What is Psychodynamic Therapy?

A Definition
Psychodynamic therapy is a “global therapy,” or form of therapy with a holistic
focus on the perspective of the client. The alternative, “problem-based” therapies,
such as cognitive behavioral therapy, aim to reduce or eliminate symptoms
instead of exploring the client’s deep-seated needs, urges, and desires (McLeod,
2014).

This translates into significant differences between these therapies in terms of

goals, techniques, and general approach.

“In contrast [to behavioral therapy], dynamic psychotherapy, which facilitates a

patient’s rewriting of his life narrative, his picture of himself, his past, present,
and future, seems uniquely positioned to address the depth of a individual’s
experience.”

Richard F. Summers

The global vs. problem-based therapy dichotomy is not the only factor that sets
psychodynamic therapy apart from these other, more common forms of therapy.
Psychodynamic therapy involves the interpretation of mental and emotional
processes rather than focusing on behavior (Strupp, Butler, & Rosser, 1988).

Psychodynamic therapists attempt to help clients find patterns in their emotions,

thoughts, and beliefs in order to gain insight into their current self. These patterns
are often found to begin in the client’s childhood since psychodynamic theory
holds that early life experiences are extremely influential in the psychological
development and functioning of an adult (Matthews & Chu, 1997).

Psychodynamic therapy aims to help the client identify important pieces of the
puzzle that makes them who they are and rearrange them in ways that allow the
client to form a more functional and positive sense of self:

“We see the central task of psychotherapy as the rewriting of a more complex and
useful narrative of the patient’s life and experience.”

Richard F. Summers

Psychodynamic therapy sessions are intense and open-ended, dictated by the

client’s free association rather than a set schedule or agenda. They are typically
scheduled once a week and last about an hour. While Freud’s psychoanalytic
therapy (described in more detail below) demanded a much greater investment of
time, current psychodynamic therapy is generally practiced in a less intensive
manner (WebMD, 2014).
Modern psychodynamic therapy also substitutes a pair of chairs for the
stereotypical couch and usually places the therapist and client face-to-face rather
than keeping the therapist hidden from the client’s view.

In these sessions, the therapist will encourage the client to talk freely about
whatever is on their (conscious) mind. The thoughts and feelings discussed will be
probed for recurring patterns in the client’s unconscious mind.

This form of therapy is commonly used with clients suffering from depression or
anxiety diagnoses, and there is some evidence suggesting that psychodynamic
therapy may be as effective in treating depression as other forms of therapy
(WebMD, 2014).

Goals of Psychodynamic Therapy

The main goals of psychodynamic therapy are to (1) enhance the client’s self-
awareness and (2) foster understanding of the client’s thoughts, feelings, and
beliefs in relation to their past experiences, especially his or her experiences as a
child (Haggerty, 2016). This is accomplished by the therapist guiding the client
through the examination of unresolved conflicts and significant events in the
client’s past.

The assumption in psychodynamic therapy is that chronic problems are rooted in

the unconscious mind and must be brought to light for catharsis to occur. Thus,
the client must have the self-awareness to discover these unconscious patterns of
thought and an understanding of how these patterns came to be in order to deal
with them.

Psychodynamic Theory, Perspective, and Key Concepts

To truly understand psychodynamic therapy, you need to go back to its roots.
While this type of therapy has changed over the last century, it is still built on the
foundations of some of the earliest work in modern psychology.

In the late 19th century, Sigmund Freud was working on his grand idea of the
human mind and the theory of human development. His theories laid the
foundation for decades of psychological research and practice.

While many of these theories were eventually found to conflict with hard evidence
gained through scientific research, they formed the basis for psychodynamic theory
and sparked a bold new school of thought that still exists today, in a modified and
updated form.

He proposed that the human mind is composed of three parts:

1. The id, which consists of instinct and forms the basis of the unconscious
mind;
2. The superego, or moral component that houses our beliefs of right and
wrong;
3. The ego, the mediator between the animal instinct of the id and the
enlightened moral thought of the superego (Haggerty, 2016).

