What is psychodynamic approach in counselling

Freud himself observed:

One might compare the relation of the ego to the id with that between a rider and his horse. The horse provides the locomotor energy, and the rider has the prerogative of determining the goal and of guiding the movements of his powerful mount towards it. But all too often in the relations between the ego and the id we find a picture of the less ideal situation in which the rider is obliged to guide his horse in the direction in which it itself wants to go.

– From the New Introductory Lectures on Psychoanalysis, 1932.

The super ego could be compared to a super parent, berating the ego, forcing it to comply with societal norms. So according to the theory, our self-concept is in constant conflict, with the poor old ego trying to balance the childish impulse of the id and the critical demands of the super ego.

Modern psychoanalysis was born out of Freud’s ideas. In the 1950’s Canadian psychiatrist Eric Berne was working as a psychiatrist in Carmel California. He noticed in his patient’s district patterns of relating to life events.

Berne, who had been trained in classic psychoanalysis, took the main tenants of the theory and developed his own perspective on it, which he named Transactional Analysis (TA for short).

While there are many theoretical overlaps between the psychodynamic approach and psychoanalysis, there are differences in the practice of the two modalities.

Psychodynamic therapy is an approach that involves facilitation a deeper understanding of one’s emotions and other mental processes. It works to help people gain greater insight into how they feel and think.

By improving this understanding, people can then make better choices about their lives. They can also work on improving their relationships with other people and work toward achieving the goals that will bring them greater happiness and satisfaction.

Psychodynamic therapy is rooted in psychoanalytic theory but is often a less intensive and lengthy process than traditional psychoanalysis. While psychoanalysis tends to focus a great deal on the patient and therapist relationship, psychodynamic therapy also places a great deal of emphasis on a patient’s relationships with other people in the outside world.

What Is Psychodynamic Therapy?

Psychodynamic therapy is a form of talk therapy. It is based on the idea that talking to a professional about problems people are facing can help them find relief and reach solutions.

Through working with a psychodynamic therapist, people are able to better understand the thoughts, feelings, and conflicts that contribute to their behaviors. This approach to therapy also works to help people better understand some of the unconscious motivations that sometimes influence how people think, feel, and act.

This approach to psychotherapy can be helpful for dealing with mental or emotional distress. It can help promote self-reflection, insight, and emotional growth.

By better understanding your emotional patterns and their roots, you are better equipped to manage your problems and develop coping techniques that will help you both now and in the future.

Uses

While it is similar to psychoanalysis in many respects, it is often less frequent and shorter in duration. Like other forms of therapy, it can be used to treat a variety of mental health problems.

Anxiety
Depression
Eating disorders
Interpersonal problems
Personality disorders
Psychological distress
Post-traumatic stress disorder
Social anxiety disorder
Substance use disorders

Factors that may impact what type of treatment is used include cost-effectiveness, availability, patient preferences, and the severity of the symptoms the person is experiencing. While cognitive-behavioral therapy (CBT) is a popular and effective approach, evidence suggests that psychodynamic therapy can be just as effective for many conditions.

Online therapy is another option that you might consider. Some research also suggests that online psychodynamic therapy may be as effective as online CBT.

How It Works

Psychodynamic therapy helps people recognize repressed emotions and unconscious influences that may be affecting their current behavior. Sometimes people act in certain ways or respond to others for reasons that they don’t really understand.

Psychodynamic therapy helps people learn to acknowledge, bear, and put into perspective their emotional lives. It also helps people learn how to express their emotions in more adaptive and healthier ways.

Important Characteristics

Some important aspects of psychodynamic therapy include:

Identifying patterns: Psychodynamic therapy helps people learn to recognize patterns in behavior and relationships. People often develop characteristic ways of responding to problems without really being aware of these tendencies. Learning to spot them, however, can help people find new approaches to coping with problems.
Understanding emotions: Research has found that psychodynamic therapy is useful for exploring and understanding emotions. Through gaining insight into emotional experiences, people are better able to recognize patterns that have contributed to dysfunction and then make changes more readily.
Improving relationships: Relationships with others are a key focus of psychodynamic therapy. In working with a therapist, people are able to understand how they often respond to others.

The therapeutic relationship itself can serve as a way to look into the relationships a person has with other people through a process known as transference. This gives people an immediate “in vivo” way to explore and then change their pattern of responses in order to improve their relationships.

How Effective Is It?

How effective is psychodynamic therapy and how does it compare to other forms of treatment?

Assessing the efficacy of psychodynamic therapy presents some challenges, but research does suggest that it can be useful in the treatment of a variety of psychological problems.

One reason that it may be difficult to assess the full efficacy of psychodynamic therapy is that many of the changes it produces can be tough to measure.

While it is relatively easy to measure changes in specific acute symptoms, it is much more difficult to measure underlying personality changes, noted researcher Jonathan Shedler in a press release by the American Psychological Association (APA).

