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?
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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.
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.
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.
Depression, defined by the American Psychiatric Association as major depressive disorder (MDD), is a mood disorder characterized by a substantial decrease in an individual’s quality of life on a number of levels. It is marked by feelings of emptiness, sadness, and a lack of hope or pleasure, in addition to thoughts and actions that significantly impair daily functioning. Thankfully, there are several depression treatment options currently available.
Depression affects roughly one in 15 adults, or 6.7% of this population. One in six people (16.6%) will reportedly experience depression at some point in their life. A number of treatment options have been shown to safely and effectively treat depression. These include Deep TMS, psychotherapy, psychopharmacology and ECT.
Deep TMS
Deep Transcranial Magnetic Stimulation (Deep TMS) is an FDA-cleared, non-invasive medical device treatment that utilizes a magnetic field to safely regulate neural activity in brain structures found to be associated with MDD. Deep TMS does not require any anesthesia and can be incorporated into an individual’s daily routine.
Extensive research has proven Deep TMS’s efficacy in alleviating symptoms of depression. As a result, it was granted FDA clearance status in 2013 for treating MDD.
As a non-invasive depression treatment option, Deep TMS is safe to undergo as a standalone treatment or in combination with antidepressant medication. This was reaffirmed by a 2019 study published in the Journal of Psychiatric Research, which not only found Deep TMS to be a safe course of treatment, but that it resulted in significantly higher remission rates when combined with pharmacotherapy, when compared to pharmacotherapy alone.
Psychotherapy
Psychotherapy, or talk therapy, refers to conversing with a mental health professional to better understand one’s experiences and resolve existing conflicts detrimental to their well-being. Several types of psychotherapy used to treat depression include cognitive-behavioral therapy (CBT), psychodynamic therapy, and interpersonal therapy (IPT).
Psychotherapy has been proven to alleviate symptoms of MDD, with many patients finding solace in sharing their own experiences while considering the different factors that may have contributed to their condition. There are many therapeutic approaches, schools of thought and training facilities, with some found to be more effective in alleviating different mental health conditions or working through specific personal challenges. Another factor is the personal connection that develops between each patient and therapist, while a third factor consists of the technical aspects of the therapeutic setting, such as session costs and time availability. It is advised to take all these aspects into account when considering psychotherapy.
Antidepressant Medications
There are several classes of antidepressant medication typically prescribed to treat depression. This line of treatment is found by many to be effective, though it should be noted that antidepressant medication may cause some side effects, and requires an adjustment period before an assessment of its efficacy can be drawn.
Despite an ongoing debate over the classification and “generations” of the different available antidepressants, there are five, generally agreed upon classes of depression medication currently on the market:
Monoamine Oxidase Inhibitors
MAOIs are another first-generation class of antidepressants that has been available since the early 1950s. MAOIs cast a wide net, attempting to regulate the activity of a number of neurotransmitters implicated in the appearance of depression. Specifically, MAOIs work by blocking the activity of the monoamine oxidase enzyme, which helps break down the neurotransmitters serotonin, norepinephrine and dopamine. As a result, MAOIs maintain the above neurotransmitters’ period of activation for longer. MAOIs are less commonly prescribed these days, due to its adverse, possible side effects, which include increased blood pressure. Nardil is one of the more well-known MAOIs.
Tricyclic Antidepressants
Like MAOIs, TCAsare also considered first-generation antidepressants. This class of medications was initially offered to patients with depression in the late 1950s. This class of medications blocks the reuptake of norepinephrine, a neurotransmitter that has been linked to mood and mood disorders. In a similar vein to ECT, TCAs are considered to be very effective in treating depression, while also causing significant side effects—in the case of TCAs, these include blurred vision and increased heart rate. As a result, many patients opt to stop this treatment. Due to their adverse side effects, these days, psychiatrists and other mental health professionals tend to prescribe other types of antidepressants before suggesting TCAs, such as SSRIs or SNRIs. Elavil is one widely available type of TCA.