Freud hypothesized that these components grew out of certain stages in childhood
development. He believed humans are born with the id, develop the ego as a
toddler, and add the superego around the age of five. Freud’s hypothesis led him to
the logical conclusion (based on his theory) that one’s personality is firmly rooted
in their childhood experiences.

While Freud believed that each component formed in each human, the
development of each component could be significantly influenced by one’s
environment and family relationships. These factors could contribute to the
development of a healthy sense of self and effective functioning, or they could
trigger the development of neuroses and dysfunctional or distressing patterns of
thought.

Whether the development led to positive or negative patterns of thoughts and

belief, Freud held that that which truly drives human behavior is buried deep
within the human mind, in what he termed the unconscious mind.

Freud theorized three levels of the mind:

1. The Unconscious: this level is where our instincts, deeply held beliefs, and
many patterns of thought and behavior reside; we are not consciously aware
of anything at this level, but Freud believed the contents of the unconscious
mind make up the vast majority of who we are, what we want, and how we
behave in order to get what we want.
2. The Subconscious or Preconscious: this level is between the conscious and
unconscious, and can be called up to consciousness with a purposeful effort
from the individual; the contents of this level are just below the surface of
consciousness.
3. The Conscious: this is the level at which we are fully aware; Freud believed
this was the level with the least defining content, the level that makes up
only a tiny sliver of who we are.
Based on this theory, Freud insisted that to truly address our issues and solve our
problems, we must dig deep into the unconscious level. This is where we store our
unspoken values, the beliefs we do not even realize we have, and the patterns of
thought and behavior developed in our childhood.

While psychodynamic theory has outgrown many of Freud’s simplistic ideas about
human nature, many of the assumptions that underlie the psychodynamic approach
are reminiscent of Freud’s work:

 The unconscious mind is one of the most powerful drivers of human

behavior and emotion;
 No behavior is without cause—all behavior is determined;
 Childhood experiences exert a significant influence on thoughts, emotions,
and behavior as an adult;
 Important conflicts during childhood development shape our overall
personality as adults (Freud, 1899).

Freud’s theories directly support the methods of psychoanalysis, but also help form
the basis of psychodynamic theory and inform the methods and techniques used in
today’s psychodynamic therapy.

Role of the Psychodynamic Therapist

Today, the role of the therapist in psychodynamic therapy is to work with the client
to discover the bases for their symptoms.
The therapist plays this role by encouraging the client to talk about the emotions
they are feeling and helping the client to identify recurring patterns in their
thoughts, emotions, and behaviors.

They can aid the client in finding the significance of these patterns and discovering
the effects they exert upon the client.

One of the most important roles of the therapist is to probe the client’s past.
Discussion of the client’s childhood and early life experiences will likely take up a
large portion of psychodynamic sessions, as this form of therapy assumes these
experiences have a significant impact on the client’s current issues.

The therapist observes how the client interacts within the therapeutic relationship
and add their own insight into the client’s relationship habits to the discussion.

The psychodynamic theory holds that how the client acts in the relationship with
the therapist usually mirrors how they act in other relationships, such as with a
parent or other important adult from their childhood (WebMD, 2014).

In general, the therapist’s role is to aid the client in connecting the dots between
their past experiences and their current problems, and leverage their internal
resources to address these problems.

Types of Psychodynamic Therapy

Throughout this piece, I have referred to psychodynamic therapy as a singular
entity to make the discussion of psychodynamic therapies easier; but truthfully
writing, psychodynamic therapy is more a category of therapies rather than a single
type.

All of the therapies below are grounded in the same overarching model of
psychodynamic theory, but they apply the tenets of this theory in different ways.

1. Brief Psychodynamic Therapy

The aspect of brief psychodynamic therapy that sets it apart from other types of
psychodynamic therapies is right in the name: brief.
This type of therapy is generally conducted over the course of only a few sessions,
or even just one session in some cases. Sometimes an individual struggling with a
specific problem only needs to make a few important connections to overcome that
problem.

