists. Major techniques include free association and interpretation.

In free association, patients are encouraged to say whatever comes to mind without censorship. The therapist then interprets the patient’s thoughts and feelings in order to understand the patient’s unconscious motivations. Patients’ hidden fantasies, wishes, and desires surface, and are then explored.

Interpretation

Interpretation is a technique in which the therapist hypothesizes about the patient’s possible unconscious conflict, or tries to help the patient see the connection between his or her current behavior and early childhood experiences. For example, the therapist of a patient who repeatedly says “it is what it is”, interprets this phrase as the patient’s bid to get rid of feelings of anger that arise.

The therapeutic relationship and psychodynamic therapy

Research shows that the therapeutic relationship is one of the biggest predictors of successful outcomes in therapy. Establishing a trusting relationship allows the client to feel safe to explore their innermost thoughts and feelings.

Psychodynamic therapy aims to establish a solid working therapeutic alliance. In doing so, how the patient experiences the therapeutic relationship can be brought up and examined in therapy.

Working in the here and now is a psychodynamic approach that can be used to uncover relationship patterns. What happens in the space between psychodynamic therapist and patient, likely happens between patient and others in their lives.

Exploration of the unconscious

Psychodynamic psychotherapy involves exploring the unconscious mind. The therapist helps the patient to gain insight into their unconscious thoughts and feelings, which can be difficult or even uncomfortable at times. This process can help the patient identify underlying issues that may be causing their current symptoms, such as trauma or complex family dynamics.

Dreams

One way that psychodynamic psychotherapy helps patients explore their past experiences is through dream work. In dream analysis, the therapist helps the patient understand the symbolism in their dreams. This can provide insight into the patient’s unconscious thoughts and feelings.

Defence mechanisms and psychodynamic therapy

Defence mechanisms are mental processes that protect us from anxiety or painful feelings. They allow us to distort reality in order to avoid confronting difficult thoughts or feelings. Common defence mechanisms include denial, projection, rationalization, and displacement.

Denial is when a person refuses to acknowledge a problem and can be harmful because it prevents the person from seeking help.

Projection is when a person attributes their own unacceptable feelings or behaviours to someone else. Projection can lead to conflicts and misunderstandings.

Rationalization is when a person justifies their harmful behaviour by coming up with a logical explanation and can be harmful as it prevents taking responsibility for actions.

Displacement is when a person redirects their anger or frustration onto someone or something else which leads to problems in relationships.

Understanding defence mechanisms can help individuals better understand why they do certain behaviours.

Analysis of transference

Transference refers to the unconscious process of projecting feelings and past relationships onto present-day situations. In therapy, transference often manifests as patients feeling emotions towards their therapist that is based on past relationships. For example, a patient who experienced neglect from their mother might view their therapist as cold and uncaring. Or a patient abandoned by their father might see their therapist as untrustworthy.

Analysing transference is one of the important therapeutic techniques. It is important because transference can influence the therapeutic relationship and ultimately the success of therapy. By understanding transference, we can help our patients work through these issues in a safe and supportive environment. Transference and countertransference are important aspects of psychodynamic treatment. They are complex phenomena and will do best with their own article to give them the space and respect they deserve.

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