Despite this difficulty, research supports the efficacy and use of psychodynamic therapy to treat a variety of conditions.

One notable review published in the journal American Psychologist concluded that the evidence supports the efficacy of psychodynamic therapy.
Another study found that psychodynamic therapy could be at least as effective as cognitive-behavioral therapy (CBT).
A 2017 review published in the American Journal of Psychiatry concluded that psychodynamic therapy was as effective as other established treatments. However, the authors of the study suggested that further research was needed to determine who benefited the most from this type of treatment.

What You Can Expect

If you decide to try psychodynamic therapy, you may meet with your therapist weekly to a few time each week. Each session typically lasts for around 45 minutes and you will continue to see your therapist for several months. In some cases, you may keep having sessions for a year or longer.

During psychodynamic therapy, people are often encouraged to talk about anything that might be on their minds. This might include things they are currently experiencing or memories of things that have happened in the past.

One form of psychodynamic therapy known as brief psychodynamic therapy is designed to produce results more rapidly, often in 25 to 30 sessions. In this shorter-term form of treatment, people may initially determine a particularly emotional area where they want to focus on.

Long-term psychodynamic therapy may take a year or longer and involve 50 or more therapy sessions.

A Word From Verywell

If you are experiencing symptoms of a mental health condition, talk to your doctor or mental health professional. They can make a diagnosis and recommend treatment options that may be best for your individual needs. Psychodynamic psychotherapy may be a good fit for you.

Introduction to Psychodynamic Theory in Social Work

Social workers balance many clients suffering from a wide range of problems, including trauma, medical conditions, mental health issues, unemployment, lack of education, discrimination, criminal records and more. Pursuing a degree in social work prepares a student to become a practitioner and to help their clients through counseling and social support systems.

Social workers base their practices on several theories and practice models, including psychodynamic theory. What once was a theory derived from Sigmund Freud is now a network of theories developed and expanded by many theorists since the early 1900s. Psychodynamic theory, also known as psychoanalytic psychotherapy, helps clients understand their emotions and unconscious patterns of behavior. By talking through these emotions and behaviors with a social worker, clients come to know themselves better and make better decisions for themselves.

What is Psychodynamic Theory?

Psychodynamic theory was originally a theory of personality created by Freud. It has evolved significantly over the years, and many theorists have contributed to it. Freud believed human behavior could be explained by intrapsychic processes and interpersonal patterns outside of a person’s conscious awareness and based on their childhood experiences. A general definition of psychodynamic theory is that forces outside of a person’s awareness explain why they behave a certain way.

Today psychodynamic theory is not a unified theory. Instead, there are many related theories regarding human development and personality. These different theories have various treatment processes, some of which are used by social workers and other clinicians, like talk therapy, dream analysis, free association and transference.

How psychodynamic theory differs from other types of therapy

Many modern types of therapy emphasize mitigating or getting rid of the symptoms of a problem. For example, if a person struggles with anxiety, cognitive behavioral therapy helps a person address the symptoms of their anxiety. Psychodynamic theory, however, explores a person’s deeply rooted drives, needs and desires. It’s considered a more global approach to therapy than a modern, problem-based therapy. You also can look at it as a difference between focusing on a person’s emotions versus their behavior.

The Psychodynamic Diagnostic Manual

Modern psychology and psychiatry use the Diagnostic and Statistical Manual (DSM). The Psychodynamic Diagnostic Manual (PDM) was published in 2006 as an alternative or additional guide for clinicians to diagnose and treat clients. It was sponsored by:

The second edition was published in 2016, and also was sponsored by the International Association for Relational Psychoanalysis and Psychotherapy.

A Brief History of Psychodynamic Theory

Many professionals have contributed to psychodynamic theory and its relationship to social work over the years. The theory has evolved significantly, and it is still part of modern social work. The National Association of Social Workers’ Standards for Clinical Social Work in Social Work Practice (PDF, XX) lists it as one of several theories social workers can use as a basis for their practices.

The evolution of psychodynamic theory can be understood through four schools of thought:

1. Drive theory

Freud believed a person’s behavior was the result of several drives including the sex (eros), self-preservation and destruction/aggression (death) drives. The id is the primitive and instinctual part of the mind that contains the foundation of these drives. It is the instinctive portion of a personality.

As a child develops, external forces from the world make it difficult to satisfy these drives. Eventually, the superego and ego impose internal hurdles and restraints. The superego is responsible for the morals of society as taught by a person’s parents, operating as a moral conscience. The ego mediates between the id and the external world—it is responsible for decision-making.

When a person’s drive-based desires might become conscious, it triggers a conflict between the drives and the superego or the ego. When a person fails to repress their desires, it creates anxiety and activates defense mechanisms.

