A new client recently asked me where I would be traveling for an upcoming trip as we looked at our schedules to make her next appointment. When she expressed further curiosity about the conference I would be attending, I explained that it was an annual conference of the society for psychoanalysis and psychoanalytic psychology. A fairly surprised look appeared on her face, and she questioned, “like Freud?” 

I readily picked up on her discomfort with the thought of psychoanalysis or being psychoanalyzed. I clarified that she was not meeting with me for psychoanalysis and offered some explanation of basic psychodynamic principles and how these applied to our initial goals for therapy. She seemed to accept my explanation, but mostly just seemed glad to know she wasn’t meeting for psychoanalysis.

Psychodynamic therapy is one of several approaches to therapy used today. However, it is often misunderstood and dismissed as an outmoded approach or historical artifact. It is also often misrepresented in popular culture and sometimes seen as irrelevant to the quick-fix demands of the public and the limitations of insurance.

Nevertheless, there is strong evidence supporting psychodynamic therapy as effective in comparison to other approaches [1], and a basic understanding of this approach is helpful regardless of your current theoretical orientation. This brief introduction will offer a contemporary definition of psychodynamic therapy and highlight several key concepts.

Psychodynamic Therapy

Psychodynamic therapy is based on the premise of psychoanalytic theory. It has a rich historical tradition and evolution through major theoretical schools including drive, ego, object relations and attachment theory, self-psychology, and contemporary relational theory.

At its core, psychodynamic therapy aims to foster psychological growth by developing greater awareness and access to the human experience. To this end, therapy fosters honesty and values authenticity with the understanding that this can lead to greater life satisfaction and personal agency or freedom.   

Psychodynamic therapy and the ways in which it is practiced have evolved significantly since the time of Freud. Rather than having a client lay down on a couch and a therapist or analyst sit out of sight or behind the client largely in silence, most current practitioners of psychodynamic therapy are more active, interpersonally engaged, and strive to foster a trusting emotional connection with their clients.  

What Makes Therapy Psychodynamic? 

Jonathan Shedler has written that, at its core, contemporary psychodynamic therapy can be understood as “a range of treatments based on psychoanalytic theory and methods,” with a focus on “exploring those aspects of self that are not fully known, especially as they are manifested and potentially influenced in the therapy relationship.” [1] 

As this definition illustrates, the foundation of a psychodynamic approach involves a focus on making the unconscious more conscious. This can also be understood as helping someone better understand aspects of themselves or their behaviors that had previously been largely unknown to them. In other words, helping one “to admit what is difficult and painful to see in ourselves” [2].

Two other foundational principles of psychodynamic psychotherapy are the impact of early childhood experiences and relationships in shaping the life of the client as an adult, and the role of transference and countertransference as a door to understanding the client and their interactions with others. The emphasis for each for these principles may differ somewhat depending on the theoretical school within psychodynamic thought. Of course, there are other important concepts beyond these two, such as defense mechanisms. Nevertheless, these two central elements are a good starting point for understanding psychodynamic therapy.

Regarding the impact of early childhood relationships, practitioners are often most concerned about how knowledge of the past will help the client in the present. One clear example may involve the ways in which early caregivers responded to a child in distress. A child reacted to in a hostile manner or ignored will likely develop unique differences as an adult when compared to a child who was acknowledged, understood and encouraged. Of course, the precise nature of these differences would still vary depending on the unique characteristics and ways each client navigated life.

The second principle of transference and countertransference explores the relationship with a focus on how the client feels towards you (transference) and how you feel toward the client (countertransference). This principle involves the repetition of past patterns of relatedness within the therapy relationship. Therefore, practitioners may benefit from paying attention to the ways a client reacts to them and their overall behavior in the therapeutic relationship.

A simplified example may include the following. A client feels warmly towards her new therapist so she works hard to please her and provide her with compliments and praise. The therapist begins to feel frustrated as she wishes her client would just focus more on what is actually going on in her life.   

The transference is seen in the client feeling warm regards for the therapist and attempting to gain the love and affection she had struggled to receive from her mother as a child. The countertransference is seen in the therapist feeling frustrated and experiencing an urge to be abrupt or harsh with the client. 

In this example, the client unknowingly repeated her past relational patterns with her mother within the therapy relationship, even causing her therapist to experience an urge to snap at her, just as her mother had done. 

This simplified example likely holds useful information to explore with the client as you discuss interpersonal relationships and work to broaden their awareness for how others may experience them. A goal here could be helping the client understand why they feel drawn to behave in certain ways towards others and use their new awareness to exercise more choice in their behavior within relationships.

