Psychodynamic Psychotherapy: What is it and who can it help?

Updated: 26/11/24

Written by Dr Sara Tookey, Clinical Psychologist​​

 

 

Psychodynamic Psychotherapy: Exploring the Depths of Human Experience

 

Psychodynamic psychotherapy is an in-depth approach that helps people understand how past experiences, unconscious processes, and relationship patterns influence their current lives. Modern psychodynamic therapy combines traditional psychoanalytic insights with contemporary research in attachment, neuroscience, and human development.

 

 

 

What is Psychodynamic Psychotherapy?

 

Psychodynamic therapy explores how past experiences and unconscious processes influence present-day:

 

• Relationships

• Emotional patterns

• Behavioural choices

• Self-perception

• Life challenges

 

 

The Science Behind Psychodynamic Therapy

 

Contemporary research demonstrates that psychodynamic therapy creates:

 

• Lasting psychological changes (Shedler, 2010)

• Continued improvement after therapy ends (Leichsenring & Rabung, 2011)

• Changes in neural processing (Buchheim et al., 2012)

• Improvements in reflective functioning (Fonagy et al., 2015)

 

 

Core Principles

 

Unconscious Processes

In psychodynamic therapy, we recognise that much of our mental life operates beyond our immediate awareness. These unconscious processes powerfully influence our behaviors, emotions, and relationships. They include automatic patterns in how we relate to others, developed from early experiences, and defense mechanisms that protect us from emotional pain. Understanding these hidden influences helps explain why we might repeat certain patterns even when they don't serve us well.

 

Early Experiences

Our early relationships and experiences, particularly with caregivers, create lasting templates for how we view ourselves and relate to others. These attachment patterns shape our expectations, emotional responses, and ways of coping with stress. The therapy explores how early family dynamics and developmental experiences continue to influence current relationships and life challenges, creating opportunities for understanding and change.

 

Relationship Patterns

Central to psychodynamic work is understanding how past relationship patterns manifest in current relationships, including the therapeutic relationship (transference). These patterns often repeat across different relationships and contexts, creating recognisable themes in a person's life. By bringing these patterns into awareness within the safety of therapy, clients can understand their origins and develop new, more satisfying ways of relating to others.

 

These concepts interweave throughout the therapeutic process, with each informing and deepening understanding of the others. The therapist's role is to help clients recognise these patterns and their origins, leading to greater self-awareness and the possibility of lasting change.

 

 

Who Can Benefit?

 

Psychodynamic therapy helps with:

 

• Depression and anxiety

• Relationship difficulties

• Identity issues

• Self-esteem concerns

• Trauma and loss

• Personality disorders

• Life transitions

• Creative blocks

 

 

What to Expect in Sessions

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Therapeutic Process

 

1. Building the therapeutic relationship

2. Exploring past and present experiences

3. Understanding patterns and themes

4. Working through difficulties

5. Developing new insights and ways of being

    

Distinctive Features

• Open-ended exploration

• Attention to feelings

• Focus on relationships

• Examination of avoidance

• Exploration of fantasies and dreams

 

 

The Evidence Base

 

Research Findings

 

Recent meta-analyses show effectiveness for:

• Depression (Driessen et al., 2015)

• Anxiety (Keefe et al., 2014)

• Personality disorders (Town et al., 2011)

• Complex trauma (Leichsenring et al., 2015)

 

Long-term Benefits

 

Studies demonstrate:

• Sustained improvement after treatment ends (Shedler, 2010)

• Better outcomes than shorter-term therapies for complex issues (Leichsenring & Rabung, 2011)

• Enhanced emotional awareness (Fonagy et al., 2015)

 

 

Key Therapeutic Elements

 

1. The Therapeutic Relationship

• Safe exploration space

• Professional boundaries

• Therapeutic alliance

• Working through difficulties

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2. Technical Elements

• Free association

• Dream analysis

• Pattern recognition

• Interpretation

• Working with defenses

   

3. Focus Areas

• Emotional awareness

• Relationship patterns

• Self-understanding

• Personal narrative

• Life meaning

 

 

Common Misconceptions

 

Myths vs. Reality

• Not just about the past

• Active, not passive

• Collaborative process

• Practical life applications

• Evidence-based approach

 

 

Special Considerations

 

When to Consider Psychodynamic Therapy

• Complex or long-standing issues

• Interest in self-understanding

• Recurring relationship patterns

• Willingness for in-depth work

• Previous therapy experience

 

 

When to Consider Alternatives

• Crisis situations requiring immediate intervention

• Specific behavioural goals

• Preference for structured approaches

• Limited time or resources

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