For instance, if a client is suffering from acute anxiety with no known source, the
identification of an event or circumstance that gave rise to this anxiety and a
strategy for coping can be accomplished in one session.

While the resolution of problems should not be expected in one session for all
those seeking treatment, there are several instances where identifying and dealing
with a specific problem can be a relatively brief investment.

Brief psychodynamic therapy has been applied to situations like:

 Rape;
 Accident (traffic, physical injury, etc.);
 Act of terrorism;
 Acute psychological disturbances (like anxiety or depression);
 Traumatic family event (discovery of a secret, divorce, etc.).

As a person grows and develops through childhood into adulthood, many environmental stimuli,
of course, contribute to shaping that person’s attitudes and behaviors. Although quite a bit of this
shaping takes place unconsciously, the outward manifestation of it all is called “personality.”

 Now, when the goal of psychological treatment is to change long-standing personality

qualities, long-term psychodynamic psychotherapy is called for. Treatment is called
“long-term” because it can take more than just a few visits—in fact, it sometimes takes
several years—to change patterns of behavior that in themselves took years to develop.
 But when a person is functioning well in society and has no deep personality deficits to
correct, and yet develops psychiatric symptoms, brief psychodynamic psychotherapy can
be used to help the person understand what he or she has been through emotionally that
brought about the symptoms.

An Example
A college student was referred by a professor when the student made some angry and
sarcastic statements in class that gave the professor cause to be concerned about
depression and possible suicidal ideation in the student. So, rather than discipline the
student for his disrespectful and disruptive behavior, the professor recommended
psychotherapy.

On meeting with the student, I learned that there had been no obvious family dysfunction
in his childhood, but there had been a time in pre-adolescence when he was hit by a car
while riding a bicycle and very nearly died. In fact, he heard the medical staff say that he
 would likely not “make it.” I also learned that the student’s remarks in class had been
provoked by something the professor had said, something very similar to comments that
the student’s father used to make to him. Sometimes the student would feel enraged by
his father’s comments, and one night he got so angry that he took off on his bike. And, as
it happened, he got hit by a car that ran a stop sign.

Treatment took two sessions. It involved some education about how a near-death
experience can cause a trauma that lingers in the unconscious even after the event is
survived. It involved some discussion about how the professor’s comments could have
triggered painful memories of childhood events. It involved some hypnosis to give the
student a new perspective on the unconscious meaning of his past and to help create a
new perspective on his future. And it involved some cognitive-behavioral instruction in
changing negative thinking.

 In the example above, treatment took two sessions. Brief psychotherapy sometimes can
take only one session, as in hypnosis for smoking cessation. Or it can take 12 sessions, as
in a focused treatment protocol for a traumatic event, such as a rape, or an accident, or an
act of terrorism. There is no specified time length, really. In the proper circumstances,
however, it can be a short and valuable investment in one’s future.

2. Psychodynamic Family Therapy

This form of psychodynamic therapy is practiced in the context of a family,

whether that family is comprised of two adults in a romantic relationship, a parent
and child(ren), siblings, grandparents and grandchildren, a traditional nuclear
family, or any combination of these family members.

This therapy is usually relatively long-term (versus the shorter term family therapy
based on CBT or IPT) and often is instigated by chronic problems in the family
(rather than a significant event or the emersion of a specific problem in the family).

Like other psychodynamic therapies, this form focuses on unconscious processes

and unresolved conflicts but views them in the context of family relationships. The
therapist will lead the family members through an exploration of family history,
especially any traumatic family events.

Often, this form of therapy emphasizes the importance of the adult members of the
family working out any conflicts with their own parents as a way to better
understand the conflicts with their partner(s) and child(ren).

Psychodynamic family therapy can help families to discover and address the deep-
seated issues that give rise to family problems, leading to a healthier and happier
family dynamic.
3. Psychodynamic Art / Music Therapy

This non-traditional form of psychodynamic therapy involves the expression of

feelings and emotions through art or music.

Like other types of psychodynamic therapy, this therapy is non-directive and non-
structured, allowing the client to lead the session. It does not require any artistic or
musical talent or ability, only that clients are able to use music or art to express
themselves.