Length of Treatment

Length of treatment can vary significantly in psychodynamic therapy. Traditionally, psychoanalytic therapy was considered an open-ended process. However, long-term psychodynamic therapy has more recently been defined as at least 24 sessions or 6 months [3], while short-term psychodynamic therapies generally set a maximum limit of 20-25 sessions. [4] Psychodynamic therapy typically involves meeting once or twice per week with a therapist, whereas classical psychoanalysis more commonly involves meeting at least three times per week.

Distinctive Features of Psychodynamic Psychotherapy

Blagys and Hilsenroch (2000) completed an extensive review of psychotherapy literature prior to the year 2000 and identified seven techniques that distinguish psychodynamic forms of therapy, or are much more prevalent in psychodynamic therapy [5]. These seven techniques are:

1. Focus on Affect and the Expression of Emotion

Here, the therapist might help a client identify and name feelings with a particular emphasis on feelings that are most elusive or difficult. In some cases, the therapy dyad focuses on feelings that are experienced as unacceptable or connected to ideas about how one should or should not feel. There is also an understanding that emotional insight differs from solely gaining an intellectual understanding. Specifically, insights that have an emotional component are often experienced more deeply and are more likely to encourage growth.

2. Exploration of Attempts to Avoid

Similar to avoiding distressing emotions, people may also work hard to avoid other aspects of themselves or honest self-reflection that is encouraged in therapy. Psychodynamic therapy attends to this avoidance, naming and processing it as part of therapy.

3. Identification of Recurring Themes and Patterns

Patterns and themes can be seen in the way everyone moves through life. Often these patterns and themes involve repeated relationships, with, for example, clients finding the same type of destructive partner again and again. Psychodynamic therapy focuses some effort on helping a client identify and process themes in their life as well as their thoughts, feelings and behaviors. This can sometimes include concepts of themselves and others.

4. Discussion of Past Experiences

As described above, a focus on early experiences is a cornerstone of psychodynamic therapy, with the goal of understanding how these early experiences continue to impact current functioning. The focus is generally on insight and awareness on how the past influences the present with the goal of fostering greater freedom in the present.

5. Focus on Interpersonal Relationships

Early experiences in significant relationships form another cornerstone of psychodynamic therapy. The emphasis here is on how these early relationships influenced personality and self-concept, as well as values and worldview. Attachment patterns are also of significant importance, and therapists are interested in how interactions with early caregivers influence current views of others and the manner in which a person gets their needs met through relationships.

6. Focus on the Therapeutic Relationship

This focus includes transference and countertransference with attention to the themes that arise between the therapist and client and how these may parallel themes in the person’s relationships outside of therapy. There is also increasing acknowledgment of the contributions of the therapist as a unique person with a unique psychology and values that influence how this relationship unfolds.  

7. Exploration of Wishes, Dreams and Fantasies

Generally, this technique refers to creating a space where a client can speak freely. This exploration allows for a broad range of content to emerge that can be used to further understand the unique way that a client navigates the world around them. It can also be a rich source of metaphor and meaning.

In addition to the psychoanalytic theories that inform psychodynamic therapy and the foundational concepts and techniques outlined above, psychodynamic therapists generally ascribe to a “psychoanalytic sensibility.” [6] This includes understanding that the source for many of our thoughts, feelings and behaviors are outside of our awareness.

There is also a strong appreciation for the complexity and contradiction that often exists within the human experience. Likewise, there is a balance between an appreciation for our common human struggles (both therapist’s and client’s) and the subjectivity of each person’s experiences. Lastly, an enduring curiosity and focus on expanding the human experience to allow for a greater sense of authenticity is paramount. Giving clients space to wonder also helps them to become curious about themselves.

Conclusion

Psychodynamic therapy is an effective approach with a rich tradition. It is continually evolving and has increasingly become a focus of research. A number of key concepts are important to this approach, and the view that unconscious motivations impact our behaviors and emotions is foundational. In contrast to traditional psychoanalysis, contemporary practitioners emphasize the interpersonal and relational aspects of therapy and view the relationship as central in therapy.

References

[1] Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 65(2) 98-109.

[2] McWilliams, N. (2004). Psychoanalytic psychotherapy: A practitioner’s guide. New York, NY: The Guilford Press.

[3] Gabbard, G. O. (2010). Long-term psychodynamic psychotherapy: A basic text. Washington, DC: American Psychiatric Publishing Inc.

[4] Levenson, H. (2010). Brief dynamic therapy. Washington, DC: American Psychological Association.

[5] Blagys, M.D. & Hilsenroth, M.J. (2000). Distinctive of short-term psychodynamic-interpersonal psychotherapy: A review of the comparative psychotherapy process literature. Clinical Psychology: Science and Practice, 7(2), 167-189.

[6] McWilliams, N. (2004). Psychoanalytic psychotherapy: A practitioner’s guide. New York, NY: The Guilford Press.

This article was originally published August 29, 2019.