Psychodynamic therapy has its roots in the theories of

Deborah C. Escalante

Psychodynamic therapy can help people improve their quality of life by helping them gain a better understanding of the way they think and feel. The idea is that this will improve their ability to make choices, relate to others, and forge the kind of life they would like to live.

When most people think of therapy, the thoughts and images that come to mind tend to be those related to psychodynamic therapy. This is because psychodynamic therapy is based on the work of Sigmund Freud, who many people know as the “father of psychoanalysis.”

Although the American Psychological Association identify five general categories of therapy — with many more subtypes — most types have roots that are traceable to Freud’s groundbreaking work.

Keep reading to learn more about psychodynamic therapy, including its origins, how it works, and its potential benefits.

What is it? 

Man having psychodynamic therapy.

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Credit Image: PavelIvanov/Getty Images

Psychodynamic therapy is a talking therapy. This means that it is based on the concept that talking about problems can help people learn and develop the skills they need to address them.

It is an approach that embraces the multifaceted aspects of an individual’s life. It strives to help people understand the sometimes unknown or unconscious motivations behind difficult feelings and behaviors.

Having this insight can lead to symptom relief, help people feel better, and allow them to make better choices.

How does it work? 

Psychodynamic therapy is based on the following key principles:

  • Unconscious motivations — such as social pressure, biology, and psychology — can affect behavior.
  • Experience shapes personality, which can, in return, affect an individual’s response to that experience.
  • Past experiences affect the present.
  • Developing insight and emotional understanding can help individuals with psychological issues.
  • Expanding the range of choices and improving personal relationships can help people address their problems.
  • Freeing themselves from their pasts can help people live better in the future.

Transference and countertransference are also important. With this approach, the client will transfer their feelings toward someone onto the therapist, and the therapist will redirect these feelings back toward the client. It can take place without the client’s awareness, and many therapists have varying approaches to this concept.

In psychodynamic therapy, the relationship between the therapist and the client is very important. It provides a container in which people can gain insights into themselves, their pasts, and their feelings. They can develop a better understanding of how they see the world and the ways in which all these factors affect their experiences.

With the help of a therapist, people undergoing psychodynamic therapy will work to understand their feelings, beliefs, and childhood experiences. The goal is to help people recognize self-defeating patterns, explore new ways of being in the world, and help people feel better.

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A psychodynamic approach to therapy can work with individuals, couples, families, and in group therapy situations.

Because its focus tends to be on relationships and understanding thoughts and feelings, which people may have avoided confronting, psychodynamic therapy can be time consuming.

Short-term psychodynamic therapy generally lasts for 25–30 sessions over a period of 6–8 months, while long-term psychodynamic therapy — according to one study — may last for longer than a year or span more than 50 sessions.

History and origins

Psychodynamic therapy grew out of the theories of Sigmund Freud. However, it has evolved considerably from the 19th-century model.

Early leaders in the field who contributed to the development of this approach include Carl Jung, Melanie Klein, and Anna Freud.

In its earlier stages, therapy could last for years, with a person even having several therapy sessions per week.

Practitioners typically had a medical background and a paternalistic approach.

Is it effective? 

Measuring the impact of treatment for psychological issues can be complicated. That said, there is evidence to suggest that psychodynamic therapy works for the following conditions:

  • Depression: Studies indicate that it can help people address recurring life patterns that play a part in their depression.
  • Social anxiety, social phobia, and panic disorder: Studies have found promising results and improved remission.
  • Anorexia nervosa: Strong evidence suggests that it promotes recovery from anorexia nervosa.
  • Pain: Unexplained chronic and abdominal pain respond well to this therapy, data suggest.
  • Borderline personality disorder: Studies have found structured, integrated, and supervised treatment to be effective.
  • Psychopathological issues in children and adolescents: Researchers have found psychodynamic treatment to be effective overall in reducing symptoms of psychopathological issues in children aged 6–18 years.

Experts report that psychodynamic therapy can also improve people’s lives by helping them:

  • strengthen their self-understanding to break self-defeating cycles
  • address issues with avoidance
  • improve their understanding of relationship dynamics

One of the most intriguing benefits of psychodynamic therapy, according to multiple studies, is that they keep on coming.

What this means is that individuals who undergo this kind of treatment continue to show improvement months after they complete it.

Vs. other forms of therapy

Although there is variety in the results, most studies have found psychodynamic therapy to be roughly as effective as two of the most common other forms of therapy: cognitive behavioral therapy (CBT) and medication.

CBT

CBT is a popular form of therapy that focuses on helping people adopt healthier ways of thinking and acting by enhancing their awareness of their choices.

Medication

Antidepressants and other medications have proven effective in treating depression and other mental health conditions.

Anyone who thinks that they may be experiencing a mental health condition should speak to a doctor to determine which type of antidepressant is most suitable for them.

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Limitations

Although psychodynamic therapy can be an effective form of treatment for many mental health conditions, the researchers behind one report found that it may be less effective for the following conditions:

  • post-traumatic stress disorder (PTSD)
  • obsessive-compulsive disorder
  • drug addiction
  • psychosis

Psychodynamic therapy can still be effective for PTSD in some cases, though there is no strong evidence for this.