Clients may showcase specific pieces and talk about the emotions they evoke,
connect them to events from childhood, or discuss the meaning they find in these
pieces. Or, clients might bring in a specific song or album that they feel they can
relate to on a deep level.

Alternatively, clients can actually create art or music in the session. It doesn’t have
to be “good” art or music, it only needs to convey the thoughts or feelings of the
clients in a way that makes sense to them.

Through art and/or music, the therapist and client can build an understanding and
form an important bond. They may find that art and music are better methods of
deep communication than talking.

This type of therapy may be particularly well suited for those who are shy or
otherwise find it difficult to talk, as well as clients who are experiencing crippling
anxiety or fear which music or art can help to soothe.

5 Psychodynamic Tools and Techniques

Psychodynamic therapy relies less on exercises and activities than most other types
of therapy, but there are some very important tools in the psychodynamic toolbox
that allow the therapist to delve deep into the unconscious mind with their clients.

The five tools and techniques below are common practice for many types of
psychodynamic therapy.

1. Psychodynamic Diagnostic Manual (PDM)

The Diagnostic and Statistical Manual, or DSM, is often referred to as the clinical
psychologist’s Bible. The DSM serves as a framework for understanding and
evaluating behavior within a therapeutic context.
Psychodynamic therapists and theorists sometimes critique the DSM’s focus on
observable symptoms and omission of more subjective experiences as criteria for
diagnosis.

To solve this problem of disagreement over diagnostic criteria, a Psychodynamic

Diagnostic Manual (or PDM) was released in 2006 as an alternative or
complement to the DSM. Those practicing psychodynamic therapy may find this
manual to be more useful in diagnosing and treating their clients than the standard
DSM.

2. Rorschach Inkblots

While these ambiguous and untidy splotches of ink are closely connected
to Freudian psychoanalysis, they are also used in some forms of psychodynamic
therapy today.

The Rorschach Inkblot test seems to be a particularly misunderstood tool in the

general population.

Pop culture has made the test out to be either an end-all, be-all test of an
individual’s personality, unique psychology, and predictor of all manner of mental
health maladies, or a useless exercise in naming unnamable shapes.

In fact, the Rorschach test is neither of these things. It cannot illuminate your entire
childhood experience, but it is also not a useless bit of trivia from a psychological
era gone by.

The original Rorschach inkblots were developed in the early 1900s by psychologist
Hermann Rorschach (Framingham, 2016). At the time, a popular game called
Blotto involved a set of inkblots that could be organized into a poem or story or
used in a round of charades.

Rorschach noticed that patients diagnosed with schizophrenia reacted differently to

these inkblots, and began studying their use as a tool for diagnosis and discussion
of symptoms.

His work resulted in a set of 10 inkblot images that can be presented to a client
with the intention of observing and projecting based on their reactions to the
images.

To conduct the Rorschach test, the therapist will present each inkblot to the client
individually and ask the client to describe what they see. They are free to use the
image as a whole, a piece of the image, or even the blank space surrounding the
image to form an interpretation.

The therapist will take notes on the client’s descriptions and how they interpret the
image. They may also ask additional questions to get the client to elaborate on
what they see.

While there is controversy over how valid and reliable the results of this test
should be considered, many therapists find that they provide valuable qualitative
information about how the client is feeling and how they think (Cherry, 2017). It
has also been found to be somewhat effective in the diagnosis of thinking disorders
(such as schizophrenia and bipolar disorder).

Those with these types of disorders tend to see and interpret the images differently
than those without such diagnoses.

The important part of this test is the process of interpretation and description
undertaken by the client, rather than any specific content seen in the inkblots. As
such, the use of this test requires a highly trained professional to conduct, score,
and interpret.

3. Freudian Slip

This may be the least formal (and perhaps least applied) technique in
psychodynamic therapy, but it is certainly not a dead concept yet.

