What's the first thing that comes to mind when you think of psychotherapy? Is it a patient lying down on a sofa talking about their childhood? Maybe it's the "How does that make you feel?" question?
Often this is how psychodynamic treatments are portrayed in popular culture, but of course, in reality, it is much more complex than that.
Psychodynamic treatments stem from Freud's psychoanalysis, the first talking cure approach to treating mental illness. Psychodynamic treatments are still used to better understand and alleviate psychological distress.
In this article, we'll demystify psychodynamic treatments by discussing the theory they are grounded on, techniques used and examples of these interventions.
- First, we'll look at the psychodynamic treatment meaning and briefly describe Freud's psychoanalytic theory, which provides the grounds for the treatment.
- We'll outline the psychodynamic therapy techniques to illustrate what the treatment may look like in practice.
- Next, we'll examine the prominent psychodynamic treatment examples, including dream analysis and group analysis.
- Then, we'll consider the example of psychodynamic therapy for depression.
- Finally, we'll evaluate the advantages and disadvantages of psychodynamic therapy.
Fig 1 - Common portrayals of psychotherapy are often very simplistic, freepik.com.
Psychodynamic Treatment Meaning
Psychodynamic treatments are a form of talking therapy grounded in Freud's theory of psychoanalysis. Assumptions that guide psychodynamic treatments are that our past experiences influence our current feelings, beliefs, and behaviour.
When we experience painful and overwhelming events or feel emotions that we deem socially unacceptable or conflicting, our defence mechanisms activate. This allows us to bury these difficult experiences deep in our unconscious.
Psychodynamic treatments in psychology aim to uncover unconscious conflicts, repressed motivations, desires, thoughts, and feelings. The approach suggests that bringing up the aspects buried deep in our unconscious to conscious awareness can provide insight, resolve inner conflicts and change unhelpful behaviour patterns.
Even though we can repress traumatic events and difficult emotions, they continue to influence us, leading to unhelpful behavioural patterns or psychological distress. The purpose of psychodynamic treatment is to develop insight into our inner world, including the unconscious, unravel our unhelpful behavioural patterns and understand where they stem from.
A person may repress memories of being bullied in childhood because their mind can't 'handle it'; this is an example of a defence mechanism. Still, the deep-rooted feelings of rejection, mistrust, anger, or shame can influence their current behaviour in relationships with others.
Psychodynamic treatments highlight the importance of the client-therapist relationship. The client-therapist relationship is crucial to create an environment where the client feels safe to explore their inner experiences and talk about potentially traumatic events. The therapist should be attuned and engaged but also allow the client the space to explore whatever is coming up for them at the right pace.
Psychodynamic Therapy Techniques
The main techniques used in psychodynamic treatments include free association, therapeutic transference and interpretation.
Free association means that the patient can talk freely about their problems and decide on the subject and the pace of emotions and events explored. The client can openly express anything that shows up, which helps the client to go beyond the defences of the critical mind and gain an insight into their unconscious without their conscious mind distorting, selecting or censoring any content.
Free association can be used; for example, in dream analysis, after identifying a recurring theme of the client's dreams, the therapist says words associated with the theme. Following this, clients say the first word that comes to mind.
Free association aims to identify hidden meanings or feelings the client may have repressed.
Talk therapy works to improve relationships through transference and counter-transference. Both help the client recognise the assumptions, beliefs, and emotions transferred to the therapist.
The therapist can also explore what feelings the client redirects onto a therapist and can present an opportunity to gain insights into the client's relational patterns.
Transference is a psychodynamic term that assumes clients unconsciously transfer their feelings (positive or negative) to their therapists. And counter-transference refers to how a therapist naturally responds and reacts to their clients.
Let's say that a client develops feelings of rejection by the therapist, leading them to avoid sessions or become aggressive. The therapist can explore the source of these feelings and assure the client that they did not intend to reject them.
Or, if a client develops an attraction towards the therapist, also known as erotic transference, this raises an opportunity to explore the client's attachment history.
Fig 3 - Therapeutic transference can help uncover the unconscious influences that lead to unhelpful patterns of behaviour in our relationships, freepik.com
Interpretation is a technique through which the therapist uses conscious thoughts, feelings, and experiences to relate them to underlying unconscious processes. This can provide clients with a new perspective on where their behaviours or symptoms might have originated.
It's also an opportunity to develop a better understanding of oneself, often in the context of one's unresolved issues from the past.
Interpretation can be used to work with transference. For example, the therapist might guide the client to interpret the emotions transferred onto them as a re-enactment of a past traumatic relationship.
Psychodynamic Treatment Examples
Let's discuss the application of psychodynamic treatments on the examples of dream analysis and group analysis.
Psychodynamic Treatments: Dream analysis
According to Freud, who proposed the theory of dream analysis after observing his clients, dreams are a window to our unconscious mind. Therefore, dream analysis is a tool for gaining insight into our repressed memories, conflicts, and desires.
Dreams were proposed to include manifest and latent content. The manifest content refers to the literal perceptions we experience when we dream, while latent content refers to the implicit meaning representing our unconscious.
According to dream analysis, one purpose of dreaming is wish fulfilment is that its a space where the unconscious desires or repressed urges can be satisfied. We can fulfil the wishes normally pushed out of our conscious awareness because we deem them unacceptable or inappropriate.