Selective Serotonin Reuptake Inhibitors
SSRIs are FDA-approved as a first-line, safe and effective treatment for depression, and have been prescribed as such since the mid-1980s. This second-generation class of medications focuses on another mood-elevating neurotransmitter, called serotonin. By blocking its reuptake process, SSRIs prevent neurons from absorbing the released serotonin back from the synaptic cleft. This keeps serotonin active within the body for a longer period of time, allowing it to have a more beneficial effect on the individual’s mood and alleviating the adverse symptoms of depression. Shown to be about as effective as the TCAs that came before them, SSRIs have significantly less severe side effects. That said, while they are generally considered to be well-tolerated, SSRI side effects have been known to cause certain patients to discontinue treatment. Weight gain and sexual dysfunction are among their more commonly cited side effects of this class of medications. Prozac is the most well-known SSRI available.
Serotonin-Norepinephrine Reuptake Inhibitors
SNRIs have been widely available since the mid-1990s, and are considered a third-generation antidepressant. SNRIs offer a hybrid between the efficacy reported early on with TCAs, as well as that associated later on with SSRIs: by blocking the reuptake processes of norepinephrine and serotonin, SNRIs tap into both neurotransmitters’ effects on the depression process, and are therefore able to “double up” on paths toward symptom relief. SNRIs are also considered a more tolerable antidepressant: its reported side effects are similar to those of SSRIs—particularly weight gain and sexual dysfunction—just not as severe as those of their predecessors. Cymbalta is among the more popular SNRIs.
Atypical Antidepressants
As the name suggests, atypical antidepressants are more of a mixed bag of options that do not fall under the previously mentioned categories, than a single, cohesive group of antidepressants. Atypical medications affect the activity of the neurotransmitters serotonin, epinephrine, norepinephrine, dopamine or a combination thereof in their own, unique way: Wellbutrin, for instance, acts as a reuptake inhibitor for dopamine, while Remeron blocks the brain’s epinephrine receptors, extending the neurotransmitter’s period of activation. Due to the diversity of this grouping, many atypical antidepressants do not share the same side effects. Nonetheless, most of the medications included in this category are reported to commonly induce dizziness, dry mouth and lightheadedness. Wellbutrin, specifically, is sometimes chosen as an alternative or supplemental depression treatment course, as it is one of the few available antidepressants not to interfere with the patient’s sexual functioning.
Electroconvulsive Therapy
Electroconvulsive therapy has been around since the 1960s, and was originally used to treat schizophrenia, before it was discovered to be even more effective as a treatment for mood disorders such as depression.
ECT works by activating a brief set of seizures in an effort to establish a new rhythm within the brain’s neural functioning. Due to the intensity of the treatment, those undergoing ECT must be sedated during its sessions.
ECT is presently considered one of the most effective treatments for depression, and particularly for treatment-resistant depression, offering hard-won symptom relief to those who have struggled to achieve it.
If ECT is such an effective form of therapy, why, then, is it not considered a first-line treatment for depression? The answer lies in the adverse side effects that often arise from it, most notably, short-term memory loss. Patients who have undergone ECT sometimes experience a lakuna, or memory gap, during treatment, causing the process itself to be daunting for those considering it.
Even beyond its actual, reported side effects, ECT has gained a rather negative reputation within popular culture and media. Commonly referred to as “shock treatment,” ECT is often depicted as an extremely painful, and even traumatic treatment process that indiscriminately “fries” the brain. The dearth of misinformation about ECT serves as further deterrence to those battling severe and treatment-resistant depression, many of whom fear irrevocable damage from this treatment.
Due to its great levels of efficacy, with its possible, severe side effects and perception as a potentially dangerous treatment, ECT is usually only recommended in cases of severe, treatment-resistant depression. First-line treatments, such as SSRIs or psychodynamic therapy, are usually offered first. Only after such less invasive options have proven to be ineffectual, will ECT normally be considered.
Additional Treatment Options for Depression
Other treatment options for depression are being explored with varying levels of clinical evidence. Examples include intravenous ketamine or esketamine, magnetic seizure therapy (MST), transcranial direct current stimulation (TDCS), vagus nerve stimulation (VNS), and deep brain stimulation (DBS).
Considering a Depression Treatment Course
When weighing one’s treatment options, it is important to bear in mind that different treatments not only come with their own, possible side effects, but that it may take time to find the right dosage or combination of treatments that work best for them. It is also imperative that patients consult their doctor regarding their mental health status, the possibility of a major depressive disorder diagnosis, and a possible interaction with other forms of treatment they are already taking.
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