A “Freudian slip” is also known as a slip of the tongue or, more formally,
parapraxes. These slips refer to instances when we mean to say one thing but
accidentally let “slip” another, specifically when deeper meaning can be attributed
to this slip.

For example, you might call it a Freudian slip when someone intends to say “That
is your best idea yet!” but accidentally says “That is your breast idea yet!” You
may assume that this individual has a certain anatomical feature in mind, or
associates the person they are addressing with said feature.

Another example could be when you are feeling frazzled or overwhelmed at work
and your boss pops by for a quick discussion. You aren’t really paying attention,
and you absentmindedly say “Thanks Mom” instead of using your boss’ name. A
psychoanalyst may consider this slip and decide that you have unresolved issues
with your mother and that you are trying to fill the void of that parental
relationship with your boss.

Freud (and some subsequent psychodynamic theorists) believed that these

“accidental” slips of the tongue are not truly accidental, but actually reveal
something meaningful about you. The Freudian theory holds that no behavior is
accidental or random; rather, every move you make and every word you say are
determined by your mind (conscious, subconscious, or unconscious) and your
circumstances.

A psychodynamic therapist may pay special attention to any such slips, whether
they occur in session or are simply related by the client during a session, and find
meaning in the word substitution. They may conclude that a slip is actually a little
piece of your unconscious finding its way to the surface, indicating an unmet
desire or unknown association between two concepts.

While most modern psychologists agree that Freudian slips are generally just
“slips,” it’s hard to argue that a slip of the tongue can’t occasionally reveal an
interesting connection in the speaker’s mind.

4. Free Association

Free association may be the single most important and most used tool for
psychodynamic therapists. This technique is simple and often effective.

In the context of psychodynamic therapy, there are two meanings attached to “free
association:” the more official therapy technique of free association, and the
general method of in-session discussion driven by the client’s free association
between topics.

The more formal technique involves the therapist reading a list of words and the
client responding immediately with the first word that comes to mind. This
exercise can shed light on some of the associations and connections the client has
hidden deep below the surface.

This technique may not be as useful to a client who is resistant to the exercise or to
sharing intimate details with the therapist. However, therapists should not assume
that a client who pauses before responding is resistant—it may indicate that the
client is getting closer to a repressed or highly significant connection.

Free association may provoke an especially intense or vivid memory of a traumatic

event, called an abreaction. This can be extremely distressing for the client, but it
can also lead to a healing experience of catharsis if the client feels like it helped
them work through a significant problem (McLeod, 2014).

The less formal concept of free association is simply the tendency to allow the
client to lead the discussion in psychodynamic therapy sessions. This kind of
relaxed, non-structured approach to dialogue in therapy is a hallmark of
psychodynamics.

Practicing this type of informal free association ensures that the therapist is not
leading the client anywhere in particular and that the client is moving authentically
from one subject to the next. This is critical in psychodynamic therapy, as it is
unlikely to reach the unconscious sources of psychological distress without
following the client’s lead.

5. Dream Analysis

Another vestige of Freudian therapy, this highly subjective technique can prove
useful for some, although its efficacy as a treatment technique is not proven via the
scientific method.

However, the effectiveness of therapy cannot always be measured and codified by

double-blind random control trials (RCTs), the gold standard of research.

Sometimes it is nearly impossible to determine which components or modes of

treatment brought about success in therapy.

It is in this ambiguous environment that some of those not-quite-established

techniques can contribute to real progress for the client. While dream analysis
cannot be formally recommended as a reliable and effective tool, it is unlikely to
cause any harm and should, therefore, be left up to the client and therapist whether
to include it in the treatment regimen.

Dream analysis is undertaken by discussing the client’s dreams in detail. The

therapist will guide the client through this discussion, asking questions and
prodding the client to remember and describe the dream in as much detail as
possible.

While the client talks about their dream, the therapist will attempt to aid the client
in sorting the “manifest” content from “latent” content. The manifest content is
what the client remembers about their dream—what happened, who was there,
how it felt, the physical and temporal environment of the dream, etc. The latent
content is what is beneath the surface of the dream, and this is where the meaning
of the dream lies