The process through which the latent content is coded into the symbolic manifest content is called dreamwork. The purpose of dreamwork is to present the unconscious in a more acceptable form for the conscious. During dream analysis, the therapist aims to reverse the process.
First, the therapist tries to improve the client's recall of dreams and the emotions they felt during the dream through recording techniques.
The therapist then attempts to relate the content of their dreams to their past or current experiences or inner conflicts.
During dream analysis, the therapist might search for recurring patterns in the client's dreams or set out to uncover what a particular event symbolises for them using free association.
Dream analysis is often combined with other techniques as part of treatment.
Psychodynamic Treatments: Group Analysis
Group analysis is a treatment developed by Foulkes in the 1940s. This treatment applies psychodynamic techniques in a group setting. Here, the contribution from the group helps clients uncover the unconscious causes driving their behaviours. Group analysis can help clients apply the insight of others to their inner conflicts and find similarities between themselves and the group.
The group can also be a space for developing one's interpersonal skills.
Exploring their transference in relationships with other group members can give clients insight into their relationships outside the group.
For this treatment to be successful, it's important that individuals actively participate with the group, communicate about themselves and be able to observe themselves and others. All these factors allow for creating a safe space for the group and the formation of relationships. With time, the therapist facilitating the group becomes decreasingly engaged, allowing the clients to lead the sessions more.
Group analysis is often centred on a particular experience or type of distress. For example, a group can focus on anxiety, depression, or grief.
There are some ethical issues in conducting therapy in a group setting, as there's no guarantee that the members of the group will keep the information revealed confidential. Moreover, despite the therapist moderating the group, sometimes the responses of others can be harmful and cause clients more distress.
Fig 3 - Psychodynamic treatments can also take place in a group setting, freepik.com
Psychodynamic Therapy for Depression Example
During psychodynamic therapy for depression, the client and therapist explore past experiences and repressed feelings, desires, and conflicts that may lead to dysfunctional behaviour. The therapist attempts to bring the unconscious into awareness to resolve these conflicts with the client.
The psychodynamic approach assumes resolution of inner conflicts can alleviate the symptoms of mental illness.
The therapist can use the techniques of free association and interpretation to identify repressed feelings or causes of depression. Say a client, in response to a random word, says an associative word that describes victimisation. The therapist can interpret past experiences of abuse, which could have caused depression.
Research has shown patients with unipolar depression who received psychoanalytic therapy compared to cognitive behavioural therapy had longer-lasting results (Huber, Zimmermann, Henrich & Klug, 2012).
Evaluation of Psychodynamic Treatments
Let's discuss the advantages and disadvantages of psychodynamic therapy.
Advantages of Psychodynamic Therapy
Today, many consider Freud's approach to mental illness outdated, but it has contributed significantly to a shift in our views on distress and mental health treatment.
Psychodynamic therapy recognises the impact of trauma, childhood experiences and relationship patterns on the expression of psychological disorders. It works by getting to the root of the problem rather than focusing solely on the symptoms, and research shows that it leads to lasting improvements.
There is scientific evidence that psychodynamic treatments are effective and long-lasting (Huber, Zimmermann, Henrich & Klug, 2012).
Disadvantages of Psychodynamic Therapy
Some may argue that psychodynamic treatment approaches can be reductionistic and deterministic.
Seeing distress as a sole cause of the unconscious ignores other factors that influence our well-being, like biological or sociocultural factors.
The traditional psychodynamic approach doesn't focus on the effects of systemic inequality, lack of access to resources or health issues as factors contributing to distress.
It may be argued that the unconscious is not the cause of all distress, and for some people, being told that repressed memories or inner conflicts cause their difficulties might feel invalidating.
Psychodynamic treatments in psychology also take longer than alternatives such as cognitive behavioural therapy and may not be appropriate for people who need immediate help.
Critics also point out that psychodynamic treatments view people's behaviour as determined by their past and unconscious motives. It doesn't acknowledge the role of free will in deciding on or changing our behaviour. It also proposes that only limited insight into oneself is possible without an intervention focusing on the unconscious.
Psychodynamic Treatments - Key Takeaways
- Psychodynamic treatments in psychology aim to uncover unconscious conflicts, repressed motivations, desires, thoughts, and feelings. This approach suggests that bringing these aspects buried deep in our unconscious to conscious awareness can provide us with insight, resolve inner conflicts and change unhelpful patterns of behaviour.
- The main psychodynamic treatment techniques include free association, therapeutic transference and interpretation.
- Psychodynamic treatments can be applied in dream analysis and group analysis.
- Psychodynamic treatments recognise the impact of trauma, childhood experiences and relationship patterns on the expression of psychological disorders; they've also shown to be effective for clients in the long term.
- The criticism of psychodynamic treatments is that they can be reductionistic and deterministic.
References
- Huber, D., Zimmermann, J., Henrich, G., & Klug, G. (2012). Comparison of cognitive-behaviour therapy with psychoanalytic and psychodynamic therapy for depressed patients - a three-year follow-up study. Zeitschrift fur Psychosomatische Medizin und Psychotherapie, 58(3), 299–316. https://doi.org/10.13109/zptm.2012.58.3.299
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