Psychodynamic Therapy

Read the history, indications, implementation, risks and benefits of psychodynamic therapy.

Psychodynamic psychotherapy is among the oldest of the practices of psychology and psychiatry and has stood the test of time as a highly effective, versatile and lasting treatment. As an increasing amount of people become willing to enter therapy, psychodynamic therapy remains a primary therapeutic option for numerous mental health conditions and substance use disorders.

What Is Psychodynamic Therapy?

Also known as insight-oriented therapy, psychodynamic therapy aims to help clients identify how their current behavior is informed, often unconsciously, by their past behavioral patterns.

Psychodynamic therapy has many similarities to psychoanalysis; the primary difference is that while psychoanalysis focuses most of its attention on the relationship between a client and a therapist, psychodynamic therapy aims to understand a client’s relationship to their outside world as well, often using the client-therapist relationship as a gauge and mirror for the client’s other relationships.

History of Psychodynamic Therapy

Because it is the oldest form of therapy, the history of psychodynamic therapy is well developed and highly documented. Sigmund Freud, the most preeminent historical figure in psychiatry and psychology, was the first therapist to use psychoanalysis and psychodynamic principles in therapy.

Freud’s Drive Theory

The psychodynamic perspective that originated with Sigmund Freud is called drive theory. Developed in the early 1900s, drive theory stated that a person’s internal unconscious drive toward sex and aggressive behavior (the id) needs a mediator (the ego) when it meets the forces of the outside world. The ego maintains psychological balance and minimizes pain by creating unconscious defense mechanisms, and the id is controlled through guilt by the superego, which develops later in childhood.

Further Advancements in Psychodynamic Therapy

As the field of psychotherapy developed, others built on Freud’s work. Anna Freud, his youngest daughter, helped develop the theory of ego psychology, which states that the ego is a flexible and responsive mechanism for psychological defense and for adaptation to mental stresses.

Melanie Klein, D.W. Winnicott and others developed object relations theory, which states that people develop an idea of who they are in their close relationships in childhood and that they carry out their adult relationships based on the ideas they carry with them from childhood. Finally, Heinz Kohut pioneered self psychology, which states that individuals develop an idea of self that is based on their perception of their experiences, which helps them establish boundaries and differentiate from others.

Modern psychodynamic psychotherapy derives from these four schools of thought to help clients address unconscious defenses, understand connections between their past and current behaviors, create a solid sense of self and possess a more adaptive psyche capable of managing stress.

How Psychodynamic Therapy Works

In psychodynamic therapy sessions, clients are invited to speak freely about whatever is on their mind. Often this invite comes in the form of the therapist simply remaining silent while actively listening at the beginning of the session. Clients may opt to talk about their current feelings, relationships, events, fantasies or fears, even if the issues don’t seem to be connected. There is no script or a predetermined response from the therapist.

During psychodynamic therapy, the therapist is taking stock of his or her own feelings about what is being discussed by the client and is using those feelings to understand the client’s experience as much as possible. It is through this understanding that the therapist can help the client gain insight into his or her patterns of behavior and gently assist the client in changing these patterns. The therapist can also help the client understand the connections to past feelings or patterns of behavior.

It takes time for these patterns to emerge, for the therapist to recognize them, for the client and therapist to establish a trusting relationship and for the client to begin responding to the therapist’s input. Therefore, sessions of psychodynamic psychotherapy typically last for at least two years. This amount of time allows a client to gain enough insight and practice to make fundamental changes in character or identity.

Types of Psychodynamic Therapy

There are two main types of psychodynamic therapy.

• Brief psychodynamic therapy: This approach works by trading in the ability to talk about disconnected ideas, instead of focusing on one major issue or thread. In exchange, the time it takes for therapy to become effective is much shorter.
• Psychodynamic family therapy: Also referred to as systemic family therapy, psychodynamic family therapy is a type of psychotherapy that addresses the unconscious communication between family members. Therapists may remain initially distant to let the dynamic manifest and can then point out specific patterns of behavior between family or group members.

Benefits of Psychodynamic Therapy

The benefits of psychodynamic therapy often last much longer than the therapy itself does. Psychodynamic therapy provides:

• The possibility for an open and trusting relationship with the therapist
• Insights into one’s past patterns of thoughts, beliefs and behavior
• Understanding the links between past and present thoughts and actions
• The ability to make large-scale behavioral changes over time
• Increased self-awareness and self-esteem

Effectiveness of Psychodynamic Therapy

The effectiveness of psychodynamic psychotherapy has been well established by empirical evidence, especially for the management of anxiety. Studies show that psychodynamic therapy is at least as effective as any other talk therapy (such as cognitive behavioral therapy) for the treatment of depression.

Brief psychodynamic therapy is an effective treatment for drug and alcohol addictions (called substance use disorders) and depressive disorders in recent larger studies.

Overall, the effectiveness of psychodynamic therapy may depend on factors like:

• The client-therapist relationship dynamic
• The client’s readiness and willingness to change
• The client’s level of self-awareness
• The skill and experience of the therapist
• The total time spent in therapy
• The willingness of family members to participate, in the case of family therapy

Goals of Psychodynamic Therapy

Though individual goals entering psychodynamic therapy may differ, there is a universal set of goals of psychodynamic therapy:

• Foster a sense of trust between client and therapist
• Encourage open and honest dialogue
• Utilize the client’s relationship with the therapist to understand a client’s established patterns
• Increase the client’s self-awareness of typical defense mechanisms
• Develop a client’s internal psychological structure to effectively manage feelings and emotions

Psychodynamic Therapy in Addiction and Mental Health Treatment

The use of psychodynamic therapy has been well established for mental health conditions like anxiety disorders and is increasingly used as a treatment for depressive disorders and substance use disorders.

Among the many reasons why psychodynamic therapy can be useful for the treatment of addictive disorders is that it offers clients the chance to gain critical insight into their behaviors while feeling understood, listened to and seen within a treatment relationship that offers a healthy model for behavior.

Active addiction, in particular, usually involves defense mechanisms like denial and rationalization. Addiction takes advantage of a person’s internal vulnerabilities established in the past. When someone can recognize when these defense mechanisms are used, or when their internal vulnerabilities are activated, the person can develop strategies for effectively and definitively changing their mindset and behavior.

Do you have a drug or alcohol addiction and co-occurring mental health condition? Are you interested in developing the insight and self-awareness needed to treat it? The Recovery Village can be your resource in finding treatment that works. Call us today and see how we can work for you.

Editor – Camille Renzoni

Cami Renzoni is a creative writer and editor for The Recovery Village. As an advocate for behavioral health, Cami is certified in mental health first aid and encourages people who face substance use disorders to ask for the help they deserve. Read more

Medically Reviewed By – Dr. Kevin Wandler, MD

Kevin Wandler holds multiple positions at Advanced Recovery Systems. In addition to being the founding and chief medical director at Advanced Recovery Systems, he is also the medical director at The Recovery Village Ridgefield and at The Recovery Village Palmer Lake. Read more