2. Ego psychology

Theories on how a person’s ego functions have evolved since Freud. He believed the ego developed from the id alone. But theorists later believed the ego did more than regulate a person’s drives. Some theorists believed the ego developed autonomously—free of intrapsychic conflict. They believed people had another drive to explore and control the world around them. According to ego psychology, a person’s environment and reality were also important to their development.

3. Object relations theory

Psychodynamic theory originally saw behavior as a function of drives. Later, theorists explained people’s behavior based on object seeking. People were shaped by their relationships with significant others around them, like their parents and siblings. Under this theory, a person’s struggles have to do with their focus on maintaining relationships with others while also differentiating themselves. As adults, people repeat object relationships they formed in childhood.

4. Self psychology

Under this theory, a person’s perception of themself is in relation to their boundaries or differences (or lack thereof) from others. Theorists believe narcissism has a healthy place in development and adulthood, though narcissism isn’t to be confused with narcissistic personality disorder. A person with a lack of self-esteem or an undeveloped sense of self might experience mental health issues. A person with a healthy sense of self can self-regulate and soothe and is resilient. Some theorists believe a lack of a sense of self came from a lack of parental empathy during childhood.

Assumptions of Psychodynamic Theory

There are several key assumptions in psychodynamic theory:

All behavior has an underlying cause.
The causes of a person’s behavior originate in their unconscious.
Different aspects of a person’s unconscious struggle against each other.
An adult’s behavior and feelings, including mental health issues, are rooted in childhood experiences.
Both innate, internal processes and the external environment contribute to adult personality.

Goals of psychodynamic theory

Psychodynamic therapy pushes for clients to:

Acknowledge their emotions. Over time, clients can start to recognize patterns in their emotions and address them, which can lead to making better choices.
Identify patterns. Clients can begin to see patterns in more than just their emotions, but also their behaviors and relationships. Or, if clients are aware of negative patterns in their life, therapy can help them understand why they make certain choices and give them the power to change.
Improve interpersonal relationships. Modern psychodynamic theory helps clients understand their relationships, as well as patterns they exhibit with relationships.
Recognize and address avoidance. Everyone has automatic ways of avoiding bad thoughts and feelings. Therapy can help clients recognize when they’re acting in a way to avoid distress and how to move forward addressing their emotions with healthy coping mechanisms.

Strengths and weaknesses of psychodynamic theory

There are several strengths to psychodynamic theory. It recognizes that a person’s childhood impacts their mental health as an adult. This idea is readily accepted in modern psychology and social work.

It recognizes that an adult is the product of both nature and nurture. People have internal drives that influence their behavior. Childhood experiences affect them, too.

Freud’s psychodynamic theory also led to psychoanalysis, which used talking as a way to identify and treat mental health conditions. Conversation is a fundamental aspect of therapy today. When you think of a clinician asking a client, “How does that make you feel?” that’s psychodynamic theory and psychoanalysis.

There are recognized weaknesses of psychodynamic theory. It doesn’t account for a person’s ability to think and control their behavior. Many theorists believe it doesn’t consider free will enough.

It’s considered unscientific because it’s difficult to prove. The theories are largely unsubstantiated. But modern medical advances have provided supporting evidence for the benefits of psychodynamic therapy.

Social workers can benefit from applying the fundamental assumptions of psychodynamic theory to their clients. Every client’s behavior has a reason. It isn’t random or happening in a vacuum. Their behavior also is likely partly or mostly in response to unconscious processes. The client might not realize why they behave a certain way.

Object relations theory and self-psychology moved psychodynamic theory from a one-person issue, focused on the unconscious issues of an individual, to two-person psychology, focused on relationships. This fits well with social work. Social workers often focus on a client’s interpersonal relationships, including the client-worker relationship, to learn about the client’s behavior and promote change.

Social workers often work with clients with multiple difficulties. Psychodynamic theory in social work provides a conceptual framework for understanding seemingly unrelated symptoms or patterns of behavior. The framework of theories offers social workers a way to address all of the client’s issues.

Social workers hope to promote change and improvement in a client’s life. By using psychodynamic therapy, they can help clients get to the root of their thoughts, emotions and behaviors. This provides a chance for self-discovery. A client has the opportunity to learn more about themselves, recognize harmful patterns of emotions or in relationships and alter their behavior.

Types of psychodynamic treatments

There are many different treatments social workers can use as part of a psychodynamic approach to modern types of therapy. The psychotherapy will focus mostly on talking. Clinicians let the client’s direct the conversation, but other techniques can be complementary to talk therapy including:

Transference: A person redirects their feelings and expectations of one person onto another—usually unconsciously. Transference is common in therapy. The client applies emotions toward their clinician and acts toward them as if they were the other person. Transference can happen in a variety of relationships, and it doesn’t necessarily demonstrate a mental health issue. When a social worker identifies and understands the client’s transference, they can gain a better understanding of a part of the client’s life and their condition.

