When I was in graduate school, I was lucky to have a wonderful mentor, a talented psychoanalyst from whom I learned both psychodiagnostics and psychotherapy. Dr. Sidney Smith will always have a special place in my heart. Like him, many of my other teachers at the California School of Professional Psychology also hailed from the San Diego Psychoanalytic Institute. Since then, I have sought additional training in other methods, more geared to the treatment of trauma. But most of all, I continue learning from my patients.
Psychodynamic therapy is a “talk therapy” that aims to provide a setting where one can safely voice one’s innermost thoughts and feelings, wishes, hopes and desires, identify and resolve the obstacles to their fulfillment, including self-doubts, negative beliefs about oneself, and fears.
The therapist listens attentively and in empathic attunement to the patient’s various communications and occasionally may point out certain areas worthy of attention, helping the patient observe him/herself from a neutral, non-judgemental and increasingly compassionate place. This can provide an opportunity for the patient to better understand himself, his behavior and his interpersonal relations with others.
During the initial sessions, both patient and therapist draw up a work plan in accordance with the patient’s goals. Periodically, they will re-assess where they are along this road map, and may redefine the patient’s priorities as needed.
It is important to realize that some forms of psychodynamic therapy are more goal-oriented and short term than others. This may be a worthwhile topic to bring up with your therapist, especially at the beginning, when you are establishing what it is that you wish to achieve from the therapy. Financial considerations are also a factor.
Psychodynamic therapy, especially psychoanalytic psychotherapy (based on principles which may be traced back to Freud’s seminal contributions in the19th century), focuses on the patient’s unconscious or hidden narratives and conflicts, in an attempt to shed light on these processes (e.g., eventually via interpretation). In other words, the patient is guided to reach certain insights, as the process adds developmental context and thus new meaning to previously enigmatic behaviors and responses.
Psychodynamic therapy focuses on inner conflicts, as manifested by mixed feelings, contradictory belief systems, inner voices or parts, and behavior. We may state that, “Part of me would like to do X,” but at the same time say that, “another part of me wants to do Y.” For example, one may wish to do something for oneself, such as go on a trip with a friend, but find it incompatible with the conflicting wish to “be there” for one’s partner, say at an important work-related event or date. A working-through of this conflict may lead to a satisfactory resolution.
Another way to describe this form of therapy is to say that it attempts to elucidate the dynamics of the instinctual forces operating within the patient’s psyche i.e., the struggle between life-affirming forces and the destructive forces steering toward a return to an inorganic state. Attention is also given to how the patient invests instinctual energy in his or her objects, and how they are experienced.
It is possible to learn about oneself and one’s own inner conflicts from one’s dreams. According to Freud, the dream represents an unconscious compromise, formed to protect sleep. In the psychotherapeutic work, dreams may be seen as a telegram from the unconscious.
In psychoanalysis, and to a lesser extent in psychodynamic therapy, the spontaneously budding patient-therapist relationship may provide a window into the patient’s preferred, conscious and unconscious modes of interpersonal relations with others. For example, a patient may idealize his therapist, perhaps raising him to the level of perfection, meanwhile devaluing himself and his own abilities. Via the therapeutic process, which may include an interpretation of these feelings, presumably transferred from a previous relationship with an earlier object (e.g., a parent) and subsequently placed upon the person of the therapist, these feelings are gradually re-owned.
The therapist’s role is to help the patient be able to make life choices from an informed, conscious place, and not while under the influence of unconscious needs or wishes. The therapist normally does not take sides with a specific voice or part, but aligns him/herself with and supports life-affirming, healing forces within the patient.
As the patient gradually feels more understood and contained, and thus less alone with it all, the therapeutic process may lead to symptomatic relief, for example, the lifting of a reactive depression. When more conflict-free energy becomes available to the patient, the therapeutic work (both within and outside the session) may pave the way for actual behavioral changes in one’s life, changes which may be associated with a greater degree of self-actualization.
Psychodynamic therapy can be used to treat various conditions. However, it requires the patient to be curious about him or herself and his or her inner world, and to be able to tolerate affects (feelings) without necessarily acting upon them, impulsively or otherwise. A certain level of introspection and psychological mindedness is needed; it may be cultivated and refined during therapy.