That said, this same report points out that results from many of the studies into various treatments for mental health conditions tend to lean toward the author’s “theoretical orientation,” or to coincide with the author’s affiliation.

Therefore, the researchers call for more systematic evidence around these treatments. They also highlight the fact that the effectiveness of psychodynamic treatment can greatly depend on the psychiatrist themselves.

Overall, it is clear that more studies into various forms of psychotherapy are necessary. This will help determine which type might be best suited for which individuals and which psychiatric conditions.

Summary

Psychodynamic therapy is a form of talking therapy that has proven effective in helping people dealing with depression, anxiety, pain, and relationship issues.

This treatment approach helps people see what is behind their problems by giving them a better understanding of their unconscious feelings, thoughts, and past experiences.

Developing these psychological skills helps people make better choices and feel better in the long-term.

Psychotherapy theories provide a framework for therapists and counselors to interpret a client’s behavior, thoughts, and feelings and help them navigate a client’s journey from diagnosis to post-treatment. Theoretical approaches are an understandably integral part of the therapeutic process. But with so many different methods out there, how do you know which counseling approach works best for you? Whether you’re a student learning about counseling theories or a client looking for the right therapist, the following detailed descriptions will give you a deeper understanding of each counseling method. These theories are integrated throughout the curriculum of Counseling@Northwestern and are built into a foundation grounded in the psychodynamic perspective.

Psychoanalysis/Psychodynamic Theory

Psychoanalysis or psychodynamic theory, also known as the “historical perspective,” has its roots with Sigmund Freud, who believed there were unconscious forces that drive behavior. The techniques he developed, such as free association (freely talking to the therapist about whatever comes up without censoring), dream analysis (examining dreams for important information about the unconscious), and transference (redirecting feelings about certain people in one’s life onto the therapist) are still used by psychoanalysts today.

Counseling@Northwestern uses this theory to train counselors, and it is embedded throughout the counselor training process. In general, psychotherapists and counselors who use this approach direct much of their focus and energy on analyzing past relationships and, in particular, traumatic childhood experiences in relation to an individual’s current life. The belief is that by revealing and bringing these issues to the surface, treatment and healing can occur. This theory is highly researched, and as the field of neuroscience advances, counselors are finding how psychodynamic theory can actually positively affect a client’s brain. Psychodynamic theory can be more time intensive in comparison to some short-term theories because it involves changing deeply ingrained behaviors and requires significant work on understanding one’s self.

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Behavioral Theory

Behavioral theory is based on the belief that behavior is learned. Classic conditioning is one type of behavioral therapy that stems from early theorist Ivan Pavlov’s research. Pavlov executed a famous study using dogs, which focused on the effects of a learned response (e.g., a dog salivating when hearing a bell) through a stimulus (e.g., pairing the sound of a bell with food).

B. F. Skinner developed another behavioral therapy approach, called operant conditioning. He believed in the power of rewards to increase the likelihood of a behavior and punishments to decrease the occurrence of a behavior. Behavioral therapists work on changing unwanted and destructive behaviors through behavior modification techniques such as positive or negative reinforcement.

Cognitive Theory

In the 1960s, psychotherapist Aaron Beck developed cognitive theory. This counseling theory focuses on how people’s thinking can change feelings and behaviors. Unlike psychodynamic theory, therapy based on cognitive theory is brief in nature and oriented toward problem solving. Cognitive therapists focus more on their client’s present situation and distorted thinking than on their past. Cognitive and behavioral therapy are often combined as one form of theory practiced by counselors and therapists. Cognitive behavioral therapy, or CBT, has been found in research to help with a number of mental illnesses including anxiety, personality, eating, and substance abuse disorders.

Humanistic Approach

Humanistic therapists care most about the present and helping their clients achieve their highest potential. Instead of energy spent on the past or on negative behaviors, humanists believe in the goodness of all people and emphasize a person’s self-growth and self-actualization.

Humanistic theories include client-centered, gestalt, and existential therapies. Carl Rogers developed client-centered therapy, which focuses on the belief that clients control their own destinies. He believed that all therapists need to do is show their genuine care and interest. Gestalt therapists’ work focuses more on what’s going on in the moment versus what is being said in therapy. Existential therapists help clients find meaning in their lives by focusing on free will, self-determination, and responsibility.

Holistic/Integrative Therapy

Holistic and integrative therapy involves integrating various elements of different theories to the practice. In addition to traditional talk therapy, holistic therapy may include nontraditional therapies such as hypnotherapy or guided imagery. The key is to use the techniques and psychotherapy tools best suited for a particular client and problem.

There are various therapies that counselors can choose to study, but the type of theory matters less than the success of the relationship between client and therapist. In the Counseling@Northwestern online Master of Arts in Counseling Program, students are prepared to become self-reflective practitioners and learn to examine the factors that influence the client-therapist relationship to become successful counselors.

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