Free association: A clinician might encourage a client to write down or speak all the thoughts that come to their mind. It might be an incoherent stream of words. It might be a random assortment of memories and emotions. The purpose of free association is to make connections between topics that might go unnoticed. This was originally developed by Freud, though it’s not a common therapy technique today.

Dream analysis: Freud also developed the technique of analyzing dreams as a way of learning more about a person’s unconscious. Modern psychodynamic clinicians use dream analysis as part of person-centered therapy, cognitive behavioral therapy, and Gestalt therapy (in Gestalt therapy, there’s the belief that dreams are messages a person sends themselves.)

Criticism of Psychodynamic Theory

Psychodynamic theory has been criticized as being too deterministic or victim-blaming to be used in modern psychology and social work. The original theories believed people had no control over their own behavior. There was a lack of personal agency.

Another criticism of psychodynamic theory, as defined by Freud, is that it is sexist. Freud believed women were inferior to men. He also believed men had stronger superegos. Women’s weaker superegos made them more prone to anxiety. It’s important to remember that Freud predominantly treated and studied middle-aged women in Vienna.

In more recent decades, psychodynamic theory has been criticized as not only sexist but also not a sufficient theory or treatment for people of color and members of the LGBTQ+ community.

Psychodynamic theory originally didn’t account for social issues like sexism, racism, poverty and homophobia. Some practitioners felt psychodynamic theory focused too much on psychotherapy treatment rather than addressing broader social concerns. In other words, practitioners focused on finding the underlying, personal cause of a client’s problems instead of addressing larger social systems that impact the client.

This is a particular concern for social workers who identify social justice as a core value of their profession. Modern social workers and practitioners consider the broader social structures that affect the client.

Summary of Resources for Further Learning

To learn more about psychodynamic theory, consider reading Freud’s texts. You also can learn more from:

Mitchell, S.A., Black, M.J. (1995) Freud and Beyond: A History of Modern Psychoanalytic Thought, New York: Basic Books.
Moore, B.E. (1995) Psychoanalysis: The Major Concepts, New Haven, Yale University Press.
Moore, B.E., Fine, B.R., eds. (1990) Psychoanalytic Terms and Concepts, New Haven: Yale University Press.
Gabbard, G.O. (2004) Long-Term Psychodynamic Psychotherapy: A Basic Text, Washington, D.C.: American Psychiatric Press.
McWilliams N. (2004) Psychoanalytic Psychotherapy, New York: Guilford Press.
Greenson, R. (1967) The Theory and Technique of Psychoanalysis, New York: International Universities Press.
McWilliams, N. (2004) Psychoanalytic Psychotherapy: A Practitioner’s Guide. New York: Guilford Press.
Rockland, L. (1989) Supportive Psychotherapy: A Psychodynamic Approach. New York: Basic Books.
Lazar, S. (2010). Psychotherapy is Worth It; A Comprehensive Review of Cost Effectiveness, American Psychiatric Publishing.
Shedler, J. (2010). The Efficacy of Psychodynamic Psychotherapy, American Psychologist, 65, 98-109.
Summers, R., Barber, J. (2009). Psychodynamic Psychotherapy: A Guide to Evidence Based Practice. The Guilford Press.
Berzoff, J., L. M. Flanagan, and P. Hertz, eds. (2011) Inside out and outside in: Psychodynamic clinical theory and psychopathology in contemporary multicultural contexts. 3d ed. Lanham, MD: Rowman & Littlefield.
Berzoff, J., ed. (2012) Falling through the cracks: Psychodynamic practice with vulnerable and oppressed populations. New York: Columbia Univ. Press.
Brandell, J. R. (2004) Psychodynamic social work. Foundations of Social Work Knowledge. New York: Columbia Univ. Press.
Goldstein, E. G. (2001) Object relations theory and self psychology in social work practice. New York: Free Press.
Sudbery, J. (2002) Key features of therapeutic social work: The use of relationships. Journal of Social Work Practice 16.2: 149–162.
Greene, R.R., & Ephross, P.H. (1991) Classic psychoanalytic thought, contemporary developments, and clinical social work. In R.R. Green & P.H. Ephross (Eds.), Human behavior theory and social work practice (pp. 39-78). New York: Aldine de Gruyter.

Social work students benefit from learning about different theories and practice models, including psychodynamic theories and treatments. Delving into the history of psychodynamic theory gives students a deeper appreciation for the benefits and possibilities of talk theory. It also provides them with a wealth of strategies to work with clients based on their unique needs and goals. The flexibility within psychodynamic therapy gives social workers many ways to help clients address their circumstances and drive change.

If you’re interested in becoming a social worker, check out our social work guide here, or find and compare online social work degrees.

Published: February 2022